Medical care
-
In 1977, the American Heart Association recommended that patients with mitral valve prolapse (MVP) and mitral insufficiency receive antibiotic prophylaxis prior to procedures that place them at risk for bacterial endocarditis. To study how clinicians conformed to this recommendation, the authors selected 126 patients with MVP admitted to a University Medical Center in 1978, the year following the official policy. ⋯ However, patients seen in consultation by a cardiologist were much more likely to have prophylaxis recommended (P less than 0.05). It was concluded that the application of an official policy about prophylaxis for a condition such as MVP, where the risks are uncertain, is likely to be guided by other factors, such as the opinions of local experts.
-
Research findings indicate cost savings associated with home care hospices, while hospital-based hospices can be as expensive as conventional care. Based on National Hospice Study data, this article identifies the characteristics of patients admitted to hospital-based and home care hospices in those areas of the country where a choice of hospice model was possible. Multivariate logistic regression indicates that the significant discriminating factors between the two patient populations relate to the availability of supportive care at home and the severity of nursing care problems at the time of hospice entry. Reinforcing selected pre-existing differences, an examination of prehospice had longer episodes of care than was the case for home care hospice patients.
-
The relationship of attitude changes to compliance with influenza immunization. A prospective study.
In a longitudinal, prospective study of patient's decisions about influenza vaccination, the stability of attitudes about the flu and flu shots, the stability of flu shot decisions, and the relationship of attitude shifts to compliance were studied. In both 1981 and 1982 for 216 patients at high risk for complications of influenza, attitudes about 15 issues in the decision to obtain a flu shot were measured and each patient's behavioral intention and flu shot behavior ascertained. ⋯ Reversals in flu shot decisions were closely related to shifts in attitudes concerning side effects of the flu shot, an association that was supported by other findings, including a marked difference in prevalence of previous side effects in shot takers (11%) versus nontakers (60%). The results suggest: intention reversals were less frequent than attitude shifts because only specific attitude changes about flu shots were associated with reversals, and interventions that induce positive attitude changes, especially about the side effects of flu shots, should be effective in improving flu shot compliance.