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[PMID]:25816384
[Au] Autor:Bloom M; Markovitz S; Silverman S; Yost C
[Ad] Endereço:Massachusetts General Hospital Cancer Center, Boston, MA, USA.
[Ti] Título:Ten trends transforming cancer care and their effects on space planning for academic medical centers.
[So] Source:HERD;8(2):85-94, 2015.
[Is] ISSN:1937-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This article aims to define the major trends currently affecting space needs for academic medical center (AMC) cancer centers. It will distinguish between the trends that promote the concentration of services with those that promote decentralization as well as identify opportunities for achieving greater effectiveness in cancer care space planning. BACKGROUND: Changes in cancer care-higher survival rates, increased clinical trials, new technology, and changing practice models-increasingly fill hospitals' and clinicians' schedules and strain clinical space resources. Conflicts among these trends are concentrating some services and dispersing others. As a result, AMCs must expand and renovate intelligently to continue providing state-of-the-art, compassionate care. CONCLUSIONS: Although the typical AMC cancer center can expect to utilize more space than it would have 10 years ago, a deeper understanding of the cancer center enterprise can lead to opportunities for more effectively using available facility resources. Each AMC must determine for itself the appropriate balance of patient volume, clinical activity, and services between its main hospital campus and satellite branches. As well, space allocation should be flexible, as care trends, medical technology, and the provider's own priorities shift over time. The goal isn't necessarily more space-it's better space.
[Mh] Termos MeSH primário: Centros Médicos Acadêmicos/tendências
Decoração de Interiores e Mobiliário/normas
Neoplasias/terapia
Serviço Hospitalar de Oncologia/tendências
Ambulatório Hospitalar/tendências
Cuidados Paliativos/tendências
Equipe de Assistência ao Paciente/tendências
Medicina de Precisão/tendências
[Mh] Termos MeSH secundário: Tecnologia Biomédica/tendências
Ensaios Clínicos como Assunto/métodos
Ensaios Clínicos como Assunto/estatística & dados numéricos
Hospitais Satélites/tendências
Seres Humanos
Decoração de Interiores e Mobiliário/métodos
Determinação de Necessidades de Cuidados de Saúde
Neoplasias/epidemiologia
Equipe de Assistência ao Paciente/organização & administração
Relações Profissional-Família
Apoio Social
Sobreviventes/estatística & dados numéricos
Pesquisa Médica Translacional/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150328
[St] Status:MEDLINE
[do] DOI:10.1177/1937586714565598


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[PMID]:26983469
[Au] Autor:Sauers-Ford HS; Moore JL; Guiot AB; Simpson BE; Clohessy CR; Yost D; Mayhaus DC; Simmons JM; Gosdin CH
[Ad] Endereço:Division of Hospital Medicine, Department of Pediatrics, and hadley.sauers-ford@cchmc.org.
[Ti] Título:Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital.
[So] Source:Pediatrics;137(4), 2016 Apr.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: In our previous work, providing medications in-hand at discharge was a key strategy to reduce asthma reutilization (readmissions and emergency revisits) among children in a large, urban county. We sought to spread this work to our satellite hospital in an adjacent county. A key initial barrier was the lack of an outpatient pharmacy on site, so we sought to determine if a partnership with community pharmacies could improve the percentage of patients with medications in-hand at discharge, thus decreasing reutilization. METHODS: A multidisciplinary team partnered with community pharmacies. Using rapid-cycle improvement methods, the team aimed to reduce asthma reutilization by providing medications in-hand at discharge. Run charts were used to display the proportion of patients with asthma discharged with medications in-hand and to track 90-day reutilization rates. RESULTS: During the intervention period, the median percentage of patients with asthma who received medications in-hand increased from 0% to 82%. A key intervention was the expansion of the medication in-hand program to all patients. Additional changes included expanding team to evening stakeholders, narrowing the number of community partners, and building electronic tools to support key processes. The mean percentage of patients with asthma discharged from the satellite who had a readmission or emergency department revisit within 90 days of their index admission decreased from 18% to 11%. CONCLUSIONS: Impacting population-level asthma outcomes requires partnerships between community resources and health providers. When hospital resources are limited, community pharmacies are a potential partner, and providing access to medications in-hand at hospital discharge can reduce asthma reutilization.
