Empiric management of community-acquired pneumonia in Australian emergency departments

Objective: To describe empiric community-acquired pneumonia (CAP) management in Australian hospital emergency departments (EDs) and evaluate this against national guidelines, including use of the pneumonia severity index and antibiotic selection. Design: A multicentre, cross-sectional, retrospective audit, April 2003 to February 2005. Setting: 37 Australian hospitals: 22 principal referral hospitals, six large major city hospitals, four large regional hospitals, four medium hospitals and one private hospital. Participants: Adult patients with a diagnosis of CAP made in the ED. Data on 20 consecutive CAP ED presentations were collected in participating hospitals. Outcome measures: Documented use of the pneumonia severity index, initial antibiotic therapy prescribed in the ED, average length of stay, inpatient mortality, and concordance with national guidelines. Results: 691 CAP presentations were included. Pneumonia severity index use was documented in 5% of cases. Antibiotic therapy covering common bacterial causes of CAP was prescribed in 67% of presentations, although overall concordance with national guidelines was 18%. Antibiotic prescribing was discordant due to inadequate empiric antimicrobial cover, allergy status (including contraindication to penicillin), inappropriate route of administration and/or inappropriate antibiotic choice according to recommendations. There was no significant difference between concordant and discordant antibiotic prescribing episodes in average length of stay (5.0 v 5.7 days; P=0.22) or inpatient mortality (1.6% v 4.1%; chi(2) = 1.82; P=0.18). Conclusions: Antibiotic therapy for CAP prescribed in Australian EDs varied. Concordance with national CAP guidelines was generally low. Targeted interventions are required to improve concordance.

Hearing sensitivity and bone mineral density in older adults: the Health, Aging and Body Composition Study

Bone mineral density (BMD) may be associated with hearing loss in older adults. Demineralization of the cochlear capsule has been associated with hearing loss in those with Paget's disease of the bone and otosclerosis. Osteoporosis may also result in cochlear capsule demineralization. We hypothesized that lower hip BMD and lower heel ultrasound measurements would be associated with hearing loss in a population-based sample of 2,089 older black and white men and women. Bone parameters and hearing function were measured at the fourth clinical follow-up visit. Audiometric threshold testing was used to measure air- and bone-conduction hearing sensitivity. BMD of the hip and its subregions was measured using dual-energy X-ray absorptiometry. Calcaneal bone measurements [broadband ultrasound attenuation (BUA), speed of sound (SOS) and the quantitative ultrasound index (QUI)] were obtained using heel ultrasound. After adjusting for known hearing loss risk factors, no association was found between hearing and any of the bone measurements in whites and black women. In black men, however, lower hip BMD was associated with higher odds of hearing loss; for each standard deviation decrease in total hip BMD, the odds of hearing loss were 1.41 (95% confidence interval 1.08, 1.83), 1.39 (95% CI 1.07, 1.82) for femoral neck BMD and 1.65 (95% CI 1.26, 2.16) for trochanter BMD. Conductive hearing loss was associated with lower heel ultrasound measurements, though only among white men. The results of this study are mixed and inconclusive. Lower BMD of the hip and its subregions was associated with hearing loss among black men, but not among whites or black women. Lower measurements on heel ultrasound were associated with conductive hearing loss, though only among white men. These results suggest that axial and appendicular bone parameters may be modestly associated with hearing loss in older men, but not in women.

Effects of sodium on potassium nutrition in three tropical root crop species

The potassium (K) nutrition and high K requirement of tropical root crops may be affected by their sodium (Na) status, as has been observed in a number of plant species. Solution culture was used to study the effects of K and Na supplies in tannia [Xanthosoma sagittifolium (L.) Schott.], sweetpotato [Ipomoea batatas (L.) Lam.] and taro [Colocasia esculenta (L.) Schott]. At low K supply, Na ameliorated symptoms of K deficiency and increased growth in tannia, and to a lesser extent in sweetpotato, but not in taro. None of the species responded to Na at adequate K supply. Differences in response to Na were attributed to differences in Na translocation to plant tops. At maximum Na supply, the Na concentration in index leaves averaged 1.82% in tannia, 0.205% in sweetpotato, and 0.0067% in taro. An increase in the supply of Na resulted in a shift in the critical K concentration for deficiency (i.e., 90% of maximum yield) in index leaves from 2.9% to 1.2% in tannia, and from 4.8% to 2.5% in sweetpotato. The critical K concentration in taro was 3.3%, irrespective of Na supply. To overcome the problem in tannia and sweetpotato of determining the critical concentration relevant to a leaf sample of unknown K status, a relationship was established for each species relating the critical K concentration to the concentration of Na in the index leaves.

The effect of manipulations to target contrast on emmetropization in chick

Emmetropization is dependent on visual feedback and presumably some measure of the optical and image quality of the eye. We investigated the effect of simple alterations to image contrast on eye growth and refractive development. A 1.6 cyc/deg square-wave-grating target was located at the end of a 3.3 cm cone,, imaged by a +30 D lens and applied monocularly to the eyes of 8-day-old chicks. Eleven different contrast targets were tested: 95, 67, 47.5, 33.5, 24, 17, 12, 8.5, 4.2, 2.1, and 0%. Refractive error (RE), vitreous chamber depth (VC) and axial length (AL) varied with the contrast of the image (RE diff. F-10.86 = 12.420, p < 0.0005; VC diff. F-10.86 = 8.756, p < 0.0005; AL diff. F-10.86 = 9.240, p < 0.0005). Target contrasts 4.2% and lower produced relative myopia (4.2%: RE diff = -7.48 +/- 2.26 D, p = 0.987; 2.1%: RE diff = -7.22 +/- 2.77 D, p = 0.951) of similar amount to that observed in response to a featureless 0% contrast target (RE diff = -9.11 +/- 4.68 D). For target contrast levels 47.5% and greater isometropia was maintained (95%: RE diff = 1.83 +/- 2.78 D; 67%: RE diff = 0.14 +/- 1.84 D; 47.5% RE diff = 0.25 +/- 1.82 D). Contrasts in between produced an intermediate amount of myopia (33.5%: RE diff = -2.81 +/- 1.80 D; 24%: RE diff = -3.45 +/- 1.64 D; 17%: RE diff = -3.19 +/- 1.54 D; 12%: RE diff = -4.08 +/- 3.56 D; 8.5%: RE diff = -4.09 +/- 3.60 D). We conclude that image contrast provides important visual information for the eye growth control system or that contrast must reach a threshold value for some other emmetropization signal to function. (c) 2005 Elsevier Ltd. All rights reserved.