Effectiveness of m-learning on knowledge and attitude of nurses about the prevention and control of MDR TB: A quasi-randomized study.

BACKGROUND: Multidrug-Resistant Tuberculosis is a fatal form because of high morbidity and poor recovery. Improper use of first line medicines and default treatment are the prime reasons of developing resistance of mycobacterium towards conventional anti- TB drugs. Nurses with refined knowledge, current evidence and positive attitude can prevent arising of MDR TB cases by ensuring adequate treatment, promoting treatment adherence and real time case monitoring. Because of paucity of data, present study was aimed to assess efficacy of m-learning in improving knowledge and attitude of nurses about the prevention and control of MDR-TB. METHODS: In this Quasi-randomized study, nurses working in the unit of pulmonary, emergency, respiratory ICU, general medicine of AIIMS Rishikesh during the months of August-October 2019 were involved. The number of participation was 190 (95 in each group; experimental and control) where m-learning intervention was available only for experimental group. There were structured questionnaire to measure knowledge and dichotomous checklist to evaluate attitude of nurses of both group before and one week after the provision of m-learning module. RESULTS: Both the group was homogeneous and m-learning intervention was effective to improve knowledge, when compared post-test knowledge score between experimental and control group (18.2 ± 5.4 vs 12.4 ± 4.4; P < 0.001); however, this one-time social media based intervention could not improve attitude of participants (10.3 ± 1.8 vs. 9.9 ± 1.8; P = 0.175). CONCLUSION: Hence, m-learning is useful for knowledge development among large number of nurses within limited resource setting but frequent provision of technology based module is recommended to acquire positive attitude among nurses.

A case study of a patient with multidrug-resistant tuberculosis.

In this case study, a nurse presents her reflections on the challenges of supporting a patient through his treatment journey for multidrug-resistant tuberculosis. The patient has significant comorbidities and social issues, such as diabetes and homelessness. There was also a language barrier. All these aspects made the management of his treatment challenging. The medication side effects and his lifestyle were also a barrier to full engagement. The same multidisciplinary team was involved with the patient and, despite the obstacles, he seemed willing to engage with treatment and the team.

I know how TB patients feel.

During 2010-11 I spent 6 months working in a rural South African hospital, where drug-resistant tuberculosis (TB) was rife. I was diagnosed with TB 10 months after my return to the UK.

Cost-optimization in the treatment of multidrug resistant tuberculosis in Nigeria.

OBJECTIVE: To compare the cost of facility-based MDR TB care (F) to home-based care (H) from the perspective of the Nigerian national health system. METHODS: We assessed the expected costs of the two MDR TB treatment approaches using a decision-analytic model with a follow-up of 6 months. MDR TB treatment outcomes were obtained from a systematic review of randomised clinical trials. The outcomes of interest included treatment success, treatment failure, treatment default and mortality and did not vary significantly between the two alternatives. Treatment costs included the cost of the following: drug therapy (F, H), hospital stay (F), nurse care (F, H), physician care (F), nursing facility (F) and transport to the healthcare provider (H). Finally, we estimated the potential cost savings associated with home-based treatment for all patients starting MDR TB treatment in Nigeria. RESULTS: The average expected total treatment cost for a Nigerian patient treated for MDR TB was estimated at US2095 for facility - based care and 1535 for home-based care, a potential saving of 25%. One of the major drivers of this difference is significantly more intensive, and therefore more costly, nursing care in hospitals. In 2013, a total of 426 patients were initiated on facility-based MDR TB treatment in Nigeria. Thus, the potential savings through home-based care are US$ 223 204 per year. CONCLUSION: In Nigeria, treatment of MDR TB using home-based care is expected to result in similar patient outcomes at markedly reduced public health costs as facility-based care.

