***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: STUDY OBJECTIVES The long-term outcomes of patients with community-acquired pneumonia ( CAP ) in terms of symptom resolution and health-related quality of life ( HRQL ) is unknown . Our objective was to determine the rate of symptom resolution using vali date d patient-based outcome measures , and to assess HRQL 18 months after the episode . PARTICIPANTS Patients were recruited from a group enrolled in a r and omized trial comparing two duration s of treatment for CAP . Between 2000 and 2003 , we included 102 adults with a mild-to-moderate-severe CAP ( pneumonia severity index , < or = 110 ) . INTERVENTIONS CAP-related symptoms were assessed until month 18 using the CAP score . The CAP score was divided into respiratory and well-being sections to assess the recovery of respiratory and well-being symptoms separately . The HRQL was assessed at 18 months using the Medical Outcomes Study 36-item short form ( SF-36 ) question naire and compared to a Dutch reference group . RESULTS Respiratory symptoms resolved within 14 days , while the well-being symptoms resolved more slowly . Taking the prepneumonia status into account , patients recovered fully from pneumonia after 6 months . Patients with comorbid conditions had significantly more symptoms prepneumonia and during follow-up than patients without comorbidities , but at all time points the proportion of patients that reached > or = 80 % of the prepneumonia health level did not depend on comorbidity , age , or etiology . SF-36 scores at 18 months were significantly impaired in four of the eight dimensions for patients with comorbid illness , but did not differ from the reference population for patients without comorbid illness . CONCLUSION Patients with mild-to-moderate-severe CAP recover fully from pneumonia after 6 months . The presence of symptoms beyond 28 days and any impairment in HRQL were found to reflect age and comorbidity rather than the persistent effects of the pneumonia itself Background : A short but sensitive question naire evaluating changes in respiratory symptoms and well being during the treatment of community acquired pneumonia ( CAP ) is needed . We have developed a measurement and evaluated its psychometric properties in 67 patients admitted with CAP . Methods : The patients were asked to indicate the presence and severity of dyspnoea , coughing , coughing up sputum , coughing up sputum with ease , the colour of the sputum , fatigue , fitness , and their state of health . The item fatigue showed substantial overlap with fitness and was therefore excluded . The response of the patients to the remaining eight items was used to calculate a CAP score . Results : The percentage of missing data ( 0.2–1.7 % ) , floor and ceiling effects ( 0.2/5.5 % ) , internal consistency ( Cronbach α = 0.87 ) , and the intraclass correlation coefficient for test-retest reproducibility ( 0.83 ) met predefined criteria , indicating good acceptability and reliability . Face and clinical validity were satisfactory . Effect sizes under treatment were large , indicating high responsiveness . Conclusion : The newly developed CAP score is a simple , reliable , valid , and highly responsive instrument . This makes it scientifically sound and clinical ly relevant for measuring outcome when evaluating treatment strategies in CAP CONTEXT Although observational studies suggest that clinical pathways may decrease costs and improve quality in hospitalized patients with community-acquired pneumonia , inferences from these studies are limited by potential selection bias and inadequate case-mix adjustment . OBJECTIVE To compare the assessment of a clinical pathway for community-acquired pneumonia with and without adjusting for patient characteristics and disease severity . DESIGN Retrospective cohort study . PATIENTS AND SETTING Consecutive series of adult patients admitted with clinical diagnosis of community-acquired pneumonia , treated with either a clinical pathway ( which included guidelines for antibiotics , tests , and ancillary care )  or usual care . MAIN OUTCOME MEASURES Total hospital charges , length of stay , clinical deterioration ( requiring mechanical ventilation or intensive care unit transfer ) , and in-hospital mortality . We used multiple linear and logistic regression to adjust for patient case mix . RESULTS Compared with patients receiving usual care ( n = 275 ) , patients in the pathway group ( n = 97 ) were more likely to be treated