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At least 703 records · Page 39Linked to original sources
PubMed2002

Community-acquired Chlamydia pneumoniae pneumonia in Japan: a prospective multicenter community-acquired pneumonia study.

OBJECTIVE: To investigate the clinical features of Chlamydia pneumoniae pneumonia in Japan and to evaluate the newly created Japanese community-acquired pneumonia (CAP) guidelines. PATIENTS AND METHODS: A multicenter CAP surveillance study was carried out in 20 hospitals between December 1999 and March 2000. The diagnosis of C. pneumoniae infection was based on isolation in cell culture, the polymerase chain reaction and serologic testing of antibodies by the microimmunofluorescence test. RESULTS: Among 232 CAP cases, C. pneumoniae was identified as the etiologic agent in 15 cases (6.5%). C. pneumoniae was the only pathogen identified in nine of these cases, while one or more additional etiological agents were found in the other six cases. Of the present and previously reported single agent C. pneumoniae pneumonia cases, about 50% were more than 60 years old and had underlying diseases. A relatively slow pulse rate in relation to fever was not seen in these patients. The mean WBC count of all patients was normal. No patient required respiratory support or admission to an intensive care unit and no deaths occurred among these patients. CONCLUSION: The clinical pictures of C. pneumoniae pneumonia as a single agent were mild to moderate and were remarkably different from those of cases of C. pneumoniae pneumonia concomitant with other bacteria. If the patient is less than 60 years old and some guideline headings are excluded, we think it would be possible to distinguish between C. pneumoniae and bacterial pneumonia.

Adolescent↗
PubMedDate not supplied

Individual and community: normative conflicts in the development of a new therapeutic community for older persons.

This paper examines the role of ideology in the establishment of a new therapeutic community for geriatric patients in a state mental hospital. Contradictory role expectations, reflected both in staff-staff and in staff-patient relationship, interfered with the program's achieving its stated goals. In order to apply a humanistic approach to programs for elderly patients, realistic goals-encompassing the range of patient competence-must be set within a reasonable time framework, and the program must provide for an appropriate range of structure.

Aged↗
PubMed1995

Severe community-acquired pneumococcal pneumonia. The French Study Group of Community-Acquired Pneumonia in ICU.

Streptococcus pneumoniae is the most frequent pathogen of severe community-acquired pneumonia (CAP) necessitating hospitalization. The main objective of this multicentre prospective study was to determine the value of clinical, biological, and radiological features for predicting pneumococcal etiology and to define prognostic factors. Streptococcus pneumoniae was isolated in 43/132 patients (33%) with CAP requiring ICU treatment. The mean age of the patients with pneumococcal pneumonia was 55 +/- 17 (SD) yrs and 34 were male. On admission, 14 patients with pneumococcal pneumonia were in shock, 24 were mentally confused, and 27 required mechanical ventilation during their hospitalization. Among the clinical, biological, and radiological features, fever > 39 degrees C, pleuritic chest pain, lobar distribution or alveolar consolidation, and an increase in immature granulocytes > or = 5% of WBC were more frequent in pneumococcal pneumonia than in other etiologies. Mortality was 35%. Fatal outcome was significantly related to the presence of impaired alertness, septic shock, mechanical ventilation, acute renal failure, and bacteremic pneumonia.

Adult↗
PubMed1999

[Diagnosis and ambulatory treatment of patients with community-acquired pneumonia: variability of complementary tests and study of the effectiveness of roxithromycin. Study Group on Ambulatory Treatment of Community-Acquired Pneumonia (NACTA)].

