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Hospital pharmacy purchases and inventories.

The results of the hospital pharmacy purchases and inventories portion of a 1978 national mail survey of pharmaceutical services in short-term hospitals are reported. A sample of 815 hospitals was selected randomly from among 5,200 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The inventory question had a response rate of 67.7%, the purchasing question, 62.2%; inventory turnover was calculated based on a response rate of 60.5% to both questions. Inventories were inordinately large in small hospitals. Inventory turnover rates, which increased with hospital size, were somewhat less than optimal in small and medium hospitals. The Pacific region's inventory/bed and purchases/bed values were substantially greater than those of any other region. Large hospitals had a 20% higher annual purchases/bed figure than the smaller hospitals, perhaps because of their relatively greater volume of outpatient services. Based on their respective demand (as measured by adjusted inpatient days), the drug purchases of the New England and Mid-Atlantic regions were less than expected, while the Mountain and Pacific regions' drug purchases were much greater than expected. Total 1979 purchases of pharmaceuticals and related supplies by pharmacies in all short-term hospitals are estimated to reach $2,215 to $2,772 million.

Hospital Bed Capacity

A study of nasometric values for normal nasal resonance.

It was the purpose of this study to obtain nasalance values for a large number of normal adult subjects speaking a variety of dialects of English. The Nasometer was used to measure the amount of nasal acoustic energy in the speech of 148 normal adults from four geographical regions of North America. Means and standard deviations for the nasalance and deviation scores are presented for each of three different reading passages. The Mid-Atlantic speakers were found to have significantly higher nasalance scores on all three reading passages. In addition, the female subjects had significantly higher nasalance scores on the Nasal Sentences. These differences are discussed with regard to potential reasons for their existence and implications for understanding velopharyngeal function in normal and abnormal speakers.

Adolescent

Association of asthma mortality with medical specialist density.

In 1980, rates of death from asthma at 5 to 34 years of age varied from .105 per 100,000 in the East North Central States to .271 in the Mountain States for whites and from .637 in the South Atlantic States to 1.343 in the Middle Atlantic States for blacks. In order to investigate possible relationships between availability of physicians and care for patients with asthma, we determined regional densities of medical specialists in allergy and immunology, emergency medicine, family practice, internal medicine, and pediatrics as listed by the Directory of Medical Specialists. Multiple linear regression analyses indicated that asthma mortality was increased in areas that had more medical specialists, even after adjustment for size of the regional area. Inadequate numbers of medical specialists do not account for higher asthma mortality rates in some regions.

Adolescent

The geographic structure of measles epidemics in the northeastern United States.

The incidence of disease across geographic space often produces distinctive regional patterns. In this paper, a modeling approach to the identification of the factors that shape the patterns is presented, and a procedure for fitting the model to observed data is given. The methodology is illustrated by an application to the geographic structure of measles epidemics among 22 states of the northeastern United States, New York City, and Washington, D.C., from 1962 to 1988. The patterns identified are interpreted in terms of the spatial behavior of measles epidemics in the region, and the implications of the methodology for surveillance and control are considered.

Humans

Dietary counseling of hypercholesterolemic patients by internal medicine residents.

OBJECTIVE: To assess the knowledge, attitudes, and practices of internal medicine residents concerning dietary counseling for hypercholesterolemic patients. DESIGN: Cross-sectional, self-administered questionnaire survey. SETTING: Survey conducted August 1989 in seven internal medicine residency programs in four southeastern and middle Atlantic states. PARTICIPANTS: All 130 internal medicine residents who were actively participating in outpatient continuity clinic. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Only 32% of the residents felt prepared to provide effective dietary counseling, and only 25% felt successful in helping patients change their diets. Residents had good scientific knowledge, but the degree of practical knowledge about dietary facts varied. Residents reported giving dietary counseling to 58% of their hypercholesterolemic patients and educational materials to only 35%. Residents who felt more self-confident and prepared to counsel reported more frequent use of effective behavior modification techniques in counseling. Forty-three percent of residents had received no training in dietary counseling skills during medical school or residency. CONCLUSION: Internal medicine residents know much more about the rationale for treatment for hypercholesterolemia than about the practical aspects of dietary therapy, and they feel ineffective and ill-prepared to provide dietary counseling to patients.

Counseling

Multi-Hospital Eastern Atlantic Restenosis Trial. II: A placebo-controlled trial of thromboxane blockade in the prevention of restenosis following coronary angioplasty.

Since platelet interactions appear to play an important role in the development of restenosis, attenuation of thromboxane-mediated reactions may improve the long-term outcome following coronary angioplasty. Phase II of the Multi-Hospital Eastern Atlantic Restenosis Trial (M-HEART) is a prospective, randomized, placebo-controlled study of thromboxane blockade in the prevention of restenosis following successful coronary angioplasty. Two forms of thromboxane blockade are evaluated: aspirin (a nonspecific inhibitor of thromboxane synthesis) and sulotroban (a specific thromboxane receptor antagonist). The design of this multicenter trial and the rationale for use of sulotroban in the prevention of restenosis are reviewed in this report.

Angioplasty, Balloon, Coronary

Sexual behavior patterns of gay university men: implications for preventing HIV infection.

Gay male university students less than 25 years old were studied to determine whether they had changed their sexual activity patterns to reduce the risk of HIV infection. Most had not established sexual behavior patterns typical of the older gay men who had been studied in earlier research. Although most of the participants surveyed were concerned about HIV infection, some did engage in risky sexual behavior. The risk-reduction strategies most often used were having fewer sexual partners and being more selective in choosing partners. Future HIV-prevention interventions must be designed to address the needs of this generation of gay men.

