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X-rays Questioned for Asthma Exacerbation Without Fever, Hypoxia

Radiography should not be used routinely to detect pneumonia in young children with asthma who do not have fever or hypoxia, according to new research.  
medscape.com
over 3 years ago
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Diagnosis and Management of Community-Acquired Pneumonia in Adults - American Family Physician

Community-acquired pneumonia is diagnosed by clinical features (e.g., cough, fever, pleuritic chest pain) and by lung imaging, usually an infiltrate seen on chest radiography. Initial evaluation should determine the need for hospitalization versus outpatient management using validated mortality or severity prediction scores. Selected diagnostic laboratory testing, such as sputum and blood cultures, is indicated for inpatients with severe illness but is rarely useful for outpatients. Initial outpatient therapy should include a macrolide or doxycycline. For outpatients with comorbidities or who have used antibiotics within the previous three months, a respiratory fluoroquinolone (levofloxacin, gemifloxacin, or moxifloxacin), or an oral beta-lactam antibiotic plus a macrolide should be used. Inpatients not admitted to an intensive care unit should receive a respiratory fluoroquinolone, or a beta-lactam antibiotic plus a macrolide. Patients with severe community-acquired pneumonia or who are admitted to the intensive care unit should be treated with a beta-lactam antibiotic, plus azithromycin or a respiratory fluoroquinolone. Those with risk factors for Pseudomonas should be treated with a beta-lactam antibiotic (piperacillin/tazobactam, imipenem/cilastatin, meropenem, doripenem, or cefepime), plus an aminoglycoside and azithromycin or an antipseudomonal fluoroquinolone (levofloxacin or ciprofloxacin). Those with risk factors for methicillin-resistant Staphylococcus aureus should be given vancomycin or linezolid. Hospitalized patients may be switched from intravenous to oral antibiotics after they have clinical improvement and are able to tolerate oral medications, typically in the first three days. Adherence to the Infectious Diseases Society of America/American Thoracic Society guidelines for the management of community-acquired pneumonia has been shown to improve patient outcomes. Physicians should promote pneumococcal and influenza vaccination as a means to prevent community-acquired pneumonia and pneumococcal bacteremia.  
aafp.org
over 3 years ago
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Pneumonia Mimics: Pearls and Pitfalls - emdocs

Pneumonia is an illness frequently seen in our emergency departments.  But, are all presentations actually pneumonia?  Are we missing other illnesses that present similarly to pneumonia?  Which ones pose significant morbidity and mortality risk to our patients?  What clues are out there that will aid us in making an alternative and critical diagnosis?  
emdocs.net
over 3 years ago
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7

Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study

Objective To determine the impact of the Hospital Value-Based Purchasing (HVBP) program—the US pay for performance program introduced by Medicare to incentivize higher quality care—on 30 day mortality for three incentivized conditions: acute myocardial infarction, heart failure, and pneumonia.  
feeds.bmj.com
over 3 years ago
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Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study

Objective To determine the impact of the Hospital Value-Based Purchasing (HVBP) program—the US pay for performance program introduced by Medicare to incentivize higher quality care—on 30 day mortality for three incentivized conditions: acute myocardial infarction, heart failure, and pneumonia.  
feeds.bmj.com
over 3 years ago
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9

Ultrasound in the Diagnosis and Management of Pneumonia

Ultrasound is a useful, cost effective tool in the diagnosis of pneumonia. It should continue to be further integrated into usual practice.  
medscape.com
over 3 years ago
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Routine Nursing Screen Eradicates Pneumonia in Oncology Unit

By screening all patients for hospital-acquired pneumonia risk on admission to an oncology unit, nurses were able to introduce prevention measures to eliminate the infection.  
medscape.com
over 3 years ago
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6

Petition urges GSK and Pfizer to lower price of pneumonia vaccine

The humanitarian charity Médecins Sans Frontières/Doctors Without Borders has delivered a petition of almost 400 000 signatures to the headquarters of GlaxoSmithKline (GSK) in London and Pfizer in New York, demanding that the companies reduce the price of their pneumonia vaccine in developing countries to $5 (£3.45; €4.40) per child.  
feeds.bmj.com
over 3 years ago
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Petition urges GSK and Pfizer to lower price of pneumonia vaccine

The humanitarian charity Médecins Sans Frontières/Doctors Without Borders has delivered a petition of almost 400 000 signatures to the headquarters of GlaxoSmithKline (GSK) in London and Pfizer in New York, demanding that the companies reduce the price of their pneumonia vaccine in developing countries to $5 (£3.45; €4.40) per child.  
feeds.bmj.com
over 3 years ago
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2272

Pneumonia: Causes, Types, & Symptoms

Pneumonia is an infection in the lungs that can be caused by a variety of different pathogens, including viruses, bacteria, fungi, and mycobacteria. Depending on the pathogen, symptoms can range in severity; this video covers the pathophysiology of a lung infection, as well as common types, clinical signs and symptoms, and treatments.  
youtube.com
over 3 years ago
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131

