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Biomedical subjects

D S Fedson

Publications and source records attributed to D S Fedson.

15 recordsLinked to original sources
PubMed1992

Disparity between influenza vaccination rates and risks for influenza-associated hospital discharge and death in Manitoba in 1982-1983.

OBJECTIVE: To determine, in a defined population, the percentage of persons who were discharged from a hospital or died of influenza-associated respiratory conditions who had a health care contact during the preceding vaccination season and to determine the relation between risk status for influenza-associated hospitalization and death and influenza vaccination rates. DESIGN: An observational study using linked-record analysis of medical claims data. SETTING AND PATIENTS: A probability sample of 100,000 noninstitutionalized adults living in Manitoba in 1982 to 1983. MEASUREMENTS: Analysis of medical claims for influenza vaccination and hospital discharges and deaths for influenza-associated respiratory conditions during the 1982-83 influenza vaccination season and influenza outbreak period. RESULTS: For the population as a whole, 50% to 60% of elderly persons (greater than or equal to 65 years of age) and 30% to 40% of younger persons had one or more health care contacts during the influenza vaccination season but fewer than 10% of all persons had been discharged from a hospital. In contrast, for elderly persons hospitalized with respiratory conditions during the influenza outbreak period, approximately 80% had at least one health care contact during the vaccination season. Among the elderly, 39% to 46% of all those discharged for influenza-associated respiratory conditions and 62% to 67% of those who died had been discharged from hospital during the previous vaccination season. Persons discharged with high-risk conditions during the vaccination season were at greater risk for hospitalization with influenza-associated respiratory conditions but were less likely to be vaccinated than were those at lower risk. CONCLUSIONS: Most persons who were hospitalized with influenza-associated respiratory conditions had contact with health care providers during the preceding influenza vaccination season. Among elderly patients, previous hospital care was common, especially among those who died. The disparity between influenza vaccination rates and risks for influenza-associated hospital discharge and death supports a strategy of hospital-based influenza vaccination.

Adult↗
PubMed1992

Clinical practice and public policy for influenza and pneumococcal vaccination of the elderly.

Influenza and pneumococcal vaccines are safe, effective, and cost-effective, but they are not used widely. Organized programs for vaccine delivery can lead to substantial improvements in vaccination rates for the elderly. Adequate reimbursement by Medicare and other third-party payers needs to be supplemented by educational programs to promote influenza and pneumococcal vaccines if the opportunity vaccination presents to improve the health and well-being of elderly persons is to be fully realized.

Aged↗
PubMed1990

Hospital-based pneumococcal immunization. Epidemiologic rationale from the Shenandoah study.

To explore the potential usefulness of a strategy of hospital-based pneumococcal immunization, we studied a population-based linked record of hospital discharges for Medicare enrollees living in the Shenandoah region of Virginia. A retrospective study of 1633 persons discharged with pneumonia in 1983 showed that 61% to 62% had been discharged within the previous 4 years. Among these patients, 87% had had one or more high-risk conditions recognized during previous hospital admissions. A cohort study demonstrated that discharged patients had a 6% to 9% probability of readmission with pneumonia within 5 years. Each such readmission could be prevented by immunizing few (approximately 100) discharged patients with pneumococcal vaccine. Furthermore, the costs of vaccination would be approximately one-third the costs of hospital care for unvaccinated discharged patients readmitted with pneumonia. These results provide an epidemiologic rationale for current recommendations that elderly patients discharged from hospitals should be immunized with pneumococcal vaccine.

Aged↗
PubMed1990

The influenza vaccination demonstration project: an expanded policy goal.

In 1980, the Public Health Service established an objective of immunizing 60% of high-risk persons with influenza vaccine annually by the year 1990. As no more than 32% of high-risk persons currently receive influenza vaccine each year, the Health Care Financing Administration (HCFA) has undertaken an influenza vaccination demonstration project for Medicare enrollees. Federally purchased vaccine is being distributed to physicians, health departments, hospitals, nursing homes and health maintenance organizations (HMOs). If the project is cost-effective, Congress has authorized HCFA reimbursement for influenza vaccination. Changing reimbursement policy alone, however, is unlikely to substantially improve influenza vaccine delivery; HCFA reimbursement for pneumococcal immunization since 1981 has not increased the use of pneumococcal vaccine. In contrast, federal purchase and distribution of vaccines to state and local health departments has helped maintain the remarkable success of childhood immunization programs. In addition, in Canada, provincial health departments purchase more than 80% of all influenza vaccine distributed, and from 1980 through 1988, per capita vaccine distribution increased 140%. These experiences suggest the need for an expanded policy goal for the influenza vaccination demonstration project that includes federal purchase and distribution of influenza vaccine. This approach, together with a change in reimbursement policy, offers greater promise for achieving our nation's objective for influenza vaccination.

Aged↗
PubMed1990

Restoring balance to internal medicine training: the case for the teaching office practice.

Medical residents require an experience beyond the tertiary care hospital to understand many aspects of contemporary medical practice and to make informed career choices. To provide this balanced training, the University of Virginia has operated for 10 years an internal medicine teaching office practice to provide an outpatient experience similar to private practice. It allows residents to work closely with general internal medicine faculty and introduces them to the knowledge and skills necessary to establish and manage a successful practice. The curriculum of the 10 week rotation includes patient care in the office and by telephone, nursing home and home visits, tutorials and seminars on primary care and office management topics, and training in the use of microcomputers. A survey of 46 (92%) of the first 50 residents completing the rotation revealed that the content of the rotation was valuable, the rotation substantially influenced career choices, and the rotation helped provide a balanced view of internal medicine practice.

Curriculum↗
PubMed1990

Pneumococcal vaccination. Controversies and opportunities.

The morbidity and mortality associated with pneumococcal infections are preventable in many high-risk individuals by immunization with 23-valent pneumococcal vaccine. While the clinical effectiveness of the current vaccine is less than ideal, use of the vaccine is cost effective. In spite of recommendations for pneumococcal vaccination of elderly and other high-risk persons, and federal reimbursement for vaccination Medicare enrollees, it was estimated in 1985 that only 10% to 15% of this target population was immunized. Strategies for immunizing high-risk individuals with pneumococcal vaccine need to involve physicians, public health professionals, health advocacy groups, and persons in the targeted populations.

Antibodies, Bacterial↗
PubMed1989

Prevention and control of influenza in institutional settings.

Despite the severe impact of influenza, only a small proportion of the population at risk--sometimes lethal--is protected by annual vaccination. The Immunization Practices Committee has established the goal of immunizing 80% of the residents of institutions for the aged and chronically ill, patients with cardiopulmonary disorders, and health care personnel in high-risk hospital settings.

Adult↗
PubMed1977

Influenza. The continuing need and justification for immunization.

A review of some of the major questions regarding influenza immunization. New insights in influenza virology and the consequence of epidemic influenza. The reasons for past failure in immunization. The rationale for continuing immunization efforts in the "post Swine-influenza" era.

Attitude of Health Personnel↗
PubMedDate not supplied

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.

Adult↗