Tuberculosis surveillance in Cape Town, South Africa: an evaluation.

SETTING: Cape Town, South Africa. OBJECTIVE: To evaluate the current system of tuberculosis surveillance in the Cape Metro region. DESIGN: This evaluation was based on the 'Updated Guidelines for Evaluating Public Health Surveillance Systems' of the Centers for Disease Control and Prevention, modified to render the framework applicable to the context of tuberculosis (TB) surveillance. The evaluation incorporated qualitative exploration of perceptions and experiences of system users. RESULTS: System users were very accepting of the system and were committed to seeing it achieve its purpose within public health. Some individuals expressed concerns about the rigidity of the Electronic TB Register software and its analysis capabilities. Dissemination of TB data and evidence-based action within the Cape Metro region are strong attributes of Cape Town's TB surveillance system. At the time of the evaluation, integration of TB and human immunodeficiency virus (HIV) data was weak, as was multidrug-resistant TB (MDR-TB) surveillance; the South African Tuberculosis Control Programme is developing initiatives to improve these areas. CONCLUSIONS: Cape Metro's TB surveillance is strong, although it would be strengthened by increasing availability of data reflecting TB-HIV co-infection and MDR-TB. Systems operations could be improved by increasing software flexibility, and increased integration of electronic data across health regions would enhance the capacity and assessment of control efforts.

Interactive conference voting. The OMERACT II Committee. Outcome Measures in Rheumatoid Arthritis Clinical Trial Conference.

We describe and analyze opinion polling results from interactive voting procedures undertaken before and after presentations during the Outcome Measures in Rheumatoid Arthritis Clinical Trials Conference (OMERACT II) in Ottawa, Canada, June 30-July 2, 1994. The scoring procedure was a matched voting design; when a participant used the same keypad at the beginning and end of voting, change within a participant could be estimated. Participants, experienced in the rheumatic diseases included clinicians, researchers, methodologists, regulators, and representatives of the pharmaceutical industry. Patients under consideration were those with any rheumatic diseases. Questions were constructed to evaluate the change in voting behavior expected from the content of the presentation. Statistically significant and substantively important changes were evident in most questions.

Total hip replacement: the case for noncemented femoral fixation because of age.

Both noncemented fixation and improved cemented fixation of total hip replacements emerged to counteract the clinical and radiographic failures of early cemented procedures. A randomized clinical trial comparing a second-generation cemented with a second-generation noncemented total hip replacement demonstrated that in the medium term both implants allow excellent, disease-specific, global and functional capacity outcome measures. No significant differences existed between the cemented and noncemented implants in terms of these parameters or revision rate. Cost-to-utility analyses of both types of replacements revealed that total hip replacement is one of the most cost-effective medical interventions. Noncemented total hip replacements seem as efficacious as cemented devices in patients younger than 70 years.

50-foot walking time: a critical assessment of an outcome measure in clinical therapeutic trials of antirheumatic drugs.

Fifty-foot walking time was used in 51 of 187 clinical therapeutic trials of antirheumatic drugs and in only 21 instances was statistical significance reached. Measurement of the 50-foot walking time showed no better performance in long-term trials of SAARDs than in short-term trials of NSAIDs. It is concluded that the 50-foot walking time is a poor outcome measure in rheumatic disease trials, despite a high intra- and interobserver reproducibility.