Tuberculose multirresistente: integralidade da atenção à saúde na perspectiva discursiva / Multidrug-resistant tuberculosis: integral healthcare from the discourse analysis perspective

Objetivo: Analisar as vivências dos doentes de tuberculose multirresistente sob a perspectiva da integralidade. Métodos: Estudo analítico, qualitativo, realizado com doentes em tratamento. Foram realizadas entrevistas semiestruturadas, transcritas na íntegra, interpretadas sob o referencial da Análise do Discurso de matriz francesa. Resultados: Notaram-se movimentos de sensibilização dos profissionais na busca da integralidade, atendendo às necessidades emocionais dos doentes, porém distanciavam-se desta em outros momentos. Quanto à organização da rede de atenção, perceberam-se fragilidades: falta de vinculação e acolhimento do doente nos serviços de saúde; falta de articulação entre os níveis de assistência; responsabilização do doente para com o tratamento e diferentes contextos da organização da Atenção Básica interferindo no acompanhamento do tratamento. Conclusão: Há necessidade de repensar a assistência ao doente de tuberculose multirresistente, de modo a assisti-lo de maneira integral, tanto em suas peculiaridades individuais relacionadas ao seu contexto de vida e processo de adoecimento, quanto ao que tange à organização e coordenação da atenção. .

Feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing for tuberculosis in primary-care settings in Africa: a multicentre, randomised, controlled trial.

BACKGROUND: The Xpert MTB/RIF test for tuberculosis is being rolled out in many countries, but evidence is lacking regarding its implementation outside laboratories, ability to inform same-day treatment decisions at the point of care, and clinical effect on tuberculosis-related morbidity. We aimed to assess the feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing at primary-care health-care facilities in southern Africa. METHODS: In this pragmatic, randomised, parallel-group, multicentre trial, we recruited adults with symptoms suggestive of active tuberculosis from five primary-care health-care facilities in South Africa, Zimbabwe, Zambia, and Tanzania. Eligible patients were randomly assigned using pregenerated tables to nurse-performed Xpert MTB/RIF at the clinic or sputum smear microscopy. Participants with a negative test result were empirically managed according to local WHO-compliant guidelines. Our primary outcome was tuberculosis-related morbidity (measured with the TBscore and Karnofsky performance score [KPS]) in culture-positive patients who had begun anti-tuberculosis treatment, measured at 2 months and 6 months after randomisation, analysed by intention to treat. This trial is registered with Clinicaltrials.gov, number NCT01554384. FINDINGS: Between April 12, 2011, and March 30, 2012, we randomly assigned 758 patients to smear microscopy (182 culture positive) and 744 to Xpert MTB/RIF (185 culture positive). Median TBscore in culture-positive patients did not differ between groups at 2 months (2 [IQR 0-3] in the smear microscopy group vs 2 [0·25-3] in the MTB/RIF group; p=0·85) or 6 months (1 [0-3] vs 1 [0-3]; p=0·35), nor did median KPS at 2 months (80 [70-90] vs 90 [80-90]; p=0·23) or 6 months (100 [90-100] vs 100 [90-100]; p=0·85). Point-of-care MTB/RIF had higher sensitivity than microscopy (154 [83%] of 185 vs 91 [50%] of 182; p=0·0001) but similar specificity (517 [95%] 544 vs 540 [96%] of 560; p=0·25), and had similar sensitivity to laboratory-based MTB/RIF (292 [83%] of 351; p=0·99) but higher specificity (952 [92%] of 1037; p=0·0173). 34 (5%) of 744 tests with point-of-care MTB/RIF and 82 (6%) of 1411 with laboratory-based MTB/RIF failed (p=0·22). Compared with the microscopy group, more patients in the MTB/RIF group had a same-day diagnosis (178 [24%] of 744 vs 99 [13%] of 758; p<0·0001) and same-day treatment initiation (168 [23%] of 744 vs 115 [15%] of 758; p=0·0002). Although, by end of the study, more culture-positive patients in the MTB/RIF group were on treatment due to reduced dropout (15 [8%] of 185 in the MTB/RIF group did not receive treatment vs 28 [15%] of 182 in the microscopy group; p=0·0302), the proportions of all patients on treatment in each group by day 56 were similar (320 [43%] of 744 in the MTB/RIF group vs 317 [42%] of 758 in the microscopy group; p=0·6408). INTERPRETATION: Xpert MTB/RIF can be accurately administered by a nurse in primary-care clinics, resulting in more patients starting same-day treatment, more culture-positive patients starting therapy, and a shorter time to treatment. However, the benefits did not translate into lower tuberculosis-related morbidity, partly because of high levels of empirical-evidence-based treatment in smear-negative patients. FUNDING: European and Developing Countries Clinical Trials Partnership, National Research Foundation, and Claude Leon Foundation.

