[Effect of clinical pathway management on pediatric pneumonia].

OBJECTIVE: To investigate effect of clinical pathway management on pediatric pneumonia. METHOD: Data were colleted from children hospitalizated with bronchial pneumonia, bronchiolitis, mycoplasma pneumonia in Center of Respiratory Disorders in Children's Hospital of Chongqing Medical University from January 2011 to December 2012. According to implement of clinical pathway management, all patients were divided into pathway management group (n = 405) and non-pathway management group (n = 503). Length of stay, costs of hospitalization, clinical effect and use of antibiotics were compared in these two groups. RESULT: In pathway management group, average length of stay of children with bronchial pneumonia and bronchiolitis was (6.1 ± 1.6) d and (6.2 ± 1.5) d respectively. While in non-pathway management group, length of stay was (7.2 ± 1.9) d and (7.3 ± 1.5) d (P = 0.000). There was no significant difference in length of stay between these two groups of children with mycoplasma pneumonia [ (6.9 ± 1.8) d vs.(7.7 ± 2.5) d] (P = 0.198). Costs of auxiliary tests in pathway management group was slightly higher than that in non-pathway management group. While other costs in pathway management group were significantly lower than those in non-pathway management group. Total costs of hospitalization of patients with these three diseases in pathway management group and non-pathway management group were ¥(4609 ± 1225) vs ¥ (5629 ± 1813) , ¥ (5006 ± 1250) vs. ¥ (5686 ± 1337), ¥ (4946 ± 1259) vs. ¥ (6488 ± 3032) respectively. There was a significant difference (P < 0.05). Percentages of antibiotics use in two groups were 70.9% vs.99.4%, 45.7% vs.93.4% and 96.2% vs.100.0%. Antibiotics related indicators such as mean number of day of use, ratio of combination and grade of antibiotics were significantly higher in pathway management group compared to non-pathway management group (P < 0.01). There was no significant difference in other indicators like clinical effect and unscheduled readmission in 30 days between two groups (P > 0.05). CONCLUSION: Clinical pathway management can regulate medical behaviors through reduction of medical costs, avoidance of excessive laboratory tests and therapy, and regulation of antibiotic use.

Evaluación del impacto económico de la neumonía causada por Mycoplasma Hyopneumoniae sobre un sistema productivo porcino tecnificado / Evaluation of the economic impact of the pneumonia caused by Mycoplasma Hyopneumoniae on a productive porcine system tecnificado

La neumonía causada por Mycoplasma hyopneumoniae afecta directamente la rentabilidad del sistema productivo porcino debido a su alta prevalenica e incidencia que produce un efecto negativo sobre la tasa de crecimiento en la etapa de acabado. Por ello, el objetivo del presente estudio fue cuantificar el impacto económico real de la enfermedad, en un sistema de producción porcina intensiva en las que se consideran estrategias de vacunación y la ausencia de ella comparando los resultados con parámetros ideales plausibles. Se recopiló información acerca de la enfermedad, se utilizó en la elaboración de un modelo determinístico de la enfermedad empleando el programa MS Excel. Los cálculos económicos se realizaron mediante un análisis marginal. El estudio reportó que la pérdida por efecto de la enfermedad en un sistema sin vacunación llega a un promedio de 4.8 kilos por animal y el tiempo que requiere para alcanzar los 91 kilos aumenta en 7 días. La merma se reduce a 2.5 kilos cuando se incluye un aditivo en la alimentación pero esto no hace que la prevalencia de la enfermedad disminuya, que en ambos casos llega a alcanzar niveles del 95 por ciento en la población. La introducción de la vacunación permite obtener animales no susceptibles a la infección que son capaces de obtener los pesos de 91 kilos a los 147 días y reduce la prevalencia de la enfermedad a 37 por ciento, 20 por ciento y 10 según el nivel de protección alcanzado sea de 80, 90 ó 95 por ciento respectivamente. El análisis marginal indica que se puede alcanzar una ganancia. Aproximadamente de $4.75 dólares por animal que llega sano al final del proceso productivo. El estudio recomienda que la vacunación debe de ser incluida en los programas de control de la enfermedad para disminuir los perjuicios económicos que ella produce en los sistemas productivos porcinos.

An epidemiologic and economic study of respiratory diseases in two conventional Danish swine herds. I: Prevalence of respiratory lesions at slaughter and their effects on growth.

A total of 578 slaughter pigs from 2 Danish conventional farrow-to-finish operations (Herds A and B) were followed from an age of 14 days to slaughter. Pigs were weighted at 3 weeks intervals and at slaughter and an extended post mortem examination of the plucks was done. Comparison of growth rates in pigs with and without specific types of lesions by the t-test and those with multiple lesions with regression models demonstrated that Mycoplasma-like pneumonia, complicated pneumonia, anterio-ventral pleuritis, fissures and atrophic rhinitis significantly reduced mean daily gain and increased the time required to reach slaughter weight. The total impact of the lesions in Herd A was an estimated reduction in mean daily gain of 27 grams and a 2 day increase in the interval from 14 days of age until slaughter (MDG14). Decreases in MDG14 in Herd B were more substantial, 98 grams and 16.7 days. Reductions in mean daily gains during the interval from the fourth weighing until slaughter were 31 grams in Herd A and 137 grams in Herd B. Chronic dorso-caudal and parietal pleuritis, without other lesions present, had no significant adverse effects on growth rates in either herd. Interactions between lesions did not significantly alter the estimates. The R2 values obtained for the regression models showed that the presence, absence or extent of lesions at slaughter explained only 13-27% of the variations in growth rates in the 2 herds.

Epidemiology of community-acquired respiratory tract infections in adults. Incidence, etiology, and impact.

Upper respiratory tract infections are the most common types of infectious diseases among adults. It is estimated that each adult in the United States experiences two to four respiratory infections annually. The morbidity of these infections is measured by an estimated 75 million physician visits per year, almost 150 million days lost from work, and more than $10 billion in costs for medical care. Serotypes of the rhinoviruses account for 20 to 30 percent of episodes of the common cold. However, the specific causes of most upper respiratory infections are undefined. Pneumonia remains an important cause of morbidity and mortality for nonhospitalized adults despite the widespread use of effective antimicrobial agents. There are no accurate figures on the number of episodes of pneumonia that occur each year in ambulatory patients. In younger adults, the atypical pneumonia syndrome is the most common clinical presentation; Mycoplasma pneumoniae is the most frequently identified causative agent. Other less common agents include Legionella pneumophila, influenza viruses, adenoviruses, and Chlamydia. More than half a million adults are hospitalized each year with pneumonia. Persons older than 65 years of age have the highest rate of pneumonia admissions, 11.5 per 1,000 population. Pneumonia ranks as the sixth leading cause of death in the United States. The pathogens responsible for community-acquired pneumonias are changing. Forty years ago, Streptococcus pneumoniae accounted for the majority of infections. Today, a broad array of community-acquired pathogens have been implicated as etiologic agents including Legionella species, gram-negative bacilli, Hemophilus influenzae, Staphylococcus aureus and nonbacterial pathogens. Given the diversity of pathogenic agents, it has become imperative for clinicians to establish a specific etiologic diagnosis before initiating therapy or to consider the diagnostic possibilities and treat with antimicrobial agents that are effective against the most likely pathogens.