Archive for January 16, 2013

Compliance with guidelines-recommended processes in pneumonia: impact of health status and initial signs.

PLoS One. 2012;7(5):e37570. doi: 10.1371/journal.pone.0037570. Epub 2012 May 22.

Menéndez R, Torres A, Reyes S, Zalacain R, Capelastegui A, Rajas O, Borderías L, Martín-Villasclaras JJ, Bello S, Alfageme I, de Castro FR, Rello J, Molinos L, Ruiz-Manzano J.

Source

Servicio de Neumología, Hospital Universitario y politecnico La Fe, CIBERES, Valencia, Spain. rosmenend@gmail.com

Abstract

Initial care has been associated with improved survival of community-acquired pneumonia (CAP). We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose <6 hours and oxygen assessment. Antibiotic adherence was 72.6%, first dose <6 h was 73.4% and oxygen assessment was 90.2%. Antibiotic adherence was negatively associated with a high Charlson score (Odds ratio [OR], 0.91), confusion (OR, 0.66) and tachycardia ≥100 bpm (OR, 0.77). Delayed first dose was significantly lower in those with tachycardia (OR, 0.75). Initial oxygen assessment was negatively associated with fever (OR, 0.61), whereas tachypnea ≥30 (OR, 1.58), tachycardia (OR, 1.39), age >65 (OR, 1.51) and COPD (OR, 1.80) were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69) and a high Charlson score (OR, 0.92) adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358284/pdf/pone.0037570.pdf

January 16, 2013 at 2:30 pm

Prospective comparison of severity scores for predicting mortality in community-acquired pneumonia.

Rev Esp Quimioter. 2012 Jun;25(2):147-54.

Luque S, Gea J, Saballs P, Ferrández O, Berenguer N, Grau S.

Source

Pharmacy Department, Hospital del Mar, Barcelona, Parc de Salut Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain.

Abstract

INTRODUCTION:

Specific prognostic models for community acquired pneumonia (CAP) to guide treatment decisions have been developed, such us the Pneumonia Severity Index (PSI) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure and age ≥ 65 years index (CURB-65). Additionally, general models are available such as the Mortality Probability Model (MPM-II). So far, which score performs better in CAP remains controversial. The objective was to compare PSI and CURB-65 and the general model, MPM-II, for predicting 30-day mortality in patients admitted with CAP.

METHODS:

Prospective observational study including all consecutive patients hospitalised with a confirmed diagnosis of CAP and treated according to the hospital guidelines. Comparison of the overall discriminatory power of the models was performed by calculating the area under a receiver operator characteristic curve (AUC ROC curve) and calibration through the Goodness-of-fit test.

RESULTS:

One hundred and fifty two patients were included (mean age 73.0 years; 69.1% male; 75.0% with more than one comorbid condition). Seventy-five percent of the patients were classified as high-risk subjects according to the PSI, versus 61.2% according to the CURB-65. The 30-day mortality rate was 11.8%. All three scores obtained acceptable and similar values of the AUCs of the ROC curve for predicting mortality. Despite all rules showed good calibration, this seemed to be better for CURB-65. CURB-65 also revealed the highest positive likelihood ratio.

CONCLUSIONS:

CURB-65 performs similar to PSI or MPMII for predicting 30-day mortality in patients with CAP. Consequently, this simple model can be regarded as a valid alternative to the more complex rules.

PDF

http://seq.es/seq/0214-3429/25/2/luque.pdf

January 16, 2013 at 2:28 pm

INDICATIONS FOR WORLDWIDE INCREASED NOROVIRUS ACTIVITY ASSOCIATED WITH EMERGENCE OF A NEW VARIANT OF GENOTYPE II.4, LATE 2012

Eurosurveillance, Volume 18, Issue 1, 03 January 2013

Rapid communications

J van Beek ()1, K Ambert-Balay2, N Botteldoorn3, J S Eden4, J Fonager5, J Hewitt6, N Iritani7, A Kroneman1, H Vennema1, J Vinjé8, P A White4, M Koopmans1, on behalf of NoroNet9

National Institute for Public Health and the Environment, Bilthoven, The Netherlands National Reference Centre for Enteric Viruses, Dijon, France Scientific Institute of Public Health, Brussels, BelgiumUniversity of New South Wales, Sydney, Australia Statens Serum Institut, Copenhagen, Denmark Institute of Environmental Science and Research, Porirua, New Zealand Osaka City Institute of Public Health and Environmental Sciences, Osaka, Japan Centers for Disease Control and Prevention, Atlanta, GA, United Stateshttp://www.noronet.nl

Globally, surveillance systems showed an increase in norovirus activity in late 2012. Molecular data shared through the NoroNet network suggest that this increase is related to the emergence of a new norovirus genotype II.4 variant, termed Sydney 2012. Healthcare institutions are advised to be prepared for a severe norovirus season.. . .

FULL TEXT

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20345

January 16, 2013 at 2:27 pm


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