1. 

Kleckner M 3rd. Blending hospital economics with quality of care: a case study. Healthc Financ Manage. 2004 Dec;58(12):64-8, 70.

La Costa Group, LLC, Carlsbad, Calif., USA. martin@lacostagroup.com

Many hospitals have attained substantial gains in cost control. Unfortunately, the impact of cost initiatives on quality of care and clinical outcomes is not clear. However, by looking at the patient management costs incurred relative to clinical outcomes as the patient progresses through diagnosis and treatment, healthcare organizations can evaluate a technology's economic value.

2. 

Hui DS, Wong KT, Antonio GE, Lee N, Wu A, Wong V, Lau W, Wu JC, Tam LS, Yu LM, Joynt GM, Chung SS, Ahuja AT, Sung JJ. Severe acute respiratory syndrome: correlation between clinical outcome and radiologic features. Radiology. 2004 Nov;233(2):579-85.

Department of Diagnostic Radiology and Organ Imaging, The Chinese Univ of Hong Kong, Prince of Wales Hosp, 30-32 Ngan Shing St, Shatin, Hong Kong SAR.

PURPOSE: To evaluate whether there is a correlation between the clinical outcomes and radiologic features of severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: The clinical, laboratory, and radiologic features of 138 patients with SARS were analyzed. Three radiologists in consensus retrospectively assessed the frontal chest radiographs obtained at presentation and during treatment (n = 2045) for the distribution (each lung was divided into upper, middle, and lower zones) and extent of lung parenchymal abnormality. Clinical end points included intensive care unit (ICU) admission and death. RESULTS: Thirty-six (26.1%) patients required ICU care, and eight (5.8%) died. The patients who required ICU care and/or died had more extensive consolidation on chest radiographs obtained initially (median percentage of consolidation, 3.30%, with interquartile range [IR] of 1.70%-8.78% vs 1.70% [IR, 0%-3.30%]; P < .001) and on day 7 after fever onset (median percentage of consolidation, 15.00% [IR, 6.48%-28.73%] vs 5.00% [IR, 2.50%-7.50%]; P < .001) than did surviving patients who did not require ICU care. Patients with involvement of more than one lung zone on initial and day 7 chest radiographs were more likely to require ICU care and/or die than were those with involvement of one or fewer zones (P < .001). Patients with bilateral pneumonic changes at presentation were more likely to have an adverse outcome than were those with unilateral pneumonia (P < .001). Involvement of more than one lung zone at baseline chest radiography was an independent predictor of ICU admission and/or death (odds ratio, 3.16; 95% confidence interval: 1.07, 9.32; P = .037) after adjustments for other significant factors (ie, patient age, and baseline neutrophil count and lactate dehydrogenase level). CONCLUSION: More extensive airspace disease at presentation is an independent predictor of adverse outcome in patients with SARS.

3. 

Bissinger R, Carlson C, Hulsey T, Eicher D. Secondary surfactant deficiency in neonates. J Perinatol. 2004 Oct;24(10):663-6.

College of Nursing, Medical University of South Carolina, SC 29445, USA.

Surfactant treatment has become the standard of care in premature infants with respiratory distress syndrome (RDS). Pulmonary hemorrhage, pulmonary edema, pneumonia, and atelectasis have been shown to liberate inflammatory mediators and plasma proteins, which damage type II pneumocytes and inactivate surfactant. These disease processes may, therefore, lead to a secondary surfactant inactivation or deficiency, which can be an unrecognized cause of respiratory decompensation after initial recovery from RDS in this vulnerable population. This is a descriptive report of three cases, which had acute respiratory decompensation between 1 and 3 weeks of age. All three infants demonstrated a response to secondary doses of surfactant. We submit that the diagnosis and treatment of secondary surfactant deficiency in the critically ill premature neonate warrants further study.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

11702.     Alvarez-Lerma F, Torres A. Severe community-acquired pneumonia. Curr Opin Crit Care. 2004 Oct;10(5):369-74. Review.

11703.    Astudillo L, Martin-Blondel G, Sans N, Dhaste G, Couret B, Arlet-Suau E. Solitary nodular form of bronchiolitis obliterans organizing pneumonia. Am J Med. 2004 Dec 1;117(11):887-8.

11704.      Bach JR. Don't forget the abdominal thrust.Chest. 2004 Oct;126(4):1388-9;

11705.      Bandi VD, Munnur U, Matthay MA. Acute lung injury and acute respiratory distress syndrome in pregnancy. Crit Care Clin. 2004 Oct;20(4):577-607. Review.

11706.        Bissinger R, Carlson C, Hulsey T, Eicher D. Secondary surfactant deficiency in neonates. J Perinatol. 2004 Oct;24(10):663-6.

11707.        Carver RT, Boysel LC, Marciniak CM, Nussbaum SB. Myotonic dystrophy presenting as new-onset hand weakness and recurrent pneumonia in a patient with paraplegia: a case report. Arch Phys Med Rehabil. 2004 Nov;85(11):1896-8.

11708.        Cetinkaya F, Gogremis A, Kutluk G. Comparison of two antibiotic regimens in the empirical treatment of severe childhood pneumonia. Indian J Pediatr. 2004 Nov;71(11):969-72.

11709.        Charles PG, Ananda-Rajah M, Johnson PD, Grayson ML. Are the Australian guidelines asking too much of the Pneumonia Severity Index (PSI)? Med J Aust. 2004 Nov 1;181(9):515;

11710.        Chen HL, Chiou SS, Hsiao HP, Ke GM, Lin YC, Lin KH, Jong YJ. Respiratory adenoviral infections in children: a study of hospitalized cases in southern Taiwan in 2001--2002. J Trop Pediatr. 2004 Oct;50(5):279-84.

11711.        Crowe JE Jr. Human metapneumovirus as a major cause of human respiratory tract disease. Pediatr Infect Dis J. 2004 Nov;23(11 Suppl):S215-21. Review.

11712.        Davies G, Wells AU, du Bois RM. Respiratory bronchiolitis associated with interstitial lung disease and desquamative interstitial pneumonia. Clin Chest Med. 2004 Dec;25(4):717-26, vi. Review.

11713.        Demetriades D, Constantinou C, Salim A, Velmahos G, Rhee P, Chan L. Liver cirrhosis in patients undergoing laparotomy for trauma: effect on outcomes. J Am Coll Surg. 2004 Oct;199(4):538-42.

11714.        Flaherty KR, Martinez FJ. Cigarette smoking in interstitial lung disease: concepts for the internist. Med Clin North Am. 2004 Nov;88(6):1643-53, xiii. Review.

11715.        Gea-Banacloche JC, Opal SM, Jorgensen J, Carcillo JA, Sepkowitz KA, Cordonnier C.  Sepsis associated with immunosuppressive medications: an evidence-based review. Crit Care Med. 2004 Nov;32(11 Suppl):S578-90. Review.

11716.        Gesell SB, Wolosin RJ. Inpatients' ratings of care in 5 common clinical conditions. Qual Manag Health Care. 2004 Oct-Dec;13(4):222-7.

11717.        Hui DS, Wong KT, Antonio GE, Lee N, Wu A, Wong V, Lau W, Wu JC, Tam LS, Yu LM, Joynt GM, Chung SS, Ahuja AT, Sung JJ. Severe acute respiratory syndrome: correlation between clinical outcome and radiologic features. Radiology. 2004 Nov;233(2):579-85.

11718.        Kaira K, Takise A, Goto T, Horie T, Mori M. Barium sulphate aspiration. Lancet. 2004 Dec 18;364(9452):2220.

11719.        Kleckner M 3rd. Blending hospital economics with quality of care: a case study. Healthc Financ Manage. 2004 Dec;58(12):64-8, 70.

11720.        Lim WS. Identifying failure of empirical treatment for pneumonia: vigilance and common sense. Thorax. 2004 Nov;59(11):918-9.

11721.        Marrie TJ, Beecroft MD, Herman-Gnjidic Z. Resolution of symptoms in patients with community-acquired pneumonia treated on an ambulatory basis. J Infect. 2004 Nov;49(4):302-9.

11722.        Narita M, Tanaka H. Two distinct patterns of pleural effusions caused by Mycoplasma pneumoniae infection. Pediatr Infect Dis J. 2004 Nov;23(11):1069;

11723.        Poon LL, Guan Y, Nicholls JM, Yuen KY, Peiris JS. The aetiology, origins, and diagnosis of severe acute respiratory syndrome. Lancet Infect Dis. 2004 Nov;4(11):663-71. Review.

11724.        van Saene HK, Ashworth M, Petros AJ, Sanchez M, de la Cal MA. Do not suction above the cuff. Crit Care Med. 2004 Oct;32(10):2160-2.

11725.        Williamson JP, Illing R, Gertler P, Braude S. Near-drowning treated with therapeutic hypothermia. Med J Aust. 2004 Nov 1;181(9):500-1.

11726.        Yiannakoulias N, Russell ML, Svenson LW, Schopflocher DP. Doctors, patients and influenza-like illness: clinicians or patients at risk? Public Health. 2004 Oct;118(7):527-31.

11727.     Reinert RR. Pneumococcal conjugate vaccines--a European perspective. Int J Med Microbiol. 2004 Oct;294(5):277-94. Review.

11728.     Remick DG. Do not get sick when you are sick: the impact of comorbid conditions. Crit Care Med. 2004 Oct;32(10):2147-8.

11729.     Fletcher MA, Fabre P, Debois H, Saliou P. Vaccines administered simultaneously: directions for new combination vaccines based on an historical review of the literature. Int J Infect Dis. 2004 Nov;8(6):328-38.

Therapy:

11730.     Barthwal MS, Deoskar RB, Rajan KE, Chatterjee RS. Intrapleural streptokinase in complicated parapneumonic effusions and empyema. Indian J Chest Dis Allied Sci. 2004 Oct-Dec;46(4):257-61.

11731.     Mouw DR, Langlois JP, Turner LF, Neher JO. Clinical inquiries. Are antibiotics effective in preventing pneumonia for nursing home patients? J Fam Pract. 2004 Dec;53(12):994-6. Review.

11732.    Peterson MW, Hornick DB. Community-acquired pneumonia guidelines: Peering back through the looking glass...clearly? Am J Med. 2004 Nov 15;117(10):799-800.