Hospital For Treatment Of Pneumonia Research Articles

Implementation of the COVID-19 Vulnerability Index Across an International Network of Health Care Data Sets: Collaborative External Validation Study.

BackgroundSARS-CoV-2 is straining health care systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate patients who require hospitalization from those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospital for treatment of pneumonia or pneumonia proxies, has been developed and proposed as a valuable tool for decision-making during the pandemic. However, the model is at high risk of bias according to the “prediction model risk of bias assessment” criteria, and it has not been externally validated.ObjectiveThe aim of this study was to externally validate the C-19 index across a range of health care settings to determine how well it broadly predicts hospitalization due to pneumonia in COVID-19 cases.MethodsWe followed the Observational Health Data Sciences and Informatics (OHDSI) framework for external validation to assess the reliability of the C-19 index. We evaluated the model on two different target populations, 41,381 patients who presented with SARS-CoV-2 at an outpatient or emergency department visit and 9,429,285 patients who presented with influenza or related symptoms during an outpatient or emergency department visit, to predict their risk of hospitalization with pneumonia during the following 0-30 days. In total, we validated the model across a network of 14 databases spanning the United States, Europe, Australia, and Asia.ResultsThe internal validation performance of the C-19 index had a C statistic of 0.73, and the calibration was not reported by the authors. When we externally validated it by transporting it to SARS-CoV-2 data, the model obtained C statistics of 0.36, 0.53 (0.473-0.584) and 0.56 (0.488-0.636) on Spanish, US, and South Korean data sets, respectively. The calibration was poor, with the model underestimating risk. When validated on 12 data sets containing influenza patients across the OHDSI network, the C statistics ranged between 0.40 and 0.68.ConclusionsOur results show that the discriminative performance of the C-19 index model is low for influenza cohorts and even worse among patients with COVID-19 in the United States, Spain, and South Korea. These results suggest that C-19 should not be used to aid decision-making during the COVID-19 pandemic. Our findings highlight the importance of performing external validation across a range of settings, especially when a prediction model is being extrapolated to a different population. In the field of prediction, extensive validation is required to create appropriate trust in a model.

Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia

ObjectivesPneumonia is a common cause of hospitalization for nursing home residents and has increased as a cause for hospitalization during the COVID-19 pandemic. Risks of hospitalization, including significant functional decline, are important considerations when deciding whether to treat a resident in the nursing home or transfer to a hospital. Little is known about postdischarge functional status, relative to baseline, of nursing home residents hospitalized for pneumonia. We sought to determine the risk of severe functional limitation or death for nursing home residents following hospitalization for treatment of pneumonia. DesignRetrospective cohort study. Setting and ParticipantsParticipants included Medicare enrollees aged ≥65 years, hospitalized from a nursing home in the United States between 2013 and 2014 for pneumonia. MethodsActivities of daily living (ADL), patient sociodemographics, and comorbidities were obtained from the Minimum Data Set (MDS), an assessment tool completed for all nursing home residents. MDS assessments from prior to and following hospitalization were compared to assess for functional decline. Following hospital discharge, all patients were evaluated for a composite outcome of severe disability (≥4 ADL limitations) following hospitalization or death prior to completion of a postdischarge MDS. ResultsIn 2013 and 2014, a total of 241,804 nursing home residents were hospitalized for pneumonia, of whom 89.9% (192,736) experienced the composite outcome of severe disability or death following hospitalization for pneumonia. Although we found that prehospitalization functional and cognitive status were associated with developing the composite outcome, 53% of residents with no prehospitalization ADL limitation, and 82% with no cognitive limitation experienced the outcome. Conclusions and ImplicationsHospitalization for treatment of pneumonia is associated with significant risk of functional decline and death among nursing home residents, even those with minimal deficits prior to hospitalization. Nursing homes need to prepare for these outcomes in both advance care planning and in rehabilitation efforts.

Crazy-paving sign in high-resolution computed tomography in parainfluenza virus pneumonia

The crazy-paving sign is the appearance of a smooth linear pattern superimposed on an area of ground-glass opacity on thin-section computed tomography (CT). A 69-year-old woman was admitted to our hospital for treatment of pneumonia. Thoracic CT showed a crazy-paving sign in the right lung field on admission. She received ceftriaxone and clarithromycin, and the symptoms and infiltration shadow promptly disappeared. Serologic testing revealed a greater than 4-fold increase in the IgG titer for parainfluenza virus I. To our knowledge, there is no previous report of the crazy-paving sign in associated with viral pneumonia in a non-immunocompromised host or with parainfluenza pneumonia.

