Bay Clinic

Abstract Background Community-acquired pneumonia (CAP) substantially contributes to mortality and morbidity globally, with beta-lactams being a primary therapeutic agent. The efficacy of adding macrolides to beta-lactams in CAP treatment remains controversial. Here, we evaluated whether beta-lactam plus macrolide treatment (BLM) is more effective than beta-lactam monotherapy (BL) for preventing CAP mortality. Methods We performed a secondary data analysis of a multicenter prospective cohort study involving patients diagnosed with CAP at four institutions. We selected patients treated with either BLM or BL. The primary endpoint was the outcome at the end of the observation period (death or recovery). The secondary endpoints were the length of hospital stay and duration of antibiotic use. Multiple imputations with bootstrapping were used to address missing data. Background characteristics were adjusted via propensity score matching. Results Of the 3,470 patients initially included in the study, 2,784 were analyzed; 306 received BLM and 2,478 received BL. The average observation period for the groups was 17.0 (± 18.4) and 24.0 days (± 24.6), respectively. After propensity score matching, mortality was similar between the groups (5.06% for BLM vs. 4.98% for BL; difference 0.00, 95% confidence interval [CI] − 3.73 to 3.71), as were recovery rates (91.79% for BLM vs. 91.69% for BL; difference 0.00, 95% CI − 4.48 to 4.82). In the subgroup analysis of patients with severe CAP, mortality was 12.00% for BLM vs. 13.33% for BL (difference 0.00, 95% CI − 20.00 to 16.13), and recovery rates were 82.86% vs. 83.33% (difference 0.00, 95% CI − 20.00 to 20.00). Conclusion Similar outcomes were observed in the mortality and recovery rates between the BLM and BL groups among patients with CAP. Clinicians should thoughtfully weigh the benefits of BLM against the potential risks, including adverse effects and antimicrobial resistance, when managing patients with CAP. Trial registration: This study protocol was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), identifier UMIN000006909, on December 19, 2011.

Neuromusculoskeletal injuries (NMSKI) are very common in the military, which contribute to short- and long-term disability. Population-level NMSKI, limited duty (LIMDU), and long-term disability episode counts in the U.S. Navy (USN) and U.S. Marine Corps (USMC) from December 2016 to August 2021 were extracted from the Musculoskeletal Naval Epidemiological Surveillance Tool. The incidence of NMSKI, LIMDU, and long-term disability was calculated. A hurdle negative binomial regression evaluated the association of body region, sex, age, rank, age by rank, and service branch on NMSKI, LIMDU, and long-term disability incidence. From December 2016 to August 2021, there were 2,004,196 NMSKI episodes (USN: 3,285/1,000 Sailors; USMC: 4,418/1,000 Marines), 16,791 LIMDU episodes (USN: 32/1,000 Sailors; USMC: 29/1,000 Marines), and 2,783 long-term disability episodes (USN: 5/1,000 Sailors; USMC: 5/1,000 Marines). There was a large-magnitude protective effect on NMSKI during the pandemic (relative risk, USN: 0.70; USMC: 0.75). Low back and ankle-foot were the most common, primarily affecting female personnel, aged 25-44 years, senior enlisted, in the USMC. Shoulder, arm, pelvis-hip, and knee conditions had the greatest rates of disability, with female sex, enlisted ranks, aged 18-24 years, and service in the USMC having the most salient risk factors. Body region, sex, age, rank, and branch were the salient factors for NMSKI. The significant protective effect during the pandemic was likely a function of reduced physical exposure and limited access to nonurgent care. Geographically accessible specialized care, aligned with communities with the greatest risk, is needed for timely NMSKI prevention, assessment, and treatment.

Patients living in remote areas have higher rates of injury-related death than those living in cities. Rural and remote health professionals working in sparsely populated places, such as Cat Island Bahamas, may have scant resources for treating emergency conditions. Local health professionals must be prepared to rely solely upon clinical judgment to perform emergency “high-stakes low-frequency” procedures while also accurately and effectively communicating with distantly located receiving specialists. However, these health providers may not recently have performed or had the opportunity to practice such emergency procedures. Telesimulation may be a useful way to teach remote practitioners both emergency procedures and communication skills. This technical report describes a simulation exercise for teaching these skills.

Psoriatic patients on tumor necrosis factor alpha inhibitors (TNFi) may be at increased risk for upper respiratory tract infections, including chronic rhino-sinusitis (CRS). Rarely, CRS can progress to orbital cellulitis (OC), an emergent ophthalmic complication wherein respiratory flora from paranasal sinus disease intrude the retro-orbital space. Single case report. We report the first case, to our knowledge, of an invasive sinusitis that rapidly evolved into OC in a patient receiving adalimumab treatment for plaque psoriasis and psoriatic arthritis. After TNFi withdrawal and appropriate medical and surgical intervention, the patient fully recovered. However, on resumption of TNFi therapy, symptoms of recalcitrant CRS returned. More investigation is needed to explore how TNFi might predispose to chronic, refractory rhino-sinusitis and subsequent progression to OC. Military physicians and other medical providers should be aware of this proposed new disease entity and the potential for rapidly evolving and invasive infections in immunocompromised patients. Screening and monitoring for chronic infectious disease, such as CRS before initiating and during TNFi therapy is warranted.

This study evaluated the Diabetes Outpatient Intensive Treatment (DOIT) program, a multiday group education and skills training experience combined with daily medical management, followed by case management over 6 months. Using a randomized control design, the study explored how DOIT affected glycemic control and self-care behaviors over a short term. The impact of two additional factors on clinical outcomes were also examined (frequency of case management contacts and whether or not insulin was started during the program). Patients with type 1 and type 2 diabetes in poor glycemic control (A1c >8.5%) were randomly assigned to DOIT or a second condition, entitled EDUPOST, which was standard diabetes care with the addition of quarterly educational mailings. A total of 167 patients (78 EDUPOST, 89 DOIT) completed all baseline measures, including A1c and a questionnaire assessing diabetes-related self-care behaviors. At 6 months, 117 patients (52 EDUPOST, 65 DOIT) returned to complete a follow-up A1c and the identical self-care questionnaire. At follow-up, DOIT evidenced a significantly greater drop in A1c than EDUPOST. DOIT patients also reported significantly more frequent blood glucose monitoring and greater attention to carbohydrate and fat contents (ACFC) of food compared with EDUPOST patients. An increase in ACFC over the 6-month period was associated with improved glycemic control among DOIT patients. Also, the frequency of nurse case manager follow-up contacts was positively linked to better A1c outcomes. The addition of insulin did not appear to be a significant contributor to glycemic change. DOIT appears to be effective in promoting better diabetes care and positively influencing glycemia and diabetes-related self-care behaviors. However, it demands significant time, commitment, and careful coordination with many health care professionals. The role of the nurse case manager in providing ongoing follow-up contact seems important.

This study evaluated the personality characteristics of U.S. Navy divers. Seventy-two active duty Navy divers completed the Million Index of Personality Styles. The sample strongly showed the traits of Enhancing. Modifying, Individuating, Thinking, and Controlling. The results are discussed in terms of adaptation to the environmental demands of military diving. Suggestions for further research are offered.