Mortality, Re-Hospitalization, and Anginal Symptoms in Patients with Subjective Anxiety and Depression Undergoing Non-Emergent Percutaneous Coronary Intervention Resident: Aaron Soufer MD Mentor: Jeptha Curtis MD Background: Coronary artery disease (CAD) patients with co-morbid depression and anxiety

Is there Seasonal Variation in Nursing Home Acquired Pneumonia? Shelli Farhadian, M.D., Ph.D., Peter Van Ness, Ph.D., M.P.H., Vincent Quagliarello, M.D. Background: Pneumonia is a leading cause of hospitalization among elderly adults, and particularly among nursing home residents. The seasonal variation in nursing home acquired pneumonia is not yet known. Studies to date on seasonal variation in pneumonia have focused exclusively on community dwelling adults. These studies find that the peak month for community acquired pneumonia (CAP) admissions was January (43% of cases), and that the months of March to May had relatively high rates of CAP admission. It is difficult, though, to extrapolate this information to a population of elderly, nursing-home residing adults. Specific Aim: To investigate the seasonal pattern of pneumonia in a cohort of older nursing home residents Hypotheses: 1. There is evidence of seasonal variation in the occurrence of the first pneumonia in a study nursing home cohort Methods: This is a secondary analysis of a cohort in which participants are nursing home residents in the New Haven area. We utilized a database already collected for a recently completed clinical trial which tested the role of a multicomponent protocol targeting oral hygiene and swallowing difficulty in an attempt at preventing nursing home acquired pneumonia. The study participants were residents of nursing homes in the New Haven area, where the average annual pneumonia incidence rate is approximately 18.9%. All study participants were observed for an average of 1.13 years (up to a maximum of 2.5 years). Pneumonia was defined by the presence of a compatible radiographic infiltrate on chest x-ray plus at least two clinical features. Subjects were considered to be at risk for pneumonia from the time they enrolled in the study until death or until the study ended. Given a fixed sample size of 12 outcome data points in the time series, no statistical tests were performed, due to lack of adequate power. Results: Of 213 total first pneumonias, 43 (20%) occurred in Fall, 55 (26%) in Spring, 60 (28%) in Summer, and 55 (25%) in Winter. There were likewise no seasonal trends in nursing home acquired pneumonia when participants were stratified according to control or intervention arm of the original clinical trial. Conclusion: Although this study was not powered to find statistical significance, our results suggest that nursing home acquired pneumonia does not follow the familiar seasonal trend of pneumonia in community dwelling adults. This suggests that modes of acquisition and transmission of pneumonia are unique in the nursing home population, and this may provide a basis for future intervention to decrease nursing home acquired pneumonia.