Early Mobilization of Patients Hospitalized With Community-Acquired Pneumonia

Mundy, Linda M.; Leet, Terry; Darst, Kate; Schnitzler, Mark A.; Dunagan, W. Claiborne

doi:10.1378/chest.124.3.883

Cited by 187 publications

(211 citation statements)

References 20 publications

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“…21 Available randomized trials of procalcitonin protocols in CAP patients lack comparisons with the use of other evidence-based guidelines. [26][27][28][29] It is unclear whether these guidelines were followed in procalcitonin protocol trials' control groups, but future studies should consider adding trial arms where these comparisons could occur. In addition, trials of varying antibiotic duration have shown, in many cases, that shorter antibiotic duration in CAP can be considered.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

et al. 2013

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BACKGROUND:Although prior randomized trials have demonstrated that procalcitonin-guided antibiotic therapy effectively reduces antibiotic use in patients with community-acquired pneumonia (CAP), uncertainties remain regarding use of procalcitonin protocols in practice. OBJECTIVE: To estimate the cost-effectiveness of procalcitonin protocols in CAP. DESIGN: Decision analysis using published observational and clinical trial data, with variation of all parameter values in sensitivity analyses. PATIENTS: Hypothetical patient cohorts who were hospitalized for CAP. INTERVENTIONS: Procalcitonin protocols vs. usual care. MAIN MEASURES: Costs and cost per quality adjusted life year gained. KEY RESULTS: When no differences in clinical outcomes were assumed, consistent with clinical trials and observational data, procalcitonin protocols cost $10-$54 more per patient than usual care in CAP patients. Under these assumptions, results were most sensitive to variations in: antibiotic cost, the likelihood that antibiotic therapy was initiated less frequently or over shorter durations, and the likelihood that physicians were nonadherent to procalcitonin protocols. Probabilistic sensitivity analyses, incorporating procalcitonin protocol-related changes in quality of life, found that protocol use was unlikely to be economically reasonable if physician protocol nonadherence was high, as observational study data suggest. However, procalcitonin protocols were favored if they decreased hospital length of stay. CONCLUSIONS: Procalcitonin protocol use in hospitalized CAP patients, although promising, lacks physician nonadherence and resource use data in routine care settings, which are needed to evaluate its potential role in patient care.

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

et al. 2013

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“…One study, based in two community hospitals and one academic medical center, randomized patients to usual care versus an early ambulation program in a group of patients hospitalized with community-acquired pneumonia. The early ambulation group was discharged from the hospital 1.2 days sooner, on average, than those in the usual care group and had no increase in adverse effects or rehospitalizations [19]. The feasibility of a walking program was also demonstrated in a small pilot study done in a communitybased hospital, which used specially trained transporters to walk ward patients during slow periods, which included nights and weekends.…”

Section: Qualitative Response Number Of Patientsmentioning

confidence: 94%

Exercise program implementation proves not feasible during acute care hospitalization

Brown¹,

Peel²,

Bamman³

et al. 2006

JRRD

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Abstract-Functional decline during hospitalization occurs in up to 65% of older adults. This study determined the feasibility of an inpatient followed by an in-home exercise program for patients with limited ambulatory ability on hospital admission. Patients aged ≥ 60 years who were admitted to the hospital with an acute medical illness associated with limited ambulatory ability were eligible for the study. Of 76 eligible patients, 10 were recruited, with only 1 patient completing the 24-week exercise program. Barriers to recruitment included illness severity, short hospital stays, and patient refusal. Hospital readmission during the in-home exercise program occurred for three of the seven exercise group participants. In the exercise group, four of the seven patients participated in at least 3 weeks of exercise posthospitalization. Qualitative interviews suggested most patients believed exercise to be beneficial, but this interest did not translate into adherence to this study protocol. Initiation of an inpatient exercise program was not feasible in the study population. The in-home program was more feasible but target criteria need refinement.

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“…La movilización (traslado de la cama a una silla durante 20 minutos luego de las primeras 24 horas de hospitalización y con incrementos progresivos en los días subsiguientes), ha demostrado reducción de la estancia hospitalaria sin incrementar el riesgo de resultados adversos (Nivel de evidencia II -Grado de recomendación A) (22).…”

Section: ¿Qué Medidas Son Fundamentales En El Tratamiento?unclassified

Diez respuestas puntuales sobre neumonía adquirida en la comunidad en adultos

Pereira

2018

carta comunitaria

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¿En qué consiste la NAC?La neumonía es una inflamación del parénquima pulmonar desencadenada por diversas especies bacterianas, virus, hongos y parásitos, que se manifiesta por fiebre, tos, estertores y opacidades en la radiografía de tórax. En nuestro país constituye la sexta causa de muerte y la primera por infección.Para catalogarla como "adquirida en la comunidad" (NAC), debe ocurrir en pacientes no hospitalizados o en aquellos hospitalizados que desarrollan manifestaciones dentro de las primeras 48 horas del ingreso (Guías de Neumonía de la Asociación Colombiana de Neumología y Cirugía de Tórax -ACNCT). § § § Médico Neumólogo -jose.bustillo@juanncorpas.edu.co. La lección de Medicina…

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Early Mobilization of Patients Hospitalized With Community-Acquired Pneumonia

Cited by 187 publications

References 20 publications

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

Exercise program implementation proves not feasible during acute care hospitalization

Diez respuestas puntuales sobre neumonía adquirida en la comunidad en adultos

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