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Pneumonia 101: When to Admit and When to Treat Outpatient

Pneumonia 101: When to Admit and When to Treat Outpatient

Medscape5 days ago
This transcript has been edited for clarity.
Pneumonias are very commonly encountered diagnoses and something that we see in many patients, whether it is in the outpatient field, in urgent care, or in a hospital.
We treat these patients generally based off symptoms, whether they're acute, mild, moderate, or chronic, even.It's important for us to check out what type of organism is growing within their sputum. This can help guide us in terms of therapies.
We can use different scores, like the pneumonia severity index or the CURB-65, to guide us as to whether a patient needs to be hospitalized or we feel we need to escalate care from oral to [intravenous] antibiotics.
Sometimes these patients require hospitalization in the ICU with mechanical ventilation to give them a chance to recover, their lungs to function better, and to help with the mucus and sputum that they are feeling.
It's important to remember prevention strategies for our patients, as some of our patients are chronically sick and can get worse with pneumonia. Aspiration precautions are very important.
Also, it is important for patients to get vaccinations, such as pneumococcal, [ respiratory syncytial virus], flu, and COVID-19, for which they are indicated. Making sure to counsel our patients on vaccinations can be important and life changing.
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Children's National Hospital in DC to end gender transition medical interventions

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This may mean that they are able to reduce their medication or put themselves into the prediabetes category, rather than fully reversing it, she says. Base meals on 'real' foods If you begin cutting out carbohydrates and sugar, you may naturally find yourself gravitating towards whole foods, such as protein, vegetables and dairy, Gowers says. 'Make sure you have a good amount of veg to fill you up – it also offers lots of fibre,' she notes. A large portion of broccoli, courgette or green beans can substitute mash, pasta or rice – and they can still be covered with gravy, Bolognese or curry. Thinly sliced cabbage that has been lightly boiled is a great low-carb option instead of tagliatelle, she notes. 'The idea is that the fewer carbs you're eating, your body shifts to burning fat, so you're going to be able to utilise your stored fat to fuel your body, rather than the sugar you were eating before,' she explains. 'The note of caution is that you don't want to add loads of extra fat when you're trying to lose weight – but it will fill you up. It's just eating real food and the fat that comes with that food.' It's also recommended not to eat too much processed meat, which includes ham, bacon and sausages. Snacking is generally not recommended, though some crudités with full-fat hummus, a couple of squares of dark chocolate or a few plain nuts won't spike your blood sugar or leave you feeling hungry, she says. 'But people find that they don't need all of those extra snacks that they were used to having before.' Have enough water and salt In the early stages of following the low-carb diet, it's important to make sure you're drinking plenty of water and having enough salt, Gowers says. 'When you switch over from having a diet that's very high in carbohydrates to low-carb, you may initially become dehydrated and get headaches or constipation,' she says. 'Insulin disrupts the way you process salt so you're releasing a lot of the salt and water that your kidneys were holding on to,' she explains. 'One of the reasons that people lose weight quite quickly is because you're losing all of that water retention.' As a result, you need to make sure you're replacing the lost salt, which you can simply do by adding salt to your meals as you cook them or adding an extra stock cube to your meals, as these are high in salt, she says. 'Having sufficient water and salt means you're not going to be dehydrated and you're less likely to get headaches, cramps and feel a bit lethargic as you transition to using fat as your fuel.' Have a support network When overhauling your diet, it's vital to have a support network around you to help you stay on track, Gowers says. 'Long-term support is what makes the difference,' she notes. It's especially important that it's available when people feel like they've drifted off their diet and are trying to get back on it again. On the eight-week TLC course, there are weekly 90-minute Zoom sessions overseen by a health coach. Once the course is finished, people are invited to monthly catch-up meetings, where there are guest speakers, such as consultants and chefs. There are also Facebook and WhatsApp groups for people to chat to each other or suggest low-carb meal ideas, and some meet for coffee or go for walks together, she says. 'It's keeping the momentum going,' she says. If you don't join the course, you can enlist the help of friends and family to keep you on track. It's initial intensive support, as well as the long-term support after the course, that is vital to ensure patients stick to the healthy changes they've made, Gowers explains. 'People can dip in and dip out; it's not that everybody needs the support all the time but you've got to be there so that when someone needs it, you're there to help and get them back on track.' Prioritise diet over exercise While exercise is excellent for health, diet is the focus when it comes to reversing type 2 diabetes, according to Gowers. 'It's what's going to give you 70 per cent of the benefits,' she says. However, you're much more likely to maintain your dietary changes if you bring in some exercise as well, so it's important to be more active, even if it's not straight away when you first try the diet, she notes. 'Once you've regained some metabolic health, you've lost a bit of weight, you're feeling so much better, you are much more likely to want to do some exercise. 'Don't beat yourself up trying to go to the gym three times a week at the beginning; start with diet and naturally you will feel more like moving about as time goes on.' 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