11 research outputs found

    QuantiFERON-TB gold in-tube implementation for latent tuberculosis diagnosis in a public health clinic: a cost-effectiveness analysis

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    BACKGROUND: The tuberculin skin test (TST) has limitations for latent tuberculosis infection (LTBI) diagnosis in low-prevalence settings. Previously, all TST-positive individuals referred from the community to Baltimore City Health Department (BCHD) were offered LTBI treatment, after active TB was excluded. In 2010, BCHD introduced adjunctive QuantiFERON-TB Gold In-Tube (QFT-GIT) testing for TST-positive referrals. We evaluated costs and cost-effectiveness of this new diagnostic algorithm. METHODS: A decision-analysis model compared the strategy of treating all TST-positive referrals versus only those with positive results on adjunctive QFT-GIT testing. Costs were collected at BCHD, and Incremental Cost-Effectiveness Ratios (ICERs) were utilized to report on cost-effectiveness. RESULTS: QFT-GIT testing at BCHD cost 43.51pertest.ImplementationofQFT−GITtestingwasassociatedwithanICERof43.51 per test. Implementation of QFT-GIT testing was associated with an ICER of 1,202 per quality-adjusted life-year gained and was considered highly cost-effective. In sensitivity analysis, the QFT-GIT strategy became cost-saving if QFT-GIT sensitivity increased above 92% or if less than 3.5% of individuals with LTBI progress to active TB disease. CONCLUSIONS: LTBI screening with TST in low-prevalence settings may lead to overtreatment and increased expenditures. In this public health clinic, additional QFT-GIT testing of individuals referred for a positive TST was cost-effective

    Programmatic Impact of QuantiFERON-TB Gold In-Tube Implementation on Latent Tuberculosis Diagnosis and Treatment in a Public Health Clinic

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    Background: QuantiFERON-TB Gold In-Tube (QFT-GIT) is considered an alternative to the tuberculin skin test (TST) for the diagnosis of tuberculosis (TB) infection, but the programmatic impact of QFT-GIT implementation is largely unknown. In March, 2010, the Baltimore City Health Department (BCHD) introduced routine QFT-GIT testing for individuals referred to the TB program for suspected latent TB infection (LTBI). Design: Retrospective study comparing LTBI diagnosis and treatment during the 13 months before and after QFT-GIT implementation at the BCHD TB clinic. Results: 607 and 750 individuals were referred by community-providers for suspected LTBI in the pre- and post-QFT-GIT periods, respectively. Most individuals in the pre- and post-QFT-GIT periods were referred on the basis of a positive TST (597/607 [98%] vs. 690/750 [92%], respectively) and were foreign-born (363/607[59%] vs. 507/750[68%], respectively). BCHD performed QFT-GIT testing for 375/543 (69%) eligible individuals in the post-QFT-GIT period, of which 185 (49%) were positive, 178 (47%) were negative, 1 (0.25%) was indeterminate, and 11 (3%) did not yield results. Concordance of QFT-GIT with TST was low (183/352[52%]). Foreign-born individuals had higher proportions of QFT-GIT positivity (57%) than US-born individuals (36%; AOR 3.3 [95%CI 1.7–6.2]). Significantly fewer individuals received a final diagnosis of LTBI in the post-QFT-GIT period (397/567 [70%]) compared to the pre-QFT-GIT period (445/452 [98%], p,0.001). In the post-QFT-GIT period, onl

    An easy way to estimate energy expenditure from hemodynamic data in septic patients Um modo simples de estimar o consumo de energia a partir de dados hemodinâmicos em pacientes sépticos

