Showing 1 – 20 of 4270
Relevance | Newest | Oldest |
  • Does This Child Have Pneumonia? The Rational Clinical Examination Systematic Review

    Abstract Full Text
    is active quiz has multimedia
    JAMA. 2017; 318(5):462-471. doi: 10.1001/jama.2017.9039

    This systematic review analyzes 23 cohort studies to assess the accuracy of individual symptoms and physical examination findings for the diagnosis of radiographic pneumonia in children.

  • Childhood Pneumonia

    Abstract Full Text
    free access
    JAMA. 2017; 318(5):490-490. doi: 10.1001/jama.2017.9428
  • JAMA July 18, 2017

    Figure 1: Trends in Hospital 30-Day Risk-Adjusted Readmission Rates and Hospital 30-Day Risk-Adjusted Mortality Rates After Discharge for Heart Failure, Acute Myocardial Infarction, and Pneumonia, 2008 Through 2014

    Linear trends in mean monthly 30-day risk-adjusted readmission rates and 30-day risk-adjusted mortality rates after discharge from hospitalization for heart failure (A), acute myocardial infarction (B), and pneumonia (C) are shown for 3 periods: January 2008 through March 2010, April 2010 through September 2012, and October 2012 through December 2014. The vertical dotted lines denote April 1, 2010, and October 1, 2012, to be proximate to dates of passage of the Affordable Care Act and implementation of the Hospital Readmissions Reduction Program, respectively. Trend lines were fitted based on predictions of truncated time series models for the 3 periods above. Risk adjustment was made for patient age, sex, comorbidities, season, and hospital length of stay.
  • JAMA July 18, 2017

    Figure 2: Correlation of Paired Monthly Trends in Hospital 30-Day Risk-Adjusted Readmission Rates and Hospital 30-Day Risk-Adjusted Mortality Rates After Discharge for Heart Failure, Acute Myocardial Infarction, and Pneumonia, 2008 Through 2014

    Correlations of paired monthly trends in hospital 30-day risk-adjusted readmission rates and hospital 30-day risk-adjusted mortality rates after discharge from hospitalization for heart failure (4221 hospitals) (A), acute myocardial infarction (2469 hospitals) (B), and pneumonia (4483 hospitals) (C) from 2008 through 2014 are shown. Risk adjustment was made for patient age, sex, comorbidities, season, and hospital length of stay.
  • Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge

    Abstract Full Text
    is active quiz
    JAMA. 2017; 318(3):270-278. doi: 10.1001/jama.2017.8444

    This cohort study examines whether reductions in hospital readmission rates following hospitalizations for heart failure, acute myocardial infarction, and pneumonia are associated with mortality rates after hospital discharge among Medicare fee-for-service beneficiaries.

  • JAMA April 11, 2017

    Figure 2: Severity of Postoperative Pulmonary Complications

    Each postoperative pulmonary complication, the worst each patient experienced throughout his/her hospital stay, was graded from 0 to 5. Grade 0 represents no symptoms or signals; grade 1, one of the following: dry cough, abnormal lung findings and temperature 37.5°C or higher with normal chest radiograph, or dyspnea without other documented cause; grade 2, two of the following: productive cough, bronchospasm, hypoxemia (Spo2 ≤ 90%) at room air, atelectasis with gross radiological confirmation (concordance of 2 independent experts) plus either temperature higher than 37.5°C, or abnormal lung findings, hypercarbia (Paco2>50 mm Hg) requiring treatment; grade 3, one of the following: pleural effusion resulting in thoracentesis, pneumonia, pneumothorax, extended noninvasive ventilation, or reintubation lasting less than 48 hours; grade 4, reintubation or invasive mechanical ventilation for 48 hours or more; and grade 5, death before hospital discharge.
  • JAMA January 17, 2017

    Figure 4: Odds Ratios for In-Hospital Mortality and for In-Hospital Mortality or ICU Length of Stay ≥3 Days (Log Scale) Comparing Encounters With ≥2 Criteria vs <2 Criterion on qSOFA, SIRS Criteria, and SOFA for Each Decile of Baseline Risk in ICU Patients With Suspected Infection (N = 184 875)

