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The use of artificial intelligence in healthcare is rapidly growing, with great potential to assist medical professionals in diagnosis and treatment of complex medical conditions. In this case report, the recommendations of a pulmonary consultation are compared to the recommendations from a large language model (LLM), ChatGPT, in regards to a case of non-resolving pneumonia. The recommendations by ChatGPT were found to be consistent with the pulmonary consultation, and no recommendations given were inappropriate. As shown in this case report, early generations of LLM such as ChatGPT were able to provide appropriate recommendations for the management of a patient with a complex medical condition.

Adult vaccinations may reduce risk for dementia. We determined whether tetanus, diphtheria, pertussis (Tdap) vaccination is associated with lower risk for dementia. Analysis conducted with Veterans Health Affairs (VHA) administrative medical record data and replicated in private sector medical claims data. Patients were ≥65 years of age and free of dementia for 2 years prior to index date. Tdap vaccination in 2011 or 2012. Follow-up through 2018. Controls had no Tdap vaccination for the duration of follow-up. After controlling for confounding, patients with, compared to without Tdap vaccination, had a significantly lower risk for dementia in both cohorts (VHA: HR=0.58; 95%CI:0.54 - 0.63 and MarketScan: HR=0.58; 95%CI:0.48 - 0.70). Results were replicated in two cohorts with different clinical and sociodemographic characteristics. Several vaccine types are linked to decreased dementia risk, suggesting that these associations are due to nonspecific effects on inflammation rather than vaccine-induced pathogen-specific protective effects.

Background: In 1995, a yearly drive-thru immunization program was initiated in Louisville, KY. Since then, more than 50,000 doses of influenza vaccine have been administered, with no reports of syncopal episodes or vehicular accidents. This report aimed to identify reported adverse events from other areas that could threaten drive-thru mass immunization approaches.Methods: To identify reported adverse events in any drive-thru mass immunization event, the authors queried the following sources: 1) the vaccine adverse event reporting system, 2) court cases, 3) healthcare risk management databases, 4) MEDLINE, and 5) communication with vaccine experts. The authors also calculated the probability of syncopal episodes using data from our past immunization experiences to further elucidate the possibility of these events occurring.Results: No adverse events due to a drive-thru mass immunization event were identified in any of the sources queried. In our data, the forecasted probability of one adverse event was 0.8 percent for a 2-day event (20,000 immunizations).Conclusions: Although syncope may occur following immunization, it is a risk that can be managed, and due to the rarity of these events, should not be used as a reason to avoid drive-thru administration of influenza vaccine.

Aspiration pneumonia is a common disease, although less well characterized than other pneumonia syndromes.We analyzed patient-level covariates associated with clinician-defined aspiration pneumonia.We used the Community-Acquired Pneumonia Organization database, a multicenter, international population of patients with community-acquired pneumonia, using data from 2001 to 2012. Aspiration pneumonia was determined by the treating clinician. We analyzed covariates associated with clinician-defined diagnosis of aspiration pneumonia using logistic regression. We compared aspiration pneumonia patients to propensity-matched cases with nonaspiration pneumonia.We studied 5185 patients. Four hundred fifty-one of these patients had aspiration pneumonia. Patients with aspiration pneumonia were older, had greater disease severity, and more comorbidities than patients with nonaspiration pneumonia. They were more likely cared for in the intensive care unit (19% vs 13%, P = 0.002), had longer unadjusted hospital length of stay (9 vs 7 days, P 0.001), and took longer to achieve clinical stability (unadjusted 8 vs 4 days, P 0.001). Confusion, nursing home residence, and cerebrovascular disease were most associated with clinician diagnosis of aspiration pneumonia (odds ratio: 4.4, 2.9, 2.3, respectively). Unadjusted inpatient mortality was higher (23% vs 9%, P 0.001). Aspiration pneumonia conferred a 2.3 odds ratio for inpatient mortality after adjusting for age, disease severity, and comorbidities.Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are associated with a clinician diagnosis of aspiration. Aspiration pneumonia is associated with greater mortality among patients with community-acquired pneumonia, which is not explained by older age, measured indices of severity, or comorbidities.

During the initial management of patients with community-acquired pneumonia (CAP), physicians need to assess severity of the disease and predict likely clinical outcomes of the patient. This information is used to make important clinical decisions, such as site of care, extent of laboratory work-up, and therapeutic interventions. CAP prediction scores were developed to help physicians define severity of disease and likely clinical outcomes of their patients. This article reviews the most relevant clinical outcomes in hospitalized patients with CAP and outlines the role of these scores as tools to help physicians predict these outcomes.

Background Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health-care-associated pneumonia (HCAP). These infections are associated with significant morbidity, mortality, and cost. The impact of vancomycin minimum inhibitory concentration (MIC) on mortality for patients with MRSA pneumonia has not been determined. Methods Adult patients in ICUs with a diagnosis of MRSA HAP, VAP, or HCAP were entered in the study. Clinical and laboratory information were prospectively collected. Vancomycin MIC and heteroresistance were determined for each MRSA isolate. Data were collected from February 2006 through August 2007. The primary outcome variable was all-cause mortality at day 28. A propensity score approach was used to adjust for confounding variables. Results The study sample consisted of 158 patients. All-cause mortality at day 28 was 32.3%. The majority of MRSA isolates had a vancomycin MIC ≥ 1.5 mg/mL (115/158, 72.8%). Propensity score analysis demonstrated an increase in 28-day mortality as vancomycin MIC increased from 0.75 to 3 mg/mL (P ≤ .001). Heteroresistance to vancomycin, demonstrated in 21.5% isolates, was not associated with mortality. Conclusions Mortality in patients with MRSA HAP, VAP, and HCAP increases as a function of the vancomycin MIC, even for strains with MIC values within the susceptible range. Evaluation of vancomycin MICs should be contemplated at the institutional level and for individual cases of MRSA pneumonia. The use of vancomycin therapy in patients with MRSA pneumonia caused by isolates with MICs between 1 and 2 mg/mL should be undertaken with caution, and alternative therapies should be considered.

Colonization in the nares with Methicillin Resistant Staphylococcus aureus (MRSA) has been described as a risk factor for eventual MRSA infection. The objective of this report is to describe the outbreak investigation, to identify the risk factors involved, and to evaluate and recommend control measures.This study was a retrospective observational outbreak study carried out in the Intensive Care and Cardiac Unit. Percentages of patients with positive conversions were graphically plotted out and were used to determine expected percentage of conversions versus observed. The case definition was determined to be a patient with a positive culture for MRSA from a nasal swab upon discharge or transfer from the ICCU whose initial swab on admission was negative.The expected number of conversions was 2% per month and the newly observed number of conversions was 6%, which was3 standard deviations from the mean. Repetitive sequence-based PCR (rep-PCR) was performed for the microbial DNA typing, which discovered genetically identical strains.The main finding in this outbreak investigation was that the common room which housed four of these patients was contaminated with MRSA. A limitation was that some patients who would have been included in the study did not get screened at discharge and their conversion status could not be ascertained and environment cultures were not performed. Active surveillance allowed for the detection of an outbreak of MRSA colonization which led to early intervention that prevented more patients from becoming colonized. Prevention of colonization should be one of the primary goal in the prevention of MRSA.