Tuberculosis in association with travel

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Abstract
Throughout history, tuberculosis has been spread by the movement of human populations. Modern travel continues to be
associated with risk of tuberculosis infection and disease. TB transmission has been documented on commercial aircraft, from
personnel or passengers to other personnel and passengers, but the risk of transmission is low. As in other settings, the likelihood of
transmission is proportional to duration and proximity of contact. Travellers from low incidence to high incidence countries have an
appreciable risk of acquiring TB infection similar to that of the general populations in the countries they visit, but the risk is higher if
they work in health care. Two-step tuberculin skin testing prior to departure, followed by single-step tuberculin testing after return,
is recommended for all such travellers. For travellers from high incidence to low incidence countries the risk of acquiring new TB
infection is low. Tuberculin screening is not beneficial and not recommended. Chest X-ray screening is expensive and complex but
may be beneficial for long-term migrants. For short-term travellers, such as the pilgrims to Mecca in Saudi Arabia, there is no
practical or feasible intervention to detect or prevent TB. Emphasis should be placed on public awareness and education campaigns
to facilitate passive diagnosis of symptomatic cases. Mycobacterium tuberculosis (MTB) continues to be a common concern for the
global traveller.

Using Computerized Clinical Decision Support for Latent Tuberculosis Infection Screening

اختصاصی از فی فوو Using Computerized Clinical Decision Support for Latent Tuberculosis Infection Screening دانلود با لینک مستقیم و پر سرعت .

Andy W. Steele, MD, MPH, Sheri Eisert, PhD, Art Davidson, MD, MPH, Taylor Sandison, MD, Pat Lyons,
Nedra Garrett, Patricia Gabow, MD, Eduardo Ortiz, MD, MPH
Background: The Centers for Disease Control and Prevention (CDC) has published guidelines recommending
screening high-risk groups for latent tuberculosis infection (LTBI). The goal of
this study was to determine the impact of computerized clinical decision support and
guided web-based documentation on screening rates for LTBI.
Design: Nonrandomized, prospective, intervention study.
Setting and
participants:
Participants were 8463 patients seen at two primary care, outpatient, public community
health center clinics in late 2002 and early 2003.
Intervention: The CDC’s LTBI guidelines were encoded into a computerized clinical decision support
system that provided an alert recommending further assessment of LTBI risk if certain
guideline criteria were met (birth in a high-risk TB country and aged 40). A guided
web-based documentation tool was provided to facilitate appropriate adherence to the
LTBI screening guideline and to promote accurate documentation and evaluation.
Baseline data were collected for 15 weeks and study-phase data were collected for 12 weeks.
Main
outcome
measures:
Appropriate LTBI screening according to CDC guidelines based on chart review.
Results: Among 4135 patients registering during the post-intervention phase, 73% had at least one
CDC-defined risk factor, and 610 met the alert criteria (birth in a high-risk TB country and
aged 40 years) for potential screening for LTBI. Adherence with the LTBI screening
guideline improved significantly from 8.9% at baseline to 25.2% during the study phase
(183% increase, p 0.001).
Conclusions: This study demonstrated that computerized, clinical decision support using alerts and
guided web-based documentation increased screening of high-risk patients for LTBI. This
type of technology could lead to an improvement in LTBI screening in the United States
and also holds promise for improved care for other preventive and chronic conditions.
(Am J Prev Med 2005;28(3):281–284) © 2005 American Journal of Preventive Medicine