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Most medicare payments for pneumonia hospitalization

San Francisco >> << Aspiration pneumonia can be deadly and costly epidemic in older Americans, according to

William B. Baine, MD, who presented a poster at the 39th Conference of IL

on antimicrobial agents and chemotherapy. Pneumonitis due to inhalation

food and vomit, commonly known as aspiration pneumonia, was the second most common primary

diagnosis, conceding only that the broad designation of a comprehensive,

'pneumonia, the body without 'Among patients hospitalized Medicare >> << to any of 55 different diagnoses indicates infection or pneumonia

, said Dr Baine, who is senior medical advisor to the Centre >> << Results and Performance Studies Agency for Health Care Policy and Research

(AHCPR) in Rockville, Md. One possible explanation >> << to clear increase in aspiration pneumonia that hospitals increasingly

may strattera 40mg indicate aspiration pneumonia to get the maximum permissible compensation

from medical care, Dr. Baine continues. Even more worrying is the possibility that

[these diagnoses] may be detecting smoldering epidemic desire

, pneumonia in elderly patients. Several processes of disease diagnosis of aspiration pneumonia

included two different processes of the disease, Dr. Baine explained. One

version of the disease, spit out stomach acid goes down in the windpipe and

reaches the lungs. The result can be acid burn, providing lung tissue susceptible >> << complicate infection. According to another version often reflect other diseases that threaten

patient's ability to cough or swallow. For example, patients in yaks

throat muscles affected by the stroke may be at high risk of aspiration pneumonia >>. << Uncoordinated swallowing saliva misdirects, food, drink, or in the airways. If the cough reflex the patient is too weak, some of these materials can pass into the lungs

- with mouth and throat bacteria. Researchers examined the AHCPR

health care financing administration computer files Medicare hospital claims for

patients issued from 1991 to 1996 to determine the patient stay on

age of patients 65 years and over with primary diagnosis of aspiration pneumonia. From 1991 to 1996 the number of hospital discharges of Medicare patients

whose reason for admission, as reported, aspiration pneumonia increased by

76%, exceeding the 100 000 cases only in 1996, Dr. Baine he said. For >> << same interval, the number of seniors who are Medicare coverage increased

less than 7%. The annual increase in the number

hospitalizations for aspiration pneumonia per 100,000 person most visibly

in the very old. Average costs and Medicare hospital reimbursement were the lowest for

white women showed lower mortality in hospitals (23%). This subgroup

patients demonstrated the shortest average hospital stay (10. 4 days) and stay in the intensive care unit >> << (0. 8 days) and reached an average Medicare payment to hospital

to only $ 8246. Unlike black people at highest risk of death

(26%) had the longest average hospital stay (14. 2 days) and in intensive care

(1. 1 days) and were responsibility for the highest reimbursement Medicare hospital. Additional 22% of patients discharged to home alive or dead were self

within 90 days of hospitalization, mortality within 90 days were even

higher in patients directed to home care, intermediate care or skilled >> << elderly and disabled, or other entity. SECONDARY HIV diagnoses among Medicare patients with primary diagnosis

aspiration pneumonia, the three most common secondary diagnoses >> << are hypovolemia, congestive heart failure and urinary tract infection. Overall discharge diagnosis most strongly associated with primary diagnosis of aspiration pneumonia

- compared with a diagnosis of pneumococcal pneumonia - were dysphagia,

hastrostomiya status, and staphylococcal pneumonia. The question whether this increase in

in aspiration pneumonia occurs with real growth of such cases or

only apparent increase in pressure resulting from selection for aspiration pneumonia

diagnostic code. Most Medicare payments for pneumonia hospitalization

covers one of the two sets of diagnostic related groups (DRH): >> << simple pneumonia and pleurisy and respiratory infections and inflammation. As a last DRG includes pneumonia, which can be particularly serious, >> << hospital payment these are usually higher than for simple pneumonia. Reporting a patient with aspiration pneumonia and pneumonia,

body is not specified, the displacement DRG from lower to higher compensation

which is obviously in favor of the hospital. If, on the other hand, Medicare

account indicates a real increase in aspiration pneumonia, the second question

question: what is the basic process of this growth? To find out which of >> << needed further study, Dr. Baine noted. Further research

should focus on possible causal factors in his opinion, including >> << opportunity not previously link between some of these conditions or their

control and the risk of aspiration pneumonia . -Lawrence

Prescott

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If the urine contains no bacteria, urethritis ...

Most women with symptoms of urinary tract infections, culture must rarely and does not affect management. Urine culture is invaluable in these situations - in all patients with systemic symptoms of pyelonephritis, pregnant women, men and in patients who regularly and frequently UTI. Uncomplicated cystitis Microbiology limited to several pathogens. As many as 90 percent of uncomplicated episodes of cystitis caused by E. coli, 10 to 20 percent are caused by Staphylococcus saprophyticus koahulazonehativnye and 5 percent or less caused by other organisms Enterobacteriaceae or enterococci. In addition, the antimicrobial susceptibility of these organisms is quite predictable. In one third uropatohenov resistant to ampicillin and sulfonamides, but most are susceptible to trimethoprim-sulfamethoxazole (from 85 to 95 percent) and fluoroquinolones (95 percent). Due to the limited range of pathogens and their susceptibility predictable, urine culture and sensitivity was adding to the choice of antibiotics for treatment of acute uncomplicated cystitis in young women. Thus, urine cultures are no longer serving as part of routine work with these patients. Instead, these patients should undergo an abbreviated laboratory work in which the presence of pyuria is confirmed by traditional urinalysis (wet examination of grief threads urine), cell chamber counting technique or strips of dough on the leukocyte esterase. Positive test leukocyte esterase has reported sensitivity of 75 to 90 percent in detecting pyuria associated with UTI. Gram staining unspun urine can be used to detect bacteriuria. In this semi-quantitative test, one organism to field immersion correlates with 100,000 CFU per ml culture. Since the procedure

CFU per ml culture. Because the procedure is timeconsuming and has low sensitivity, it is usually not performed in most clinical laboratories if it is specifically requested. Test strips nitrites used as a surrogate marker for bacteriuria. Mochy probe becomes more affordable easy to use tool that can be used in any office of a doctor. While many disorders can be detected in strip, nitrite test and leukocyte oxidase test is most useful. Nitrite formed from nitrate reduction of urinary active bacteria while leukocytes oxidase reflects leukocytes in urine. If both are positive then UTI in more than 90% of cases. Positive Test for Nitrites a probe while the specific UTI is only 30% sensitivity. It should be noted that not all uropatohenov reducenitrates in nitrites. For example, enterococci, S. saprophyticus and Acinetobacter species and therefore give false-negative results. In patients with a high index of suspicion of UTI and a negative probe, direct strattera dosage urine and nitrates or nitrites in. For example, enterococci, S. saprophyticus and Acinetobacter species and therefore give false-negative results. In patients with a high index of suspicion of UTI and a negative probe, direct study of culture and urine or should be done to rule out infection as the cause piror symptoms. If the urine contains no bacteria, urethritis, vaginitis or prostatis be regarded as the most likely. Adenovirus and chemotherapeutic drugs can lead to bacterial, not cystits. Other factors include tuberculosis bladder stones, tumors of the bladder and interstitial cystitis. .