On the basis of the risk factors identified in recent studies, we developed an algorithm for empiric therapy of HCAP, which suggests that not all such patients require a broad-spectrum multidrug regimen in order to achieve appropriate and effective therapy. This algorithm needs validation in future studies.

Japan Medical Association Center for Clinical Trials, JMA-IIA00054.

Diabetes mellitus (DM) is a highly prevalent condition affecting about 347 million people worldwide. In addition to its numerous clinical implications, DM also exerts a negative effect on patient's sleep quality. Impaired sleep quality disrupts the adequate glycemic control regarded as corner stone in DM management and also lead to many deleterious effects causing a profound impact on health related quality of life. This article outlines various factors leading to impaired sleep quality among diabetics and delineates how individual factor influences sleep. The article also discusses potential interventions and lifestyle changes to promote healthy sleep among diabetics.

Background: The frequency of, and risks for, postoperative pulmonary complications (PPCs) after laparotomy are incompletely understood. The wide-ranging incidence of PPCs in the literature reflects methodological issues including variable definitions of PPCs and varied patient populations. Objectives: We sought to elucidate the incidence of PPCs after laparotomy and clarify risks for their development. Methods: We conducted a retrospective study of all laparotomies in adult patients on the general surgery service at our university-affiliated hospital in 2004. The definition of PPCs was rigorous and relevant in terms of key outcomes (morbidity, mortality, length of stay). We used a template for the review of medical records to identify PPCs and their consequences. Results: Twenty-five PPCs (7.0%) occurred in 359 laparotomies. Logistic regression modeling identified the following independent predictors of risk: upper abdominal incisions (OR 15.3; p = 0.025), reoperation (OR 7.1; p = 0.013), emergency surgery (OR 6.3; p = 0.001) and nasogastric tubes (OR 5.4; p = 0.008). PPCs were associated with increased mortality (OR 6.17; p = 0.01), intensive care unit care (OR 13.0; p = 0.001), increased mean hospital length of stay (17.7 days longer; p = 0.001) and longer mean postoperative length of stay (15.2 days longer; p = 0.001). Conclusions: The incidence of PPCs after laparotomy in this study is lower than in many prior reports and reflects the relevant definition of PPCs used. Upper abdominal surgery carried the greatest risk. Reoperation was a risk not identified previously. Emergency procedures and the use of nasogastric tubes were confirmed as key risks. Morbidity, mortality and lengths of stay were significantly increased after PPCs.

Japan Medical Association Center for Clinical Trials JMA-IIA00146.