Economic Impact of Implementing Pneumonia Treatment Guidelines for Intravenous to Oral Conversion

Background Inpatient treatment of pneumonia produces significant costs to the health care system. In an effort to improve quality of care, decrease length of stay, and decrease drug costs associated with treating pneumonia, on October 1, 2006, the Veterans Affairs New York Harbor Healthcare System (VANYHHS) implemented guidelines for treating hospitalized patients with pneumonia. These guidelines included specific criteria for initial selection of an antimicrobial agent based on patient risk factors, conversion from intravenous (IV) to oral antibiotics, and selection of an appropriate oral agent for conversion. The primary objective of this study was assessment of the economic impact of implementing pneumonia treatment guidelines at the VANYHHS. Methods Retrospective analysis of 100 patients admitted to the VANYHHS for treatment of pneumonia was completed before implementation of the guidelines, and then those data were compared with similar data from a group of 100 patients admitted to the hospital for treatment of pneumonia after implementation of the guidelines. Electronic medical records were reviewed for (1) initial antibiotic therapy administered, (2) time needed for conversion from IV to oral antibiotics after becoming eligible for the switch based on implemented guidelines, and (3) length of hospital stay. Results Data from the preguideline group demonstrated that it took an additional 2.31 days to convert patients from IV to oral antibiotics after they were eligible for the switch to oral therapy. The mean length of stay was 9.2 days. Data from the postguideline group illustrated that the time needed to convert patients from IV to oral therapy was decreased to 1.09 days ( P = 0.002) and the mean length of stay was decreased to 8.76 days ( P = 0.677) when compared with the preguideline group data. The estimated annual cost savings from implementing pneumonia treatment guidelines based on the decrease in mean length of stay was $290,482.20 annually. Conclusion Implementing pneumonia treatment guidelines was associated with decreased length of stay and, thus, a decrease in the costs associated with treating pneumonia in an institutional setting. It is estimated that the VANYHHS could save nearly $300,000 annually as a result of the implementation of the treatment guidelines for pneumonia.

Case 43-1990

Presentation of Case A 3 1/2-year-old boy was admitted to the hospital because of pharyngitis, fever, rash, and cervical lymphadenopathy. The child was born to a 21-year-old woman by spontaneous vaginal delivery after a full-term second pregnancy; the pregnancy and delivery were uncomplicated; the birth weight was 4.3 kg. The child's early growth and development were normal. He had recurrent bouts of otitis media during the first year of life, but drainage tubes were not required. He was otherwise well until 1 1/2 years before entry, when he was admitted to another hospital for treatment of pneumonia of the right . . .

Stability of Patient Preferences Regarding Life-Sustaining Treatments

Physicians often express concern about the reliability of critically ill patients' preferences regarding life-sustaining treatments. We interviewed 30 Veterans Administration intensive care unit patients to determine their preferences for resuscitation, resuscitation requiring mechanical ventilation, artificial hydration and nutrition, and hospitalization for treatment of pneumonia. Patients expressed their preferences considering their current health and then two hypothetical scenarios, stroke and dementia. Follow-up interviews occurred one month later to assess preference stability. We found a diversity of opinions about life-sustaining treatments. Despite significant changes in health status and mood (p less than 0.05), treatment preferences were stable over time (kappa = .35-.70). Our results suggest that life-sustaining treatment preferences solicited during a serious illness are reliable and may be used in decision-making when a patient becomes unable to communicate or is mentally incapacitated.

Management of a Mildly Symptomatic 65-Year-Old Woman with an Atrial Septal Defect in the Setting of Normal Pulmonary Artery Pressure

A 65-year-old woman was referred to our institution for evaluation of a heart murmur. She had learned of a heart murmur eight years ago. Three to four years prior to referral, she began therapy with furosemide and digoxin; however, she did not recall her symptoms at that time. She felt well until two months prior to admission when she was admitted to her local hospital for treatment of pneumonia. Since that time she had been bothered by a persistent nonproductive cough. The patient and her family noted a gradual increase in dyspnea on exertion in the last month, but she denied orthopnea, nocturnal dyspnea, chest pain and weight gain. She has had mild ankle edema.