Adult

Paid and unpaid benefits. Strategies for nurse recruitment and retention.

One of the biggest problems facing hospital administrators is the recruitment and retention of nursing staff. The authors examine how a sampling of hospitals are meeting this challenge and describe important tangible and intangible benefits that can curb nursing turnover. This study defines ways to boost employee morale and cut administrative costs.

Humans

Nurses' attitudes toward patients with AIDS and AIDS-related risk factors.

Three variables were experimentally manipulated by simulation measurement using six vignettes in a completely randomized, partial hierarchical, experimental design: medical diagnosis (AIDS v. non-AIDS), sexual orientation (heterosexual v. homosexual) and intravenous drug-use history (IVDU v. non-IVDU). Following each vignette, the same Prejudicial Evaluation Scale (PES) and Social Interaction Scale (SIS) were used to measure nurses' attitudes toward patients and their willingness to interact with patients. Vignette questionnaires were randomly assigned to 360 acute-care nurses. Although sexual orientation was found not to influence PES and SIS scores, an AIDS medical diagnosis and a history of intravenous drug use were found to increase nurses' negative attitudes toward patients significantly and reduce their willingness to interact with patients. Study findings did not vary according to nurses' age, academic preparation or previous practice experience with patients with AIDS.

Acquired Immunodeficiency Syndrome

A population-based study of neuroblastoma incidence, survival, and mortality in North America.

PURPOSE: The purpose of this study was twofold: (1) to provide a population-based estimate of neuroblastoma incidence, disease stage and age distribution, and survival and mortality rates in North America; and (2) to compare these figures in the province of Quebec at a time shortly before the institution of province-wide screening with those in a population-based control group, the Greater Delaware Valley (GDV) Pediatric Tumor Registry. MATERIALS AND METHODS: In Quebec, the four major pediatric teaching hospital records were searched for children with a diagnosis of neuroblastoma. Tumor board registry data and information supplied to the Division of Vital Statistics were also reviewed. Birth statistics were obtained from the population registry. The GDV Pediatric Tumor Registry is a population-based registry of pediatric cancer covering all of Delaware and parts of New Jersey, Pennsylvania, and Maryland. Age, stage of disease, and follow-up data were obtained through December 31, 1989, with Evans neuroblastoma staging data used for all comparisons. RESULTS: One hundred thirty children with neuroblastoma were identified in Quebec and 165 in the GDV, in a combined population of 3,178,736 children. The annual incidence of neuroblastoma was 10.95/10(6) under the age of 15 years and 27.75/10(6) between the ages of 0 and 4 years. The annual mortality rate due to neuroblastoma was 4.89/10(6) and 9.10/10(6) for the age groups 0 to 14 and 0 to 4, respectively. The overall 10-year survival rate for the 295 cases of neuroblastoma was 55%. The 10-year survival rates for patients with Evans stage I-IV and IVS disease were 88%, 90%, 63%, 21%, and 81%. There was no significant difference observed in the incidence, mortality, or survival in the two populations. CONCLUSION: These data represent the first large, population-based description of the clinical presentation and outcome of patients with neuroblastoma in North America, with no significant differences noted between Quebec patients and the GDV patients.

Adolescent

The liberating effects of RN-to-BSN education.

This study investigated whether postlicensure baccalaureate education was associated with decreased acceptance of oppressed status for nursing and the self, with behavioral changes in job performance, and in joining a professional organization. Selected writings of Freire (1970a, 1970b, 1973) concerning education of the oppressed were used to form the conceptual framework. Baccalaureate education was conceptualized as a means of overcoming oppression-related behaviors and attitudes in nurses. The criterion measures were self-reports of job performance, joining the American Nurses Association (ANA), self-concept measurements, and perception of nursing measured by a semantic differential. Except for self-concept, which remained unchanged, all the findings were in the predicted direction supporting the conceptual framework.

Adult

Nursing intensity. Going beyond patient classification.

Two patient classification systems, Medicus and GRASP, were compared to the Patient Intensity for Nursing Index (PINI). Approximately 50% of the variability in both classification systems was not accounted for by PINI items. The patterns of correlation between PINI items and GRASP and Medicus scores indicated that these two classification systems do not measure nursing resource use in the same way. Nurse administrators should be aware that estimates of nursing care costs will vary depending on the patient classification system used to measure nursing intensity.

Costs and Cost Analysis

Influenza viruses in birds of the Atlantic flyway.

Isolation of type A influenza viruses from the feces of 5013 birds of 16 species was attempted during a 33-month study (1977-79). Seventy viruses were isolated from the feces of 3403 ring-billed gulls in Baltimore, Md., during 16 months of sampling. Six hemagglutinin (HA) subtypes and seven neuraminidase (NA) subtypes in 15 combinations were found. The H13N6 virus was the only subtype found each year and accounted for 40% of the isolates. The rate of isolation from gulls was 0.26% in the cold months and 3.0% in the warm months. Hemagglutination-inhibition (HI) and elution-inhibition antibody profiles reflected the presence of some but not all of the viruses isolated. In mute swans, the rates of seroconversions were 16% for HA antibody and 14% for NA antibody, whereas the viral isolation rate was 0.4% over a 3-year period. Both the H5 and the N2 subtypes, which were responsible for the lethal chicken outbreaks in 1983 in Pennsylvania, were isolated from gulls in 1978 in association with subtypes not found in the chicken virus. Also, seroconversions for the H5 HA occurred in mute swans in 1978.

Age Factors