Specialized Consults Can Link Hospitalized Patients To Outpatient Addiction Treatment

MedicalResearch.com Interview with:
Dr. Zoe Weinstein MD Instructor, Boston University School of Medicine Director of the Inpatient Addiction Consult Service Boston Medical Center
Dr. Zoe Weinstein MD
Instructor, Boston University School of Medicine
Director of the Inpatient Addiction Consult Service
Boston Medical Center

MedicalResearch.com: What is the background for this study?

Response: Substance use disorders are highly prevalent, especially among hospitalized patients, however substance use often goes unaddressed in the hospital setting, even if substance use is the underlying cause of the hospitalization (such as a blood stream infection from intravenous drug use).

This study reviews the experience of one hospital in starting an Addiction Consult Service to address substance use among hospitalized patients, and help connect them with long-term outpatient addiction treatment directly from the hospital.

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Community-Acquired Pneumonia Requiring Hospitalization Remains Significant Burden Especially For Elderly

MedicalResearch.com Interview with:
Seema Jain, MD Medical Epidemiologist Epidemiology and Prevention Branch, Influenza Division Centers for Disease Control and Prevention Atlanta, GA 30329Seema Jain, MD
Medical Epidemiologist
Epidemiology and Prevention Branch, Influenza Division
Centers for Disease Control and Prevention
Atlanta, GA 30329

Medical Research: What is the background for this study? What are the main findings?

Dr. Jain: Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. The last population-based study of community-acquired pneumonia was conducted in the 1990s before the pneumococcal conjugate vaccine and improved diagnostics (molecular detection and urine antigen tests) were available.  Thus, this was an opportune time to examine this question again.  The CDC Etiology of Pneumonia in the Community (EPIC) study attempts to fill in gaps in knowledge about pneumonia in adults, including older adults, by providing estimates of the incidence of community-acquired pneumonia hospitalizations in U.S. adults, as well as its viral and bacterial causes.

The main findings were that the burden of community-acquired pneumonia requiring hospitalization in adults was substantial, with the greatest burden found in adults 80 years of age and older. Human rhinovirus (HRV), influenza and Streptococcus pneumoniae were the most commonly detected pathogens.  However, no pathogen was detected in the majority of adults hospitalized with community-acquired pneumonia.

Medical Research: What should clinicians and patients take away from your report?

Dr. Jain:

  • Increasing coverage of recommended influenza and pneumococcal vaccines and developing effective vaccines and treatments for human metapneumovirus (HMPV), respiratory syncytial virus (RSV) and parainfluenza viruses (PIV) could reduce the pneumonia burden among adults.
  • It’s crucial for adults, especially older adults and adults with certain medical conditions, to receive recommended influenza and pneumococcal vaccines to prevent pneumonia.
  • A yearly flu vaccine is recommended for everyone age 6 months and older.
  • Pneumococcal vaccines are recommended for all adults age 65 and older and for adults younger than 65 years who have certain medical conditions or who smoke cigarettes.
  • In the majority (62%) of patients, no pathogen was detected, highlighting the need for development of new, more sensitive rapid diagnostic tests and methods to accurately identify pneumonia pathogens and target appropriate treatment.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Jain: We need future research to help the development of better diagnostic tests for determining microbiological causes of pneumonia, including tests that can distinguish between bacteria, viruses, and other pathogens.  In addition, for the respiratory pathogens we do know contribute to pneumonia but for which we do not have any prevention methods, such as HMPV and RSV, we need to develop prevention methods that could reduce the burden of disease, this includes vaccines.  We also need to determine factors associated with use of vaccines that we have at hand- both for influenza and pneumococcus- to increase uptake in the adult population.

Citation:

Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults

Seema Jain, M.D., Wesley H. Self, M.D., M.P.H., Richard G. Wunderink, M.D., Sherene Fakhran, M.D., M.P.H., Robert Balk, M.D., Anna M. Bramley, M.P.H., Carrie Reed, Ph.D., Carlos G. Grijalva, M.D., M.P.H., Evan J. Anderson, M.D., D. Mark Courtney, M.D., James D. Chappell, M.D., Ph.D., Chao Qi, Ph.D., Eric M. Hart, M.D., Frank Carroll, M.D., Christopher Trabue, M.D., Helen K. Donnelly, R.N., B.S.N., Derek J. Williams, M.D., M.P.H., Yuwei Zhu, M.D., Sandra R. Arnold, M.D., Krow Ampofo, M.D., Grant W. Waterer, M.B., B.S., Ph.D., Min Levine, Ph.D., Stephen Lindstrom, Ph.D., Jonas M. Winchell, Ph.D., Jacqueline M. Katz, Ph.D., Dean Erdman, Dr.P.H., Eileen Schneider, M.D., M.P.H., Lauri A. Hicks, D.O., Jonathan A. McCullers, M.D., Andrew T. Pavia, M.D., Kathryn M. Edwards, M.D., and Lyn Finelli, Dr.P.H. for the CDC EPIC Study Team

July 14, 2015DOI: 10.1056/NEJMoa1500245

Seema Jain, MD (2015). Community-Acquired Pneumonia Requiring Hospitalization Remains Significant Burden Especially For Elderly