Active case-finding of tuberculosis compared with symptom-driven standard of care: a modelling analysis.

BACKGROUND: In settings with large case detection gaps, active case-finding (ACF) may play a critical role in the uberculosis (TB) response. However, ACF is resource intensive, and its effectiveness depends on whether people detected with TB through ACF might otherwise spontaneously resolve or be diagnosed through routine care. We analysed the potential effectiveness of ACF for TB relative to the counterfactual scenario of routine care alone. METHODS: We constructed a Markov simulation model of TB natural history, diagnosis, symptoms, ACF and treatment, using a hypothetical reference setting using data from South East Asian countries. We calibrated the model to empirical data using Bayesian methods, and simulated potential 5-year outcomes with an 'aspirational' ACF intervention (reflecting maximum possible effectiveness) compared with the standard-of-care outcomes. RESULTS: Under the standard of care, 51% (95% credible interval, CrI: 31%, 75%) of people with prevalent TB at baseline were estimated to be diagnosed and linked to care over 5 years. With aspirational ACF, this increased to 88% (95% CrI: 84%, 94%). Most of this difference represented people who were diagnosed and treated through ACF but experienced spontaneous resolution under standard-of-care. Aspirational ACF was projected to reduce the average duration of TB disease by 12 months (95% CrI: 6%, 18%) and TB-associated disability-adjusted life-years by 71% (95% CrI: 67%, 76%). CONCLUSION: These data illustrate the importance of considering outcomes in a counterfactual standard of care scenario, as well as trade-offs between overdiagnosis and averted morbidity through earlier diagnosis-not just for TB, but for any disease in which population-based screening is recommended.

Anesthesia Learning in the Digital Age: Are Program Directors and Residents on the Same Page?

BACKGROUND: In our current digital age, textbooks have been supplemented or supplanted by multiple online modalities for knowledge acquisition. Trainees, often from a younger generation than their program directors (PDs), prefer asynchronous options such as podcasts, videos, and question banks. We sought to identify whether an educational gap exists between PDs and trainees regarding what is assigned and what is used. METHODS: A national cross-sectional survey was conducted in the United States in 2018-2019 to characterize anesthesiology resident and PD perceptions of academic knowledge acquisition. RESULTS: Of the 149 PDs, 85 completed the survey (57%). Of the 85 PDs, 36 forwarded the survey to residents. Of the 1414 residents who received the survey, 503 residents responded to the survey (36%). The PDs thought residents used didactics, assigned reading, and scheduled simulations more than residents reported (P < .001). Residents reported using self-directed learning more (P = .004). Most residents (74.1%) reported using textbooks or online reading materials. Those residents reporting >70th percentile on the In-Training Exam used textbooks or online materials more than those who reported low scores (<30th percentile; P = .001). CONCLUSIONS: There is a discrepancy between PD and resident views on where and how knowledge acquisition occurs. Asynchronous forms of education (especially podcasts) are popular, but they are rarely assigned by programs. Although residents have a wide variety of learning preferences, textbook and online reading may be associated with higher In-Training Exam scores (a common way that knowledge acquisition is measured). The PDs should consider providing multiple options for optimizing knowledge acquisition, including textbook reading, to meet resident preferences and maximize testing success.