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Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
The Pneumonia Severity Index (PSI) stratifies CAP by comorbidity and risk of mortality [45]. Most pregnant patients with CAP will fall into subset I; this is a group that, if non-pregnant, would be appropriately treated as outpatients. There are, however, no reliable data as to inpatient versus outpatient therapy in pregnancy.
Care of Critically Ill Patients with HIV
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Joseph Metmowlee Garland, Andrew Levinson, Edward Wing
Appropriate triage to the CCU of patients with pneumonia can be challenging and dependent on the resources of the specific health care system and community [76]. In general, patients who show signs of confusion, renal failure or other organ failure, and hypoxemia not yet receiving mechanical ventilation, should be considered for CCU admission. Scoring systems and predictive models such as the pneumonia severity index (PSI) [77] confusion, urea, respiratory rate, blood pressure plus age ≥ 65 years (CURB-65) [78], and predisposition, insult, response, and organ dysfunction (PIRO) [79] can be helpful in assisting and identifying patients at high risk of clinical decompensation. One of the most recent pneumonia predictive models, PIRO, may be particularly helpful in predicting outcomes in patients with HIV as it takes immunocompromised status into account in its risk score calculation [79]. In treating patients with severe CAP, underlying cardiac and pulmonary disease, in addition to HIV, can delay recognition and significantly increase morbidity and mortality. Many HIV-infected patients have chronic lung disease and cardiac disease at baseline, which significantly increases the risk of clinical decompensation from pneumonia [80].
Clinical Reasoning and Diagnostic Errors
Published in Paul Cerrato, John Halamka, Reinventing Clinical Decision Support, 2020
Several debiasing strategies have been developed over the decades to combat these cognitive errors, though most of these tools have never been formally labeled as “debiasing.” Even the simple act of taking a detailed medical history using a well-documented assessment form gives the diagnostic process structure and discourages snap judgments. So does a thorough physical examination that covers all the organ systems. Similarly, there are many clinical prediction rules that can help clinicians more accurately evaluate a patient’s condition and shift the diagnostic process from the subjective to the objective end of the continuum. The CHADS2 score, for example, collects patient data to help clinicians diagnose the risk of stroke with atrial fibrillation; the APGAR score lets clinicians evaluate the health status of a newborn. They join diagnostic and assessment rules such as the Pneumonia Severity Index (PSI) and the Wells criteria for pulmonary embolism, which helps facilitate a diagnosis by assigning a numeric probability to the existence of a suspected disorder.
Cost impact analysis of novel host-response diagnostic for patients with community-acquired pneumonia in the emergency department
Published in Journal of Medical Economics, 2022
John E. Schneider, Jacie T. Cooper
Because hospital reimbursement and antimicrobial stewardship programs are increasingly tied to quality, efficiency, and cost of care, we developed a cost-impact model (CIM) that compared the cost impact and clinical benefits between using SOC combined with MMBV (SOC + MMBV) relative to SOC alone. The patient population was stratified according to the pneumonia severity index (PSI) in recognition of the different treatment pathways likely to align with disease severity. Value drivers considered in this analysis include the costs of antibiotic use, hospital admissions, hospital length of stay, antibiotic-related adverse events, and Clostridioides difficile (CDI). The main expected benefit captured by this analysis will be avoiding antibiotic overuse and decreasing inappropriate underuse. Economic results are considered from the payer and provider perspective as cost savings per CAP-presenting ED patient, while clinical outcomes are presented per 1,000 patients as antibiotic patients avoided, antibiotic days saved, hospital admissions avoided, and hospital days saved.
Community-acquired pneumonia in hospitalised patients: changes in aetiology, clinical presentation, and severity outcomes in a 10-year period
Published in Annals of Medicine, 2022
Júlia Sellarès-Nadal, Joaquín Burgos, María Teresa Martín-Gómez, Andrés Antón, Roger Sordé, Daniel Romero-Herrero, Pau Bosch-Nicolau, Anna Falcó-Roget, Cristina Kirkegaard, Dolors Rodríguez-Pardo, Oscar Len, Vicenç Falcó
We collected epidemiologic information (age, sex, residency in nursing home, smoking, alcohol consumption and vaccination status), comorbidities (hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus, chronic renal failure, neurological disorders, and neoplasms) and immunosuppressive factors (solid organ transplantation, haematopoietic transplantation, chemotherapy, long-term use of corticosteroids, and HIV infection). We also registered clinical information, laboratory results, radiological findings, microbiological information, and severity data (septic shock and respiratory failure). Empirical treatment was recorded. Evolutive variables, such as admission at the Intensive Care Unit (ICU) and in-hospital mortality were collected. CURB-65 score and Pneumonia Severity Index (PSI) were calculated.
Clinical features of Legionnaires’ disease at three Belgian university hospitals, a retrospective study
Published in Acta Clinica Belgica, 2022
Marco moretti, Sabine D. Allard, Nicolas Dauby, Deborah De Geyter, Bhavna Mahadeb, Véronique Y. Miendje, Eric V. Balti, Philippe Clevenbergh
A previous study investigated various predictive scores in LD. Pneumonia severity index (PSI) and CURB-65 may be good prognostic scores to estimate the 30-day CA LD death-rate [6]. Nevertheless, they were designed to evaluate CA pneumonia and their predictive value in HA LD was not significant [6]. SOFA score is a validated predictive tool to estimated organ failure and mortality in ICU. The algorithm is based on the Partial O2 pressure/Fraction of inspired oxygen (P/F) ratio, which is fundamental to assess lung function, and on serum creatinine and bilirubin, which might be positive predictors for 30-day mortality in LD [6]. Serum creatinine was significantly increased in HA LD patients compared to CA LD [9]. In our study, a significantly higher SOFA score at pneumonia diagnosis was observed in HA LD in comparison with CA LD. Consequently, a larger percentage of HA LD patients were admitted to ICU and had more frequent unfavourable outcomes.