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T Kenyon

Publications and source records attributed to T Kenyon.

16 recordsLinked to original sources
PubMed2003

Cost-effectiveness of home-based care versus hospital care for chronically ill tuberculosis patients, Francistown, Botswana.

SETTING: Francistown, Botswana, 1999. OBJECTIVE: To determine the affordability and cost-effectiveness of home-based directly observed therapy (DOT) compared to hospital-based DOT for chronically ill tuberculosis (TB) patients, and to describe the characteristics of patients and their caregivers. DESIGN: Costs for each alternative strategy were analysed from the perspective of the health system and caregivers, in 1998 US dollars. Caregiver costs were assessed using a structured questionnaire administered to a sample of 50 caregivers. Health system costs were assessed using interviews with relevant staff and documentary data such as medical records and expenditure files. These data were used to calculate the average cost of individual components of care, and, for each alternative strategy, the average cost per patient treated. Cost-effectiveness was calculated as the cost per patient compliant with treatment. The characteristics of caregivers and patients were assessed using demographic and socio-economic data collected during interviews, and medical records. RESULTS: Overall, home-based care reduced the cost per patient treated by 44% compared with hospital-based treatment (dollars 1657 vs. dollars 2970). The cost to the caregiver was reduced by 23% (dollars 551 vs. dollars 720), while the cost to the health system was reduced by 50% (dollars 1106 vs. dollars 2206). The cost per patient complying with treatment was dollars 1726 for home-based care and dollars 2970 for hospitalisation. Caregivers were predominantly female relatives (88%), unemployed (48%), with primary school education or less (82%), and with an income of less than dollars 1000 per annum (71%). Of those patients with an HIV test result, 98% were HIV-positive. CONCLUSION: Home-based care is more affordable and cost-effective than hospital-based care for chronically ill TB patients, although costs to caregivers remain high in relation to their incomes. Structured home-based DOT should be included as a component of the National Tuberculosis Control Programme in Botswana.

Adolescent↗
PubMed2002

Use of a computerized tuberculosis register for automated generation of case finding, sputum conversion, and treatment outcome reports.

SETTING: Tuberculosis (TB) rates in southern Africa have increased dramatically in recent years. Provision of accurate data for surveillance, program management, and supervision is increasingly essential. OBJECTIVE: To develop software that would provide more efficient collection, compilation, and analysis of TB data on an ongoing basis. DESIGN: The 'Electronic TB Register' is a user-friendly, Epi-Info based software program based on the WHO/IUATLD format of recording and reporting. Individual records from the TB registry are entered in a program that provides interactive support. The software provides several patient management and supervision functions, such as lists of defaulters. Finally, it generates standard quarterly and annual reports on case-finding, sputum conversion, and cohort analysis, and provides graphs of trends and maps of TB indicators. RESULTS: The 'Electronic TB Register' software has been successfully implemented in five pilot projects in southern Africa. User acceptance has been high and quality of data has improved, although timeliness remains unchanged. Factors critical for success include a functioning, paper-based system, involvement of staff from the TB program, health information systems, and health facilities, ongoing training, and backup support. CONCLUSIONS: The 'Electronic TB Register' is a potentially powerful tool for surveillance, management, and supervision for countries with well-functioning paper-based recording and reporting systems.

Confidentiality↗
PubMed2001

Risk factors for latent tuberculosis infection among children in New York City.

OBJECTIVE: Although identification and appropriate treatment of children with latent tuberculosis (TB) infection (LTBI) is considered critical to the control and elimination of TB in the United States, there are limited data on risk factors for LTBI in pediatric populations. METHODS: To further improve targeted screening for LTBI, we performed a matched case-control study from September 1996 to December 1998. We actively surveyed 24 primary care clinics serving Northern Manhattan and Harlem twice monthly for case participants 1 to 5 years old with LTBI, defined as a child with a Mantoux tuberculin skin test (TST) >/=10 mm and a normal chest radiograph. Two age- and clinic-matched control participants with TSTs equal to 0 mm were enrolled per case. To determine risk factors for LTBI, a bilingual research worker reviewed the medical records of study participants and administered a questionnaire to the parents of participants. RESULTS: We enrolled 96 cases and 192 controls whom did not differ by age, gender, ethnicity, and race; overall, the mean age of participants was 2.9 years, 51% were male, 80% were Hispanic, and 9% black. Logistic regression analysis demonstrated that contact with an adult with active TB, foreign birth, foreign travel, and a relative with a positive TST were predictive of case status. In contrast, a history of a previous negative TST proved protective and BCG immunization was not an independent risk factor for a positive TST, suggesting that boosting was not important in this population. CONCLUSIONS: We identified several risk factors for LTBI in children that can be used to refine targeted surveillance for TB among Hispanic immigrant populations in the United States.