by family physicians than specialists and had lower pneumonia severity scores . In the unadjusted analysis , total hospital charges were lower among pathway patients ( $ 2456 ; 95 % CI , $ 175 to $ 4737 ; P = 0.04 ) ; in the adjusted analysis , the difference in total charges was smaller ( average reduction $ 1807 ; CI , $ 4164 lower to $ 549 higher ; P = 0.13 ) . In the unadjusted analysis , length of stay was lower among pathway patients ( 1.8 days lower ; CI , 3.9 lower to 0.4 higher ; P = 0.12 ) ; in the adjusted analysis , the difference in length of stay was smaller ( 0.9 days lower ; CI , 3.2 lower to 1.3 higher ; P = 0.4 ) . Although unadjusted analysis showed significantly lower in-hospital mortality in pathway patients , this difference was not confirmed in the adjusted analysis . CONCLUSIONS Clinical pathways may reduce costs and improve quality of care in community-acquired pneumonia . In nonr and omized studies , however , selection bias and case-mix differences may explain some of the apparent effectiveness Based on recent guidelines for the management of community-acquired pneumonia , this study was design ed to evaluate the effectiveness of a new fluoroquinolone compared with st and ard antimicrobial regimens , in conditions relating as closely as possible to the real world setting . In this study , 564 patients were r and omised to either oral moxifloxacin ( 400 mg o.d . ) or to st and ard oral therapy ( amoxicillin 1 g t.i.d . or clarithromycin 500 mg b.i.d . alone or in combination ) for up to 14 days using a double-blind procedure . The choice between the three st and ard regimens was made by the clinician prior to r and omisation . Clinical response , quality of life , symptoms , healthcare re sources and safety were assessed . In the per- protocol population , clinical success was reported for 201 of 215 ( 93.5 % ) and 217 of 231 ( 93.9 % ) in the moxifloxacin and st and ard groups , respectively , at 7–10 days post-therapy . At 28–35 days follow-up , continued clinical cure was observed in 183 of 192 ( 95.3 % ) moxifloxacin and 207 of 221 ( 93.7 % ) st and ard groups . Drug-related adverse events were reported in 55 of 274 ( 20 % ) moxifloxacin and 86 of 279 ( 31 % ) st and ard patients with diarrhoea > 5 % . Oral moxifloxacin monotherapy was as effective as , and better tolerated than , optimal antibiotic strategy represented either by mono- or combination therapy ( amoxicillin and /or clarithromycin ) in community-acquired pneumonia management In a population -based study , the consumption of re sources for treating adult patients with community-acquired pneumonia was determined . During a 2‐yr period , all cases with a clinical and radiological suspicion of community-acquired pneumonia that occurred in patients aged > 14 yrs in a community of 74,610 inhabitants were investigated prospect ively . Of 292 cases with a suspicion of community-acquired pneumonia , 224 were included ( 18.5 % misdiagnoses ) . The mean number of visits per patient was 4.5 ( 72 % in the primary care setting ) . Inpatient care was recommended in 59.8 % of cases ; after discharge , 44 % of patients were managed in outpatient clinics . The mean direct cost of pneumonia treated in the hospital setting was (euros)1,553 , whereas the mean cost of cases treated as out patients was 196 . A total of 15.7 % of admissions were considered inappropriate and the length of stay could have been reduced by 3.5 days in the most severe cases . A reduction in inappropriate admissions and lengths of hospital stay would result in a decrease in cost of 17.4 % . Community-acquired pneumonia in Maresme , Spain , occurs at a low incidence , although with a high percentage of hospitalisations ( in part inappropriate ) , result ing in considerable costs CONTEXT Large variations exist among hospitals in the use of treatment re sources for community-acquired pneumonia ( CAP ) . Lack of a common approach to the diagnosis and treatment of CAP has been cited as an explanation for these variations . OBJECTIVE To determine if use of a critical pathway improves the efficiency of treatment for CAP without compromising the well-being of patients . DESIGN Multicenter controlled clinical trial with cluster r and omization and up to 6 weeks of follow-up . SETTING Nineteen teaching and community hospitals in Canada . PATIENTS A total of 1743 patients with CAP presenting to the emergency department at 1 of the participating institutions between January 1 and July 31 , 1998 . INTERVENTION