Tuberculous mastitis–A great mimicker

ObjectiveTo focus on the increasing incidence of breast tuberculosis, its mistaken identity with carcinoma or pyogenic abscess and its effective diagnosis on cytology.MethodsThis retrospective study was carried over short period of two months. Six patients were included. air dried and wet fixed smears prepared and stained with May-Grunwwald-Giemsa and Papanicolaou respectively. Zeihl Neelson staining was also applied.ResultsAge groups varied from 16 to 70 years. