ABSTRACT
Tuberculosis (TB) patients who do not complete treatment pose a potential public health risk. In West Yorkshire, local clinicians suspected that this risk was overestimated by the national Enhanced Tuberculosis Surveillance system. We audited patients who failed to complete treatment and were categorised as lost-to-follow-up (LTFU) between 2004 and 2008, using a combination of hand searching existing records and obtaining additional information from clinicians. In the study period 2,031 TB cases with reported outcome were notified in West Yorkshire, 23% (n=474) did not complete treatment, and 199 (42%) of those were categorised as LTFU 12 months after notification. Of these 199, 49% (n=98) remained LTFU after the audit, 51% (n=101) were re-classified to the following categories: 24% (n=47) transferred abroad, 16% (n=31) recommenced and completed treatment, 6% (n=13) transferred to another clinic in the United Kingdom (UK), and 5% (n=10) died. These patients therefore no-longer posed a public health risk. Further training for clinicians to improve accuracy of outcome reporting has been initiated. Nationally, the collection of treatment outcome data needs to be strengthened and extending the follow-up for treatment outcome monitoring should be considered.
Subject(s)
Disease Notification/standards , Lost to Follow-Up , Outcome Assessment, Health Care/statistics & numerical data , Tuberculosis, Pulmonary/therapy , Adult , Clinical Audit , Databases, Factual , Disease Notification/statistics & numerical data , England/epidemiology , Female , Follow-Up Studies , Humans , Information Storage and Retrieval/standards , Male , Middle Aged , Outcome Assessment, Health Care/trends , Patient Compliance/ethnology , Patient Compliance/statistics & numerical data , Patient Transfer/statistics & numerical data , Population Surveillance , Risk Factors , Time Factors , Treatment Outcome , Treatment Refusal , Tuberculosis, Pulmonary/ethnology , Tuberculosis, Pulmonary/mortalityABSTRACT
The prevalence of thyroid disease and thyroid autoantibodies was evaluated in 367 patients with polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA). Thirty-seven patients had antibodies to thyroid microsomes or thyroglobulin; 18 had hypothyroidism requiring thyroxine replacement therapy. The prevalence of hypothyroidism (4.9%) was significantly greater than that found in 84 control subjects.
Subject(s)
Giant Cell Arteritis/complications , Hypothyroidism/complications , Polymyalgia Rheumatica/complications , Aged , Aged, 80 and over , Autoantibodies/analysis , Autoimmune Diseases/complications , Autoimmune Diseases/epidemiology , Autoimmune Diseases/immunology , England/epidemiology , Female , Humans , Hypothyroidism/epidemiology , Hypothyroidism/immunology , Male , Microsomes/immunology , Middle Aged , Prevalence , Prospective Studies , Thyroglobulin/immunology , Thyroid Gland/immunologyABSTRACT
One cause of post-operative morbidity in the elective repair of abdominal aortic aneurysms is the development of a paralytic or 'adynamic' ileus. In a series of 20 consecutive patients undergoing such a procedure, the maintenance of small bowel motility and absorptive capacity in the immediate post-operative period was assessed using barium sulphate and xylose passed down a naso-duodenal tube sited at the time of surgery. This simple study demonstrated that small bowel function was preserved in all cases, and hence that patients could be fed enterally via naso-duodenal tube (in particular using very low residue formulae) rather than using costly parenteral regimens, should an ileus persist.
