A clinical pathway for community-acquired pneumonia: an observational cohort study

Frei, Christopher R.; Bell, Allison; Traugott, Kristi A.; Jaso, Terry C.; Daniels, Kelly R.; Mortensen, Eric M.; Restrepo, Marcos I.; Oramasionwu, Christine U.; Ruiz, Andres D.; Mylchreest, William R.; Sikirica, Vanja; Raut, M.; Fisher, Alan C.; Schein, Jeff

doi:10.1186/1471-2334-11-188

Cited by 13 publications

(11 citation statements)

References 26 publications

(35 reference statements)

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“…Clinical pathway management regulates medical behaviors and reduces unnecessary examinations and treatment. [16][17][18][19] Additionally, they help avoid excessive medical spending, which may effectively curb the practice of hospitals' relying on drug sales or medical instrumentation for income. In doing so, they establish a reasonable, effective and optimized medical service system.…”

Section: Discussionmentioning

confidence: 99%

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Study of the Application of Clinical Pathways in Varicella, Acute Bacillary Dysentery, Measles, Scarlet Fever, and Rubella

Xu¹,

Qin²,

Zhao³

et al. 2014

N A J Med Sci

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In order to explore the clinical pathways that fit the actual situation of our country and department of infectious diseases, an analysis was performed to evaluate the effectiveness of clinical pathways for varicella, acute bacillary dysentery, measles, scarlet fever and rubella when compared with traditional standard medical care. Using a retrospective comparative study design, varicella, acute bacillary dysentery, measles, scarlet fever and rubella patients who were managed on a clinical pathway (clinical pathway group) were compared with a retrospective group of patients who received traditional medical care (control group) prior to the pathway's implementation. The following outcomes were measured: length of hospital stay, hospitalization costs. There was a significant reduction in the median hospitalization costs in the clinical pathway group patients in all five infectious diseases (P<0.05). The clinical pathway group's length of hospital stay for varicella, measles, acute bacillary dysentery and rubella were significantly shorter than the control group (P<0.05). The implementation of clinical pathways in varicella, acute bacillary dysentery, measles, scarlet fever and rubella might contribute to better quality of care and cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%

“…Although controversial elements still exist, we think that clinical pathways can have a positive impact on the quality in infectious disease care. [20][21][22][23][24][25]…”

Section: Discussionmentioning

confidence: 99%

Study of the Application of Clinical Pathways in Varicella, Acute Bacillary Dysentery, Measles, Scarlet Fever, and Rubella

Xu¹,

Qin²,

Zhao³

et al. 2014

N A J Med Sci

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“…; Frei et al. ). However, the emergence of virulent serotypes not covered by current vaccines and the notable rise in antibiotic resistance raises concern for increased mortality risk caused by S. pneumoniae .…”

Section: Introductionmentioning

confidence: 97%

“…For many years, routine vaccination, antibiotic use, and adjunctive therapies have proven efficacious in certain settings and for certain groups. For example, immunization programs have proven successful in reducing pneumonia and are predicted to reduce child mortality by 30% by 2015 globally (Boyce et al 1995;Frei et al 2011). However, the emergence of virulent serotypes not covered by current vaccines and the notable rise in antibiotic resistance raises concern for increased mortality risk caused by S. pneumoniae.…”

Section: Introductionmentioning

confidence: 99%

Corticotropin-releasing hormone improves survival in pneumococcal pneumonia by reducing pulmonary inflammation

Burnley

Jones

2017

Physiol Rep

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The use of glucocorticoids to reduce inflammatory responses is largely based on the knowledge of the physiological action of the endogenous glucocorticoid, cortisol. Corticotropin‐releasing hormone (CRH) is a neuropeptide released from the hypothalamic–pituitary–adrenal axis of the central nervous system. This hormone serves as an important mediator of adaptive physiological responses to stress. In addition to its role in inducing downstream cortisol release that in turn regulates immune suppression, CRH has also been found to mediate inflammatory responses in peripheral tissues. Streptococcus pneumoniae is a microorganism commonly present among the commensal microflora along the upper respiratory tract. Transmission of disease stems from the resident asymptomatic pneumococcus along the nasal passages. Glucocorticoids are central mediators of immune suppression and are the primary adjuvant pharmacological treatment used to reduce inflammatory responses in patients with severe bacterial pneumonia. However, controversy exists in the effectiveness of glucocorticoid treatment in reducing mortality rates during S. pneumoniae infection. In this study, we compared the effect of the currently utilized pharmacologic glucocorticoid dexamethasone with CRH. Our results demonstrated that intranasal administration of CRH increases survival associated with a decrease in inflammatory cellular immune responses compared to dexamethasone independent of neutrophils. Thus, providing evidence of its use in the management of immune and inflammatory responses brought on by severe pneumococcal infection that could reduce mortality risks.

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“…During the 1990s, there were some advances in the application of risk factor criteria, including CURB-65 (confusion, blood urea > 42.8 mg/dL, respiratory rate > 30/minute, blood pressure < 90/60 mmHg, age > 65 years) as well as its simplified version, i e, CRB-65 (16,17). Both of these measures are valid (18,19), though they have some limitations. They can predict the probability of death; however, they cannot determine the inflammatory response, which is now considered as a key aspect in the prognosis of CAP (20).…”

Section: Introductionmentioning

confidence: 99%

Relationship Between the Serum Level of C-Reactive Protein and Severity and Outcomes of Community-acquired Pneumonia

Malek

Gohari

Mirmohammadkhani

et al. 2019

Arch Clin Infect Dis

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Background: Evaluation of severity, complications, and risk of death due to community-acquired pneumonia (CAP) plays a major role in making decisions about treatment. Biomarkers are one of the tools used to diagnose the disease. Objectives: The current study aimed at evaluating the relationship between C-reactive protein (CRP) serum level and outcomes of CAP in affected patients. Methods: CRP serum level was measured on the 1st and 3rd days of admission in 73 patients. Chest X-ray was taken and CURB-65 (confusion, blood urea > 42.8 mg/dL, respiratory rate > 30/minute, blood pressure < 90/60 mmHg, age > 65 years) criteria was also applied. The patients were followed up for 30 days and evaluated for admission to intensive care unit (ICU), need for mechanical ventilation, inotropic support, incidence of pleural effusion, empyema, lung abscess, and death. Results: CRP level on the 3rd day of admission had a significant and direct relationship with the incidence of complications and death in patients. There were no significant relationship between CURB-65 score and mean CRP level on admission. There was a significant relationship between mean CRP level on 3rd day and CURB-65 score. Clinical status had a significant relationship with mean CRP levels on the 1st and 3rd days of admission. Considering a cutoff point of 25 for CRP level on the 3rd day of admission, there was a significant difference between two groups in terms of mortality rate and CURB-65 scores. Conclusions: The results of the current study showed that elevated CRP level on the 3rd day of admission could be a sign of increased risk of complications and severity of the disease as well as death. It can be used as a factor for the prognosis of complications and outcomes.

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A clinical pathway for community-acquired pneumonia: an observational cohort study

Cited by 13 publications

References 26 publications

Study of the Application of Clinical Pathways in Varicella, Acute Bacillary Dysentery, Measles, Scarlet Fever, and Rubella

Study of the Application of Clinical Pathways in Varicella, Acute Bacillary Dysentery, Measles, Scarlet Fever, and Rubella

Corticotropin-releasing hormone improves survival in pneumococcal pneumonia by reducing pulmonary inflammation

Relationship Between the Serum Level of C-Reactive Protein and Severity and Outcomes of Community-acquired Pneumonia

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