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    PURPOSE: The purpose of this study is to compare the resting energy expenditure (REE) obtained by indirect calorimetry (IC) to the REE calculated by predictive equations (Brandi and Liggett) using the oxygen consumption (VO2) obtained by Fick's method in septic patients. METHODS: Prospective study in septic patients admitted in an intensive care unit of a university hospital. Fifteen adult patients (11 men and four women) were studied. VO2 measurements were made using a portable metabolic cart connected to a respirator and a pulmonary artery catheter. RESULTS: The APACHE II at admission was 22.6&plusmn;7.2 with a mortality risk of 46.1&plusmn;27.7%. The mean REE obtained by IC and by the Brandi and Liggett equations were 1699&plusmn;271, 1815&plusmn;355 and 1361&plusmn;277 kcal.day-1 respectively. There were no statistically significant differences between the two methods, with the two means showing a difference of 8.7%. REE values were close for IC x BRANDI (r=0.80), but the IC x LIGGETT correlation was only 0.58. CONCLUSIONS: The results suggest that REE can be easily calculated by obtaining VO2 with the Swan-Ganz catheter and using the Brandi equation even for septic patients under mechanical ventilation.<br>OBJETIVO: O objetivo desse estudo foi o de comparar o consumo de oxigênio em repouso (COR) obtido por calorimetria indireta (CI) com valores do COR calculados por equações preditivas (Brandi e Ligget) que utilizam o consumo de oxigênio (VO2) obtido pelo método de Fick em pacientes sépticos. MÉTODOS. Estudo prospectivo em pacientes sépticos internados em unidade de terapia intensiva de um hospital universitário. Quinze pacientes adultos (onze homens e quatro mulheres). As medidas de VO2 foram realizadas usando um aparelho metabólico portátil conectado ao respirador e por cateter em artéria pulmonar. RESULTADOS: O índice APACHE II na admissão foi 22.6&plusmn;7.2 com risco de mortalidade de 46.1&plusmn;27.7%. As médias do COR obtidas por CI e pelas equações de Brandi and Liggett foram, respectivamente, 1699&plusmn;271, 1815&plusmn;355 e 1361&plusmn;277 kcal.day-1 Não se observaram diferenças estatisticamente significantes entre os dois métodos com as duas médias mostrando uma diferenças de 8.7%. Os valores de COR Também foram próximo dos valores de CI x BRANDI (r=0.80), mas a correlação com CI x LIGGETT apenas 0.58. CONCLUSÕES: Os resultados sugerem que o COR pode ser facilmente calculado para obter-se o VO2 com o cateter de Swan-Ganz e pelo uso da equação de Brandi para pacientes sépticos em ventilação mecânica

    QuantiFERON-TB gold in-tube implementation for latent tuberculosis diagnosis in a public health clinic: a cost-effectiveness analysis

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    Abstract Background The tuberculin skin test (TST) has limitations for latent tuberculosis infection (LTBI) diagnosis in low-prevalence settings. Previously, all TST-positive individuals referred from the community to Baltimore City Health Department (BCHD) were offered LTBI treatment, after active TB was excluded. In 2010, BCHD introduced adjunctive QuantiFERON-TB Gold In-Tube (QFT-GIT) testing for TST-positive referrals. We evaluated costs and cost-effectiveness of this new diagnostic algorithm. Methods A decision-analysis model compared the strategy of treating all TST-positive referrals versus only those with positive results on adjunctive QFT-GIT testing. Costs were collected at BCHD, and Incremental Cost-Effectiveness Ratios (ICERs) were utilized to report on cost-effectiveness. Results QFT-GIT testing at BCHD cost 43.51pertest.ImplementationofQFT−GITtestingwasassociatedwithanICERof43.51 per test. Implementation of QFT-GIT testing was associated with an ICER of 1,202 per quality-adjusted life-year gained and was considered highly cost-effective. In sensitivity analysis, the QFT-GIT strategy became cost-saving if QFT-GIT sensitivity increased above 92% or if less than 3.5% of individuals with LTBI progress to active TB disease. Conclusions LTBI screening with TST in low-prevalence settings may lead to overtreatment and increased expenditures. In this public health clinic, additional QFT-GIT testing of individuals referred for a positive TST was cost-effective.</p

    Factors associated with QFT-GIT test positivity among those tested at BCHD.

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    <p>Only individuals with QFT-GIT performed by BCHD are included. 11 individuals had blood drawn for QFT-GIT but did not have interpretable results due to insufficient blood volume during venipuncture, sample transportation issues, or processing error. There was 1 indeterminate result.</p><p>°p<0.001 for both univariate and multivariate analysis comparing foreign-born to US born individuals.</p><p>°° P = 0.042 comparing HIV positive to HIV negative individuals.</p>†<p>Referral source was omitted from multivariate regression model due to collinearity with birth country.</p>††<p>p = 0.001 comparing those referred from Refugee health services to those referred from primary care providers/other; p = 0.03 comparing those referred from local health departments to those referred from primary care providers/other.</p

    Differences in LTBI diagnosis among referrals to BCHD between study periods and by QFT-GIT test status.

