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The Indian Journal of Tuberculosis Dec 2020Surveillance of tuberculosis is one of the oldest disease surveillance systems in the world. This article briefly reviews its history, describes its methods and main... (Review)
Review
Surveillance of tuberculosis is one of the oldest disease surveillance systems in the world. This article briefly reviews its history, describes its methods and main results, with a specific focus on low- and middle-income countries, and underlines its main challenges and future prospects. Surveillance of tuberculosis started more than two centuries ago with the recording of tuberculosis mortality in England and Wales. After Koch's discovery of the tubercle bacillus, repeated tuberculin surveys were implemented to monitor infection, and case notification of active disease was progressively established during the 20th century. Because treatment of tuberculosis disease is the key intervention to stop transmission, monitoring of treatment outcome and more recently of drug resistance became integral parts of tuberculosis surveillance. At global level, the World Health Organization (WHO) is publishing a global TB report annually since 1997. Reports present data notified by each country as well as global estimates. Estimates of tuberculosis incidence are based on case notification adjusted by various correction factors, or on derivation from results of tuberculosis prevalence surveys, e.g. in India. In 2018, 10.1 million cases of tuberculosis are estimated to have occurred, among which about 0.5 million were resistant to rifampicin, and an estimated 1.5 million patients died. While global estimates are useful to raise public awareness and attract public and private funding, their uncertainty make them less useful to guide national policies. The backbone of tuberculosis surveillance at national and subnational level is the case notification. Newly diagnosed cases of active disease, whether new or recurrent, are reported with their key characteristics (age, sex, case category, HIV co-infection, drug resistance), and treatment outcomes are reported after scheduled treatment termination. All countries follow internationally standardized definitions. Incidence rates are compared by time to observe trends, by place to compare geographical areas, and by patient's characteristics to identify high-risk groups. The laboratory plays an essential role, since the surveillance of bacteriologically confirmed cases allows the most reliable comparisons, and because of the importance of the identification of drug resistance. The number of patients examined for tuberculosis diagnosis is also a key indicator to monitor case-finding activities. Tuberculosis surveillance is today among the most performant surveillance systems for infectious diseases. The two major changes currently observed are the move from paper-based registers to individual computerized surveillance databases and the multiplication of indicators for documenting progress towards tuberculosis elimination. There is a risk that implementation of these changes be followed by a loss in data quality. All efforts should be made to accompany these changes with adequate quality control. This will only be possible if health care workers are actively involved in the process of data production and analysis.
Topics: Global Health; Humans; Population Surveillance; Tuberculosis, Pulmonary
PubMed: 33308670
DOI: 10.1016/j.ijtb.2020.11.006 -
Obstetrics and Gynecology Feb 2020To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.
OBJECTIVE
To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.
DATA SOURCES
We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE.
METHODS OF STUDY SELECTION
Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews.
TABULATION, INTEGRATION, RESULTS
Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms.
CONCLUSION
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
Topics: Female; Gynecology; Humans; Obstetrics; Pregnancy; Prenatal Care; Quality of Health Care; Randomized Controlled Trials as Topic; Telemedicine
PubMed: 31977782
DOI: 10.1097/AOG.0000000000003646 -
Progress in Cardiovascular Diseases 2023Artificial Intelligence (AI) is a broad discipline of computer science and engineering. Modern application of AI encompasses intelligent models and algorithms for... (Review)
Review
Artificial Intelligence (AI) is a broad discipline of computer science and engineering. Modern application of AI encompasses intelligent models and algorithms for automated data analysis and processing, data generation, and prediction with applications in visual perception, speech understanding, and language translation. AI in healthcare uses machine learning (ML) and other predictive analytical techniques to help sort through vast amounts of data and generate outputs that aid in diagnosis, clinical decision support, workflow automation, and prognostication. Coronary computed tomography angiography (CCTA) is an ideal union for these applications due to vast amounts of data generation and analysis during cardiac segmentation, coronary calcium scoring, plaque quantification, adipose tissue quantification, peri-operative planning, fractional flow reserve quantification, and cardiac event prediction. In the past 5 years, there has been an exponential increase in the number of studies exploring the use of AI for cardiac computed tomography (CT) image acquisition, de-noising, analysis, and prognosis. Beyond image processing, AI has also been applied to improve the imaging workflow in areas such as patient scheduling, urgent result notification, report generation, and report communication. In this review, we discuss algorithms applicable to AI and radiomic analysis; we then present a summary of current and emerging clinical applications of AI in cardiac CT. We conclude with AI's advantages and limitations in this new field.