[Mh] Termos MeSH primário: Asma/tratamento farmacológico
Asma/epidemiologia
Serviços Comunitários de Farmácia/tendências
Continuidade da Assistência ao Paciente/tendências
Hospitais Satélites/tendências
Readmissão do Paciente/tendências
[Mh] Termos MeSH secundário: Antiasmáticos/administração & dosagem
Asma/diagnóstico
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Asthmatic Agents)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170523
[Lr] Data última revisão:
170523
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160318
[St] Status:MEDLINE


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[PMID]:23410948
[Au] Autor:Charasse C; Boulahrouz R; Leonetti F; Potier J; Stanescu C; Le Cacheux P; Ang KS; Baluta S
[Ad] Endereço:Service de Néphrologie-dialyse, Hôpital Yves-le-Foll, rue Marcel-Proust, 22000 Saint-Brieuc, France. christophe.charasse@ch-stbrieuc.fr
[Ti] Título:[Teledialysis in satellite hospital: 5-year practice in Saint-Brieuc].
[Ti] Título:Hémodialyse en unité de dialyse médicalisée télésurveillée: une expérience de cinq années..
[So] Source:Nephrol Ther;9(3):143-53, 2013 Jun.
[Is] ISSN:1872-9177
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:The ageing population, the need for patient care delivery closer to home and reducing travel cost and isolation and, not at least, optimising medical team activity lead to adapt treatment by hemodialysis. Telehealth is an alternative now enabled by recent regulatory changes. We summarize here the regulatory and organisational conditions in a monitored Medicalized Dialysis Unit (MDU) and report the local experience of Saint-Brieuc Hospital; the feasibility and functionality over time (5 years) of this approach was demonstrated in clinical practice with selected patients; over short-term and for a still-limited number of patients, its clinical results are comparable to those observed in a MDU running on a traditional regimen (weekly visits and on-call 24 hours on-site 24 of the nephrologist); the degree of patient satisfaction, some of them very old people, is high. Stability of communications mainly depending of the operators and audio-video quality needed for a friendly and efficient exchange, could be improved. Relevant analysis of cost is necessary to adjust compensation and to encourage the deployment of teledialysis. The development of this technique is suitable in order to maintain oldering populations close to home, to assure the fairest access to medical care and to serve its purpose, which is the care in all its dimensions.
[Mh] Termos MeSH primário: Unidades Hospitalares de Hemodiálise/estatística & dados numéricos
Hospitais Satélites/estatística & dados numéricos
Diálise Renal/métodos
Telemedicina/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
França
Seres Humanos
Masculino
Meia-Idade
Monitorização Ambulatorial/métodos
Satisfação do Paciente
Inquéritos e Questionários
[Pt] Tipo de publicação:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Mês de entrada:1401
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130216
[St] Status:MEDLINE


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[PMID]:23354221
[Au] Autor:Draman CR; Seman MR; Mohd Noor FS; Kelsom WM
[Ad] Endereço:Medical Department, International Islamic University Malaysia, Malaysia. cherosle@gmail.com
[Ti] Título:Diagnostic yield of kidney biopsies performed in a suburban, satellite hospital.
[So] Source:Saudi J Kidney Dis Transpl;24(1):178-83, 2013 Jan.