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    *<p>includes individuals that had QFT-GIT performed by referral source. 11/399 individuals in the post-QFT-GIT period had QFT-GIT drawn but no results available; there was 1 indeterminate result in the post-QFT-GIT-period.</p><p>°p<.001 comparing final diagnosis of LTBI between pre-QFT-GIT and post-QFT-GIT periods.</p><p>°°p = .827 for pre-QFT-GIT period comparing LTBI diagnosis between those with and without a QFT-GIT result; p<.001 in post-QFT-GIT period comparing LTBI diagnosis between those with and without QFT-GIT performed.</p>**<p>p = .81 comparing treatment initiation among those diagnosed with LTBI between pre-QFT-GIT and post-QFT-GIT periods; p = 0.690 comparing treatment initiation between those with and without QFT-GIT performed in the pre-QFT-GIT period; p = .349 comparing treatment intiation between those with and without QFT-GIT performed in the post-QFT-GIT period.</p>†<p>Analysis restricted to those who started an INH X 9 months regimen prior to Nov 30, 2010 or Rifampin X 4 months prior to March 30, 2011 to allow time for completion. p = .606 comparing overall treatment completion between pre-QFT-GIT period and post-QFT-GIT period. p = 0.101 comparing those with and without QFT-GIT performed in the post-QFT-GIT period; p = 0.70 comparing those with and without QFT-GIT in the pre-QFT-GIT period.</p

    Concordance of TST and QFT-GIT results among referred individuals that came to BCHD for LTBI evaluation and had both tests performed.

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    †<p>Overall, 352 individuals had a TST and interpretable QFT-GIT result available. There was an overall concordance of 52.3%.</p>*<p>8 individuals with negative TST results were referred and evaluated by BCHD. 4 individuals with B-waivers had negative TST, but were referred due to an abnormal CXR; 4 individuals had both TST and QFT-GIT performed by referral source.</p

    Characteristics of individuals referred to Baltimore City Health Department TB Clinic for evaluation of suspected <i>M. tuberculosis</i> infection, by study period.

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    <p>Abbreviations: SD, Standard Deviation. BCHD, Baltimore City Health Department.</p>*<p>Ethnicity data was based on referral documentation and/or initial evaluation at BCHD. P-value for global comparison of equality of proportions of ethnicities by χ<sup>2</sup> test.</p>†<p>HIV test results are available only for those that came to BCHD for evaluation. HIV status not available for those who did not complete an LTBI evaluation at BCHD.</p>**<p>Includes referrals from other local health departments in Maryland and other states, as well as employment TB testing conducted through other BCHD programs.</p

    Avaliação do efeito da clorpromazina sobre a função renal de cães submetidos à isquemia e reperfusão

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    A isquemia renal está presente em diferentes situações como em cirurgias renais, vasculares e no transplante renal. O objetivo deste trabalho foi avaliar a integridade e a função renal de cães submetidos à isquemia e reperfusão com ou sem aplicação de clorpromazina. Para tanto foram utilizados 12 cães distribuídos aleatoriamente em dois grupos de seis indivíduos: grupo A com isquemia e reperfusão sem tratamento por clorpromazina e o grupo B com isquemia e reperfusão tratados previamente com clorpromazina. De cada cão foi coletado sangue e urina antes da isquemia, no inicio da reperfusão, após 120 minutos de reperfusão e semanalmente até 28º dia pós-cirúrgico para verificar possíveis efeitos tardios da isquemia/reperfusão. Avaliações da integridade e função renal foram feitas por exame físico, concentração sérica de ureia e creatinina e determinação da GGT urinária. A avaliação da relação proteína urinária/creatinina urinária (PU/CU) e atividade da GGT urinária são exames mais sensíveis para detectar lesão tubular aguda que o exame de urina de rotina, uma vez que estas variáveis apresentaram alteração mais precocemente. Não houve ação protetora da clorpromazina conforme constatado por meio da urinálise, dosagens séricas de ureia e creatinina, excreção urinária de GGT e PU/CU.<br>Renal ischemia may occur in different situations such as vascular or renal surgery and also in renal transplantation. This study evaluates renal function in dogs submitted to ischemia and reperfusion after chlorpromazine application. Twelve adult mongrel dogs were distributed into two groups with six animals each. Group A was composed of dogs submitted to renal ischemia and reperfusion without previous administration of chlorpromazine. Group B was composed of dogs with renal ischemia and reperfusion previously treated with chlorpromazine. In order to evaluate the possible ischemia/reperfusion late effects, blood and urine samples were sampled in four different times: Before ischemia, early stages of reperfusion, 120 minutes after reperfusion, and every week until 28th day postsurgery. Renal function was evaluated by clinical examination, serum urea and creatinine levels and urinary GGT activity. PU/CU and GGT urinary activity were more sensitive in detecting acute tubular injury than routine urine examination because these variables showed earlier changes. Based on urinalysis, urea and creatinine serum levels plus urinary excretion of GGT and PU/CU, no evidences of protective action of chlorpromazine were observed
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