Case-Control Studies↗
PubMed2000

Validation of the surveillance system for tuberculosis in Botswana.

SETTING: Gaborone and Francistown, Botswana, where surveillance data in the 1997 Electronic Tuberculosis (TB) Register suggest that 39% of pulmonary TB patients did not have pre-treatment sputum smear microscopy performed. OBJECTIVE: To determine the proportion of patients with reportedly missing pre-treatment sputum smear results in 1997 who had smears examined, and to identify stages in the system where results were lost. METHODS: Patients with pulmonary TB in 1997 who were missing pre-treatment sputum smear results in the Electronic TB Register were cross-matched with laboratory records; medical records were reviewed. RESULTS: Of 374 patients with pre-treatment sputum smear results missing, 224 (60%) actually had had a sputum smear examined in the laboratory. The proportion of pulmonary TB patients in Gaborone and Francistown who did not have sputum examined was therefore 16% instead of 39%. Most missing results (69%) had not been transcribed from the laboratory results onto the TB Treatment Card. Patients who had a negative smear result or who sought care at a clinic that was different from where their diagnostic evaluation had been initiated were more likely to have missing results. CONCLUSIONS: The actual performance of the Botswana National TB Programme with respect to sputum microscopy examination is much better than surveillance indicators suggest. In addition to sputum collection, proper recording of results needs reinforcement among health care workers to improve routine performance indicators.

Botswana↗
PubMed1997

Nosocomial transmission of human immunodeficiency virus and subsequent transmission of multidrug-resistant tuberculosis in a healthcare worker.

A phlebotomist with nosocomially acquired human immunodeficiency virus infection developed tuberculosis 10 months after exposure to multidrug-resistant Mycobacterium tuberculosis during a nosocomial outbreak. Healthcare workers with immunosuppression are at increased risk of tuberculosis if infected and, if exposed, should be considered for preventive therapy regardless of tuberculin skin-test status.

Adult↗
PubMed1996

Laparoscopic treatment of known choledocholithiasis.

BACKGROUND: Occasionally patients present to the surgeon with known common duct stones. These will frequently have been detected by imaging modalities: ultrasound, computed tomography (CT) scans, transhepatic cholangiogram (THC) or IV cholangiography. Occasionally there are stones that had failed attempts at endoscopic retrieval (ERCP). METHODS: A retrospective analysis of a prospectively gathered database of 77 laparoscopic common bile duct explorations was done to assess the incidence, treatments and outcomes of patients who had known common duct stones (CDS) before surgery. RESULTS: Eighteen patients (23%) were identified as having a preoperative diagnosis of CDS. All underwent a laparoscopic common bile duct exploration. This exploration was successful in all cases. Outcomes were good with a 4% complication rate and one case of retained common duct stones (4%). CONCLUSIONS: Before laparoscopic cholecystectomy, known choledocholithiasis was considered a surgical disease except in cases of acute cholangitis or the very morbidly ill. The ability to perform cholecystectomy laparoscopically made many practitioners avoid open common duct exploration and, instead, rely on ERCP as primary treatment for known or suspected common duct stones. As techniques of laparoscopic common duct exploration improve, the ability to deal with common duct pathology surgically has increased, offering new options for treatment of this patient population. We present our experience with 18 patients who presented with known choledocholithiasis and were treated laparoscopically with good results.

Gallstones↗
PubMed1995

The knit stitch. An improved method of laparoscopic knot tying.