Topics: Humans; Artificial Intelligence; Fractional Flow Reserve, Myocardial; Heart; Algorithms; Tomography, X-Ray Computed; Computed Tomography Angiography
PubMed: 37689230
DOI: 10.1016/j.pcad.2023.09.001 -
Zeitschrift Fur Gerontologie Und... Nov 2022The clinical presentation of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) is very heterogeneous and the risk of a severe course clearly... (Review)
Review
The clinical presentation of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) is very heterogeneous and the risk of a severe course clearly increases with age. Therefore, older adults are an important target group for vaccinations. Several vaccines are currently licensed in Europe for older adults, namely two mRNA vaccines, two adenoviral vector vaccines and a protein-based vaccine. The immunogenicity and clinical efficacy of these vaccines in the first approval trials were equal or only slightly reduced for older adults compared to younger age groups; however, the concentration of neutralizing antibodies and protection against infection greatly declined over time and the latter is substantially reduced for virus variants, particularly for the Omicron variant. Nevertheless, protection against severe disease and hospitalization is maintained at a high level for longer time periods, and after three vaccine doses (2 + 1 schedule) also for the Omicron variant. Additional booster vaccinations are currently recommended for patients with risk factors, especially older adults. With respect to the currently valid recommendations for different age and risk groups, the publications and notifications of the national vaccine advisory bodies should be referred to.All currently available vaccines target the original virus strain. New vaccines, which are adapted to virus variants are currently being developed and tested, and it is highly likely that they will be used in the near future; however, viral evolution is ongoing and a continuous development of adapted vaccines will probably be necessary.
Topics: Humans; Aged; COVID-19; SARS-CoV-2; Vaccination; Antibodies, Neutralizing
PubMed: 36112215
DOI: 10.1007/s00391-022-02102-x -
Clinical Epidemiology 2016The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the... (Review)
Review
AIM OF THE DATABASE
The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the disease-modifying treatment, and it is an important data source for epidemiological research.
STUDY POPULATION
The DMSTR includes all patients with multiple sclerosis who had been treated with disease-modifying drugs since 1996. At present, more than 8,400 patients have been registered in this database. Data are continuously entered online into a central database from all sites in Denmark at start and at regular visits.
MAIN VARIABLES
Include age, sex, onset year and year of the diagnosis, basic clinical information, and information about treatment, side effects, and relapses.
DESCRIPTIVE DATA
Notification is done at treatment start, and thereafter at every scheduled clinical visit 3 months after treatment start, and thereafter every 6 months. The longitudinally collected information about the disease activity and side effects made it possible to investigate the clinical efficacy and adverse events of different disease-modifying therapies.
CONCLUSION
The database contributed to a certain harmonization of treatment procedures in Denmark and will continue to be a major factor in terms of quality in clinical praxis, research and monitoring of adverse events, and plays an important role in research.
PubMed: 27822098
DOI: 10.2147/CLEP.S99500 -
Journal of Drugs in Dermatology : JDD Jan 2021The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood,... (Review)
Review
The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the "lessons learned" with the COVID-19 pandemic. In this paper, the board-certified core aesthetic physicians classified these recommendations into four generalized areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies. Proactive strategies are provided in each of these categories that, if implemented, may alleviate the processes involved with an efficient office closure and reopening process including, in the case of COVID-19, methods to reduce the risk of transmission to doctors, staff, and patients. These strategies also include being prepared for emergency-related notifications of employees and patients; the acquisition of necessary equipment and supplies such as personal protective equipment; and the maintenance and accessibility of essential data and contact information for patients, vendors, financial advisors, and other pertinent entities.J Drugs Dermatol. 2021;20(1):10-16. doi:10.36849/JDD.5803.
Topics: COVID-19; Civil Defense; Disaster Planning; Disasters; Disease Management; Humans; Personnel Staffing and Scheduling; Physician's Role
PubMed: 33400419
DOI: 10.36849/JDD.5803 -
Nursing Standard (Royal College of...To investigate the nursing practice of fasting patients before surgery.
AIM
To investigate the nursing practice of fasting patients before surgery.
METHOD
A descriptive research design was used. The instrument used was a structured interview schedule based on that of Hung (1992). A random sample of 20 nurses was selected for the study.
RESULTS
The findings indicated that patients fast for longer periods than research suggests is necessary. The communication between the operating theatre and the wards was found to be reasonably good in relation to notification about delays or alterations in the operating lists. However, half of the respondents did not give patients anything to eat or drink if a delay occurred.
CONCLUSION
Ritualistic practice prevailed and there was a lack of application of research findings. There was general agreement about the need for change, but resistance to change was a major problem. This study has implications for nursing practice, education and administration.
Topics: Fasting; Humans; Interviews as Topic; Perioperative Nursing; Preoperative Care
PubMed: 12056195
DOI: 10.7748/ns2002.05.16.36.33.c3197 -
International Journal of Cardiology Jul 2021The remote follow-up of pacemakers and implantable cardiac defibrillators (ICDs) usually includes scheduled checks and alert transmissions. However, this results in a...
BACKGROUND
The remote follow-up of pacemakers and implantable cardiac defibrillators (ICDs) usually includes scheduled checks and alert transmissions. However, this results in a high volume of remote data reviews to be managed. We measured the relative contribution of scheduled and alert transmissions to the detection of relevant conditions, and the workload generated by their management.
METHODS
At our center, the frequency of remote scheduled transmissions is 4/year. Moreover, all system-integrity and clinical alerts are turned on for wireless notification. We calculated the number of transmissions received from January to December 2020, and identified transmissions that necessitated in-hospital access for further assessment and transmissions that required clinical discussion with the physician. For all alert transmissions, we identified whether the alert was clinically meaningful (i.e. center was not previously aware of the condition and no action had yet been taken to treat it).
