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1.
N C Med J ; 79(4): 210-217, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29991608

RESUMEN

BACKGROUND Statewide interventions are critical to meeting the goals of the National HIV/AIDS Strategy in this country. In 2012, the North Carolina Division of Public Health developed the North Carolina State Bridge Counselor program to improve linkage to and reengagement in care for newly diagnosed persons and persons living with HIV who were out-of-care.METHODS We reviewed the planning process for the North Carolina State Bridge Counselor program, which involved a review of existing strengths-based counseling models for persons living with HIV, implementation of these models, and communication strategies with other providers. State bridge counselor responsibilities were delineated from the role of disease intervention specialists while retaining the fieldwork capability of disease intervention specialists to conduct outreach and provide services for persons living with HIV throughout the state.RESULTS Program implementation required extensive planning with stakeholders, incorporation of strengths-based counseling models, development of performance standards, and utilization of CAREWare, an HIV care software program to document referrals and data-sharing between state bridge counselors and clinics. By the end of 2014, state bridge counselor services were provided to approximately 60 of the 400 persons living with HIV (15%) who are diagnosed each quarter in North Carolina, with increasing utilization of the program.LIMITATIONS We assessed the development of this intervention specific to the North Carolina Division of Public Health, which may limit its generalizability. However, the State Bridge Counselor program was implemented in both urban and rural areas throughout the state, which increases its applicability to different public health programs throughout the country.CONCLUSION We demonstrated that a statewide State Bridge Counselor program for linkage and reengagement activities can be implemented by leveraging existing infrastructures, electronic medical records, HIV care networks, and fieldwork activities.


Asunto(s)
Consejo , Infecciones por VIH/prevención & control , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud , Cooperación del Paciente , Derivación y Consulta , Infecciones por VIH/psicología , Implementación de Plan de Salud , Humanos , North Carolina
2.
BJOG ; 119(4): 439-48, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22251453

RESUMEN

OBJECTIVE: To compare the cost-effectiveness of an additional 24-hour inpatient observation for asymptomatic term neonates born to group B streptococcus (GBS)-colonised mothers with adequate intrapartum antibiotic prophylaxis (IAP) after an initial 24-hour in-hospital observation. DESIGN: Cost-effectiveness analysis from a societal perspective. SETTING: United States. POPULATION: Asymptomatic term neonates born to GBS-colonised mothers with IAP after an initial 24-hour in-hospital observation. METHODS: Monte Carlo simulation for a decision tree model incorporating the following chance events: development of GBS sepsis during the second 24 hours of life, development of GBS sepsis between 48 hours and 7 days of life, prompt versus delayed treatment for sepsis, neonatal mortality and long-term health sequelae. MAIN OUTCOME MEASURES: Expected cost and quality-adjusted life years (QALYs), Incremental cost-effectiveness ratio (ICER). RESULTS: Delayed, versus early, hospital discharge results in similar mean expected QALYs, but substantially higher expected cost. The mean difference in QALY is 0.00016 (95% CI 0.00005-0.00040), whereas the mean difference in cost is $1170.96 (95% CI $750.13-1584.32). The ICER is estimated to be $9,771,520.87 per QALY (95% CI $2,573,139.89-24,407,017.82). The proportion of early-onset GBS that develops during the second 24 hours of life, the cost of 24 hours of inpatient observation, and the probability of long-term sequelae following prompt versus delayed treatment play important roles in determining the cost-effectiveness of delayed hospital discharge. CONCLUSION: Cost-effectiveness analysis suggests that with adequate IAP, discharging asymptomatic term neonates to home after 24 hours is the preferred approach compared with 48 hours inpatient observation.


Asunto(s)
Antibacterianos/economía , Profilaxis Antibiótica/economía , Tiempo de Internación/economía , Alta del Paciente/economía , Complicaciones Infecciosas del Embarazo/economía , Infecciones Estreptocócicas/economía , Infecciones Estreptocócicas/prevención & control , Streptococcus agalactiae , Adulto , Antibacterianos/uso terapéutico , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Árboles de Decisión , Femenino , Humanos , Recién Nacido , Madres , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus agalactiae/aislamiento & purificación , Estados Unidos
5.
Am Rev Respir Dis ; 137(4): 759-64, 1988 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-3128148

