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2.
PLoS One ; 15(10): e0241169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33104736

RESUMO

Novel coronavirus (named SARS-CoV-2) can spread widely in confined settings including hospitals, cruise ships, prisons, and places of worship. In particular, a healthcare-associated outbreak could become the epicenter of coronavirus disease (COVID-19). This study aimed to evaluate the effects of different intervention strategies on the hospital outbreak within a tertiary hospital. A mathematical model was developed for the COVID-19 transmission within a 2500-bed tertiary hospital of South Korea. The SEIR (susceptible-exposed-infectious-recovered) model with a compartment of doctor, nurse, patient, and caregiver was constructed. The effects of different intervention strategies such as front door screening, quarantine unit for newly admitted patients, early testing of suspected infected people, and personal protective equipment for both medical staff and visitors were evaluated. The model suggested that the early testing (within eight hours) of infected cases and monitoring the quarantine ward for newly hospitalized patients are effective measures for decreasing the incidence of COVID-19 within a hospital (81.3% and 70% decrease of number of incident cases, respectively, during 60 days). Front door screening for detecting suspected cases had only 42% effectiveness. Screening for prohibiting the admission of COVID-19 patients was more effective than the measures for patients before emergency room or outpatient clinic. This model suggests that under the assumed conditions, some effective measures have a great influence on the incidence of COVID-19 within a hospital. The implementation of the preventive measures could reduce the size of a hospital outbreak.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Infecção Hospitalar/transmissão , Controle de Infecções/métodos , Modelos Teóricos , Pandemias , Pneumonia Viral/transmissão , Centros de Atenção Terciária , COVID-19 , Teste para COVID-19 , Cuidadores , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Diagnóstico Precoce , Serviço Hospitalar de Emergência , Departamentos Hospitalares , Humanos , Incidência , Programas de Rastreamento , Corpo Clínico Hospitalar , Recursos Humanos de Enfermagem Hospitalar , Ambulatório Hospitalar , Pandemias/prevenção & controle , Pacientes , Quartos de Pacientes , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , República da Coreia/epidemiologia , SARS-CoV-2 , Sensibilidade e Especificidade , Avaliação de Sintomas , Visitas a Pacientes
3.
Sci Rep ; 10(1): 14609, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32884082

RESUMO

In February 2018, the Ministry of Food and Drug Safety in Korea approved tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) co-formulate for use in pre-exposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) infection. This study aimed to estimate the cost-effectiveness of PrEP in men who have sex with men (MSM), a major risk group emerging in Korea. A dynamic compartmental model was developed for HIV transmission and progression in MSM aged 15-64 years. With a combined model including economic analysis, we estimated averted HIV infections, changes in HIV prevalence, discounted costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). PrEP was evaluated in both the general MSM and high-risk MSM populations and was assumed to reduce infection risk by 80%. Implementing PrEP in all MSM would avert 75.2% HIV infections and facilitate a gain of 37,372 QALYs at a cost of $274,822 per QALY gained over 20 years relative to the status quo. Initiating PrEP in high-risk MSM with an average of eight partners per year (around 20% of MSM) would improve the cost-effectiveness, averting 78.0% HIV infections and add 29,242 QALYs at a cost of $51,597 per QALY gained, which is within the willingness-to-pay threshold for Korea of $56,000/QALY gained. This result was highly sensitive to annual PrEP costs, quality-of-life for people who are on PrEP, and initial HIV prevalence. Initiating PrEP in a larger proportion of MSM in Korea would prevent more HIV infections, but at an increasing cost per QALY gained. Focusing PrEP on higher risk MSM and any reduction in PrEP cost would improve cost-effectiveness.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Análise Custo-Benefício , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Modelos Teóricos , Profilaxia Pré-Exposição/economia , Fármacos Anti-HIV/economia , Infecções por HIV/economia , Humanos , Masculino , Qualidade de Vida , República da Coreia
4.
Bone Joint J ; 101-B(12): 1542-1549, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31786996

RESUMO

AIMS: Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. PATIENTS AND METHODS: We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes. RESULTS: In multivariate regression analysis, the factors associated with unfavourable outcome were old age (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.07 to 5.86; p = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR 3.05; 95% CI 1.06 to 8.80; p = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR 3.85; 95% CI 1.62 to 9.13; p = 0.002). Patients with unfavourable outcomes had a significant trend toward higher ESR during treatment compared with patients with favourable outcome (p = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. CONCLUSION: Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR is not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavourable outcomes. Cite this article: Bone Joint J 2019;101-B:1542-1549.


