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| 结核病诊断与治疗过程中的提醒系统与未取药患者追踪 |
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| Reminder systems and late patient tracers in the diagnosis and management of tuberculosis |
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| Liu Q., Abba K., Alejandria M.M., Balanag V.M., Berba R.P., Lansang M.A.D. 2009/5/29 18:39:20 |
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Cochrane Database of Systematic Reviews, 2008, Volume 0, Issue 4
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| Background: Reminder systems and late patient tracers as strategies to improve patients' adherence to tuberculosis screening, diagnosis, and treatment are used in some countries, but their effectiveness has not previously been systematically reviewed. Objectives: To assess the effects of reminder systems and late patient tracers on completion of diagnostics, commencement of treatment in people referred for curative or prophylactic treatment of tuberculosis, completion of treatment in people starting curative or prophylactic treatment for tuberculosis, and cure in people being treated for active tuberculosis. Search strategy: We searched the Cochrane Infectious Diseases Group Specialized Register (June 2008), Cochrane Effective Practice and Organization of Care Group Specialized Register (April 2007), CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE (1966 to June 2008), EMBASE (1974 to June 2008), LILACS (1982 to June 2008), CINAHL (1982 to June 2008), SCI-EXPANDED (1945 to June 2008), SSCI (1956 to June 2008), mRCT (June 2008), Indian Journal of Tuberculosis (1983 to June 2008), and reference lists. We also contacted researchers working in the field. Selection criteria: Randomized controlled trials (RCTs), including cluster RCTs and quasi-RCTs, and controlled before-and-after studies comparing any reminders or late patient tracers with no or other kinds of reminders or late patient tracers. We included people in any setting who require treatment for tuberculosis or require prophylaxis against tuberculosis and are referred to tuberculosis diagnostic or screening services. Data collection and analysis: Two authors independently assessed trial risk of bias and extracted data. No meta-analysis could be undertaken due to the heterogeneity of interventions across trials. Main results: Nine trials involving 5257 participants met the inclusion criteria. Three assessed the use of late patient tracers, and six assessed reminder systems. Late patient tracers (home visit and letter) were shown to be beneficial in increasing adherence to tuberculosis treatment compared with no late patient tracer. The results from almost all the reminder trials, except one, show benefits of different types of reminders compared to no reminder on adherence to tuberculosis clinic appointments. Authors' conclusions: The included trials show significantly better outcomes among those tuberculosis patients for which late patient tracers and reminders are used. Studies of good quality (large and with rigorous study design) are needed to decide the most effective late patient tracer actions and reminders in different settings. Future studies of reminders in chemoprophylaxis and treatment settings would be useful. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. |
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| Correspondence Address: Liu, Q.; Effective Healthcare Research Programme Consortium China (Chongqing), School of Public Health, Chongqing Medical University, No.1 YixueYuan Road, Chongqing, 400016, China; email: liuqin81622@163.com |
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 疾病资源中心
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
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