The aim of this study was to investigate treatment failure (TF) in hospitalised community-acquired pneumonia (CAP) patients with regard to initial antibiotic treatment and economic impact.CAP patients were included in two open, prospective multicentre studies assessing the direct costs for in-patient treatment. Patients received treatment either with moxifloxacin (MFX) or a nonstandardised antibiotic therapy. Any change in antibiotic therapy after .72h of treatment to a broadened antibiotic spectrum was considered as TF.Overall, 1,236 patients (mean¡SD age 69.6¡16.8 yrs, 691 (55.9%) male) were included. TF occurred in 197 (15.9%) subjects and led to longer hospital stay (15.4¡7.3 days versus 9.8¡4.2 days; p,0.001) and increased median treatment costs (J2,206 versus J1,284; p,0.001). 596 (48.2%) patients received MFX and witnessed less TF (10.9% versus 20.6%; p,0.001). After controlling for confounders in multivariate analysis, adjusted risk of TF was clearly reduced in MFX as compared with b-lactam monotherapy (adjusted OR for MFX 0.43, 95% CI 0.27-0.68) and was more comparable with a b-lactam plus macrolide combination (BLM) (OR 0.68, 95% CI 0.38-1.21).In hospitalised CAP, TF is frequent and leads to prolonged hospital stay and increased treatment costs. Initial treatment with MFX or BLM is a possible strategy to prevent TF, and may thus reduce treatment costs.

No abstract

In a retrospective macroscopic and microscopic study of celloidin‐embedded macrosections from 45 adults with primary metaphyseal intraosseous sarcomas, we ascertained the incidence, extent, and mode of tumor extension into, across, or around articular cartilage into a joint. Invasion of articular cartilage by tumor occurred in more thane one‐third of the macrosections examined. In more than one‐half of the cases, the sarcoma extended under the capsule insertion to involve the margin of the articular cartilage, thus leaving only a pseudocapsule between tumor and joint. Tumors frequently extended across or around the osseous‐tendinous junction of the cruciate ligaments into the knee joint. Our findings have important implications for the surgical management of appendicular metaphyseal intraosseous sarcomas. For primary bone sarcomas, extraarticular resections should be considered seriously when limb salvage is contemplated, especially in the knee region.

People with intellectual and developmental disabilities (IDD) experience elevated risk for poor health and social outcomes in adulthood and are at risk for experiencing homelessness and housing instability. Although the exact prevalence of IDD among homeless populations is unknown, a small body of literature related to the intersection of IDD and homelessness suggests differential health needs and service use patterns, with a need for targeted health and social services. In this study, we explore the perceptions and experiences of 18 homeless or disability service providers about (a) their clients at the intersection of IDD and homelessness and (b) their role and the services provided at the intersection of IDD and homelessness. Participants struggled to provide appropriate, accessible services for this population, owing to lack of training and awareness of specific needs, fragmented systems, and inadequately funded healthcare and housing support. Our findings also reveal that clients at this intersection have high contact with public systems, which places them at risk for losing their right to self-determination. Recommendations center on systems transformation to facilitate the ability of providers to collaborate and to make data-driven decisions to deliver person-centered care.

No abstract