Hepatitis B vaccine: persistence of antibody following immunization.

We examined the persistence of hepatitis B surface antibody following hepatitis B vaccination in a group of health care workers. Of the 187 vaccine recipients screened, 39 were found to be antibody negative. Life table analysis showed the proportion retaining antibody at one, two, three, and four years from the first dose of vaccine was 92%, 84%, 73%, and 55% respectively. The likelihood of retaining antibody was significantly decreased as the age of the vaccine recipient increased. These results indicate that a large proportion of vaccine recipients no longer had detectable antibody four years after receipt of the vaccine. It remains to be shown if such individuals who have lost antibody are susceptible to the development of clinical hepatitis.

Hand dexterity in hospital personnel with multiple needlestick injuries.

OBJECTIVE: To test the hypothesis that multiple needlestick injuries in hospital employees may be due to intrinsic deficits in hand dexterity. DESIGN: A case-control study comparing employees with multiple reported needlestick injuries to those with none. Hand dexterity was tested using the Purdue Pegboard Test, a standardized validated test of hand dexterity. SETTING: A 300-bed, acute care teaching hospital. PARTICIPANTS: Fifteen hospital employees who sustained four or more injuries were compared to 19 controls. RESULTS: No differences were detected in hand dexterity between the case and control groups. CONCLUSIONS: While employees with multiple needlestick injuries accounted for 85% of reported injuries, underlying factors responsible for injuries in this high-risk subgroup do not include measurable deficits in hand dexterity.

Effect of student and preceptor gender on clinical grades in an ambulatory care clerkship.

BACKGROUND: Although several studies have addressed the effect of student gender on clinical performance evaluation, none has looked at the effect of preceptor gender or the interaction of preceptor gender and student gender. We investigated the possibility of gender effects in an ambulatory care clerkship where the preceptor-student ratio is usually one to one. METHOD: Clinical grades given by preceptors to third-year students after a required one-month ambulatory care medicine clerkship were analyzed by student gender, preceptor gender, and preceptor-student gender pairs. The study was conducted from August 1990 to October 1992 at the Medical College of Wisconsin. A total of 121 preceptors (97 men and 24 women) and 375 students (233 men and 142 women) participated. Analyses of variance were used to detect significant differences. RESULTS: On a scale of 0 to 4, the female students received a higher mean clinical grade than the male students (3.1 versus 3.0, p < .04). Preceptor gender had no effect on clinical grades until student gender was considered. The highest mean grade of 3.3 was given by male preceptors to female students, and the lowest mean grade of 2.9 was given by female preceptors to male students (p < .01). CONCLUSION: The female students received higher clinical grades in the ambulatory care clerkship, especially when the preceptor was male. Perhaps gender interaction should be considered when assigning students to preceptors and evaluating grading practices.

Influenza immunization in the elderly: knowledge and attitudes do not explain physician behavior.

The records of 847 elderly clinic patients were reviewed and the 95 primary care physicians who managed their care were surveyed to determine factors related to their ordering of influenza immunization. Overall, 41 percent of the eligible patients were offered vaccine (range 0-90 percent). Physician offering of vaccine was unrelated to patient age, sex, or race but was higher in patients seen on multiple visits (47 vs 39 percent) and in those vaccinated during the prior year (61 vs 35 percent). Physician offering of vaccine was not associated with perceived incidence of severe side effects or estimates of vaccine efficacy.

Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer.

We investigated whether printed or videotaped information is more effective in enhancing colon cancer knowledge. Subjects (n = 1100) were randomized into three groups: to receive a booklet, view a videotape, or receive no intervention. Subjects receiving the intervention showed increased knowledge compared with control subjects (booklet = 23% and videotape = 26% vs no intervention = 3%). Findings suggest that personalized educational materials are effective in enhancing colon cancer knowledge.

Biochemical tests for pheochromocytoma: strategies in hypertensive patients.

OBJECTIVE: To determine the optimal clinical strategy utilizing either 1) serum catecholamines, 2) urinary metanephrines, or 3) urinary vanillylmandelic acid measurements in the evaluation of hypertensive patients with suspected pheochromocytoma. DESIGN: Prospective clinical determination of test-operating characteristics. SETTING: Tertiary care university medical center. PATIENTS/PARTICIPANTS: 415 patients referred for evaluation of suspected pheochromocytoma. INTERVENTIONS: All subjects had measurements of the three above-mentioned biochemical tests with the diagnosis of pheochromocytoma established by tissue confirmation. RESULTS: All three biochemical tests were similar in sensitivity (0.70-0.75), specificity (0.90-0.95), and receiver operating characteristics. With an estimated disease prevalence of 5.9% in symptomatic hypertensive patients, the predictive value of any single negative test would be 98% in ruling out disease. CONCLUSIONS: All three biochemical tests have similar performance characteristics and only a single test need be performed to exclude pheochromocytoma in most symptomatic hypertensive patients in a primary care population.

Bedside case presentations: why patients like them but learners don't.

STUDY OBJECTIVE: To determine current attitudes of patients, medical students, housestaff, and clinical faculty toward bedside case presentations. DESIGN: Survey using multiple-choice questionnaire and open comments for students, housestaff, and faculty, and a structured interview of patients. SETTING: Major teaching hospitals on the campus of a midwestern medical school, staffed by full-time faculty. PARTICIPANTS: 136 medical students, 58 housestaff, 66 faculty, and 73 patients. MEASUREMENTS AND MAIN RESULTS: 85% of patients liked the case presentation discussion at the bedside, but 95% of both students and housestaff felt more comfortable with such discussion away from the patient. Attending faculty were about evenly divided in preference, with the younger staff preferring the conference room setting. Most patients (88%) opposed rounds in the hallway. Duration of rounds of one to two hours was felt desirable by most, but 50% of students preferred a duration of less than one hour. For length of new patient case presentation, 60% of learners again favored brevity, less than 5 minutes. CONCLUSIONS: Bedside rounds are an opportunity to sharpen diagnostic skills and to demonstrate the art of medicine. They are undervalued by learners and younger faculty but appreciated by patients. The authors recommend that faculty improve bedside rounds by assessing team members' educational needs, by cultivating sensitivity and respect for the needs of all parties, and by assuring pertinence and brevity of bedside discussion.