Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positiv...Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positive in 2010.The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV.The aim is to reduce fragmentation,improve access,enhance efficiency and improve quality of care.Ghana’s TB/HIV policy comprises three linked sets of activities:effective implementation of the Stop TB Strategy for TB control,improved HIV prevention and care,and the implementation of additional TB/HIV activities.Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care.The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.Methods:A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted.Anonymised patient data was collated from TB registers from each facility,and analysed to determine if TB treatment outcomes changed significantly after integration.Results:TB treatment success was 50%(95%CI 49-52)prior to,and 69%(95%CI 65-73)after,integration(Χ243.96,p<0.00).Treatment success increased from 43%to 53%at the one-stop shop(OSS),from 69%to 78%at the partially integrated site(PIS)and substantially from 46%to 78%at the referral site(RS)(Χ264.54;p<0.01).Defaults and cases transferred out reduced from 14.3%and 15.3%prior to integration,to 1.4%and 9.0%after integration,respectively,accounting for a significant increase in treatment success.Death rates remained high at 18%in all cases studied and 25%in HIV-associated cases after integration.Conclusion:TB/HIV integration may improve TB treatment success,but its exact impact is difficult to ascertain due to non-spec展开更多
目的:探讨P3T模块化个性注射技术在双源CT心脏"一站式"检查中的优势。方法:将拟行心脏"一站式"检查的40例患者随机分为2组。对照组采用按公斤体质量计算用量的常规给药方案。试验组采用Medrad公司新研发的P3T模块...目的:探讨P3T模块化个性注射技术在双源CT心脏"一站式"检查中的优势。方法:将拟行心脏"一站式"检查的40例患者随机分为2组。对照组采用按公斤体质量计算用量的常规给药方案。试验组采用Medrad公司新研发的P3T模块化个性注射技术根据患者的情况计算得出的给药方案。对比剂均采用370 mgI/mL优维显,2组均在Siemens公司的二代双源CT机上完成心脏"一站式"检查,在其余相同参数下对比分析2组的图像质量及对比剂用量。结果:试验组及对照组共40例患者均成功完成检查,2组一般资料均无统计学差异(P>0.05)。图像质量在冠状动脉的显示上:2组冠脉近、中段的CT值均无统计学差异(右冠近段CT值P=0.829、右冠中段CT值P=0.837、前降支近段CT值P=0.927、前降支中段CT值P=0.731、回旋支近段CT值P=0.637、回旋支中段CT值P=0.949);2组冠脉近中段CT值差异均无统计学意义(右冠近中段CT值差异P=0.991、前降支近中段CT值差异P=0.512、回旋支近中段CT值差异P=0.164)。试验组冠状动脉远段的CT值均高于对照组,差异有统计学意义(右冠远段CT值P=0.016、前降支远段CT值P=0.012、回旋支远段CT值P=0.024);试验组冠脉中远段及近远段CT值差异均小于对照组,差异有统计学意义(右冠中远段CT值差异P=0.000、右冠近远段CT值差异P=0.011、前降支中远段CT值差异P=0.002、前降支近远段CT值差异P=0.002、回旋支中远段CT值差异P=0.000、回旋支近远段CT值差异P=0.006)。图像质量在心肌灌注分析上:对比剂产生的线束硬化伪影数目试验组明显少于对照组(44 vs. 69);2组在舒张期基底部层面及心腔中间层面各段正常心肌平均碘含量无统计学差异(基底部层面心肌碘含量P=0.236、中间部层面心肌碘含量P=0.624);试验组在舒张期心尖层面及心尖段的正常心肌平均碘含量高于对照组,差异有统计学意义(心尖层面心肌碘含量P=0.012、心尖段心肌碘�展开更多
文摘Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positive in 2010.The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV.The aim is to reduce fragmentation,improve access,enhance efficiency and improve quality of care.Ghana’s TB/HIV policy comprises three linked sets of activities:effective implementation of the Stop TB Strategy for TB control,improved HIV prevention and care,and the implementation of additional TB/HIV activities.Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care.The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.Methods:A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted.Anonymised patient data was collated from TB registers from each facility,and analysed to determine if TB treatment outcomes changed significantly after integration.Results:TB treatment success was 50%(95%CI 49-52)prior to,and 69%(95%CI 65-73)after,integration(Χ243.96,p<0.00).Treatment success increased from 43%to 53%at the one-stop shop(OSS),from 69%to 78%at the partially integrated site(PIS)and substantially from 46%to 78%at the referral site(RS)(Χ264.54;p<0.01).Defaults and cases transferred out reduced from 14.3%and 15.3%prior to integration,to 1.4%and 9.0%after integration,respectively,accounting for a significant increase in treatment success.Death rates remained high at 18%in all cases studied and 25%in HIV-associated cases after integration.Conclusion:TB/HIV integration may improve TB treatment success,but its exact impact is difficult to ascertain due to non-spec
文摘目的:探讨P3T模块化个性注射技术在双源CT心脏"一站式"检查中的优势。方法:将拟行心脏"一站式"检查的40例患者随机分为2组。对照组采用按公斤体质量计算用量的常规给药方案。试验组采用Medrad公司新研发的P3T模块化个性注射技术根据患者的情况计算得出的给药方案。对比剂均采用370 mgI/mL优维显,2组均在Siemens公司的二代双源CT机上完成心脏"一站式"检查,在其余相同参数下对比分析2组的图像质量及对比剂用量。结果:试验组及对照组共40例患者均成功完成检查,2组一般资料均无统计学差异(P>0.05)。图像质量在冠状动脉的显示上:2组冠脉近、中段的CT值均无统计学差异(右冠近段CT值P=0.829、右冠中段CT值P=0.837、前降支近段CT值P=0.927、前降支中段CT值P=0.731、回旋支近段CT值P=0.637、回旋支中段CT值P=0.949);2组冠脉近中段CT值差异均无统计学意义(右冠近中段CT值差异P=0.991、前降支近中段CT值差异P=0.512、回旋支近中段CT值差异P=0.164)。试验组冠状动脉远段的CT值均高于对照组,差异有统计学意义(右冠远段CT值P=0.016、前降支远段CT值P=0.012、回旋支远段CT值P=0.024);试验组冠脉中远段及近远段CT值差异均小于对照组,差异有统计学意义(右冠中远段CT值差异P=0.000、右冠近远段CT值差异P=0.011、前降支中远段CT值差异P=0.002、前降支近远段CT值差异P=0.002、回旋支中远段CT值差异P=0.000、回旋支近远段CT值差异P=0.006)。图像质量在心肌灌注分析上:对比剂产生的线束硬化伪影数目试验组明显少于对照组(44 vs. 69);2组在舒张期基底部层面及心腔中间层面各段正常心肌平均碘含量无统计学差异(基底部层面心肌碘含量P=0.236、中间部层面心肌碘含量P=0.624);试验组在舒张期心尖层面及心尖段的正常心肌平均碘含量高于对照组,差异有统计学意义(心尖层面心肌碘含量P=0.012、心尖段心肌碘�
