Life In The Slower Lane

Here is the structured PICO analysis for the thirteenth article you uploaded:

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Full Title (verbatim and exact):

“Pneumonia-Associated Emergency Transfers, Functional Decline, and Mortality in Nursing Home Residents”

Guion V, Sabra A, Martin C, et al.

Journal of the American Medical Directors Association (JAMDA), 2023; 24(6):747–752

DOI: https://doi.org/10.1016/j.jamda.2023.02.108

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Type of Article:

Case-control observational multicentre study (secondary analysis of the FINE study)

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PICO Analysis:

Population:

• 1037 nursing home residents (NHRs) transferred to 17 emergency departments (EDs) in France
• Mean age: 87.2 ± 7.1 years; 68.4% women
• Residents were transferred during 4 nonconsecutive weeks in 2016 (one per season) 

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Intervention:

• Pneumonia diagnosis during ED visit or hospitalisation
• Patients identified with pneumonia (n = 232; 22.4%) were compared to those without pneumonia

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Comparator:

• NHRs without pneumonia (n = 805; 77.6%) during the same ED transfer events

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Outcome:

1. Person-centred outcomes:

• Mortality:
  • Pneumonia group: 24.1% mortality
  • Non-pneumonia group: 8.7% mortality
  • Significant difference (P < .001)
• Functional capacity (Katz ADL scale):
  • Median ADL decreased from 2.0 to 1.5 in the pneumonia group
  • Stable at 2.0 in the non-pneumonia group
  • However, no statistically significant difference in functional change between groups (P = .414) 

2. Process outcomes:

• Pneumonia cases had:
  • Higher ED and hospital length of stay
  • More frequent hospital admission (81.8% vs 46.1%)
  • More symptoms prior to transfer (dyspnoea, fever, fatigue, drowsiness) 

3. Health system outcomes:

• Pneumonia-associated ED transfers contributed to longer care pathways and significantly greater system use
• Suggests potential for early symptom recognition (e.g., dyspnoea, fever, anorexia, fatigue, drowsiness) to prevent ED transfers through earlier on-site management 

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Summary Conclusion:

This study highlights that pneumonia in nursing home residents is a major contributor to mortality following emergency department transfer, though not independently associated with increased functional decline. It suggests a weeklong prodrome of symptoms that could be used to identify early cases and potentially prevent ED transfers through timely on-site intervention. The findings support improving pneumonia risk stratification, advance care planning, and proactive management in residential aged care settings.

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