    ICU indicates intensive care unit; qSOFA, quick Sequential [Sepsis-related] Organ Function Assessment; SIRS, systemic inflammatory response syndrome; SOFA, Sequential [Sepsis-related] Organ Function Assessment. Data referenced against the model of baseline risk of in-hospital mortality (Panel A) and baseline risk of in-hospital mortality or ICU length of stay ≥3 days (Panel B) determined for the cohort, based on variables independent of the scoring systems (data available in eTables 1-2 in the Supplement). Number of patients included in the analysis: SOFA, 183 331); qSOFA, 183 078); SIRS, 182 974). Error bars indicate the 99% CIs. Panel A, Interpretive example: the x-axis divides the cohort into deciles of baseline mortality risk, determined by all available information at the time of ICU admission including factors relating to the ICU (size, type, location, and admission source), admission time (month, day, and hour) and patient (age, sex, comorbidities, pregnancy, diabetes, indigenous status, and treatment limitations). For a middle-aged woman with no comorbidities (decile 5) admitted to the ICU with pneumonia, her chance of dying in the hospital is 4.55 (99% CI, 3.24-6.38) times greater if she has 2 or more SOFA points compared with less than 2 SOFA points. Alternatively, her risk of dying in-hospital increases 2.53 (99% CI, 2.04-3.15) times if she has 2 or more SIRS criteria compared with less than 2 SIRS criteria, and 2.10 (99% CI, 1.87-2.37) times if she has 2 or more qSOFA points compared with less than 2 qSOFA points. Panel B, Interpretive example: the x-axis divides the cohort into deciles of baseline risk of in-hospital mortality or ICU length of stay ≥3 days, determined by all available information at the time of ICU admission including factors relating to the ICU (size, type, location, and admission source), admission time (month, day, and hour) and patient (age, sex, comorbidities, pregnancy, diabetes, indigenous status, and treatment limitations). For a middle-aged woman with no comorbidities (decile 5) admitted to the ICU with pneumonia, her chance of dying in the hospital is 4.53 (99% CI, 3.88-5.28) times greater if she has 2 or more SOFA points compared with less than 2 SOFA points. Alternatively, her risk of dying in-hospital increases 2.51 (99% CI, 2.24-2.83) times if she has 2 or more SIRS criteria compared with less than 2 SIRS criteria, and 1.90 (99% CI, 1.76-2.05) times if she has 2 or more qSOFA points compared with less than 2 qSOFA points.
  • Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions

    Abstract Full Text
    free access
    JAMA. 2016; 316(24):2647-2656. doi: 10.1001/jama.2016.18533

    This cohort study of Medicare fee-for-service beneficiaries compares trends in readmission rates for target and nontarget conditions among hospitals penalized vs not penalized under the Hospital Readmission Reduction Program.

  • You’ve Got Mail

    Abstract Full Text
    JAMA. 2016; 315(21):2275-2276. doi: 10.1001/jama.2016.1757
  • JAMA February 23, 2016

    Figure 4: Fold Change in Rate of In-Hospital Mortality (Log Scale) Comparing Encounters With ≥2 vs <2 Criteria for Each Decile of Baseline Risk in the UPMC Validation Cohort (N = 74 454)

    ICU indicates intensive care unit; LODS, Logistic Organ Dysfunction System; qSOFA, quick Sequential [Sepsis-related] Organ Function Assessment; SIRS, systemic inflammatory response syndrome; SOFA, Sequential [Sepsis-related] Organ Function Assessment. Panel A shows ICU encounters comparing fold change for SIRS, SOFA, LODS, and qSOFA. Panel B shows non-ICU encounters. Medians and ranges of baseline risk of in-hospital mortality within decile shown are below the x-axis.Interpretive example: The x-axis divides the cohort into deciles of baseline risk, determined by age, sex, comorbidities, and race/ethnicity. For a young woman with no comorbidities (panel A, decile 2) admitted to the ICU with pneumonia, her chance of dying in the hospital is 10-fold greater if she has 3 SOFA points compared with 1 SOFA point. On the other hand, she has only a small increase in the chance of dying if she has 3 SIRS criteria compared with 1 SIRS criterion. For an older woman with chronic obstructive pulmonary disease admitted to the ward with pneumonia (panel B, decile 6), her chance of dying in the hospital is 7-fold higher if she has 3 qSOFA points compared with 1 qSOFA point. On the other hand, she has only a 3-fold increase in odds of dying if she has 3 SIRS criteria compared with 1 SIRS criterion.
  • JAMA February 23, 2016