RESUMEN

Sarcoidosis is a granulomatous disorder of unknown cause characterized by activation of T-lymphocytes. We here report the use of an enzyme-linked immunosorbent assay for the soluble interleukin-2 receptor (IL-2R) as a measure of T-cell activation in serum samples and bronchoalveolar lavage fluids in 15 patients with active sarcoidosis. The geometric mean (x divided by SEM) value for soluble IL-2R in serum samples from patients with sarcoidosis was 1,110 (x divided by 1.17) versus 224 (x divided by 1.08) U/ml for normal control subjects (p less than 0.001). Detectable levels of soluble IL-2R were present in bronchoalveolar lavage fluids from 10 of 15 patients with sarcoidosis versus only 2 of 36 normal control subjects (p less than 0.001). Levels of soluble IL-2R in serum samples from untreated patients with sarcoidosis correlated with 67gallium lung scanning scores (p less than 0.05) but not with serum angiotensin-converting enzyme concentrations or constituents of bronchoalveolar lavage. In 5 patients, the level of soluble IL-2R in serum samples fell from 1,499 (x divided by 1.20) to 476 (x divided by 1.58) U/ml (p less than 0.05) after 6 wk of successful treatment with corticosteroids, whereas the changes in soluble IL-2R in bronchoalveolar lavage fluids were more variable. These observations suggest that measurements of soluble IL-2R, particularly in serum samples, may reflect disease activity and be clinically useful in the management of patients with sarcoidosis.


Asunto(s)
Líquido del Lavado Bronquioalveolar/metabolismo , Receptores Inmunológicos/metabolismo , Sarcoidosis/metabolismo , Corticoesteroides/uso terapéutico , Humanos , Concentración Osmolar , Receptores de Interleucina-2 , Valores de Referencia , Sarcoidosis/sangre , Sarcoidosis/tratamiento farmacológico , Sarcoidosis/fisiopatología , Solubilidad
6.
Sarcoidosis ; 4(2): 87-93, 1987 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-2821601

RESUMEN

We have previously reported serum elevations of the soluble form of the interleukin-2 receptor (IL-2R), a marker of T-cell activation, in sarcoidosis. In the present study, an enzyme-linked immunosorbent assay for soluble IL-2R was employed to compare sera from normal controls with those from patients with active sarcoidosis or idiopathic pulmonary fibrosis (IPF). Sera from patients with active sarcoidosis and parenchymal lung disease (radiographic Stages II or III) had geometric mean values for soluble IL-2R of 1975 units/ml compared to 640 units/ml for normal controls (p less than 0.001, Student's t-test). By contrast, soluble IL-2R levels were lower (989 units/ml, p less than 0.05 compared to normals) in patients with active sarcoidosis but no radiographic evidence for parenchymal disease (Stages 0 or I). Soluble IL-2R levels were not elevated in patients with inactive sarcoidosis. Three of the 4 sarcoidosis patients with the highest levels of soluble IL-2R also manifested hypercalcemia. While levels of soluble IL-2R were elevated for the group of patients with IPF (1171 units/ml, p less than 0.05 compared to normals), the striking elevations of soluble IL-2R noted in active sarcoidosis were not seen and there was greater overlap with normal values. We conclude that marked serum elevations of soluble IL-2R are more suggestive of active pulmonary sarcoidosis than IPF.


Asunto(s)
Enfermedades Pulmonares/sangre , Receptores Inmunológicos/metabolismo , Sarcoidosis/sangre , Corticoesteroides/uso terapéutico , Adulto , Anciano , Femenino , Radioisótopos de Galio , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Peptidil-Dipeptidasa A/sangre , Cintigrafía , Receptores de Interleucina-2 , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/tratamiento farmacológico , Solubilidad
7.
J Infect Dis ; 140(2): 244-8, 1979 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-383855

RESUMEN

Recent in vitro susceptibility studies have shown that amikacin inhibits more than 90% of isolates of Nocardia. This study was designed to evaluate the effect of treatment with amikacin or sulfonamides on infection caused by Nocardia asteroides with the use of murine models. In an acute lethality model in which infection was induced by intraperitoneal injection, 13 (45%) of 29 mice that had been treated with amikacin survived, in comparison to zero of 39 untreated animals in the control group and one of 39 mice that had been treated with sulfadiazine (P less than 0.001 for amikacin). When infected with a strain of N. asteroides that was resistant to amikacin, all mice that were treated with amikacin and all untreated mice died. Drug therapy was also evaluated in a chronic infection model, in which abscesses were produced by an intraperitoneal injection of N. asteroides in saline. Treatment with either amikacin (P less than 0.001) or sulfonamide (P less than 0.02) for two to three weeks significantly increased the rate of resolution of these abscesses. These murine models demonstrate that amikacin has in vivo activity against Nocardia and may be potentially useful in the treatment of human disease.


Asunto(s)
Amicacina/uso terapéutico , Kanamicina/análogos & derivados , Nocardiosis/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Amicacina/farmacología , Animales , Enfermedad Crónica , Ratones , Ratones Endogámicos BALB C , Nocardia asteroides/efectos de los fármacos , Sulfonamidas/farmacología
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