OBJECTIVE:To examine whether patients' experiences with nontechnical aspects of care such as patient education and discharge planning are associated with long-term outcomes.DESIGN: Observational cohort study.SETTING: Twenty-three New Hampshire hospitals during 1996 and 1997.PARTICIPANTS: Acute myocardial infarction (AMI) patients (N = 2,272) enrolled prior to discharge. MEASUREMENTS:Surveys asking about problems with care and health were mailed to patients 1, 3, and 12 months after discharge. Patients were stratified into``worse'' or``better'' care groups on the basis of their hospital care problem score. Outcomes included self-reported overall health, physical health, mental health, chest pain, and shortness of breath. Other clinical measures were obtained from hospital discharge abstracts.MAIN RESULTS: The 1-, 3-, and 12-month surveys were returned by 1,346 (59.2%), 1,046 (46%), and 964 (42.4%) enrolled patients, respectively. The primary analytic cohort consisted of the 762 patients who completed both the 1-and 12-month surveys. After adjustment for postdischarge health status and other clinical factors, patients experiencing worse hospital care had lower ratings of overall health (48.4 vs 52.5 on 100-point scale; P = .02) and physical health (59.7 vs 68.4; P < .001), and were more likely to have chest pain (odds ratio [OR], 1.6; confidence interval [CI], 1.0 to 2.4; P = .04) 12 months after their AMI than other patients. However, differences in reports of chest pain were reduced if patients reporting worse hospital care had better experiences with subsequent ambulatory care. CONCLUSIONS:Patients' experiences with nontechnical processes of AMI hospital care are associated with long-term outcomes; however the association between a negative hospital experience and subsequent chest pain may be offset by more positive outpatient experiences.

The purpose of this study was to develop the Caring Behaviors Inventory for Elders (CBI-E) and to establish its psychometric characteristics further. The 28-item CBI-E was framed by Watson’s theory of human caring. Aconvenience sample (N = 215) of elders and their caregivers (N = 138) completed the instrument. Psychometric analysis included item analysis, test-retest reliability, internal consistency reliability with Cronbach’s alpha coefficients, contrasted groups construct validity, and factorial validity, using principal components analysis with varimax rotation. Preliminary construct validity was established. Five dimensions of the CBI-E were identified: attending to individual needs, showing respect, practicing knowledgeably and skillfully, respecting autonomy, and supporting religious/spiritual beliefs. Additional testing is warranted.

Unilateral condylar hypoplasia results in facial, skeletal, and dental deformity and is a condition that is often treated with surgery and orthodontics. This report describes implant-supported prosthodontic rehabilitation in a 70-year-old patient who chose not to undergo orthognathic surgery. The patient underwent full-mouth dental extraction and placement of 9 maxillary and 5 mandibular implants. She received implant-supported cantilevered fixed prostheses in both arches to improve and minimize her skeletal and dental crossbite.