[Is] ISSN:1319-2442
[Cp] País de publicação:Saudi Arabia
[La] Idioma:eng
[Ab] Resumo:Kidney biopsy is indicated to confirm the clinical diagnosis or to evaluate prognosis of a renal problem. It is a reliable and safe procedure, especially with real-time ultrasound guidance. This is a single-center, retrospective review of the biopsies performed in Hospital Tengku Ampuan Afzan, Pahang from 2000 to 2010. The demographic data, clinical parameters, and histological reports were extracted from clinic records and analyzed to determine the diagnostic adequacy of biopsy samples for both lupus and non-lupus patients. A total of 219 biopsies were performed throughout the period and only 74 were included in this review. Their mean age was 22.5 ± 10.5 years. 59.5% of the biopsies were performed on female patients. Malays comprised 79.7% (n = 59) of them, followed by Chinese (18.9%, n=14) and Indian (1.4%, n=1). About one-third of the biopsies(n = 25) were performed on patients with lupus nephritis and two-thirds (n = 49) on non-lupus nephritis patients. At the time of biopsy, their serum creatinine values were normal, serum albumin 28.4 ± 10 g/L and total cholesterol 8.9 ± 4.6 mmol/L (mean ± SD). The urine dipstick was 3+ for both proteinuria and hematuria and daily protein excretion was 3.6 ± 3.2 g. Sixty-seven specimens were considered adequate and only six (8%) were inadequate for histological interpretations. The mean number of glomeruli in the biopsy specimens was 16 ± 9.9 (range: 0-47 glomeruli). In non-lupus patients, focal segmental glomerulosclerosis was the commonest histological diagnosis (n = 15, 30.6%), followed by minimal change disease (n = 13, 26.5%) and mesangial proliferative glomerulonephritis (n = 7, 14.3%). Membranous nephropathy was diagnosed in four (8.2%) and membranoproliferative glomerulonephritis in two (4.1%) specimens. Both post-infectious glomerulonephritis and advanced glomerulosclerosis were found in one specimen each. Among the lupus nephritis patients (n = 25), 88% of them were females (P <0.05) and lupus nephritis WHO class IV was the commonest variant (n = 12, 48%) followed by WHO class III (n = 7, 28%). Membranous glomerulopathy or lupus nephritis WHO class V was found in three (12%), and two (8%) had lupus nephritis WHO class II. Serum albumin, urinalysis findings, and daily urinary protein excretion were comparable for both lupus and non-lupus patients. In conclusion, renal biopsy in our center is adequate and sufficient for histological interpretations and management of patients with renal problems.
[Mh] Termos MeSH primário: Biópsia/utilização
Hospitais Satélites
Nefropatias/patologia
Rim/patologia
Serviços de Saúde Suburbana
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Feminino
Seres Humanos
Malásia
Masculino
Reprodutibilidade dos Testes
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1303
[Cu] Atualização por classe:130128
[Lr] Data última revisão:
130128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130129
[St] Status:MEDLINE


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[PMID]:23242439
[Au] Autor:Lau KK; Rathinam S; Waller DA; Peake MD
[Ad] Endereço:Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK.
[Ti] Título:The effects of increased provision of thoracic surgical specialists on the variation in lung cancer resection rate in England.
[So] Source:J Thorac Oncol;8(1):68-72, 2013 Jan.
[Is] ISSN:1556-1380
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: There is a wide variation in the lung cancer resection rate in England. We assessed the effect of the regional provision of thoracic surgery service on the variation in lung cancer resection rate. METHODS: A retrospective observational study correlating National Lung Cancer Audit data with thoracic surgery workforce data was performed to review the lung cancer resection rate in England in 2008 and 2009. RESULTS: In 2008, there was a sixfold variation in resection rate, with a higher resection rate in hospitals where surgeons were based (base hospitals) than in peripheral hospitals (20.0% versus 11.6%, p < 0.001). The resection rate was also higher in cancer networks, which were served by two or more specialist thoracic surgeons (14.6% versus 12.7%, p = 0.028), and where surgeons were present in more than two-thirds of the lung cancer multidisciplinary team meetings (14.4% versus 12.0%, p = 0.046). In 2009, the overall resection rate increased from 14.5% to 18.4%. Four units increased their number of specialist thoracic surgeons and had a significantly higher increase in resection rate than units without expansion (relative rise 66.3% versus 19.2%; p = 0.022). CONCLUSIONS: The large variation in the resection rate seems, in part, to be related to the local availability of specialist thoracic surgeons. The greatest improvement in the resection rate was in units with expansion of specialist thoracic surgeons. We suggest the expansion of specialist thoracic surgeons will improve the resection rate and thereby the overall survival of lung cancer in England. This has significant implications for the future of training in cardiothoracic surgery and organization of cancer services.
