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A case-finding Clinical Decision Support System to Identify Subjects with Chronic Obstructive Pulmonary Disease Based on Public Health Data

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Tsinghua Science and Technology 2023年第3期28卷 525-540页

作者： Xinshan Lin Yi Lei Jun Chen Zhihui Xing Ting Yang Qing Wang Chen Wang Department of Pulmonary and Critical Care Medicine China-Japan Friendship HospitalBeijing 100029China School of Software Engineering the Faculty of Information TechnologyBeijing University of TechnologyBeijing 100124China Intelligent Healthcare Unit Baidu IncBeijing 100093China Department of Automation Tsinghua UniversityBeijing 100084China Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100005China

Chronic obstructive pulmonary disease(COPD)is a serious chronic respiratory disease.Improving the ability to identify patients with COPD in primary medical institutions is important to prevent and treat the disease.With the continuous development of medical digitization,the application of big data informatization in the medical and health fields has become possible.Recently,applying innovative technologies such as big data analysis,machine learning,and artificial intelligence-assisted decision-making in the medical field has become an interdisciplinary research hotspot.Based on the identification and diagnosis of COPD in the high-risk population,this study proposes a convenient and effective clinical decision support system to help identify patients with COPD in primary health institutions.The results of the preliminary experiments show that the proposed method is convenient and effective compared with the existing methods.

关键词： artificial intelligence machine learning case finding chronic obstructive pulmonary disease(COPD) clinical decision support system(CDSS)

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The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

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Infectious Diseases of Poverty 2019年第6期8卷 61-75页

作者： Suman Chandra Gurung Kritika Dixit Bhola Rai Maxine Caws Puskar Raj Paudel Raghu Dhital Shraddha Acharya Gangaram Budhathoki Deepak Malla Jens W.Levy Job van Rest Knut Lonnroth Kerri Viney Andrew Ramsay Tom Wingfield Buddha Basnyat Anil Thapa Bertie Squire Duolao Wang Gokul Mishra Kashim Shah Anil Shrestha Noemia Teixeira de Siqueira-Filha Birat Nepal Medical Trust KathmanduNepal Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK KNCV Tuberculosis Foundation The HagueNetherlands Department of Public Health Sciences Karolinska InstitutetStockholmSweden Research School of Population Health Australian National UniversityCanberraAustralia University of St Andrews St AndrewsUK University of Liverpool LiverpoolUK Oxford University Clinical Research Unit KathmanduNepal National Tuberculosis Centre BhaktapurNepal Nick Simons Institute LalitpurNepal Institute for Health Technology Assessment Porto AlegreBrazil

Background:The World Health Organization(WHO)End TB Strategy has established a milestone to reduce the number of tuberculosis(TB)-affected households facing catastrophic costs to zero by 2020.The role of active case finding(ACF)in reducing patient costs has not been determined globally.This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding(PCF),and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal.Methods:The study was conducted in two districts of Nepal:Bardiya and Pyuthan(Province No.5)between June and August 2018.One hundred patients were included in this study in a 1:1 ratio(PCF:ACF,25 consecutive ACF and 25 consecutive PCF patients in each district).The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs.Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20%of their annual household income.The intensity of catastrophic costs was calculated using the positive overshoot method.The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs.Meanwhile,the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis.Results:Ninety-nine patients were interviewed(50 ACF and 49 PCF).Patients diagnosed through ACF incurred lower costs during the pre-treatment period(direct medical:USD 14 vs USD 32,P=0.001;direct non-medical:USD 3 vs USD 10,P=0.004;indirect,time loss:USD 4 vs USD 13,P<0.001).The cost of the pre-treatment and intensive phases combined was also lower for direct medical(USD 15 vs USD 34,P=0.002)and non-medical(USD 30 vs USD 54,P=0.022)costs among ACF patients.The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds.A lower intensity of catastrophic costs was also documented for ACF patients,although the difference was not statistically signifi

关键词： Tuberculosis case finding Cost Catastrophic cost Patient-incurred cost Nepal

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Buruli ulcer in Nigeria:results of a pilot case study in three rural districts

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Infectious Diseases of Poverty 2016年第1期5卷 328-336页

作者： Kingsley N.Ukwaja Anthony O.Meka Alphonsus Chukwuka Kingsley B.Asiedu Kristina L.Huber Miriam Eddyani Joseph N.Chukwu Moses C.Anyim Charles C.Nwafor Daniel C.Oshi Nelson O.Madichie Ngozi Ekeke Martin Njoku Kentigern Ntana Department of Medicine Federal Teaching HospitalFMC RdAbakalikiEbonyi StateNigeria Medical Department German Leprosy and TB Relief AssociationEnuguEnugu StateNigeria St Benedict’s Tuberculosis and Leprosy Rehabilitation Hospital OgojaCross River StateNigeria Global Buruli Ulcer Initiative Department of Control of Neglected Tropical DiseasesWorld Health OrganizationGenevaSwitzerland Department of Infectious Diseases and Tropical Medicine University HospitalLudwig-Maximilians UniversityMunichGermany Mycobacteriology Unit Department of MicrobiologyInstitute of Tropical MedicineAntwerpBelgium

Background:Buruli ulcer(BU),also known as Mycobacterium ulcerans disease,is the third most common mycobacterial disease worldwide.Although BU disease has been diagnosed among Nigerians in neighbouring West African countries,data on the burden of the disease in Nigeria itself are scanty.This study aimed to assess the magnitude and epidemiology of BU in the South South region of Nigeria.Methods:We conducted a cross-sectional survey in the Ogoja territory(comprising 31 communities).We undertook sensitisation programmes centred on BU in 10 of the communities.Participants were asked to identify community members with long-standing ulcers,who were then invited for evaluation.We also contacted traditional healers to refer their clients who had non-healing ulcers.All suspected cases had a full clinical evaluation and laboratory testing.Confirmed cases were given treatment in a referral hospital in the territory.Results:We diagnosed 41 clinical BU cases;36(87.8%)of which were confirmed by quantitative polymerase chain reaction(qPCR).These 36 PCR-confirmed cases were diagnosed in a total population of 192,169 inhabitants.Therefore,the estimated crude prevalence of BU was 18.7 per 100,000 population,varying from 6.0 to 41.4 per 100,000 in the districts surveyed.The majority(66.7%)of the cases were females.About 92%of the BU lesions were located on the patients’extremities.No differences were observed between the sexes in terms of the location of the lesions.The age of the patients ranged from four to 60 years,with a median age of 17 years.All 35(100%)patients who consented to treatment completed chemotherapy as prescribed.Of the treated cases,29(82.9%)needed and received surgery.All cases healed,but 29(82.9%)had some limitations in movement.Healing with limitations in movement occurred in 18/19(94.7%)and 8/10(80.0%)of patients with lesions>15 cm(Category III)and 6–15 cm in diameter(Category II),respectively.The median duration of treatment was 130(87–164)days for children and 98(56–134)days for adults(p=0.15).Conclusions:In

关键词： Buruli ulcer Mycobacterium ulcerans Epidemiology case finding Endemicity Ogoja Cross River State Nigeria

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