Acceptance of hepatitis B vaccine by medical and surgical residents

To assess factors influencing acceptance of hepatitis B vaccine, 547 medical residents and 230 surgical residents were surveyed. The vaccination rate among 315 (58%) medical residents who responded was 46%; for 124 (54%) surgical residents who responded it was 76%. Most medical (93%) and surgical (94%) residents who were vaccinated believed they were at risk of hepatitis B virus infection. Among unvaccinated medical residents, 71% indicated concern about vaccine-related side effects, including potential but unknown reactions (58%) and possible transmission of AIDS (37%) and hepatitis (16%). Unvaccinated surgical residents were also concerned about side effects (64%). Stepwise discriminant function analysis revealed that medical residents were vaccinated if they were concerned about risk of exposure to hepatitis B virus and the chronic complications of infection and if they had received hepatitis B immune globulin and influenza vaccine. Surgical residents were vaccinated if they believed hepatitis B vaccine was efficacious, but were not vaccinated if they believed hepatitis B virus infection was not serious. Received from the Division of General Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia. Supported in part by Merck Sharp & Dohme. Presented at the Ninth Annual Meeting of the Society for Research and Education in Primary Care Internal Medicine, May 1, 1986.     

Range-gated pulsed Doppler power frequency spectrum analysis for the diagnosis of carotid arterial occlusive disease

Carotid arterial disease was investigated with a Duplex Scanner using Power Frequency Spectrum Analysis. Sixty-one carotid systems were evaluated noninvasively and angiographically, while 20 controls were examined and assumed to be normal. Peak frequency and 50% frequency bandwidth, a quantitative index of spectral broadening, were correlated with the percentage of stenosis. Peak frequency predicted the presence or absence of hemodynamically significant stenoses (greater than or equal to 50% diameter reduction) with 90.8% accuracy, while 50% frequency bandwidth correctly identified similar lesions with 93.2% accuracy (p = NS). Also, with the latter results, carotid systems were grouped into less than 25%, 25% to 49%, and greater than or equal to 50% stenosis categories with an 86.4% accuracy. Similar statistical evaluation was attempted for peak frequency results. It was not possible to separate hemodynamically insignificant lesions (less than 50% diameter reduction) into distinct groups because of the overlap of results among those arteries with less than 50% stenosis. Finally, all eight occluded internal carotid arteries were identified with combined Doppler/imaging analysis. However, with imaging alone, only 5 of 8 (63%) occluded arteries were correctly identified.     

Late MRI after head injury in children: relationship to clinical features and outcome

To characterize the brain pathology in relation to long-term outcome after pediatric head injury, 55 children were studied by magnetic resonance imaging (MRI) at least 3 months after sustaining moderate to severe closed head injury (CHI). Thirty-nine of the patients had abnormal signal intensity consistent with residual brain lesions, including 28 children with lesions involving the frontal lobes. The clinical features of children with frontal lesions, extrafrontal lesions, and diffuse injury were compared. The analysis disclosed that children with frontal lobe lesions were more frequently disabled than children who sustained diffuse injury. Our MRI findings indicate that residual brain lesions are more common after moderate to severe CHI in children than previously thought and that the frontal lobes are most frequently involved. Further investigation is indicated to elucidate whether distinctive cognitive and behavioral sequelae are associated with frontal lobe lesions in children.     

Preventive health for the elderly. Role of vaccination.

Elderly patients should receive three vaccinations as part of routine health maintenance: influenza virus vaccine, pneumococcal vaccine, and tetanus-diphtheria toxoid. The injections are inexpensive, well-tolerated, and effective. The greatest barrier to effective immunization of the elderly population is not patient compliance but physician compliance. You are the key to the preventive health of your patients.     

The impact of economic considerations on clinical decisionmaking: the case of thrombolytic therapy

This study examines the intravenous use of two thrombolytic agents [streptokinase (SK) and tissue plasminogen activator (tPA)] in the acute phase of myocardial infarction (MI). These two agents have very different costs and offer an excellent opportunity to study both the impact of economic factors on clinical decisionmaking and the potential for cost savings by limiting the use of expensive new therapeutic agents. A nationwide survey of the 5,792 acute care general hospitals listed in the American Hospital Association's 1988 data file was responded to by 2,651 hospitals (46%) and revealed that 2,384 of these responding hospitals (90%) were using thrombolytic therapy. For 2,200 of these 2,384 hospitals (92%), the respondent was a physician who primarily used one of the two drugs. Eight hundred eighty-six of these 2,200 physicians (40%) primarily used SK while 1,314 (60%) primarily used tPA. SK users were more concentrated in federal public hospitals (69% used SK) than in nonfederal public hospitals (47% used SK), and were least concentrated in private hospitals (36% used SK). There was no difference between the rate of SK vs tPA use in investor-owned and not-for-profit private hospitals. SK users most often (62%) cited various economic factors as the reason for their choice. The users of tPA primarily (73%) cited clinical preferability as the reason for their choice even though trials are still ongoing to see which drug is preferable. Several multivariate analyses shed light upon the association between choice of thrombolytic agent and various additional physician and hospital characteristics. These data clearly indicate that while new therapies are rapidly implemented by the medical community, considerations of cost have a substantial impact upon the pattern of implementation and reflect a desire to implement cost savings in the use of new drugs.