BACKGROUND: Community-acquired pneumonia (CAP) has been the subject of a number of studies. Nevertheless, studies focused on effectiveness of therapy and variability of diagnostic tests are scarce. PATIENTS AND METHODS: Observational study of the diagnostic methodology used in patients attending hospital Emergency Departments for possible CAP and assessment of effectiveness and reliability of empiric ambulatory therapy with roxithromycin (150 mg/12 h, for a minimum of ten days). The only mandated complementary tests included PA and lateral chest X-ray views and blood count. Microbiological tests were left to the discretion of the attending physician. Clinical and biological follow-up of the patient consisted of three outpatient visits. RESULTS: The study was conducted at 18 spanish hospitals from October 1997 to March 1998. The final total of patients with CAP enrolled was 161 (75 women and 86 men). Three patients required hospital admission. In a 3% of patients the Gram staining of the sputum specimen was performed; in 53% of patients blood cultures were obtained (3.4% were positive) and in 23% of patients serological determinations are performed (16.7% were positive). The final microbiological results led to the disclosure of the etiologic agent of CAP in 5.5% of patients. In only one patient did the results prompt a change in antibiotic therapy. The clinical course was favorable in 92.5% of patients. In 12 patients (7.5%) a change of antibiotic was made or a second antibiotic was added. The mean therapy duration with roxithromycin was 11.9 days (range: 7-22 days). In five patients (3.1%), the observed adverse events were attributed to roxithromycin, and in no case was discontinuation of therapy necessary. CONCLUSIONS: The variability of diagnostic tests used in patients with CAP is remarkable but their yield is of little effect. Patients with CAP candidates for ambulatory therapy can receive empiric antibiotic therapy with roxithromycin. In this series, roxithromycin had a high clinical effectiveness and was well tolerated.

Adolescent↗
PubMed2000

Community intervention to screen risk of cardiovascular diseases in a rural Texas community.

This study describes the effectiveness of cardiovascular risk screening for elderly patients of a primary care practice in a rural community. A controlled trial sample of 44 eligible patients was screened in a primary care practice setting in August 1998. All patients completed health risk questionnaires; 93% of the 44 had laboratory work and a complete physical examination. Cost comparisons were made between the cost of the health screening and the cost of hospitalization for cardiovascular disease in Fort Worth, Tex. Within the sample population, the mean age was 67.9 years (+/- 8.1). A high prevalence of obesity among females (53%), hypertension (58.5%), lipid disorders (63.4%), and elevated glucose levels (19.5%) was found. Preventive health screenings and programs can be cost-effective in identifying and managing major disease (cardiovascular diseases, lipid disorders, and diabetes) and in preventing potential costly hospitalizations.

Age Distribution↗
PubMed2003

[Community acquired pneumonia in a hospitalized community: etiological study].

BACKGROUND: Community-acquired pneumonia (CAP) that requires hospitalization, is a common and serious disease. A permanent assessment in specialized centers, to define therapeutic guidelines according to local epidemiological factors, is mandatory. AIM: To study the etiology of CAP requiring hospital admission. PATIENTS AND METHODS: Adult patients with CAP, admitted to the Clinical Hospital of the University of Chile between 1999 and 2001 were studied. A clinical, radiological and microbiological assessment was done in all patients. Blood and sputum cultures and serology for Chlamydia and Mycoplasma pneumoniae were performed. RESULTS: Thirty one patients aged 62 +/- 18 years, 12 female, met inclusion criteria. An etiologic diagnosis was made in 74% of cases, (52% definitive, 22% probable). Frequency of definitive diagnosis was: 25% Mycoplasma pneumoniae, 19% Chlamydia pneumoniae and 13% Streptococcus pneumoniae. Mixed etiology was found in 16% and a final diagnosis was not obtained in 26% of the cases. No correlation was found between clinical and radiological patterns, and the etiologic agent. C reactive protein and erythrosedimentation rate were significantly higher in CAP due to Chlamydia and Streptococcus pneumoniae. CONCLUSIONS: The higher frequency of Mycoplasma and Chlamydia pneumoniae, than previously reported, suggests that atypical agents should be considered in the initial antimicrobial therapy prescribed to these patients.

Adult↗
PubMed2005

An analysis of a community-acquired pathogen in a Kentucky community: methicillin-resistant Staphylococcus aureus.

CONTEXT: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have been reported in patients with recognized predisposing risk factors in several cities in the United States and across the world. Reviewing risk factors in adult patients with CA-MRSA in Kentucky has not been reported. OBJECTIVE: To determine the risk factors of 15 patients with CA-MRSA in Louisville KY, to compare the sensitivities of each pathogen and to recommend management. SETTING: An infectious diseases private practice in Louisville, KY. MATERIALS AND METHODS: This is a case series of patients with CA-MRSA. The disease course for each patient was reviewed for risk factors, such as participation in physical contact sports and prison exposure. The antimicrobial sensitivities of each pathogen were also reviewed. Recommendations were produced from the information obtained. RESULTS: A total of 15 patients were reviewed. Five patients had a family member or significant-other with a current CA-MRSA infection. Three had traditional risk factors (healthcare workers). All of the isolates were susceptible to vancomycin and resistant to oxacillin. All of the isolates tested for trimethoprim/sulfamethoxazole (TMP/SMX), tetracycline, and rifampin were sensitive. A majority (83%) of those tested for clindamycin and only 50% of those tested for levofloxacin were sensitive. All isolates tested for cefazolin were resistant. CONCLUSIONS: An emerging risk factor for acquiring an MRSA skin and soft tissue infection is having a significant-other with a current diagnosis of CA-MRSA. After incision and drainage, a review of the antimicrobial sensitivities indicates that oral treatment may be adequate for a selection of cases.