Assuntos
Antituberculosos/uso terapêutico , Procedimentos Ortopédicos , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/terapia , Adulto , Idoso , Biomarcadores/sangue , Sedimentação Sanguínea , Terapia Combinada , Efeitos Psicossociais da Doença , Feminino , Seguimentos , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Prognóstico , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose da Coluna Vertebral/sangue
5.
Int J Infect Dis ; 83: 49-55, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30959246

RESUMO

OBJECTIVES: In 2014, South Korea expanded its national health insurance coverage to include newer antifungal agents, such as echinocandins. This study aimed to investigate the effects of policy change on the prescription patterns of antifungals, medical costs and clinical outcomes of candidemia. METHODS: This retrospective cohort enrolled hospitalized patients with candidemia at three tertiary care hospitals in South Korea from January 2012 to December 2015. The utilization of antifungal agents, medical costs, length of hospital stay (LOS), and mortality before and after the health-care benefit expansion were compared, and the factors associated with all-cause 28-day mortality during the study period were analyzed. RESULTS: A total of 769 candidemia cases were identified. The incidence of candidemia did not significantly vary during the study period (P = 0.253). The proportion of echinocandins, as the initial antifungal agent, and medical costs associated with candidemia significantly increased since the change in insurance coverage (P < 0.001). There was no significant difference in LOS and mortality associated with candidemia before and after the health-care benefit expansion (P = 0.696 and 0.931, respectively). Multivariate logistic regression analysis showed that initial treatment with caspofungin was associated with decreased mortality (adjusted odds ratio: 0.784; 95% confidence interval: 0.681-0.902; reference: fluconazole). CONCLUSIONS: Although the utilization of newer antifungal agents and medical cost for candidemia has significantly increased since the health-care benefit expansion, there has been no change in the outcome of candidemia. However, the further increased use of newer antifungals may improve the outcome of candidemia in this country.


Assuntos
Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Custos de Cuidados de Saúde , Idoso , Antifúngicos/economia , Uso de Medicamentos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , República da Coreia , Estudos Retrospectivos
6.
J Psychosom Res ; 80: 53-7, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26721548

RESUMO

OBJECTIVES: The Montreal Cognitive Assessment (MoCA) is a useful screening tool for mild cognitive impairment. We aimed to know whether the full MoCA and subsets of the full test are effective for detecting HIV-associated neurocognitive disorder (HAND). METHODS: We examined the socio-demographic, clinical, functional, and neuropsychological levels of 194 HIV-infected patients. We compared total scores and scores from each cognitive domain of MoCA between patients with and without HAND. We also examined the utility of subsets of the full test using a few selective domains. The diagnostic accuracies of MoCA and subset composition were evaluated. RESULTS: The total scores of MoCA (P<0.001) and scores from Trail Making Test-B (P=0.020), attention domain (P=0.005), and immediate (P=0.003) and delayed recall (P=0.002) differed between patients with and without HAND. A subset composed of Trail Making Test-B, rescored serial subtraction, and immediate/delayed recall showed a 69.2% accuracy. CONCLUSIONS: Our results suggest that the MoCA and its subsets alone are not sufficient in screening for HAND. Further studies will be needed to develop a simpler and easier screening tool for HAND based on this study.


Assuntos
Complexo AIDS Demência/diagnóstico , Complexo AIDS Demência/psicologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Testes Neuropsicológicos , Adulto , Atenção , Transtornos Cognitivos/etiologia , Função Executiva , Feminino , Infecções por HIV/psicologia , Humanos , Testes de Linguagem , Masculino , Programas de Rastreamento , Memória de Curto Prazo , Rememoração Mental , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Teste de Sequência Alfanumérica
7.
Scand J Infect Dis ; 46(2): 136-40, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24228824

RESUMO

BACKGROUND: There have been various efforts to identify less costly but still accurate methods for monitoring the response to HIV treatment. We evaluated a pooling method to determine if this could improve screening efficiency and reduce costs while maintaining accuracy in Seoul, South Korea. METHODS: We conducted the first prospective study of pooled nucleic acid testing (NAT) using a 5 minipool + algorithm strategy versus individual viral load testing for patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. The viral load assay used has a lower level of detection of 20 HIV RNA copies/ml, and the cost per assay is US$ 136. The 5 minipool +algorithm strategy was applied and 43 pooled samples were evaluated. The relative efficiency and accuracy of the pooled NAT were compared with those of individual testing. RESULTS: Using the individual viral load assay, 15 of 215 (7%) plasma samples had more than 200 HIV RNA copies/ml. The pooled NAT using the 5 minipool + algorithm strategy was applied to 43 pooled samples; 111 tests were needed to test all samples when virologic failure was defined at HIV RNA ≥ 200 copies/ml. Therefore, 104 tests were saved over individual testing, with a relative efficiency of 0.48. When evaluating costs, a total of US$ 14,144 was saved for 215 individual samples during 10 months. The negative predictive value was 99.5% for all samples with HIV RNA ≥ 200 copies/ml. CONCLUSIONS: The pooled NAT with 5 minipool + algorithm strategy seems to be a very promising approach to effectively monitor patients receiving ART and to save resources.


Assuntos
Antirretrovirais/uso terapêutico , Monitoramento de Medicamentos/métodos , Infecções por HIV/tratamento farmacológico , HIV/isolamento & purificação , Ácidos Nucleicos/isolamento & purificação , Manejo de Espécimes/métodos , Carga Viral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Monitoramento de Medicamentos/economia , Feminino , HIV/genética , Infecções por HIV/virologia , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Ácidos Nucleicos/genética , República da Coreia , Manejo de Espécimes/economia , Falha de Tratamento , Carga Viral/economia , Adulto Jovem
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