RESULTS
Of 8545 transmissions received from 1697 pacemakers and ICDs, 5766 (67%) were scheduled and 2779 (33%) were alert transmissions received from 764 patients (45%); 499 (9%) scheduled transmissions required clinical discussion with the physician, but only 2 of these necessitated in-hospital visits for further assessment. Of the alert transmissions, 664 (24%) required clinical discussion, and 75 (3%) necessitated in-hospital visits. The proportion of alerts judged clinically meaningful was 7%.
CONCLUSION
Scheduled transmissions generate 67% of remote data reviews for pacemakers and ICDs, but their ability to detect clinically relevant events is very low. A strategy that relies exclusively on alert transmissions could ensure continuity of patient monitoring while reducing the workload at the center.
Topics: Defibrillators, Implantable; Electronics; Follow-Up Studies; Humans; Monitoring, Physiologic; Workload
PubMed: 33930512
DOI: 10.1016/j.ijcard.2021.04.043 -
Frontiers in Pharmacology 2021Drugs are regulated in the United States (US) by the Controlled Substances Act (CSA) if assessment of their abuse potential, including public health risks, show such... (Review)
Review
Drugs are regulated in the United States (US) by the Controlled Substances Act (CSA) if assessment of their abuse potential, including public health risks, show such control is warranted. An evaluation via the 8 factors of the CSA provides the comprehensive assessment required for permanent listing of new chemical entities and previously uncontrolled substances. Such an assessment was published for two kratom alkaloids in 2018 that the Food and Drug Administration (FDA) have identified as candidates for CSA listing: mitragynine (MG) and 7-hydroxymitragynine (7-OH-MG) (Henningfield et al., 2018a). That assessment concluded the abuse potential of MG was within the range of many other uncontrolled substances, that there was not evidence of an imminent risk to public health, and that a Schedule I listing (the only option for substances that are not FDA approved for therapeutic use such as kratom) carried public health risks including drug overdoses by people using kratom to abstain from opioids. The purpose of this review is to provide an updated abuse potential assessment reviewing greater than 100 studies published since January 1, 2018. These include studies of abuse potential and physical dependence/withdrawal in animals; receptor binding; assessments of potential efficacy treating pain and substance use disorders; pharmacokinetic/pharmacodynamic studies with safety-related findings; clinical studies of long-term users with various physiological endpoints; and surveys of patterns and reasons for use and associated effects including dependence and withdrawal. Findings from these studies suggest that public health is better served by assuring continued access to kratom products by consumers and researchers. Currently, Kratom alkaloids and derivatives are in development as safer and/or more effective medicines for treating pain, substances use disorders, and mood disorders. Placing kratom in the CSA via scheduling would criminalize consumers and possession, seriously impede research, and can be predicted to have serious adverse public health consequences, including potentially thousands of drug overdose deaths. Therefore, CSA listing is not recommended. Regulation to minimize risks of contaminated, adulterated, and inappropriately marketed products is recommended.
PubMed: 35197848
DOI: 10.3389/fphar.2021.775073 -
Nature Sep 2021Enhancing vaccine uptake is a critical public health challenge. Overcoming vaccine hesitancy and failure to follow through on vaccination intentions requires effective... (Randomized Controlled Trial)
Randomized Controlled Trial
Enhancing vaccine uptake is a critical public health challenge. Overcoming vaccine hesitancy and failure to follow through on vaccination intentions requires effective communication strategies. Here we present two sequential randomized controlled trials to test the effect of behavioural interventions on the uptake of COVID-19 vaccines. We designed text-based reminders that make vaccination salient and easy, and delivered them to participants drawn from a healthcare system one day (first randomized controlled trial) (n = 93,354 participants; clinicaltrials number NCT04800965) and eight days (second randomized controlled trial) (n = 67,092 individuals; clinicaltrials number NCT04801524) after they received a notification of vaccine eligibility. The first reminder boosted appointment and vaccination rates within the healthcare system by 6.07 (84%) and 3.57 (26%) percentage points, respectively; the second reminder increased those outcomes by 1.65 and 1.06 percentage points, respectively. The first reminder had a greater effect when it was designed to make participants feel ownership of the vaccine dose. However, we found no evidence that combining the first reminder with a video-based information intervention designed to address vaccine hesitancy heightened its effect. We performed online studies (n = 3,181 participants) to examine vaccination intentions, which revealed patterns that diverged from those of the first randomized controlled trial; this underscores the importance of pilot-testing interventions in the field. Our findings inform the design of behavioural nudges for promoting health decisions, and highlight the value of making vaccination easy and inducing feelings of ownership over vaccines.
Topics: Adult; Aged; Appointments and Schedules; COVID-19 Vaccines; California; Female; Health Behavior; Humans; Immunization Programs; Intention; Kaplan-Meier Estimate; Male; Ownership; Public Health; Reminder Systems; Vaccination
PubMed: 34340242
DOI: 10.1038/s41586-021-03843-2