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Community-acquired pneumonia (CAP) remains a common and serious clinical problem despite the availability of potent antibiotics and aggressive supportive measures. The management of CAP begins with recognition of the likely pathogens causing the illness in the individual patient; identification of several simple clinical clues allows the organization of the broad variety of possible organisms into a more manageable list of likely pathogens. Once the most likely pathogens are identified, then initial antibiotics may be chosen to cover those possibilities. A number of treatment guidelines have been introduced in the past 10 years, most of which share more similarities than differences. We review 2 of the more established guidelines, those published by the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA). We also review the likely modifications of the ATS guidelines and discuss the impact of bacterial resistance on antibiotic choices.

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Pulmonary rehabilitation measures acquired a poor reputation when early studies failed to demonstrate improvements in traditional pulmonary function tests. However, current evidence now indicates that such measures benefit patients with severe chronic obstructive pulmonary disease (COPD). Alleviation of symptoms, improved quality of life, improved nutrition, and decreased health care costs are some of the benefits seen in patients who successfully complete a rehabilitation program. This article reviews the role of a comprehensive rehabilitation program in the continuing care of the patient with severe COPD, the components of such a program, and specific measures to be considered.

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Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality in the United States. The ideal of a simple diagnostic evaluation yielding a specific etiologic diagnosis allowing directed antimicrobial therapy remains elusive. Empiric therapy is justified as initial management, as the specific bacteriological etiology of most cases of CAP is usually unknown, and delaying therapy while attempting to find a diagnosis may be injurious to the patient. Guidelines have been developed to assist in the recognition and evaluation of CAP based on age and underlying medical illness as predictors of outcome. While these criteria are by no means perfect and cannot be applied to every individual, they offer a rational approach to the initial management of the patient.

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In response to the current emphasis on health maintenance and disease prevention, the authors developed a comprehensive education program in which sophomore medical students interview a standardized patient about breast problems and risk factors, receive one-on-one instruction from the standardized patient during the clinical breast examination, and practice recommendations for screening and instruction in breast self-examination. In this pilot study sophomore students who underwent the comprehensive education program were compared with students who received the traditional, didactic instruction and practiced on plastic breast models. The students who received the didactic instruction had mean scores on a multiple-choice knowledge-base pretest and posttest of 54.6% and 76.8%, respectively. The students who participated in the comprehensive education program had mean pretest and posttest scores of 51.2% and 78.5%, respectively. All students participated in a practical test of the clinical breast examination during an objective structured clinical examination. The students who had received the didactic instruction scored 69.9% (mean), compared with 84.1% for the students who had had the comprehensive education program. The comprehensive breast education program teaches medical students about risk factors, screening recommendations, and clinical breast examination more effectively than do traditional didactic methods.

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