Radiographic evaluation of nursing- and healthcare-associated pneumonia.

AIM: Radiographic testing has an important role in the diagnosis and evaluation of pneumonia. The aim of the present study was to evaluate the usefulness of computed tomography (CT), in comparison with chest roentography (CR), in the diagnosis and evaluation of nursing- and healthcare-associated pneumonia (NHCAP) . METHODS: The utility of CT in the diagnosis of NHCAP was compared with that of CR in a prospective study of patients who visited the emergency room in Nissan Tamagawa Hospital, Tokyo, Japan, with clinical symptoms that were indicative of NHCAP. We also evaluated whether particular CT findings were risk factors for NHCAP-associated mortality. RESULTS: A total of 162 patients with suspected NHCAP were included in the study. The 162 patients included 147 (90.6%) patients who were diagnosed with NHCAP based on the detection of pneumonic infiltration on CT. In contrast, CR was not capable of recognizing pneumonic infiltration in 15 of the 147 (10.2%) patients. A multivariable analysis which was carried out to determine the risk factors for NHCAP-associated mortality, showed that oxygen desaturation had the greatest odds ratio, followed by a blood urea nitrogen level of ≥21 mg/dL and the detection of bilateral pneumonic infiltration by CT. CONCLUSIONS: We herein show that CT is superior to CR for the diagnosis and evaluation of NHCAP. The present study will provide a foundation for further studies to clarify whether the use of CT in the diagnosis and evaluation of NHCAP can improve the clinical outcome of patients with NHCAP. Geriatr Gerontol Int 2017; 17: 41-47.

Positive Trend in the Antarctic Sea Ice Cover and Associated Changes in Surface Temperature.

The Antarctic sea ice extent has been slowly increasing contrary to expected trends due to global warming and results from coupled climate models. After a record high extent in 2012 the extent was even higher in 2014 when the magnitude exceeded 20×106 km2 for the first time during the satellite era. The positive trend is confirmed with a newly reprocessed sea ice data that addressed inconsistency issues in the time series. The variability in sea ice extent and ice area was studied alongside surface ice temperature for the 34-year period starting 1981 and the result of the analysis show a strong correlation of -0.94 during the growth season and -0.86 during the melt season. The correlation coefficients are even stronger with a one-month lag in surface temperature at -0.96 during the growth season and -0.98 during the melt season suggesting that the trend in sea ice cover is strongly influenced by the trend in surface temperature. The correlation with atmospheric circulation as represented by the Southern Annular Mode (SAM) index appears to be relatively weak. A case study comparing the record high in 2014 with a relatively low ice extent in 2015 also shows strong sensitivity to changes in surface temperature. The results suggest that the positive trend is a consequence of the spatial variability of global trends in surface temperature and that the ability of current climate models to forecast sea ice trend can be improved through better performance in reproducing observed surface temperatures in the Antarctic region.

A Prospective Analysis of the Efficacy and Complications Associated With Deep Sedation With Midazolam During Fiberoptic Bronchoscopy.

BACKGROUND: Moderate sedation has been commonly used for fiberoptic bronchoscopy (FB). However, patients may find FB under moderate sedation to be unpleasant. We therefore examined whether deep sedation was a useful premedication for FB. METHODS: We designed a prospective, randomized study using a patient questionnaire to address the perceptions of the procedures and complications of patients who underwent FB with deep sedation (deep sedation group) with midazolam in comparison with those who underwent FB with moderate sedation (moderate sedation group) with the same drug. Patients were asked to grade FB as being easy or difficult to tolerate. The primary endpoint was tolerability and the secondary endpoints included complications associated with the procedure. RESULTS: A total of 80 patients were included in the study. A significantly lower number of patients in the deep sedation group reported that the technique was difficult to tolerate (5.0% vs. 40.0%, moderate sedation group; P<0.001). However, the dose of oxygen required to maintain an oxygen saturation of ≥90% was higher in the deep sedation group (7.3±4.7 vs. 2.7±1.6 L/min; P<0.0001). There were no cases of prolonged oxygen desaturation or deaths related to FB in either group. CONCLUSION: In the present study, deep sedation had a beneficial effect on patient tolerance to FB. Although oxygen desaturation during FB represents a potentially serious complication, deep sedation may be considered to be a useful premedication for FB.

Computed Tomography for the Diagnosis and Evaluation of the Severity of Community-acquired Pneumonia in the Elderly.

OBJECTIVE: We herein assessed the utility of computed tomography (CT) for the diagnosis and ascertainment of the severity of community-acquired pneumonia (CAP) in the elderly. METHODS: The utility of CT compared with chest radiography (CR) for the diagnosis of CAP was prospectively studied among elderly inpatients with clinical symptoms and signs indicative of CAP at the Department of Respiratory Medicine in Nissan Tamagawa Hospital during the one-year period from January 2013 to December 2013. Additionally, we evaluated whether the findings of CT were useful as predictive factors related to the mortality rate associated with CAP. RESULTS: One hundred and forty-two patients, 65 years of age or older, were surveyed upon hospital admission for suspected CAP. Of the 142 patients included, 127 (89.4%) had pneumonic infiltration diagnosed by CT, however, CR could not recognize pneumonic infiltration in 9.4% (12/127) of these patients. In 127 CAP-positive patients, bilateral pneumonic infiltration was more frequently detected by CT in non-survivors than survivors (79.0% vs. 53.7%; p <0.05). By a multivariable analysis to determine the prognostic factors related to mortality from CAP, oxygen desaturation showed the greatest odds ratio among the other predictive factors, followed by comorbid neoplastic disease, blood urea nitrogen ≥21 mg/dL, male gender, and bilateral pneumonic infiltration diagnosed by CT. CONCLUSION: We herein demonstrated that CT was superior to CR for diagnosing and evaluating the severity of CAP in elderly patients.