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1.
Int J Tuberc Lung Dis ; 24(1): 36-42, 2020 01 01.
Article in English | MEDLINE | ID: mdl-32005305

ABSTRACT

CONTEXT: Adherence to treatment for tuberculosis (TB) is an important predictor of treatment outcomes. The World Health Organization guidelines recommend a patient-centred approach to adherence support; however, the extent to which policies in high-burden countries facilitate this approach remains uncertain.DESIGN: A cross-sectional survey of current national patient care and support policies in high TB burden countries was performed.RESULT: Responses were provided by TB care programmes in 23 of the 30 high TB burden countries, comprising 77.4% of TB cases globally. Clinic-based and household adherence support and patient education were recommended in all countries, while policies for digital technologies and social supports have been adopted in a small minority of countries. Financial or material support (such as reimbursement for transportation) and psychological support to patients-if included in the policies-was mainly recommended only for specific sub-groups of patients.CONCLUSION: National policies in many countries have not yet fully adopted global recommendations for patient care and support. Further scale-up of evidence-based approaches to care is required to improve quality of care for patients in high TB burden settings.


Subject(s)
Tuberculosis , Cross-Sectional Studies , Humans , Patient Care , Policy , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Tuberculosis/therapy , World Health Organization
2.
Int J Tuberc Lung Dis ; 7(9 Suppl 1): S63-71, 2003 Sep.
Article in English | MEDLINE | ID: mdl-12971656

ABSTRACT

SETTING: Kiboga District, a rural district in central Uganda. OBJECTIVE: As part of routine tuberculosis control programme operations, to measure the effectiveness and acceptability of community-based tuberculosis (TB) care using the directly observed treatment, short-course (DOTS) strategy for TB control. The implementation of the DOTS strategy with active participation of local communities in providing the option of treatment supervision in the community is known in Uganda as community-based DOTS (CB-DOTS). DESIGN: Effectiveness was measured by comparing TB case-finding and treatment outcomes before and after the introduction of CB-DOTS in 1998. Acceptability was measured by administering a knowledge, attitudes and beliefs questionnaire to community members, health care workers and TB patients before and after the intervention. RESULTS: A total of 540 TB patients were registered in the control period (1995-1997) before the introduction of CB-DOTS, and 450 were registered in the intervention period (1998-1999) after the implementation of CB-DOTS. Following the implementation of CB-DOTS, treatment success among new smear-positive pulmonary TB cases increased from 56% to 74% (RR 1.3, 95%CI 1.2-1.5, P < 0.001) and treatment interruption decreased from 23% to 1% (RR 16.5, 95%CI 6.1-44.7, P < 0.001). There was no significant difference in the proportion of deaths before and after the implementation of CB-DOTS (15% vs. 14% for new smear-positive pulmonary, and 38% vs. 29% for new smear-negative and extra-pulmonary TB cases). The acceptability of CB-DOTS was very high among those interviewed, mainly because CB-DOTS improved access to TB care, decreased costs and enabled patients to stay with their families. CONCLUSIONS: In enabling patients to choose TB treatment supervision in the community, CB-DOTS provided a highly effective and acceptable additional option to conventional TB care. Efforts are underway to address the high case fatality rates in both study groups before and after the introduction of CB-DOTS. CB-DOTS is an example of shared responsibility between health services and communities in tackling a major public health priority.


Subject(s)
Community Health Services/statistics & numerical data , Tuberculosis, Pulmonary/prevention & control , Community Health Workers , Female , Health Care Reform , Humans , Male , Patient Compliance , Program Evaluation , Rural Population , Treatment Outcome , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/mortality , Uganda/epidemiology
3.
Int J Tuberc Lung Dis ; 7(9 Suppl 1): S72-9, 2003 Sep.
Article in English | MEDLINE | ID: mdl-12971657

ABSTRACT

SETTING: Kiboga district, a rural area in Central Uganda. OBJECTIVE: To assess the cost and cost-effectiveness of community-based care for new smear-positive pulmonary tuberculosis patients compared with conventional hospital-based care. METHODS: Costs were analysed from the perspective of health services, patients, and community volunteers in 1998 US dollars, using standard methods. Cost-effectiveness was calculated as the cost per patient successfully treated. FINDINGS: The cost per patient treated for new smear-positive patients was dollars 510 with the conventional hospital-based approach to care (dollars 419 for the health system and dollars 91 for patients), and dollars 289 with community-based care (dollars 227 for health services, dollars 53 for patients and dollars 9 for volunteers). Important new costs associated with community-based care included programme supervision (dollars 18 and dollars 9 per patient at central and district levels, respectively) and training (dollars 18 per patient). The cost per patient successfully treated was dollars 911 with the hospital-based strategy and dollars 391 with community-based care, reflecting both lower costs and higher effectiveness (74% vs. 56% successful treatment rate) with community-based care. Length of hospital stay fell from an average of 60 to 19 days. CONCLUSION: There is a strong economic case for the implementation of community-based care in Uganda.


Subject(s)
Community Health Services/economics , Health Care Costs/statistics & numerical data , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/economics , Community Health Services/statistics & numerical data , Cost-Benefit Analysis , Costs and Cost Analysis , Humans , Rural Health Services , Uganda
4.
Chir Organi Mov ; 82(3): 249-61, 1997.
Article in English, Italian | MEDLINE | ID: mdl-9494242

ABSTRACT

With regard to increasing reservations as to homologous transfusions and the objective risks that they involve, since 1984 we have been using an autotransfusion technique in total hip arthroplasty constituting blood predeposit for hemodilution, and intra- and postoperative blood recovery. When this method was used postoperative complications were not very significant even when patients were high-risk (cardiopathic); furthermore, the use of homologous transfusions was required in 2.2% of the patients in 1994 as compared to 90% in 1985. The use of our orthopaedic protocol allows for rapid recovery of movement in the patient thus reducing time bed-ridden and related risks (DVT and/or PTE); the transfusion protocol allows for a return to normal of hemodynamic conditions a few days after surgery. Finally, the reduced incidence of complications caused by homologous transfusions (hepatitis, AIDS...) constitutes a financial saving for the government.


Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Blood Transfusion, Autologous , Aged , Dental Cementum , Diabetes Mellitus/physiopathology , Female , Humans , Intraoperative Period , Male , Middle Aged , Myocardial Ischemia/physiopathology , Postoperative Period , Treatment Outcome
5.
Br J Anaesth ; 79(5): 662-4, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9422909

ABSTRACT

Using a prospective audit, we have evaluated the efficacy of an integrated autotransfusion regimen which comprised predepositing and intra- and postoperative blood salvage in major orthopaedic surgery. We examined prospectively the records of 1785 patients (1198 females, 5867 males, mean age 62 (range 16-90) yr, preoperative haemoglobin concentration 13.4 (SD 1.4) g dl-1) undergoing total hip arthroplasty (THA, 1229 patients), THA after removal of internal fixation devices (RFD + THA, 18 patients), total knee arthroplasty (TKA, 263 patients), revision surgery of the hip (HR cup + stem revision, 197 patients; cup revision, 53 patients; stem revision, 16 patients) and total knee revision (TKR, nine patients). We estimated that the number of predonations (MSBOS = maximum surgery blood order schedule) was 2 u. for THA, TKA and TKR, and 3 u. for partial or total hip revision and total hip arthroplasty with fixation removal. We found that it was possible to obtain the MSBOS in 1597 patients (89.5%). Homologous red blood cell (HRBC) transfusions were carried out in 131 patients (7.3%). We found that the need to use HRBC was significantly associated with failure to meet the number of MSBOS, female sex, lower preoperative haemoglobin concentration, use of calcium heparin for antithrombosis prophylaxis, more extensive surgery, higher ASA rating and co-existing diseases such as coronary artery disease.


