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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Mortality rates are a widely used measure of hospital quality. A central problem with this measure is selection bias: simply put, severely ill patients may choose high quality hospitals. We control for severity of illness with an instrumental variables (IV) framework using geographic location data. We use IV to examine the quality of pneumonia care in Southern California from 1989 to 1994. We find that the IV quality estimates are markedly different from traditional GLS estimates, and that IV reveals different determinants of quality. Econometric tests suggest that the IV model is appropriately specified, that the GLS model is inconsistent.
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PMID:Estimating the quality of care in hospitals using instrumental variables. 1084 33

Influenza is associated with a high prevalence of cardiac complications, including myocarditis and exacerbation of ischemic heart disease or heart failure (HF). However, only four cases of stress-induced takotsubo cardiomyopathy (TC), all of them triggered by virus A influenza, have been reported so far. Another two TC cases after anti-influenza vaccination are also available in the literature. The authors describe a new case of TC, this time provoked by influenza B. An 89-year-old female with a history of hypertension and chronic obstructive pulmonary disease (COPD) was admitted due to a fever (39oC), muscle aches and cough. Pneumonia was excluded in chest X-ray while the test for influenza confirmed virus B infection, so she was given oseltamivir. On the second day of hospitalization, she developed severe HF. ECG showed new negative T waves in inferior and anterolateral leads coexisting with a moderate troponin I and marked brain natriuretic peptide release, while echocardiography revealed left ventricular (LV) apical ballooning with decreased ejection fraction (EF 24%) and global longitudinal strain (GLS -8.1%). Symptomatic treatment of HF was initiated. The symptoms of influenza resolved after 5 days. LV function began to improve after 4 days and became normal after 6 days (EF 58%, GLS -18.1%). Despite an advanced age and the coexisting disorders (COPD, mild cognitive impairment, possible neoplastic disease), the patient was discharged in stable clinical condition on day 10. The authors conclude that in the evaluation of cardiac complications of influenza, TC should be taken into account.
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PMID:Takotsubo cardiomyopathy triggered by influenza B. 3024 Mar 71