Adult↗
PubMed1988

Victoria Cottage Hospital--from the community, for the community.

Victoria Hospital, Wynberg, will have been in use for 100 years on 25 June 1988, serving the community of the southern suburbs of Cape Town as a general specialist hospital. When it opened its doors for the first time it consisted of two six-bed wards and one two-bed ward, the latter for paying patients.

History, 19th Century↗
PubMed1986

Symposium on surgical manpower in the smaller community. Training and continuing medical education requirements for practice in the small community.

The author considers the training requirements of a general surgeon who will be the only surgical specialist in a small community. Apart from the usual heavy gastrointestinal content, the surgeon's training should include 1 year of fracture and trauma training, the care of head injuries and urologic injuries, and, the management of abdominal gynecologic problems and the technique of cesarean section. Attendance at smaller regional surgical meetings, participation in the Surgical Education and Self-assessment Program (SESAP) of the American College of Surgeons and other continuing education programs are also essential in maintaining standards.

Canada↗
PubMed1987

A large-scale autologous blood program in a community hospital. A contribution to the community's blood supply.

In an attempt to eliminate the hazards of homologous blood transfusions during major orthopedic surgical procedures, 1672 patients donated 6615 units of autologous blood in a ten-year period. Most of the blood components were stored frozen. The autologous units were later used in 1938 surgical procedures. Intraoperative blood salvage yielded 125,105 mL of blood with an average hematocrit of 80% (0.80), which was reinfused into 934 patients. Autologous blood components accounted for 95% of the transfusion requirements. Thus, the risks of homologous transfusions were avoided in the vast majority of the procedures. Ninety-one percent of the donors were older than 50 years of age and 8.4% were between 80 and 91 years of age. The large-scale use of autologous blood has been feasible, practical, and cost efficient, has contributed to the community's blood supply, and provides the patient with the safest blood available--his own blood.

Adolescent↗
PubMedDate not supplied

Community-acquired lower respiratory tract infection in the elderly: a community-based study of incidence and outcome.

BACKGROUND: We studied the incidence, characteristics, and survival of elderly patients from a defined community who had pneumonia or bronchitis (lower respiratory tract infection). METHODS: This study was a population-based retrospective cohort study of residents of Rochester, Minnesota, aged 65 years or older with a first episode of pneumonia or bronchitis during the calendar year 1987. RESULTS: Overall age- and sex-adjusted incidence rates for an initial episode in a calendar year were 5452 per 100,000: 2420 per 100,000 (95 percent confidence interval, 2056 to 2783 per 100,000) for bronchitis and 3032 per 100,000 (95 percent confidence interval, 2639 to 3425 per 100,000) for pneumonia. After exclusion of eight cases diagnosed at autopsy, the overall 30-day mortality was 10.7 percent. Patients with pneumonia had lower survival than expected for the Minnesota white population (log-rank statistic = 117.38, P < 0.0001). The observed survival of patients with bronchitis was also significantly less than expected (log-rank statistic = 6.25, P = 0.012). CONCLUSION: Lower respiratory tract infections are common in the elderly. Most patients in this study were not hospitalized, and atypical presentations were not observed. Early mortality (30 days) was high. Among elderly patients with either pneumonia or bronchitis, the survival was lower than expected. This study confirmed the need for population-based studies, because more than two-thirds of patients would have been missed if only hospitalized patients were included.

Aged↗
PubMedDate not supplied

Community demonstration project initiative: technical support for program development at the community level.

