Screening for tuberculosis among 2381 household contacts of sputum-smear-positive cases in The Gambia

اختصاصی از نیک فایل Screening for tuberculosis among 2381 household contacts of sputum-smear-positive cases in The Gambia دانلود با لینک مستقیم و پر سرعت .

Dolly Jackson-Sillaha, Philip C. Hill a,∗, Annette Foxa, Roger H. Brookesa,
Simon A. Donkora, Moses D. Lugosa, Stephen R.C. Howiea,
Katherine R. Fielding b, Adama Jallowc, Christian Lienhardtd,
Tumani Corraha, Richard A. Adegbolaa, Keith P. McAdama

Summary Contact investigation is a key component of tuberculosis (TB) control in developed,
but not developing, countries. We aimed to measure the prevalence of TB among household
contacts of sputum-smear-positive TB cases in The Gambia and to assess the sensitivity of an
enzyme-linked immunospot (ELISPOT) assay in this regard. Household contacts of adult smearpositive
TB patients were assessed by questionnaire, purified protein derivative (PPD) skin test,
ELISPOT assay, physical examination, chest X-ray and sputum/gastric aspirate. Thirty-three
TB cases were identified from 2174 of 2381 contacts of 317 adult smear-positive pulmonary
TB patients, giving a prevalence of 1518/100 000. The cases identified tended to have milder
disease than those passively detected. The sensitivity of ESAT-6/CFP-10 ELISPOT test as a
screening test for TB disease was estimated as 71%. Fifty-six per cent of contacts with a PPD
skin test result ≥10mm induration had detectable responses to ESAT-6/CFP-10 by ELISPOT; 11%
with a negative PPD skin test (<10mm) had a positive ESAT-6/CFP-10 response. Active screening
for TB among contacts of TB patients may have a role in TB control in The Gambia. These individuals
are a high-risk group, and the disease identified is less advanced than that found through
passive case detection. An ELISPOT assay was relatively insensitive as a screening test for TB.
© 2007 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights
reserved.

Using Computerized Clinical Decision Support for Latent Tuberculosis Infection Screening

اختصاصی از نیک فایل Using Computerized Clinical Decision Support for Latent Tuberculosis Infection Screening دانلود با لینک مستقیم و پر سرعت .

Andy W. Steele, MD, MPH, Sheri Eisert, PhD, Art Davidson, MD, MPH, Taylor Sandison, MD, Pat Lyons,
Nedra Garrett, Patricia Gabow, MD, Eduardo Ortiz, MD, MPH
Background: The Centers for Disease Control and Prevention (CDC) has published guidelines recommending
screening high-risk groups for latent tuberculosis infection (LTBI). The goal of
this study was to determine the impact of computerized clinical decision support and
guided web-based documentation on screening rates for LTBI.
Design: Nonrandomized, prospective, intervention study.
Setting and
participants:
Participants were 8463 patients seen at two primary care, outpatient, public community
health center clinics in late 2002 and early 2003.
Intervention: The CDC’s LTBI guidelines were encoded into a computerized clinical decision support
system that provided an alert recommending further assessment of LTBI risk if certain
guideline criteria were met (birth in a high-risk TB country and aged 40). A guided
web-based documentation tool was provided to facilitate appropriate adherence to the
LTBI screening guideline and to promote accurate documentation and evaluation.
Baseline data were collected for 15 weeks and study-phase data were collected for 12 weeks.
Main
outcome
measures:
Appropriate LTBI screening according to CDC guidelines based on chart review.
Results: Among 4135 patients registering during the post-intervention phase, 73% had at least one
CDC-defined risk factor, and 610 met the alert criteria (birth in a high-risk TB country and
aged 40 years) for potential screening for LTBI. Adherence with the LTBI screening
guideline improved significantly from 8.9% at baseline to 25.2% during the study phase
(183% increase, p 0.001).
Conclusions: This study demonstrated that computerized, clinical decision support using alerts and
guided web-based documentation increased screening of high-risk patients for LTBI. This
type of technology could lead to an improvement in LTBI screening in the United States
and also holds promise for improved care for other preventive and chronic conditions.
(Am J Prev Med 2005;28(3):281–284) © 2005 American Journal of Preventive Medicine