Alcohol use as a risk factor for tuberculosis – a systematic review

<p>Abstract</p> <p>Background</p> <p>It has long been evident that there is an association between alcohol use and risk of tuberculosis. It has not been established to what extent this association is confounded by social and other factors related to alcohol use. Nor has the strength of the association been established. The objective of this study was to systematically review the available evidence on the association between alcohol use and the risk of tuberculosis.</p> <p>Methods</p> <p>Based on a systematic literature review, we identified 3 cohort and 18 case control studies. These were further categorized according to definition of exposure, type of tuberculosis used as study outcome, and confounders controlled for. Pooled effect sizes were obtained for each sub-category of studies.</p> <p>Results</p> <p>The pooled relative risk across all studies that used an exposure cut-off level set at 40 g alcohol per day or above, or defined exposure as a clinical diagnosis of an alcohol use disorder, was 3.50 (95% CI: 2.01–5.93). After exclusion of small studies, because of suspected publication bias, the pooled relative risk was 2.94 (95% CI: 1.89–4.59). Subgroup analyses of studies that had controlled for various sets of confounders did not give significantly different results and did not explain the significant heterogeneity that was found across the studies.</p> <p>Conclusion</p> <p>The risk of active tuberculosis is substantially elevated in people who drink more than 40 g alcohol per day, and/or have an alcohol use disorder. This may be due to both increased risk of infection related to specific social mixing patterns associated with alcohol use, as well as influence on the immune system of alcohol itself and of alcohol related conditions.</p

Does electronic decision support influence advanced life support in simulated cardiac arrest?

Introduction: In-hospital cardiac arrest is common but survival rates vary considerably. The reasons for this may relate to human factors. Decision support systems and tools have been suggested as a means of reducing human errors and improving outcomes. Methods: This study aimed to: investigate if an electronic decision support system (eDSS) influenced advanced life support (ALS) in a simulated in-hospital cardiac arrest scenario; and explore practitioners' views of their performance with and without the eDSS. Teams of nurses and student nurses managed two scenarios with and without using an eDSS, and their adherence to an ALS protocol was assessed. Teams then took part in group interviews. Results: Teams using the eDSS were more likely to adhere to the drug and shock administration elements of the ALS protocol but were less safe in doing so, which may have been because they were unfamiliar with it. The interviews yielded one overarching theme—team working—and three subthemes of team performance and dynamics, team leader performance and areas for development. Some considered the eDSS as a source of reassurance that supported organisation and communication, while others found it a distraction; reduced situational awareness was observed when it was used. Conclusion: While an eDSS can support practitioners managing a simulated cardiac arrest, it is important to test prototypes in extensive simulation-based situations before they are used in clinical practice

Soft Copy Display Requirements for Digital Mammography

One of the advantages of digital mammography is to display mammograms on softcopy (electronic displays). Softcopy display of mammography is challenging because of the spatial and contrast resolution demands present in mammograms. We have designed and developed a softcopy mammography display application, Mammoview, which is capable of allowing radiologists to read mammograms as quickly and as accurately as they can on film alternators. We review the studies using Mammoview to elucidate the requirements of a successful softcopy display station. The design and development of the Mammoview softcopy display station are described in this article, and results of several studies using Mammoview are reported, including subjective feedback from Radiological Society of North America (RSNA) conference demonstrations, and clinical studies measuring performance in terms of speed and accuracy. Additional analysis of user interactions and user feedback is used to study the successes and shortcomings of mammography display stations like Mammoview. Overall, radiologist readings using Mammoview have been shown to be as fast and as accurate as readings using mammography film alternators. However, certain parts of the softcopy interface were more successful than their film counterparts, whereas others were less successful. Data analysis of the recorded human–computer interactions for the softcopy component of the clinical trial indicate statistically significant correlations between the difference in review time of softcopy versus alternator readings and three factors: the number of interactions, the reader, and the size of the image being reviewed. The first factor (number of interactions) suggests that simpler interfaces require less time to use; the second factor, the reader, supports previous findings that radiologists vary in how fast they read screening mammography studies; the third, size of image, suggests that the speed of softcopy review is increased relative to film readings when images are significantly larger than the display size. Feedback from radiologists using the system in clinical trials and at demonstration exhibits at RSNA indicated good acceptance of the interface and easy adaptation. Radiologists indicated that they felt comfortable using the interface, and that they would use such a softcopy interface in clinical practice. Finally, preliminary work suggests that the addition of a simple interaction to incorporate computer-aided detection (CAD) results would improve reading accuracy without significantly increasing reader times