Intracorporeal suturing is essential to advanced laparoscopy and is a rate-limiting step in many procedures. We have outlined an improved method of intracorporeal knot tying which is easier to learn, faster, and more consistently performed than current methods. Conventional intracorporeal knot-tying technique was compared to the knit-stitch method by ten volunteer surgeons. Each participant tied ten conventional-style knots in a video trainer. Surgeons were then taught the knit-stitch method and tied an additional ten knots. Knot-tying times were recorded and compared. Participants were asked to choose the method they preferred. The knit-stitch method was demonstrated to be faster than the conventional method for all participants, regardless of level of training or laparoscopic expertise (mean 63 +/- 19 vs 97 +/- 48 s; P < 0.001). The difference was most marked in participants with the least laparoscopic suturing experience. The knit-stitch was preferred by 90% of the surgeons. Reasons cited for this preference were ease of learning, conservation of instrument motion, better utilization of the nondominant hand, and ability to work with shorter suture. Knit stitching is a faster, more consistent method of intracorporeal suturing. It is preferred because of its simplicity, efficiency, and potential to further reduce tissue trauma during the course of laparoscopic suturing.

Laparoscopy↗
PubMed1995

Laparoscopic lumbar discectomy.

BACKGROUND: Minimally invasive spine surgery is gaining popularity. Results of currently used percutaneous posterior techniques fall short of standard open microdiscectomy. Using a posterior percutaneous technology with an anterior laparoscopic approach may improve results and still maintain the advantages of a minimally invasive procedure. METHODS: Patients with symptomatic lumbar protruded discs confirmed by computed tomography or magnetic resonance imaging were offered the procedure. Transperitoneal visualization of the retroperitoneum was supplemented with fluoroscopic guidance. A small window made to the disc allowed the percutaneous nucleotome to be inserted through the anterior annulus. The automated nucleotome aspirated the nucleus, leaving the ligaments intact. RESULTS: All patients underwent successful dissection and placement of the nucleotome. Of the 23 patients, 21 left the hospital in less than 24 hours. The initial neurologic outcome is that 20 out of 23 patients had improved symptoms or were asymptomatic. Complications were minimal. CONCLUSION: Laparoscopic lumbar discectomy is safe, and for carefully selected patients, can be an alternative to posterior microdiscectomy.

Adolescent↗
PubMed1992

Maternal mortality in the Thyolo District of southern Malawi.

The Sisterhood Method, a community-based survey technique, was used to estimate the Life Time Risk of a woman dying a maternal death in Southern Malawi. With this figure, the maternal mortality ratio for that area was calculated to be 409 deaths per 100,000 live births. The 4124 adults interviewed reported 150 maternal deaths in sisters. An in-depth questionnaire was then used to determine that 56% of these deaths occurred outside a health facility, largely due to lack of transportation or poor access to fixed health care facilities; 25% died from excessive hemorrhage; 20% from obstructed labour; 18% from abortion; 13% from sepsis; while eclampsia accounted for only 4% of the maternal deaths. This field experience with the Sisterhood Method technique combined with an in-depth questionnaire for determining causes of maternal deaths has provided useful information in a simple and cost-effective manner for use in planning intervention strategies designed to decrease maternal mortality.

Adolescent↗
PubMed1978

Ventricular fibrillation from diatrizoate with and without chelating agents.

The toxicity of Renografin 76% was compared with that of Hypaque 76% by selective injection of each into the right coronary artery of dogs. Renografin contains the chelating agents sodium citrate and disodium edetate, while Hypaque contains calcium disodium edetate and no sodium citrate. Ventricular fibrillation occurred significantly more often with Renografin, suggesting that chelating agents contribute to toxicity in coronary angiography.

Angiography↗
PubMedDate not supplied

Reduction in ventricular fibrillation using calcium-enriched Renografin 76.

Renografin 76 has been shown to have significant calcium-binding properties in vivo and in vitro. Two contrast media solutions were compared by selective injection into the right coronary artery of dogs. One set of injections was made with commercially available Renografin 76 (referred to as stock Renografin) and another set of injections was made with Renografin 76 to which had been added 24 mMols/liter of calcium chloride dihydrate. Ventricular fibrillation occurred significantly more often with the stock Renografin 76. The nature of the calcium binding and its effects are discussed.

Angiography↗