Subject(s)
Arthroplasty, Replacement , Blood Transfusion, Autologous , Adolescent , Adult , Aged , Aged, 80 and over , Evaluation Studies as Topic , Female , Hemoglobins/metabolism , Humans , Intraoperative Care/methods , Male , Medical Audit , Middle Aged , Postoperative Care/methods , Prospective Studies , Risk Factors
6.
Int J Artif Organs ; 18(3): 159-66, 1995 Mar.
Article in English | MEDLINE | ID: mdl-7499019

ABSTRACT

The anaesthesiologist plays a central role in co-ordinating the combined application of the various blood saving techniques. In fact, to carry out transfusion therapy correctly, the anaesthesiologist must plan the right number of units of predeposit blood during the first examination, estimate the salvage of intra and post operative blood loss and spread the infusion of the units over the first three days in order to keep the patient in a state of haemodilution. From January 1992 to June 1994 in the department of anaesthesia and the intensive care unit, 980 patients were treated for total joint replacement: 714 total hips (7 after removal of plates and screws) 145 revisions, and 121 total knee prostheses. Basal Hb was 13.4 +/- 1.4 g/dl (range 6.7-17.9 g/dl). Homologous transfusions were carried out in 6.3% of these patients. The need to use homologous transfusions was negatively influenced by female sex, coronary heart disease (p = 0.005), length of surgery and type of antithromboembolic prophylaxis (indobufen has a significantly low incidence-p = 0.0001--compared to calcium heparin or low molecular weight heparin).


Subject(s)
Anesthesiology/methods , Blood Transfusion, Autologous/standards , Hemoglobins/metabolism , Adult , Aged , Aged, 80 and over , Anesthesiology/standards , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Coronary Disease/physiopathology , Female , Hemodilution/standards , Hemoglobins/analysis , Heparin/administration & dosage , Heparin/therapeutic use , Hip Prosthesis/adverse effects , Humans , Intraoperative Complications/prevention & control , Isoindoles , Knee Prosthesis/adverse effects , Longitudinal Studies , Male , Middle Aged , Phenylbutyrates/administration & dosage , Phenylbutyrates/therapeutic use , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/therapeutic use , Postoperative Complications/prevention & control , Sex Factors , Thromboembolism/prevention & control
7.
Chir Organi Mov ; 80(1): 57-9, 1995.
Article in English, Italian | MEDLINE | ID: mdl-7641542

ABSTRACT

The aim of this study was to assess the pattern of adaptation to severe Haemodilution in pts with normal or stenotic carotid vessels. We enrolled 180 consecutive pts undergoing total hip replacement: 138 pts had echo-Doppler documented normal carotid arteries, 10 pts had kinking and 32 pts had monolateral or bilateral stenosis of internal carotid arteries (lesions, class of stenosis 1-49%). Haemoglobin values on the 4th day after surgery was 8.7 +/- 1.2 g/dl with no statistically significant differences in pts (patients) with carotid disorders versus normal pts. No pt showed clinical signs of cerebral ischemia or brain damage in the postoperative period. These results are consistent with experimental and clinical data showing that normovolaemic anaemia is well tolerated without disabling symptoms in pts with mild or moderate stenosis of carotid arteries.


Subject(s)
Carotid Artery Diseases/complications , Hemodilution , Hip Prosthesis , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/physiopathology , Carotid Stenosis/complications , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/physiopathology , Hematocrit , Hemodynamics , Humans , Ischemic Attack, Transient/etiology , Risk Factors , Ultrasonography, Doppler
8.
Clin Chim Acta ; 145(3): 259-65, 1985 Feb 15.
Article in English | MEDLINE | ID: mdl-3987029

ABSTRACT

Spectrin extractability was measured in the erythrocyte membranes from patients with Duchenne Muscular Dystrophy (DMD), from DMD definite carriers (in whom serum creatine kinase (CK) was also measured) and patients affected by other myopathies. After the extraction of spectrin from ghosts with EDTA, membrane proteins were examined using sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Spectrin extractability was also investigated in the presence of an excess of calcium. Spectrin extraction from erythrocyte ghosts was significantly reduced with respect to controls in DMD patients, in DMD definite carriers and in patients affected by limb-girdle dystrophy, but not in patients suffering from other non-dystrophic myopathies. Fifty percent of DMD definite carriers showed a reduced extraction of spectrin and some of them had normal serum CK. Reduced extractability was also observed in red blood cells incubated in media containing excess calcium. Our results could suggest that reduced spectrin extractability is connected with a modification of intracellular calcium levels.


Subject(s)
Erythrocyte Membrane/analysis , Muscular Dystrophies/blood , Spectrin/isolation & purification , Adolescent , Adult , Calcium/blood , Child , Child, Preschool , Female , Heterozygote , Humans , Male , Muscular Dystrophies/genetics
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