The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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While weekend hospital admissions are associated with higher mortality, the effects of weekend hospital stays are not known. We assessed whether patients hospitalised for chronic obstructive pulmonary disease (COPD) or pneumonia have higher mortality during weekend and Friday stays. Our cohort consisted of all hospitalisations for COPD or pneumonia during 1990-2007 from the healthcare databases of the province of Quebec, Canada. ⋯ Independently of the admission day, mortality was higher during weekend stays (HR 1.07, 95% CI 1.04-1.09) and Friday stays (HR 1.05, 95% CI 1.02-1.08), relative to Monday-Thursday stays. Patients hospitalised for COPD or pneumonia are at increased risk of death when staying over on a Friday or a weekend. The additional 40-56 deaths per 100 000 patients staying in hospital on those days are most likely due to reduced access to healthcare at that time.
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The prognosis of patients with malignant pleural mesothelioma remains poor and although it is clear that multimodal therapy is necessary to improve long-term results, precise treatment schemes have not yet been unequivocally established. Single-modality therapy does not have a major impact on long-term survival and combined-modality therapies are being further evaluated. However, the relative contributions of chemotherapy, radiotherapy and surgery have not been clearly determined at the present time. ⋯ The role of post-operative radiotherapy has to be further elucidated. Further treatment options that are currently explored include hyperthermic intrapleural chemotherapy, immunotherapy, gene therapy and photodynamic therapy. However, no randomised comparisons are available yet.
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We aimed to determine the coverage and yield of tuberculosis contact investigation, and compliance with guidelines, and to identify opportunities for improvement. Data were extracted from records on contacts of pulmonary tuberculosis patients at the Public Health Service (Amsterdam, the Netherlands) from 2008 to 2011. Additional data were obtained from the national tuberculosis register. ⋯ Starting treatment was associated with Dutch nationality (aOR 2.6, 95% CI 1.2-5.4) and being a close contact (aOR 10.5, 95% CI 1.5-70.7). Treatment completion was achieved by 129 (91%) of the 142 contacts who started treatment. Two areas for improvement were identified: further expanding LTBI screening, particularly among BCG-vaccinated contacts and contacts of sputum smear-negative index patients, and expanding preventive treatment among contacts with LTBI.