Hospitals were assigned to continue conventional management ( n = 10 ) or implement the critical pathway ( n = 9 ) , which consisted of a clinical prediction rule to guide the admission decision , levofloxacin therapy , and practice guidelines . MAIN OUTCOME MEASURES Effectiveness of the critical pathway , as measured by health-related quality of life on the Short-Form 36 Physical Component Summary ( SF-36 PCS ) scale at 6 weeks ; and re source utilization , as measured by the number of bed days per patient managed ( BDPM ) . RESULTS Quality of life and the occurrence of complications , readmission , and mortality were not different for the 2 strategies ; the 1-sided 95 % confidence limit of the between-group difference in the SF-36 PCS change score was 2.4 points , which was within a predefined 3-point boundary for equivalence . Pathway use was associated with a 1.7-day reduction in BDPM ( 4.4 vs 6.1 days ; P = .04 ) and an 18 % decrease in the admission of low-risk patients ( 31 % vs 49 % ; P = .01 ) . Although in patients at critical pathway hospitals had more severe disease , they required 1.7 fewer days of intravenous therapy ( 4.6 vs 6.3 days ; P = .01 ) and were more likely to receive treatment with a single class of antibiotic ( 64 % vs 27 % ; P<.001 ) . CONCLUSION In this study , implementation of a critical pathway reduced the use of institutional re sources without causing adverse effects on the well-being of patients Recent clinical trials in patients with community-acquired pneumonia ( CAP ) demonstrated that switching from intravenous to oral antibiotic therapy is safe once clinical improvement is evident , thereby facilitating early hospital discharge . This study evaluated the use of a critical pathway to improve the efficiency of treating CAP in 1743 patients at 19 teaching and community hospitals in Canada . Hospitals were r and omized to continue conventional management of CAP ( 10 hospitals ) or implement a critical pathway ( 9 hospitals ) . The main clinical outcome measure was patients ' scores ( assessed 6 wks after hospital presentation ) on the Short-Form 36 Physical Component Summary , a quality -of-life question naire . Secondary clinical outcome measures included occurrence of complications , readmission rates , and mortality . The primary economic outcome measure was re source utilization , measured by the number of bed days/patient managed ( BDPM ) . Clinical outcomes were good in both groups , with no significant differences between the two management strategies . However , use of the clinical pathway was associated with a 1.7-day reduction in BDPM and fewer admissions of low-risk patients OBJECTIVE The purpose of this study was to assess use of a critical pathway design ed to manage community-acquired pneumonia more efficiently than its management with conventional therapy . METHODS Economic outcomes were assessed in conjunction with a cluster- design , r and omized , controlled trial . Nineteen participating Canadian hospitals were r and omized to implement the critical pathway ( n = 9 ) or conventional therapy ( n = 10 ) . The critical pathway included a clinical prediction rule to guide the admission decision , treatment with levofloxacin , and practice guidelines .  Patient data on medical re source use , lost productivity , and quality of life  were collected prospect ively for > or = 6 weeks after treatment . Costs were calculated from the government , health care system , and societal perspectives , with imputation of missing outpatient costs and the costs of lost productivity when necessary . Bootstrapping was used to identify 95 % CIs for the total cost per patient . RESULTS The analysis included all eligible patients in the critical pathway ( n = 716 ) and conventional therapy ( n = 1027 ) arms . There were fewer hospital admissions in the critical pathway arm than in the conventional therapy arm , both overall ( 46.5 % vs 62.2 % ; P = 0.01 ) and in low-risk patients ( 33.2 % vs 46.8 % ; P < 0.001 ) . Compared with conventional therapy , hospitals in the critical pathway arm had 1.6 fewer bed days per patient managed ( P = 0.05 ) and used fewer inpatient medical re sources . The 2 study arms had similar outpatient , readmission , and lost-productivity costs , and similar quality -of-life outcomes . The critical pathway produced cost savings from all 3 perspect 
    Output:
    
There are only very limited and , furthermore , out date d data available on the costs and quality of life impacts of CAP .