[Mh] Termos MeSH primário: Carcinoma Pulmonar de Células não Pequenas/cirurgia
Hospitais/estatística & dados numéricos
Neoplasias Pulmonares/cirurgia
Pneumonectomia/estatística & dados numéricos
Cirurgia Torácica/recursos humanos
[Mh] Termos MeSH secundário: Inglaterra
Hospitais Satélites/estatística & dados numéricos
Seres Humanos
Auditoria Médica
Equipe de Assistência ao Paciente/organização & administração
Estudos Retrospectivos
Estatísticas não Paramétricas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1306
[Cu] Atualização por classe:121217
[Lr] Data última revisão:
121217
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:121218
[St] Status:MEDLINE
[do] DOI:10.1097/JTO.0b013e3182762315


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[PMID]:21636187
[Au] Autor:Brocklehurst P; Rafiq R; Lowe D; Rogers S
[Ad] Endereço:Dental Public Health, School of Dentistry, The University of Manchester, Coupland 3, Oxford Road, Manchester, M13 9PL, UK. paul.brocklehurst@postgrad.manchester.ac.uk
[Ti] Título:Analysis of the impact of deprivation on urgent suspected head and neck cancer referrals in the Mersey region between January 2004 to December 2006.
[So] Source:Br J Oral Maxillofac Surg;50(3):215-20, 2012 Apr.
[Is] ISSN:1532-1940
[Cp] País de publicação:Scotland
[La] Idioma:eng
[Ab] Resumo:Serious delay in patients presenting with head and neck cancer is associated with poor outcomes. We aimed to examine the influence of deprivation on professional delay in the Mersey region from 2004 to 2006. The study sample comprised 6681 patients who were referred between January 2004 and December 2006. The dataset was dominated by the largest hospital (H1), which received 48% of all cases. Median referral overall was 12 days (IQR 8-15 days), and 74% of patients were referred in 14 days or less. Professional delay (percentage 14 days or less) was associated with hospital (from 58% H1 to 97% H5), year of referral (from 64% in 2004 to 80% in 2006), age (from 69% under 55 years to 80% over 75 years), and deprivation (Index of Multiple Deprivation 2000 from 67% most deprived (IMD 1) to 85% least deprived (IMD 5)). Hospital location was associated with these factors and the results imply that by far, the most important variable in predicting professional delay was the hospital that received the referral. Trends over time in age, and to a lesser extent, for deprivation were noted in H1, but were largely absent across other hospitals. Some of them needed to make substantial improvements to meet the two-week referral pathway and it would be interesting to compare these results with current practice. This study highlights the importance of maintaining the standards of the current policy on two-week referrals for suspected head and neck malignancy.
[Mh] Termos MeSH primário: Neoplasias de Cabeça e Pescoço/diagnóstico
Encaminhamento e Consulta/estatística & dados numéricos
Populações Vulneráveis/estatística & dados numéricos
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Auditoria Clínica
Diagnóstico Tardio/estatística & dados numéricos
Inglaterra
Feminino
Hospitais Satélites/estatística & dados numéricos
Hospitais Estaduais/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1209
[Cu] Atualização por classe:120402
[Lr] Data última revisão:
120402
[Sb] Subgrupo de revista:D; IM
[Da] Data de entrada para processamento:110604
[St] Status:MEDLINE
[do] DOI:10.1016/j.bjoms.2011.05.002


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[PMID]:22235599
[Au] Autor:Dulski TM; Basavaraju SV; Hotz GA; Xu L; Selent MU; DeGennaro VA; Andrews D; Ford H; Coronado VG; Ginzburg E
[Ad] Endereço:Division of Injury Response, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
[Ti] Título:Factors associated with inpatient mortality in a field hospital following the Haiti earthquake, January-May 2010.
[So] Source:Am J Disaster Med;6(5):275-84, 2011 Sep-Oct.