    Figure 4: Serum Lactate Level Analysis

    Adjusted odds ratio for actual serum lactate levels for the entire septic shock cohort (N = 18 840). The covariates used in the regression model include region (United States and Europe), location where sepsis was suspected (emergency department, ward, or critical care unit), antibiotic administration, steroid use, organ failures (pulmonary, renal, hepatic, and acutely altered mental state), infection source (pneumonia, urinary tract infection, abdominal, meningitis, and other), hyperthermia (>38.3°C), hypothermia (<36°C), chills with rigor, tachypnea (>20/min), leukopenia (<4000 cells/µL), hyperglycemia (plasma glucose >120 mg/dL [6.7 mmol/L]), platelet count <100 ×103/μL, and coagulopathy (eMethods 3 in the Supplement). The adjusted odds ratio (OR) for the 6 groups presented in eTable 7 in the Supplement and the adjusted OR for the individual variables (lactate, vasopressor therapy, and fluids) are reported in eTable 8 in the Supplement. To convert serum lactate values to mg/dL, divide by 0.111.
  • JAMA February 9, 2016

    Figure 2: Studies Assessing Short-term Mortality for β-Lactam Plus Macrolide Combination Therapy or Respiratory Fluoroquinolone Monotherapy vs β-Lactam Monotherapy for Patients Hospitalized With Community-Acquired Pneumonia

    Some values were estimated based on available data. NR indicates not reported; OR, odds ratio.aUnless otherwise indicated.bHazard ratio not adjusted OR.cData collected in 1993.dData collected in 1995.eData collected in 1997.fCalculated using available data and is unadjusted.gData are for subgroup with radiographically confirmed pneumonia.
  • JAMA February 9, 2016

    Figure 1: Risk-Standardized Mortality Rates for Acute Myocardial Infarction, Heart Failure, or Pneumonia, 2010-2013

    Bin width is equal to 0.5%, and bars are centered over the midpoint of each bin.
  • JAMA February 9, 2016

    Figure 2: Risk-Standardized Readmission Rates for Acute Myocardial Infarction, Heart Failure, or Pneumonia, 2010-2013

    Bin width is equal to 0.5%, and bars are centered over the midpoint of each bin.
  • Pneumonia

    Abstract Full Text
    free access
    JAMA. 2016; 315(6):626-626. doi: 10.1001/jama.2016.0320
  • Association of Admission to Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia

    Abstract Full Text
    free access
    JAMA. 2016; 315(6):582-592. doi: 10.1001/jama.2016.0278

    This cross-sectional study compares mortality and readmission rates for acute myocardial infarction, heart failure, and pnemonia among older men treated at VA and non-VA hospitals in urban metropolitan statistical areas.

  • JAMA January 12, 2016

    Figure: Flow of Participants in the REVOLENS Study

    CT indicates computed tomography; FEV1, forced expiratory volume in the first second.aThe reasons for not performing bilateral treatment were death before second treatment (n = 1), anaphylactic shock at induction of anesthesia for the second coil treatment (n = 1) (further analyses demonstrated allergy to penicillin), and pneumonia after the first coil treatment leading to unwillingness of the patient to undergo a second coil treatment (n = 1).bThese 2 patients were alive at 12 months but did not attend the planned visit at 12 months.
  • JAMA September 22, 2015

    Figure: Instrumental Variable Subgroup and Sensitivity Analyses for 30-Day Mortality Among Elderly Patients With Pneumonia Admitted to the ICU vs General Ward

    ICU indicates intensive care unit; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification. With exception of the inverse probability weighting estimate, all models used an instrumental variable to adjust for all variables in Table 1 and Table 2 in addition to all 29 individual Elixhauser comorbidities and clustering of patients within hospitals. The regression models excluded 11 703 patients (1%) due to missing differential distance (n = 5166), admission source (n = 4053), urban/rural (n = 2430), pneumonia volume (n = 107). The Angus organ failure score identifies severity of illness by patient organ failures derived from the administrative record with a maximum score of 6. Higher scores indicate more organ failures. Details of the inverse probability weighting estimate can be found in eAppendix 2 in the Supplement. The severely ill subgroup excluded individuals with shock (ICD-9-CM: 458, 785.5-785.59, 958.4, 998.0), cardiac or respiratory arrest (ICD-9-CM: 427.5, 799.1), cardiopulmonary resuscitation (ICD-9-CM: 99.60, 99.63), or invasive or noninvasive mechanical ventilation (ICD-9-CM: 96.7, 96.70, 96.71, 96.72, 93.90). Error bars represent 95% CIs for absolute mortality differences (ICU vs general ward) for all models.
  • Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia

    Abstract Full Text
    free access
    JAMA. 2015; 314(12):1272-1279. doi: 10.1001/jama.2015.11068

    This cohort study investigates the association between intensive care unit admission and 30-day mortality for Medicare patients with pneumonia.

  • Mysterious Pneumonia Etiology

    Abstract Full Text
    JAMA. 2015; 314(12):1218-1218. doi: 10.1001/jama.2015.11209