Consensus on care for critically ill patients.
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Advance Directives↗
Biomedical subjects
M P Harward
Publications and source records attributed to M P Harward.
Nutritive therapies for osteoporosis. The role of calcium.
Nutrition is a major component of osteoporosis prevention. Adequate calcium intake throughout life is the essential nutritive therapy for osteoporosis prevention. Calcium also has a role as an adjunctive therapy in the treatment of established osteoporosis.
Calcium, Dietary↗
Assessing medical interview performance. Effect of interns' gender and month of training.
Observation of history taking is commonly used to assess interviewing skills in medical internships, yet specific interviewing problems are infrequently documented. We evaluated videotaped recordings of 83 complete medical histories of new patients for content and questioning technique. Frequent deficiencies were found in history of medication compliance, gynecologic and psychiatric history, use of open questions, and mental status examination. The initial segments of 48 interviews were evaluated, and in 44% the patient was not allowed to complete their opening statement of concerns. Female physicians allowed fewer patients to finish their opening statement, and physicians at the end of the internship permitted the patients less time to express their concerns. Structured evaluation of complete histories reveals frequent interviewing problems as well as possible important effects of physician gender and length of training.
Age Factors↗
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.
Aged↗
Evaluation of sexual dysfunction in women.
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Female↗
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↗
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↗
Sexual function of women taking antihypertensive agents: a comparative study.
OBJECTIVE: To develop a method to evaluate the effects of clonidine and prazosin on sexual function in hypertensive women. DESIGN: Crossover, active-drug controlled pilot study. SETTING: Community recruitment to a university-based teaching hospital. PATIENTS: Ten premenopausal and eight postmenopausal women with mild hypertension and unimpaired sexual function. INTERVENTION: Periodic, self-administered daily diaries assessed the sexual arousal and desire and orgasmic function of women receiving placebo, clonidine, and prazosin. MEASUREMENTS AND MAIN RESULTS: Using analysis of variance for orgasmic characteristics and comparison of the percentages of yes responses to the sexual function questions, no significant difference in the levels of sexual function of women receiving placebo, clonidine, and prazosin was found. However, there was a suggestion that clonidine and prazosin affected some aspects of sexual function. Of the women who received clonidine first, fewer were receptive to partner approach during medication therapy (49%) than during placebo (61%). Fewer women wished for their partners to approach them (WISH) during therapy (41% and 53% for clonidine and prazosin, respectively) than during placebo (60%). In the group that received prazosin first, WISH was affected (32% for prazosin, 31% for clonidine, 45% for placebo). Orgasmic strength increased from 2.1 on placebo to 2.7 on clonidine (second medication), measured on a four-point Likert scale. CONCLUSIONS: This pilot study developed a method using self-administered daily diaries for evaluating the effects of antihypertensive agents on sexual function in hypertensive women. These potential effects need to be evaluated in larger studies.
Analysis of Variance↗