Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To assess if chest radiographic findings present on admission are associated with severity of childhood community-acquired pneumonia (CAP), a total of 161 children hospitalized with pulmonary infiltrate were enrolled in the study; 48 (30%) patients were excluded because of presence of bilateral chest radiographic alterations (33; 20%) and presence of underlying diseases (15; 9%). According to WHO and BTS criteria, severe CAP was present in 57 (50%) and in 96 (85%) cases, respectively; 29 (26%) were aged less than 1 year. The median age (months) was 22 (mean 24 +/- 14, range 2-58). Overall, radiographic finding was right-sided in 77 (68%) cases and the upper lobe was compromised in 36 (32%) cases. By analyzing data stratified to age, the frequency of upper lobe involvement was significantly higher among severe cases (WHO criteria) only for those patients aged > or =1 year (13/35 [37%] vs. 7/45 [16%], P = 0.03, OR [95% CI] 3.2 [1.1-9.2]). The specificity and positive predictive value of upper lobe involvement for severity among the latter group of patients were 84% (95% CI 70-93%) and 65% (95% CI 41-84%), respectively. No association was found by using the BTS criteria. The admission chest radiography was useful to predict severity of children aged > or =1 year hospitalized with CAP.
 ...
PMID:Severity of childhood community-acquired pneumonia and chest radiographic findings. 1920 52

Non-invasive ventilation (NIV) is a clinically proven, cost-effective intervention for acidotic exacerbations of COPD that is recommended by UK national guidelines. This study examines the extent to which these recommendations are being followed in the UK. Between August and October 2003 a national audit of COPD exacerbations was conducted by the Royal College of Physicians and the British Thoracic Society. 233 (94%) UK hospitals submitted data for 7,529 prospectively recruited acute COPD admissions, documenting process of care and outcomes from a retrospective case note audit. They also completed a resources and organisation of care proforma. Nineteen hospitals (8%) reported they did not offer NIV. There was no access to NIV in 92 (39%) intensive care units in 88 (36%), high-dependency units or on general wards of 85 (34%) hospitals. In 74 (30%) NIV was available on all 3 sites. A low pH (<7.35) was noted at some time during admission for 26% (1714/6544) of patients and NIV was administered to 31%. Patients receiving NIV were more often admitted under a respiratory physician, or seen at some stage by a respiratory specialist and had more severe disease (higher PaCO2 (median 9.8 v 7.8 kPa), lower oxygen tension (median 8.8 v 9.8 kPa), higher incidence of peripheral oedema (48% v 39%), of pneumonia (27% v 16%), higher in-hospital mortality (26% v 14%) and at 90 days (37% v 24%) and longer hospital stays (median 9 v 7 days) than those not receiving NIV. Hospitals with least usage of NIV had similar mortality rates to those using NIV more often. A comprehensive NIV service is not available in many hospitals admitting patients with acute respiratory failure secondary to COPD. Access to acute NIV is inadequate and does not conform with NICE and BTS guidelines. These observational audit data do not demonstrate benefits of NIV on survival when compared to conventional management, contrary to results from randomised trials. Reasons for this are unclear but unmeasured confounding factors and poor patient selection for NIV are likely explanations.
 ...
PMID:Non-invasive ventilation (NIV) in the clinical management of acute COPD in 233 UK hospitals: results from the RCP/BTS 2003 National COPD Audit. 1981 72

When considering a diagnosis of LRTI the main differentiation to make is between pneumonia and non-pneumonic LRTI. It is more difficult to make this distinction in the community because of access constraints to chest radiography and the lack of a quick, simple marker to identify patients with true pneumonia accurately. The diagnosis of pneumonia in the community, without a chest radiograph, is suggested by symptoms that include: cough; (purulent) sputum production; breathlessness; pleurisy; occasional haemoptysis along with new focal signs on chest examination (e.g. crepitations, bronchial breathing, and dullness to percussion); at least one systemic feature (e.g. sweating, fevers, shivers, aches and pains and/or temperature >38 degrees C); and no other explanation for the symptoms. A recent observational study of around 150,000 patients with LRTI in the UK found that the following factors were associated with increased respiratory infection-related mortality: increasing age; smoking; increasing Charlson co-morbidity index; prior antibiotic prescribing; frequent consultation and prior specialist referral or admission. Acute adult LRTI presenting to GPs is a predominantly viral illness most commonly caused by rhinoviruses and influenza viruses. The most common bacterial cause of pneumonia is Streptococcus pneumoniae but frequently no organism is identified. In patients where you suspect non-pneumonic LRTI, the evidence suggests that chest radiography and blood tests for CRP are not helpful in their management in the community. The BTS guidelines recommend that GPs, particularly those working in out-of-hours and emergency assessment centres, should consider using pulse oximeters. The CRB-65 is a helpful tool in the community. Patients scoring 0 or 1 have the lowest mortality risk, however, a score of 2 or more should be a cause for concern and the patient may need to be admitted to hospital for assessment.
 ...
PMID:Managing LRTI in adults in the community. 2004 6