A statewide initiative to improve the care of hospitalized pneumonia patients: The Connecticut Pneumonia Pathway Project.

PURPOSE: A statewide quality improvement initiative was conducted in Connecticut to improve process-of-care performance and to decrease length of stay for patients hospitalized with community-acquired pneumonia. SETTING AND METHODS: Data were collected on 1,242 elderly (> or =65 years) pneumonia patients hospitalized at 31 of 32 acute care hospitals between January 16, 1995, and March 15, 1996, and on 1,146 patients hospitalized between January 1, 1997, and June 30, 1997. Interventions included feedback of performance data (Qualidigm, the Connecticut Peer Review Organization), dissemination of an evidence-based pneumonia critical pathway (Connecticut Thoracic Society), and sharing of pathway implementation experiences (hospitals). Process and outcome measures included early antibiotic administration, blood culture collection, oxygenation assessment, length of stay, 30-day mortality, and 30-day readmission rates. Analyses were adjusted for severity of illness and hospital-specific practice patterns. RESULTS: After the statewide initiative, improvements were noted in antibiotic administration within 8 hours of hospital arrival (improvement from 83.4% to 88.8%, relative risk [RR] = 1.21; 95% confidence interval [CI]: 1.10 to 1.32), oxygenation assessment within 24 hours of hospital arrival (93.6% to 95.4%; RR = 1.23, 95% CI: 1.11 to 1.38), and length of stay (7 days to 5 days, P <0.001). There were no significant changes in blood culture collection within 24 hours of hospital arrival, blood culture collection before antibiotic administration, 30-day mortality, or 30-day readmission rates. CONCLUSIONS: Statewide improvements were demonstrated in the care of hospitalized pneumonia patients concurrent with a multifaceted quality improvement intervention. Further research is needed to separate the effects of the quality improvement interventions from secular trends.

Early switch and early discharge strategies in patients with community-acquired pneumonia: a meta-analysis.

BACKGROUND: The effectiveness of early switch and early discharge strategies in patients with community-acquired pneumonia remains unknown. METHODS: We searched the MEDLINE, HEALTHSTAR, EMBASE, Cochrane Collaboration, and Best Evidence databases from January 1, 1980, to March 31, 2000, for community-acquired pneumonia studies that included specific switch criteria or recommendations to switch on a particular day. RESULTS: From 1794 titles identified, 121 articles were reviewed. We identified 10 prospective, interventional, community-acquired pneumonia-specific studies that evaluated length of stay (LOS). Nine studies applied an early switch from parenteral to oral antibiotic criteria. Six different criteria for switching were applied in the 9 studies. Five of the studies that applied early switch criteria also applied separate criteria for early discharge. Six studies applied an early switch and early discharge strategy to an intervention and control group, and 5 of these provided SD values for LOS. The mean change in LOS was not significantly (P =.05) reduced in studies of early switch and early discharge (-1.64 days; 95% confidence interval, -3.30 to 0.02 days). However, when the 2 studies in which the recommended LOS was longer than the control LOS were excluded from the analysis, the mean change in LOS was reduced by 3 days (-3.04 days; 95% confidence interval, -4.90 to -1.19 days). Studies did not reveal significant differences in clinical outcomes between the intervention and control groups. CONCLUSIONS: There is considerable variability in early switch from parenteral to oral antibiotic criteria for patients with community-acquired pneumonia. Early switch and early discharge strategies may significantly and safely reduce the mean LOS when the recommended LOS is shorter than the actual LOS.

[Chemical constituents of Corydalis decumbens (Thunb.) Pers].

Six compounds were isolated from the quaternary ammoruinn parts of the bulbs of Corydalis decumbenbs in Shangrao District. The structures of menisperine and ferulic acid obtained for the first time from this plant were identified. Other compounds were found identical with the literature so far reported.

Motion sickness in quail: body-rotation-induced conditioned fluid aversions in C. coturnix japonica.

The presence of motion sickness in Japanese quail (C. coturnix japonica) was examined by using a conditioned fluid aversion as an index. Twenty-three birds were divided into three groups. One group received a novel fluid (yellow-sour water) followed by 30 min of body rotation at 70 rpm (on a schedule of 15 s on and 5 s off). Another group received the novel fluid followed by exposure to a sham rotation procedure. The third group experienced the rotation procedure following access to water. The group receiving the rotation procedure contingent on presentation of the novel fluid exhibited a conditioned aversion to this fluid (relative to the control groups) over days of acquisition (p less than .025) which subsequently dissipated when rotation was no longer contingent on the presentation of the yellow-sour water (extinction). These data thus demonstrate the presence of motion sickness in a gallinaceous species as indexed by a conditioned fluid aversion procedure.