Adjuvant diagnosis of tuberculosis in hemodialysis patients using fourth generation interferon γ releasing assay.

INTRODUCTION: Dialysis patients have a 10-25 times higher risk of reactivation of tuberculosis (TB). In this study, we investigated the diagnostic ability of QuantiFERON (QFT)-plus for TB in hemodialysis patients. QFT-plus, an interferon gamma release assay, is characterized by its use of CD4 and CD8 T cell signals. METHODS: Hemodialysis patients aged 20 years or older who underwent QFT-plus measurement in our hospital were included, inclusion criteria being fever above 37°C, high inflammatory response, and infiltrative pulmonary shadows. RESULTS: Forty-six patients were enrolled. Of these, 15% were QFT positive, 4% were diagnosed with active TB, 76% were QFT negative, 8% had inconclusive results. Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 87.5%, 28%, and 100%, respectively. CONCLUSIONS: QFT-plus may be useful for the diagnosis of active TB in dialysis patients. Further studies in cohorts with larger sample sizes are expected.

Work-related musculoskeletal disorders in the upper extremity among the staff of a Japanese university hospital.

PURPOSE: The Hand20 is an outcome assessment tool developed in Japan to measure upper extremity disability. The purpose of this study was to investigate occupational musculoskeletal disorders in the upper extremity of hospital personnel and to obtain normative data for the Hand20 in a nonclinical population. METHODS: A cross-sectional questionnaire study was carried out among 2,600 researchers and staff members of the Faculty of Medicine and its affiliated hospital. RESULTS: There were 1,120 responders who went to their daily work without consulting a doctor about any upper extremity disorders, and 232 of these responders complained of upper extremity pain. The mean Hand20 score was 2.67 [standard deviation (SD) 7.06]. Women tended to have significantly higher total Hand20 scores than men (mean ± SD: men = 2.03 ± 5.15, women = 2.94 ± 7.71, p < 0.01). The Hand20 score tended to increase in participants over 40 years of age (p < 0.001). Significant differences were not found by work intensity (p = 0.712). Binominal logistic analysis revealed that the risk of a high Hand20 score (over the 75 % inter-quartile range, over 13.1) was greater with increasing age [odd ratios (ORs) 1.051, 1.071, respectively] and female sex (ORs 1.786, 1.966, respectively), and that the risk of upper extremity pain was greater with increasing age (OR 1.051), heavy physical work (OR 2.042), and physical work (OR 1.916). CONCLUSIONS: Females in all age groups and both sexes in middle age or older need to be informed about their higher risk of upper extremity disorders and should be educated about how to avoid work-related musculoskeletal disorders and their progression.

Development and validation of a ten-item questionnaire with explanatory illustrations to assess upper extremity disorders: favorable effect of illustrations in the item reduction process.

BACKGROUND: The purpose of this study is to develop a short and valid measure for upper extremity disorders and to assess the effect of attached illustrations in item reduction of a self-administered disability questionnaire while retaining psychometric properties. METHODS: A validated questionnaire used to assess upper extremity disorders, the Hand20, was reduced to ten items using two item-reduction techniques. The psychometric properties of the abbreviated form, the Hand10, were evaluated on an independent sample that was used for the shortening process. RESULTS: Validity, reliability, and responsiveness of the Hand10 were retained in the item reduction process. It was possible that the use of explanatory illustrations attached to the Hand10 helped with its reproducibility. The illustrations for the Hand10 promoted text comprehension and motivation to answer the items. These changes resulted in high acceptability; more than 99.3% of patients, including 98.5% of elderly patients, could complete the Hand10 properly. CONCLUSION: The illustrations had favorable effects on the item reduction process and made it possible to retain precision of the instrument. The Hand10 is a reliable and valid instrument for individual-level applications with the advantage of being compact and broadly applicable, even in elderly individuals.