RESUMO
SETTING: District Chest Clinic, Kalutara, Sri Lanka. OBJECTIVES: To determine the coverage of culture and drug susceptibility testing (CDST), delays in CDST, treatment initiation, obtaining CDST results and treatment outcomes of previously treated tuberculosis (TB) patients. DESIGN: Retrospective cohort study involving review of records and reports. All previously treated TB patients from January 2008 to June 2013 were included in the study. RESULTS: Of 160 patients, 126 (79%) samples were sent for CDST; 79 (63%) were culture-positive and no multi-drug-resistant (MDR) TB cases were reported. Respectively 9% and 15% of patients experienced a delay in sending samples (median delay 21 days) and receiving CDST reports (median delay 71 days), while 20% experienced delays in initiating the retreatment regimen (median delay 11.5 days). The cohort recorded an 82% treatment success rate. CONCLUSION: Of all retreatment patients, only 79% were tested for CDST and there were sizeable delays in sample transportation and treatment initiation. Possible ways forward to strengthen the programme are discussed.
Contexte : Dispensaire de pneumologie du district de Kalutara, Sri Lanka.Objectif : Déterminer la couverture du test de culture et de sensibilité aux médicaments (CDST), les délais des tests de résistance aux médicaments, de mise en Åuvre du traitement et d'obtention des résultats du CDST ainsi que les résultats du traitement chez des patients tuberculeux déjà traités auparavant.Schéma : Etude rétrospective de cohorte par revue de dossiers et de rapports. Tous les patients tuberculeux de janvier 2008 à juin 2013 déjà traités ont été inclus dans l'étude.Résultats : Sur 160 patients, 126 (79%) ont été référés pour un CDST ; 79 (63%) avaient une culture positive et il n'y a eu aucun cas de TB-MDR. Environ 9% et 15% des patients, respectivement, ont eu un retard d'expédition des échantillons (retard médian 21 jours) et de réception du rapport du CDST (retard médian 71 jours), tandis que 20% ont subi un retard de mise en Åuvre de la reprise du traitement (retard médian 11,5 jours). Le taux de succès thérapeutique de la cohorte atteignait 82%.Conclusion : Parmi tous les patients en retraitement, seulement 79% ont bénéficié d'un CDST et il y a eu des retards considérables dans le transport des échantillons et la mise en Åuvre du traitement. Des discussions sont en cours afin de renforcer le programme.
Marco de referencia: El consultorio distrital de neumología de Kalutara, en Sri Lanka.Objetivos: Determinar la cobertura con la culture y las pruebas de sensibilidad a los medicamentos antituberculosos (CDST), el retraso en el análisis de la farmacorresistencia, el comienzo del tratamiento y la obtención del resultado del CDST y los desenlaces terapéuticos de los pacientes con diagnóstico de tuberculosis (TB) y antecedente de tratamiento previo.Método: Se llevó a cabo un estudio retrospectivo de cohortes con análisis de las historias clínicas y los informes de laboratorio. Se incluyeron en el estudio todos los pacientes tuberculosos atendidos entre enero del 2008 y junio del 2013 que habían recibido tratamiento antituberculoso.Resultados: De los 160 pacientes incluidos en el estudio se enviaron 126 muestras para CDST (79%); en 79 muestras se obtuvo un cultivo positivo para TB (63%) y no se notificaron casos de multidrogorresistencia. Se observó retraso en el envío de las muestras en el 9% de los casos (mediana del retraso 21 días) y en el 15% de los pacientes hubo retraso en la obtención de los resultados del CDST (mediana del retraso 71 días); en 20% de los pacientes se retrasó el comienzo del régimen de retratamiento (mediana del retraso 11,5 días). La tasa de éxito terapéutico en la cohorte estudiada fue 82%.Conclusión: De todos los pacientes en retratamiento, se practicaron CDST solo en 79% de los casos y se observaron retrasos considerables en el transporte de las muestras y el comienzo del tratamiento. En el artículo se proponen métodos encaminados a fortalecer el programa.
RESUMO
OBJECTIVES: To establish whether review articles provide consistent conclusions on associations between workplace psychosocial factors and musculoskeletal pain and, if differences exist, to explore whether this is related to the methods used. METHODS: Reviews, reported up to February 2007, that included consideration of workplace psychosocial factors and upper limb, back or knee pain were identified through searches of multiple databases. The specific work-related psychosocial factors considered were job demands, support, job autonomy and job satisfaction. The conclusions of each review on one or more of the psychosocial/musculoskeletal pain associations were extracted. RESULTS: 15 review articles were identified that considered one or more of the regional pain syndromes included in the study. For back pain, the most consistent conclusions (four reviews positive out of six) were with high job demands and low job satisfaction. The studies of upper limb pain were exclusively related to shoulder and/or neck pain, and the most consistent positive conclusions were with high and low job demands (four reviews positive out of six and two reviews positive out of three, respectively). For knee pain, only a single review was identified. For individual reviews of back and upper limb pain, there were marked differences in the number of associations concluded to be positive between reviews. CONCLUSIONS: The reasons for reviews coming to different conclusions included that they were often evaluating different bodies of evidence (according to their search criteria, the year when the review was conducted, the role that quality assessment played in whether studies contributed to evidence, and the combination of risk factors addressed in individual studies), but more important was whether the review specified explicit criteria for making conclusions on strength of evidence. These conclusions emphasise the importance of developing standardised methods for conducting such evaluations of existing evidence and the importance of new longitudinal studies for clarifying the temporal relationship between psychosocial factors and musculoskeletal pain in the workplace.