Pleurisy - American Family Physician

Pleuritic chest pain is a common presenting symptom and has many causes, which range from life-threatening to benign, self-limited conditions. Pulmonary embolism is the most common potentially life-threatening cause, found in 5 to 20 percent of patients who present to the emergency department with pleuritic pain. Other clinically significant conditions that may cause pleuritic pain include pericarditis, pneumonia, myocardial infarction, and pneumothorax. Patients should be evaluated appropriately for these conditions before an alternative diagnosis is made. History, physical examination, and chest radiography are recommended for all patients with pleuritic chest pain. Electrocardiography is helpful, especially if there is clinical suspicion of myocardial infarction, pulmonary embolism, or pericarditis. When these other significant causes of pleuritic pain have been excluded, the diagnosis of pleurisy can be made. There are numerous causes of pleurisy, with viral pleurisy among the most common. Other etiologies may be evaluated through additional diagnostic testing in selected patients. Treatment of pleurisy typically consists of pain management with nonsteroidal anti-inflammatory drugs, as well as specific treatments targeted at the underlying cause.  
aafp.org
over 3 years ago
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An often forgotten cause of chest pain

A 66 year old white woman presented to the emergency department of a district general hospital with shortness of breath and chest pain, which radiated to her back. She had previously received antibiotics from her general practitioner for a presumed chest infection. Comorbidities included drug controlled hypertension. On examination she was tachypnoeic and hypertensive with a blood pressure of 170/90 mm Hg. No disparity in blood pressure was seen between her arms. Because clinical signs and plain chest radiography were suggestive of a left sided basal pneumonia with associated parapneumonic effusion (fig 1⇓), she received intravenous antibiotics.  
feeds.bmj.com
over 3 years ago
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7

An often forgotten cause of chest pain

A 66 year old white woman presented to the emergency department of a district general hospital with shortness of breath and chest pain, which radiated to her back. She had previously received antibiotics from her general practitioner for a presumed chest infection. Comorbidities included drug controlled hypertension. On examination she was tachypnoeic and hypertensive with a blood pressure of 170/90 mm Hg. No disparity in blood pressure was seen between her arms. Because clinical signs and plain chest radiography were suggestive of a left sided basal pneumonia with associated parapneumonic effusion (fig 1⇓), she received intravenous antibiotics.  
feeds.bmj.com
over 3 years ago
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7

Efficacy and Safety of Corticosteroids in Pneumonia

Although widely used, is there an actual benefit to using a short course of systemic corticosteroids in community-acquired pneumonia?  
medscape.com
over 3 years ago
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8

Treatment of Gram-Negative Pneumonia in Critical Care

Beta-lactam antibiotics have been the standard treatment approach for gram-negative pneumonia in mechanically ventilated patients -- but have they been overused? What are the alternatives?  
medscape.com
over 3 years ago
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Ovarian Torsion - emdocs

Naturally, we have all been taught to think “outside the box” and know to consider conditions outside the abdominal cavity (ex, Pneumonia, Testicular Torsio  
emdocs.net
over 3 years ago
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Emergency Medicine Literature of Note: No Single Reliable Criterion for Diagnosing Acute Heart Failure

I've always been an advocate for less radiation. I believe in reducing the excessive number of CTPAs for low-mod pretest probability VTE patients. Would I dare consider a CT for an undifferentiated dyspneic patient in whom I've actually ruled out PE?Not until recently. Because of my aversion to excessive testing, and hell, PE is off the table, what do you mean CT?But what I'm suggesting is to consider a SOB CT. For the sick patient, at risk for significant morbidity/mortality. Is it safe to continue admitting with a CXR, a diagnosis of multifactorial dyspnea, and a plan for fluids or diuretics or fluids? Or maybe antibiotics or nebs and steroids or anticoagulation?Excessive imaging risks radiation, high costs, and incidentalomas. But if your threshold for getting a SOB CT is as high as mine used to be, we're only considering it for the sick undifferentiated patient. CT is certainly not perfect, interstitial findings may not parse out pneumonia vs fluid overload, but most of the time your diagnostic uncertainty will be relieved. Ah, an evident pneumonia, maybe distinct consolidation, maybe patchy opacities, maybe findings consistent with heart failure, maybe malignancy, and sometimes even PE when you thought not. For the sick undifferentiated dyspneic patient stop futzing around and realize you have a pretty reliable simple test at your disposal.Try ultrasound first...  
emlitofnote.com
over 3 years ago
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Antiviral treatment for influenza infection in people with cystic fibrosis | Cochrane

Cystic fibrosis is a genetic, life-threatening disorder which affects many organs in the body. and people with cystic fibrosis have a higher risk of chronic lung disease. Influenza can worsen the course of the disease in cystic fibrosis by increasing the risk of pneumonia and secondary respiratory complications. During a pandemic (an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people), flu symptoms may be more severe and complications more frequent. Severe cases of pandemic flu have occurred in people with underlying chronic conditions including people with cystic fibrosis. Although there is no evidence that people with cystic fibrosis are more likely to contract this infection than healthy people, the impact for them could be greater and the outcome worse as the lower airways are more often affected. Antiviral agents are important in managing influenza and include the neuraminidase inhibitors zanamivir and oseltamivir. These drugs can limit the infection and prevent the spread of the virus.  
cochrane.org
over 3 years ago
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Patient Has Pneumonia? Think Legionellosis

Dr Nicholas Gross warns clinicians not to overlook legionellosis as a possible source of community-acquired pneumonia.  
medscape.com
over 3 years ago