Tuberculosis screening and chest x-ray films.
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Biomedical subjects
Publications and source records attributed to L B Reichman.
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UNLABELLED: CLINICAL ISSUES: After declining for decades, the incidence of tuberculosis is again increasing, and strains resistant to multiple drugs are appearing. The greatest increases in infection have been in blacks and Hispanics. The disease is most aggressive in patients infected with human immunodeficiency virus and in patients receiving immunosuppressive therapy; diagnosis may be difficult in these groups. Resistance to antituberculosis drugs is the result of inadequate regimens or of patients not complying with prescribed regimens. RECOMMENDATIONS: The current epidemic can be stopped, but this will require a serious commitment by the public, the medical community, government, and industry. Physicians must prevent the spread of tuberculosis, detect people who are infected, treat infected people preventively with isoniazid, and, in people with active disease, rapidly establish the diagnosis and use adequate, directly supervised, four-drug regimens to treat it. Convenient combined preparations and programs to directly supervise the taking of medications are needed.
Literature describing experiences in the implementation of a smoke-free policy in a hospital suggests that, with careful preparation and close monitoring, a smoke-free policy can be successfully instituted. Despite this pervasive viewpoint, any hospital personnel considering the adoption of a smoke-free policy should be aware that the institution of such a policy may be quite difficult. The experience at University Hospital suggests that a strong policy statement, administrative support, and a comprehensive implementation plan have helped to achieve widespread compliance with the smoke-free policy among hospital employees. Unfortunately, the smoke-free policy has been less successful changing the smoking activities of the patients. Although others have not reported this compliance problem, we believe it is a real problem that many institutions will face. We present methods used to identify, combat, and monitor this compliance problem.
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