Select population groups are at greater than average risk for cancer incidence and mortality. Lack of experience reaching high-risk populations, particularly those characterized by high proportions of the socioeconomically disadvantaged, presented a challenge to the American Cancer Society (ACS). A partial solution was to integrate outreach to high-risk populations into ACS national priorities and to fund community demonstration projects consistent with these priorities. Technical assistance (TA), which includes expert advice and problem solving, was provided during the first phase to facilitate the development of these projects into "model" projects to learn what initiatives can best be disseminated, or diffused, into target populations. TA also was used to assess how it can enhance the potential for replication. Evaluation of this initiative resulted in a plan to disseminate model projects to selected ACS divisions with varied resources and capabilities (e.g., outreach to high-risk populations, planning, program development, and evaluation) for replication. During the next phase, projects will be evaluated to document the role of TA in facilitating local empowerment and nationwide diffusion of effective cancer prevention and control programs.

Community Health Services↗
PubMed1997

Depression in dementia: a study of mood in a community sample and referrals to a community service.

The association between degree of cognitive impairment and severity of depressive symptoms was examined in a randomly selected community-based sample of elderly people and in a sample of patients referred to an old age psychiatry service. Findings contradict previous reports of less cognitive impairment in demented patients with depressive symptoms. We suggest that sample selection bias has contributed to the earlier reports.

Affect↗
PubMed1997

[Community-acquired pneumonia in adults. Clinical practice guideline for Argentina. Study Group on Community Acquired Pneumonia].

Community-acquired pneumonia (CAP) affects approximately 1% of the population annually. Initial antimicrobial therapy is most often empirical. Guidelines designed in other countries for the empirical management of CAP are not recommended for use in Argentina. Studies from other countries were considered together with unpublished local data to define the potential etiologic microorganisms and their antimicrobial susceptibility. Recommended diagnostic tests, groups of patients for different therapies and hospitalization criteria were defined. Severe CAP requiring intensive care was distinguished from the rest because of its distinct spectrum of etiologic agents and its high mortality, requiring a more focused therapy. Age, coexisting conditions and severity of illness were taken into account in the election of therapy.

Argentina↗
PubMed2004

Cancer patients' expectations of experiencing treatment-related side effects: a University of Rochester Cancer Center--Community Clinical Oncology Program study of 938 patients from community practices.

BACKGROUND: Adequate management of treatment-related side effects is important for patients and challenging for clinicians. Side effects generated by various treatments have been characterized reasonably well. However, to the authors' knowledge, less is known regarding what patients expect to experience regarding these side effects and how patient characteristics are related to these expectations. METHODS: Patients with cancer (n = 1015 patients) from 17 Community Clinical Oncology Program (CCOP) institutions affiliated with the University of Rochester Cancer Center CCOP Research Base were surveyed regarding their expectations of experiencing side effects associated with cancer treatment, with 938 patients providing evaluable data. Patients responded to the item, "Indicate your expectations of having this side effect" for 12 common side effects. Patients rated their expectations using a 5-point Likert scale, from 1 ("I definitely will not have this") to 5 ("I definitely will have this"). RESULTS: The median number of symptoms expected (characterized by any value other than one) was nine. The six most expected symptoms were fatigue, nausea, sleep disturbance, weight loss, hair loss, and skin problems. Patients age > 60 years expected to have fewer symptoms than younger patients; female patients expected more side effects than male patients; and patients who had some college education expected more side effects than patients who were high school graduates or had not completed high school. CONCLUSIONS: Patients with cancer clearly exhibit expectations regarding treatment-related side effects; and age, gender, and education level appear to influence these expectations. Further careful characterization of patient expectations and how expectations relate to experience may lead to earlier and more effective management of side effects.

Adult↗
PubMed1976

Physical performance capacity of children in Norway. Part IV. The rate of growth in maximal aerobic power and the influence of improved physical education of children in a rural community - population parameters in a rural community.

During a period of 4 years the annual increase of the physical performance of 31 boys and 34 girls was examined in a longitudinal study. In spite of the expected mean increase of the physical performance unsystematic annual variations of the increase of the maximal oxygen uptake related to body weight were observed. These variations can only be explained by the variations of the daily physical activity. The fact that in the longitudinal study a clear better performance over the years was observed than in a cross sectional study which was performed in the first year of the longitudinal study confirms this tendency. This can partly be explained by the improvement of the possibilities for physical activities in the community since the begin of the longitudinal study.

Adipose Tissue↗