Using nursing practice guidelines for the prevention of multidrug-resistant tuberculosis among hospitalized adult patients in Bangladesh.

Multidrug-resistant tuberculosis (MDR-TB) is one of the major public health concerns worldwide particularly in developing countries, including Bangladesh. Thus far, there are no well-validated clinical guidelines for the prevention of MDR-TB. This study aims to evaluate the improvement in nurses' practice using the newly developed Nursing Practice Guidelines for the Prevention of MDR-TB (NPG: MDR-TB) among hospitalized adult patients in Bangladesh. The guidelines were developed, disseminated and evaluated among 64 nurses by assessing nursing practice for the prevention of MDR-TB during pre- and postimplementation of the guidelines. Significant differences between pretest and post-test mean scores of nursing practice for the prevention of MDR-TB in case finding and case holding were found in three levels of wards, including Level 0 (non-TB), Level 1 (TB) and Level 2 (MDR-TB) (P < 0.001). This indicated that the guidelines might be applicable to reduce the development of MDR-TB in hospitals. However, this was a preliminary study with a limited time frame. Further evaluation is, therefore, needed.

Caracterización de pacientes con tuberculosis y tuberculosis resistente a múltiples medicamentos en instituciones de tercer nivel de Bogotá DC / Characterization of patients with tuberculosis and multidrug-resistant tuberculosis in third level institutions in Bogota DC

La tuberculosis es un problema de salud pública del mundo, que continúa empeorando principalmente, por la creciente prevalencia de la Resistencia a Múltiples Medicamentos, las precarias condiciones de vida y trabajo de la población, la presencia del Virus de la Inmunodeficiencia Humana, entre otros. Objetivos: Caracterizar los pacientes portadores de tuberculosis y tuberculosis resistente a múltiples medicamentos, en instituciones de tercer nivel de complejidad. Metodología: Estudio cuantitativo, de alcance descriptivo, transversal, de corte retrospectivo realizado en 6 instituciones de tercer nivel de Bogotá. La recolección de datos se realizó entre Octubre de 2010 y Enero de 2011, con un total de 640 registros clínicos de pacientes diagnosticados entre Octubre de 2008 y Octubre de 2010. Se salvaguardaron los aspectos éticos. Resultados: En cuanto al tipo de tuberculosis se encontró que el 46% de las personas portaban TB Pulmonar, el 41% extrapulmonar y en el 14% no tenía, registraba esta información. Se halló que de forma predominante el 64% de los participantes eran hombres, el 21% eran mayores de 65 años y el 44% pertenecían al régimen contributivo. Se evidenció que el 2.2% de los casos fueron diagnosticados como TB MDR; de ellos el 71% pertenecían al sexo masculino, el 36% tenía entre 25-34 años y el mayor porcentaje pertenecían en igual proporción tanto a los pacientes no afiliados como a los que pertenecen al régimen subsidiado en un 36%. Conclusiones: Las características socio-demográficas de los pacientes diagnosticados con TB brindan una herramienta efectiva a la hora de orientar las acciones de los programas de control de la enfermedad por parte de las autoridades en salud (AU)