[Is] ISSN:1932-149X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe factors associated with inpatient mortality in a field hospital established following the 2010 Haiti earthquake. DESIGN: Data were abstracted from medical records of patients admitted to the University of Miami Global Institute/Project Medishare hospital. Decedents were compared to survivors in terms of age, sex, length of stay, admission ward, diagnosis, and where relevant, injury mechanism and surgical procedure. Three multivariate logistic regression models were constructed to determine predictors of death among all patients, injured patients, and noninjured patients. RESULTS: During the study period, 1,339 patients were admitted to the hospital with 100 inpatient deaths (7.5 percent). The highest proportion of deaths occurred among patients aged < or = 15 years. Among all patients, adult intensive care unit (ICU) admission (adjusted odds ratio [AOR] = 7.6 and 95% confidence interval [CI] = 3.4-16.8), neonatal ICU/pediatric ICU (NICU/PICU) admission (AOR = 7.8 and 95% CI = 2.7-22.9), and cardiac/respiratory diagnoses (AOR = 8.5 and 95% CI = 4.9-14.8) were significantly associated with death. Among injured patients, adult ICU admission (AOR = 7.4 and 95% CI = 1.7-33.3) and penetrating injury (AOR = 3.3 and 95% CI = 1.004-11.1) were significantly associated with death. Among noninjured patients, adult ICU admission (AOR = 6.6 and 95% CI = 2.7-16.4), NICU/PICU admission (AOR = 8.2 and 95% CI = 2.1-31.8), and cardiac/ respiratory diagnoses (AOR = 6.5 and 95% CI = 3.6-12.0) were significantly associated with death. CONCLUSIONS: Following earthquakes in resource-limited settings, survivors may require care in field hospitals for injuries or exacerbation of chronic medical conditions. Planning for sustained post-earthquake response should address these needs and include pediatric-specific preparation and long-term critical care requirements.
[Mh] Termos MeSH primário: Cuidados Críticos/organização & administração
Terremotos/mortalidade
Serviço Hospitalar de Emergência/organização & administração
Mortalidade Hospitalar
Hospitais Satélites
Ferimentos e Lesões/mortalidade
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Criança
Pré-Escolar
Feminino
Haiti
Seres Humanos
Lactente
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Análise de Sobrevida
Ferimentos e Lesões/etiologia
Ferimentos e Lesões/terapia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1208
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:120113
[St] Status:MEDLINE


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[PMID]:22008143
[Au] Autor:Tali A; Addebbous A; Asmama S; Chabaa L; Zougaghi L
[Ad] Endereço:Centre Hospitalier Mohammed VI, Hôpital Ibn Tofayl Gueliz, Laboratoire des Analyses Médicales, Marrakech, Morocco. taliali1@yahoo.fr
[Ti] Título:Respiratory cryptosporidiosis in two patients with HIV infection in a tertiary care hospital in Morocco.
[So] Source:Ann Biol Clin (Paris);69(5):605-8, 2011 Sep-Oct.
[Is] ISSN:0003-3898
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:Respiratory cryptosporidiosis is recognized as a late-stage complication in persons with AIDS. We report two cases of respiratory cryptosporidiosis in patients with HIV infection. The first patient was a 46-year-old person with chronic diarrhea, a two-month history of low-grade fever, progressive dyspnea and productive cough. The search for acid-fast bacillus, Pneumocystis jirovecii, Toxoplasma gondii and Cryptococcus sp. in sputum was negative on several samples. The modified Ziehl has shown oocysts of Cryptosporidium sp. in induced sputum. The patient's death occurred, due to electrolytes disorders. The second patient was a 45-year-old person hospitalized for chronic fluid diarrhea, complicated with weight loss, dry cough, dyspnea stage II and low-grade fever. The patient was HIV-positive with low CD4 count and pancytopenia. Acid-fast oocysts of Cryptosporidium sp. were observed in stool samples and induced sputum. The patient was treated daily with azithromycin 500  mg resulting of disappearance of gastrointestinal and respiratory disorders.
