An intervention study directed at hospitalized asthma patients who had a history of frequent health care use resulted in a significant reduction in subsequent hospitalizations, many fewer lost work or school days, and lower direct and indirect health care costs. Researchers investigated 96 adults hospitalized for an asthma exacerbation who had a history of frequent hospitalizations for the disease. Fifty of the patients were placed randomly in an asthma nurse specialist intervention program while 46, the control group, received usual care for 6 months. The patients were predominately young African American women. According to the authors, asthma affects 15 million Americans. Hospitalizations account for almost half of the disease's associated direct health care expenditures. African Americans are over three times more likely than white persons to be hospitalized for the disease. The research team demonstrated a 60 percent reduction in total hospitalizations (31 readmissions in the intervention group versus 71 in the control group). The intervention group lost 264 days of work or school, while the control group missed 1,040 days. In addition, intervention patients showed a substantial reduction in direct and indirect health care costs, saving $6,462 per patient. The study results appear in the first issue for November 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
Decision analysis points up best treatment strategy for ventilator-associated pneumonia
In an effort to develop an optimal treatment strategy against deadly ventilator-associated pneumonia, researchers using decision analysis revealed that initial use of three antibiotics, followed by diagnostic testing, led to better patient survival, less antibiotic use, and lower cost. According to the authors, initial treatment with three antibiotics led to improved survival (66 percent versus 54 percent associated with one or two antibiotics), plus decreased cost ($41,483 versus $55,447). Testing with mini-brochoalveolar lavage did not improved survival but did reduce cost ($39,967 down from $41,483), since it lowered antibiotic use per survivor (39 days versus 63). The researchers said that ventilator-associated pneumonia complicates the course of patients on mechanical ventilation in between 8 and 28 percent of the cases. The resulting disease has a mortality rate ranging from 24 to 50 percent, plus it increases the patient's stay in the intensive care unit and hospital. Because of the time that it takes to get the "right" antibiotic therapy, diagnostic testing has not been shown to impact survival. For their research, the investigators used a decision analysis model employing a hypothetical group of immune-competent critically ill patients who were on mechanical ventilation for 7 days. The medical scientists generated a number of possible strategies associated with varied diagnostic paths. The researchers' probability estimates were derived from a literature search of 111 articles on the illness. The research is published in the first issue for November2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
Very premature infants can achieve normal surfactant and function
Results from a study of premature infants who were born at from 23 to 31 weeks gestation indicated that they had a surfactant deficiency and dysfunction on their first day of life; however, normal composition and function could occur after their first week of life despite continuing lung disease. The investigators studied tracheal aspirate samples from 35 infants most of whom had been intubated to allow passage of oxygen into their lungs; most had respiratory distress syndrome. The investigators found that surfactant samples obtained from premature infants within the first week of life contained low levels of surfactant proteins A, B, and C. Yet, after more than one week, despite continuing lung disease, some of the infants in the study had surfactant with normal in vitro function. The results showed that their tracheal aspirate samples contained all the surfactant proteins at levels comparable to those in adults. Surfactant is a substance that coats the lining of the tiny air sacs of the lungs (alveoli) and reduces their surface tension, preventing them from collapsing. Premature infants frequently experience respiratory distress because of a lack of surfactant. The research is published in the first issue for November 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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Journal
American Journal of Respiratory and Critical Care Medicine