Tuberculosis is a public health problem around the world. This problem is worsening daily due to the increasing prevalence of multiple drugs resistance, poor living and working conditions, AIDS, inter alia. Aim: To characterize patients with tuberculosis and multi-drug resistant tuberculosis who consult third level of complexity institutions. Methods: Quantitative-descriptive-cross-sectional-retrospective study developed in six third-level institutions in Bogota D.C. The data collection was done between October 2010 and January 2011. 640 medical records from patients with diagnoses done between October 2008 and October 2010 were collected. Ethical aspects were taken into account. Results: 46% of the patients had pulmonary TB, 41% had extrapulmonary TB, 14% did not have records about this information. 64% of the patients were male (predominant). 21% of the patients were older than 65 years old. 44% of the patients were in contributory system. 2.2% of the cases were diagnosed as MDR TB. Within this group, 71% of these cases were men. 36% were 25-34 years old. There were no differences with respect to affiliation system in this sub-group. Conclusions: Socio-demographic characteristics of the TB patients are an important tool to develop programs to control this disease (AU)

Nurses as providers of emotional support to patients with MDR-TB.

AIM: To identify the forms and means of emotional support that nurses provide to patients living with multidrug-resistant tuberculosis (MTR-TB) in Lima, Peru. BACKGROUND: A fundamental role of nurses is to provide emotional support, defined as all the strategies that a health team employs to assure the psychosocial well-being of the patient. However, neither the forms of emotional support nor the means used by nurses in resource-poor settings have been much written about. This paper describes a qualitative study of a team of seven nurses working in a programme that provides individualized MDR-TB treatment to patients in Lima, Peru. It describes the various forms of support that facilitated the ability of patients to adhere to treatment despite socio-economic difficulties, social stigma, drug side effects, problems related to different stages of treatment and concurrent illnesses/special situations. METHODS: Qualitative study methods were employed over the course of 8 years to observe nurses and patients in an MDR-TB treatment programme. These included participant observation, structured observation sessions of nurses with their patients and focus groups with seven nurses. CONCLUSION: Through theme and content analyses of qualitative data, ten situations related to MDR-TB treatment were found. These ten issues served as an analytical framework used to identify and discuss the various types of emotional support provided by both formal and informal means. This type of support focused on problems related to different stages of treatment, social stigma of the illness, treatment adherence, side effects, socio-economic difficulties, death and concurrent illnesses/special situations. PRACTICE IMPLICATIONS: The essential role of the nurse as a provider of emotional support in the development or implementation of similar programmes with MDR-TB should, in future, be taken into account.

The role of the nurse in the community-based treatment of multidrug-resistant tuberculosis (MDR-TB).

SETTING: A community-based treatment program for multidrug-resistant tuberculosis (MDR-TB) in Lima, Peru. OBJECTIVES: To describe the activities carried out by the nurses working with the program. DESIGN: A qualitative study using a variety of ethnographic methods, including participant observation, focus groups, and key informant interviews over a 5-year period. RESULTS: Nurses were responsible for carrying out a wide variety of activities within the program. These included patient-focused activities such as identifying patients, evaluating patients prior to starting and during therapy, and managing emergencies; educational activities for both patients and health professionals managing MDR-TB; and coordination activities, including over-seeing health workers and communicating between team members. CONCLUSION: Nurses play a key role in the community-based management of MDR-TB.

Actions taken by nursing education programs in the United States to prevent tuberculosis transmission in nursing students.

Measures to prevent tuberculosis include education and skin testing of at-risk groups, including health care workers. This study focused on policies and practices related to tuberculosis in nursing education programs, especially skin testing and instruction. Data were collected from a stratified random sample of nursing administrators in associate and baccalaureate degree programs in the United States using an instrument adapted from a medical school study. Several factors may have contributed to fewer skin test conversions in nursing programs than in medical schools. Although most nursing education programs considered skin testing a priority, there were inconsistencies related to skin testing type and process when compared with recent Centers for Disease Control and Prevention guidelines. Major content gaps related to multidrug-resistant tuberculosis and the differences between pulmonary and extrapulmonary symptomatology were found.