Follow up chest radiograph in community acquired pneumonia (CAP)-are we meeting the standards? (2019)

Type of publication:
Conference abstract

Author(s):
*Zeb M.S.; *Hamze H.; *Ali A.; *Annabel M.; *Ahmad N.; *Moudgil H.; *Ibrahim J.; *Srinivasan K.S.; *Crawford E.

Citation:
American Journal of Respiratory and Critical Care Medicine; May 2019; vol. 199 (no. 9)

Abstract:
Introduction and objectives CAP accounts for 29,000 deaths per annum in the UK with In-patient mortality of 17.7% [1]. In older population (>65years) associated malignancy is 9.1%. Current guidelines [2] recommend chest radiograph (CXR) follow up 6 weeks after CAP in high risk patients. We aimed to audit our follow up practice with a view to service improvement for early detection of malignancy and complications from CAP. Methods Patients were identified via retrospective review of local database of patients recorded as “CAP” on discharge from 02/01/2017 to 01/31/2018. CXR reports were reviewed using patient archives communication system for radiology and clinical portal. Results 97 patients were identified with discharge diagnoses recorded as “CAP”. We excluded patients below 50 years of age (n=7), those without radiographic pneumonia (n= 26), CXR not reported (as patient deceased) (n=2) and patients with CAP who died within 6 weeks of presentation (n=25, mean age 83 years; this included inpatients as well as those died post discharge from hospital). Patients included (n=37). Mean age 74 years. Female patients (n=19, 50.1%). 14 (37.8%) patients had follow up CXR. One of these showed incomplete resolution with no further follow up or investigation arranged. Three patients were considered not suitable for follow up in view of their co-morbidities. 20/37 (58%) patients didn’t have appropriate follow up arranged. Conclusion(s): Our results underestimated CAP incidence at secondary level based on the discharge diagnosis of CAP. Mortality in this cohort was high signifying the severity of pneumonia, particularly with increasing age. There was one unresolved consolidation with no lung cancers diagnosed implying small sample size as a limitation in our study. Nevertheless 26 (27%) of patients had clinical diagnosis of CAP with no radiographic evidence. There was heterogeneity in the follow up CXR arrangements with patients shared between hospital specialists and primary care. For improvement we need to ensure appropriate follow up CXR (streamlined by staff education), radiology reports (highlighting the need for repeat CXR) and virtual clinics are arranged.

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Penicillin allergy in patients being treated for pneumonia-making a case for quality improvement project (2019)

Type of publication:
Conference abstract

Author(s):
*Mahendiran T.; *Omar M.K.; *Moudgil H.; *Crawford E.; *Srinivasan K.; *Makan A.; *Ahmad N.

Citation:
Thorax; Dec 2019; vol. 74 (Suppl. 2)

Abstract:
Background Penicillin allergy is reported by approximately 10% of the UK population, however only 20% of these actually have a true allergy.1 In addition, a documented penicillin ‘allergy’ may be associated with a prolonged length of stay (LOS) related to longer duration of treatment, complications and adverse effects related to second-line antibiotic use.2 Aim Our primary aim was to establish a documentation of the type of allergy to Penicillin within a cohort of patients presenting to our hospitals with community acquired pneumonia. Secondary aim was to compare the length of hospital stay, readmission within 30 days, complications and 30-day mortality between patients with and without penicillin allergy. Method We obtained data on all hospital admissions with a coded diagnosis of Pneumonia for the period covering October-December 2017. We divided this cohort into those with and without penicillin allergy; allergy information being obtained from discharge summaries and local pharmacy information system. Microsoft Excel and http://vassarstats.net/was used for statistical evaluation. Results 308 admissions were coded as pneumonia in this period. We excluded 77 admissions due to lack of data. Of the remaining, 187 had no penicillin allergy and 44 were allergic to penicillin. This gives a prevalence of 19% (44/231), which is higher than the reported prevalence above, of which 95% (42/44) did not have the type of allergy mentioned. Allergic group was older with a mean age (SD) 75 (15) v 72 (16) years [p value=0.0005], had more females 69% (31/44) v 41% (77/187) [p value=0.02], same LOS 6 days [p value=0.39], more readmissions 20% (9/44) v 16% (29/187) [p value=0.56], no greater complications 20% (9/44) v 20% (37/187) [p value=0.92] and a higher unadjusted overall mortality 14% (6/44) v 10% (18/187) (p value=0.61) Conclusion Data shows: 1. Poor documentation of the type of allergy to Penicillin. This needs a Quality improvement project as it is likely that most patients may not have a true allergy as shown in previous studies.1 2. Allergic group were older, with more females but the other variables were not statistically significant. We would recommend further research in this area to inform future practice.

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Community-acquired pneumonia: what community nurses should know. (2019)

Type of publication:
Journal article

Author(s):
*Pickstock, Shirley

Citation:
Journal of Community Nursing; Apr 2019; vol. 33 (no. 2); p. 50-54

Abstract:
Pneumonia has a huge impact upon the healthcare system in the UK and is not only associated with higher rates of hospital admissions than any other respiratory disease, but also carries a high risk of mortality. This article offers an overview of community-acquired pneumonia in adult patients, including the pathophysiology, common aetiologies, at-risk groups and pharmacological management. There is also a brief discussion on differential diagnoses and potential strategies to support clinical decision-making in the community.

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