Validation of the Infectious Diseases Society of America/American Thoratic Society Minor Criteria for Intensive Care Unit Admission in Community-Acquired Pneumonia Patients Without Major Criteria or Contraindications to Intensive Care Unit Care

Background Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. Objective We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. Research design A questionnaire survey was carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. Ethical considerations This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. Findings Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students’ attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. Conclusion As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress.

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Radiographically Confirmed Community-Acquired Pneumonia in Pediatric Patients Prior to Pneumococcal Vaccination in Nepal

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0037-1607266 ◽

2017 ◽

Vol 13 (01) ◽

pp. 057-062

Author(s):

Dhruba Shrestha ◽

Ganendra Raya ◽

Amar Prajapati ◽

Suruchi Dhaubhadel ◽

Sushmita Puri ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pleural Effusion ◽

Intensive Care Unit Admission ◽

Pneumococcal Vaccination ◽

Community Acquired Pneumonia ◽

Blood Cultures ◽

Hospital Treatment ◽

High Morbidity ◽

Rural Nepal

Background The massive burden of pediatric pneumonia is associated with high morbidity and mortality, particularly in developing countries where immunization programs are absent or recently been implemented. The objective of this study was to describe the number of hospitalizations and outcomes of children aged 1 month to 10 years with community-acquired pneumonia (CAP) between January 1, 2014, and June 30, 2015, in semi-rural Nepal. Methods This retrospective study was undertaken prior to the implementation of the pneumococcal conjugate vaccination (PCV) program in Bhaktapur district of Nepal. Chart review of children with CAP, defined as the presence of symptoms, physical examination findings compatible with bacterial pneumonia together with lobar consolidation on chest X-ray (CXR), was performed. Data extracted included laboratory parameters and blood cultures on admission, antibiotic treatment, and length of hospital stay, as well as complications, such as death, intensive care unit admission, pleural effusion, and empyema. Outcomes assessed were clinical improvement accompanied by radiological improvement of consolidation. Results During the study period, 367 patients were admitted with pneumonia, of which, 74 (20%) had definite CXR evidence of lobar pneumonia. A total of 86.5% of the cases were children < 5 years of age. Admission blood cultures from all patients were negative. More than 80% of patients had white blood cell (WBC) counts >11,000/mm3 and ≥ 75% neutrophils. The highest number of cases presented between February and July. Forty-three of 45 patients responded to crystalline penicillin (CP), and 25/27 patients treated with cefotaxime also responded; the mean duration of treatment was 10 ± 2.3 days. There were no deaths. None of the patients developed empyema, sepsis, or pleural effusion or required intensive care unit admission. Conclusions CAP in pre-PCV semi-rural Nepal mostly affects male children < 5 years old and peaks between March and May. In-hospital treatment with CP or cefotaxime is effective.

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