Medicine of the Future in America

Medicine of the Future in America News - Part 2

Hospitalizations for Tuberculosis: Diagnosis of TB

The prevalence of HIV in our study population of hospitalized TB patients was 3.3%, which is lower than the national estimate of the HIV-TB coinfectiv-ity rate of 10% published by the Centers for Disease Control and Prevention. This finding may be due to a tendency to list HIV as the primary diagnosis when TB and HIV were coincident. In fact, this appears to be a plausible explanation, as the prevalence of HIV-TB coinfectivity reached 11.3% when we included patients with a primary diagnosis of HIV and a secondary diagnosis of TB. We focused on TB as a primary diagnosis in order to capture outcomes that are most likely attributable to TB illness. Nevertheless, in a secondary analysis (data not presented) we calculated the mortality rate of patients with a primary diagnosis of HIV and a secondary diagnosis of TB to assess whether they had different mortality rates than those patients in our study. The mortality rate was 4.8%, which is similar to that for patients with a primary diagnosis of TB. Thus, we do not believe that including these patients in our analysis would have changed our results significantly. Continue reading

Hospitalizations for Tuberculosis: DCI

Hospitalizations for Tuberculosis: DCIOlder age was a strong, independent predictor of mortality. Given the aging of the American population, mortality from TB in the elderly is an enormous concern. Mortality may be higher in older adults because they may receive less vigorous care, or older persons may have more severe disease because of a decreased immunologic status and decreased baseline functional status. Older people with TB have been shown to have more extensive disease, based on chest radiograph findings at presentation. Importantly, age may have a modifying effect on TB illness itself, making the diagnosis of TB more difficult. Older TB patients have a higher prevalence of nonspecific symptoms, a lower prevalence of fever, and less frequently manifest a positive tuberculin skin test. This less classic presentation may contribute to the longer delay in presentation and initiation of treatment, and may lead to a higher risk of death. Continue reading

Hospitalizations for Tuberculosis: Mortality rate

While all people are susceptible to infection with TB, the majority of cases occur in men, minorities, and the socially disadvantaged. Our results are consistent with these previous epidemiologic data.
This study extends previous insights, and shows that men continue to be at greater risk and that most of the patients admitted to the hospital with TB were racial minorities, residents of regions with lowhouse-hold incomes, and had publicly funded or no health insurance. Continue reading

Hospitalizations for Tuberculosis: Discussion

Hospitalizations for Tuberculosis: DiscussionWhen hospital admission source was added to the multivariate model, the associations with patient characteristics and mortality were not significantly changed. However, patients admitted to the hospital through the emergency department were more than twice as likely to die during their hospitalization compared to those with routine hospital admissions (OR, 2.38; p = 0.001). Hospital characteristics were not significant in multivariate analysis and, when included in the multivariate model, did not significantly change the results (data not shown). Continue reading

Hospitalizations for Tuberculosis: Outcomes

Comorbid illness was common in patients with TB, with 29% having a DCI score of 1, 9% having a score of 2, and 4% having a score of > 3. Seventy-five patients (3.3%) were identified as having HIV infection.
Over half of the patients with TB (57%) were admitted to the hospital through the emergency department, and Table 2 shows the characteristics of the hospitals to which TB patients were admitted. Compared to non-TB patients, those with TB were more likely to be admitted to urban hospitals (92% vs 84%, respectively; p < 0.001) and those designated as teaching hospitals (61% vs 43%, respectively; p < 0.001).  Continue reading

Hospitalizations for Tuberculosis: Results

Hospitalizations for Tuberculosis: ResultsLogistic regression models were developed to evaluate the mortality outcome. Unweighted and weighted distributions for independent variables were similar, thus unweighted values were used in logistic models for simplicity. Bivariate analyses were conducted to determine the association of potential predictors of in-hospital mortality. The following multivariate models were used to adjust for potential confounding and interaction: (1) patient characteristics; (2) patient characteristics and hospital admission source; and (3) patient characteristics and hospital characteristics. The goodness of fit of the multiple logistic regression models was assessed using the Hosmer-Lemeshow test. Data from the logistic regression analyses are presented as crude and adjusted odds ratios (ORs), with corresponding 95% confidence intervals (CIs) and p values. Statistical analyses were performed using a statistical software package (Stata, version 6.0; Stata Corp; College Station, TX). Continue reading

Hospitalizations for Tuberculosis: Database

We used the 2000 Nationwide Inpatient Sample (NIS), a database of hospital inpatient stays, developed by the Healthcare Cost and Utilization Project. As the largest all-payer inpatient care database that is publicly available in the United States, the NIS data set represents 20% of non-federal US hospitals. These data include a stratified random sample of 994 hospitals in 28 states, encompassing approximately 7.5 million inpatient stays. Continue reading

Hospitalizations for Tuberculosis

Hospitalizations for Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and transmitted by aerosolized droplet nuclei, infecting approximately one third of the world population. In 1997, it was estimated that almost 2 million people died of TB worldwide, with a case fatality rate as high as 23%. In the United States, active TB disease usually can be treated successfully, with an extended therapeutic course of a combination of antibiotics, often using directly observed therapy (DOT). According to a recent expert consensus statement,2 “it is well established that appropriate therapy of TB rapidly renders the patient noninfectious… minimizes the risk of disability or death from TB and nearly eliminates the possibility of relapse.” Despite the availability of curative therapy, TB affects the quality of life of the people infected. A large proportion of patients with TB are being hospitalized, and inhospital mortality remains high, with estimates of mortality rates ranging widely from 2 to 12%. Some studies have examined the costs of TB hospitalizations, however, few investigations have addressed the poor outcomes of hospitalized patients with TB. Continue reading

Exercise Training Improves Overall Physical Fitness and Quality of Life: Effects of Exercise Training on Aerobic Endurance

Previous studies have found that strength training alone- or combined with AT was associated with a 11 to 20% increase in distance walked in 6 min in older women with CAD or heart failure. We found that 8 weeks of AT or COMT was associated with a 10% increase in the distance walked in 6 min. Thus, the heightened V02peak that occurs with AT or COMT also increases aerobic endurance, which allows older women with CAD to increase the distance that they can walk during a 6-min period. Continue reading

Exercise Training Improves Overall Physical Fitness and Quality of Life: Baseline Analysis

Exercise Training Improves Overall Physical Fitness and Quality of Life: Baseline AnalysisAt baseline, the social QOL of the AT subjects was significantly greater than that of COMT subjects (Table 1). No significant difference was found between the groups for any other baseline measure (Table 1). generic wellbutrin
Effects of Exercise Training on Vo2peak and Distance Walked in 6 min
Both AT and COMT resulted in a similar increase in peak exercise ventilation, oxygen pulse, V02peak, and distance walked in 6 min (Fig 2). No significant change in peak heart rate was found after training (pretraining, 115 ± 19 beats/min, vs posttraining. 119 ± 20 beats/min). Continue reading

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