[Mh] Termos MeSH primário: Criptosporidiose/diagnóstico
Criptosporidiose/etiologia
Infecções por HIV/complicações
Doenças Respiratórias/diagnóstico
Doenças Respiratórias/etiologia
[Mh] Termos MeSH secundário: Infecções Oportunistas Relacionadas com a AIDS/complicações
Criptosporidiose/patologia
Hospitais Satélites
Seres Humanos
Masculino
Meia-Idade
Marrocos
Doenças Respiratórias/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1111
[Cu] Atualização por classe:111019
[Lr] Data última revisão:
111019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:111020
[St] Status:MEDLINE
[do] DOI:10.1684/abc.2011.0626


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[PMID]:21776947
[Ti] Título:Services and facilities.
[So] Source:Trustee;64(6):32, 1, 2011 Jun.
[Is] ISSN:0041-3674
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Hospitals are investing in emergency departments and technology.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/estatística & dados numéricos
Hospitais Comunitários/estatística & dados numéricos
Hospitais Satélites/organização & administração
[Mh] Termos MeSH secundário: Aglomeração
Acesso aos Serviços de Saúde
Necessidades e Demandas de Serviços de Saúde
Planejamento Hospitalar
Seres Humanos
Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1109
[Cu] Atualização por classe:110722
[Lr] Data última revisão:
110722
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:110723
[St] Status:MEDLINE


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[PMID]:21364757
[Au] Autor:Bonnet M; Gagnidze L; Githui W; Guérin PJ; Bonte L; Varaine F; Ramsay A
[Ad] Endereço:Epicentre, Paris, France. maryline.bonnet@geneva.msf.org
[Ti] Título:Performance of LED-based fluorescence microscopy to diagnose tuberculosis in a peripheral health centre in Nairobi.
[So] Source:PLoS One;6(2):e17214, 2011 Feb 18.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Sputum microscopy is the only tuberculosis (TB) diagnostic available at peripheral levels of care in resource limited countries. Its sensitivity is low, particularly in high HIV prevalence settings. Fluorescence microscopy (FM) can improve performance of microscopy and with the new light emitting diode (LED) technologies could be appropriate for peripheral settings. The study aimed to compare the performance of LED-FM versus Ziehl-Neelsen (ZN) microscopy and to assess feasibility of LED-FM at a low level of care in a high HIV prevalence country. METHODS: A prospective study was conducted in an urban health clinic in Nairobi, Kenya. Three sputum specimens were collected over 2 days from suspected TB patients. Each sample was processed with Auramine O and ZN methods and a 4(th) specimen was collected for TB culture reference standard. Auramine smears were read using the same microscope, equipped with the FluoLED™ fluorescence illuminator. Inter-reader agreement, reading time and technicians' acceptability assessed feasibility. RESULTS: 497 patients were included and 1394 specimens were collected. The detection yields of LED-FM and ZN microscopy were 20.3% and 20.6% (p = 0.64), respectively. Sensitivity was 73.2% for LED-FM and 72% for ZN microscopy, p = 0.32. It was 96.7% and 95.9% for specificity, p = 0.53. Inter-reader agreement was high (kappa = 0.9). Mean reading time was three times faster than ZN microscopy with very good acceptance by technicians. CONCLUSIONS: Although it did not increase sensitivity, the faster reading time combined with very good acceptance and ease of use supports the introduction of LED-FM at the peripheral laboratory level of high TB and HIV burden countries.
[Mh] Termos MeSH primário: Tuberculose/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Algoritmos
Eficiência
Estudos de Viabilidade
Feminino
Hospitais Satélites
Seres Humanos
Quênia
Lasers Semicondutores
Luz
Masculino
Microscopia de Fluorescência/instrumentação
Microscopia de Fluorescência/métodos
Meia-Idade
Modelos Biológicos
Mycobacterium tuberculosis/isolamento & purificação
Sensibilidade e Especificidade
Escarro/química
Escarro/microbiologia
Tuberculose/epidemiologia
Tuberculose/microbiologia
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1109
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:110303
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0017214



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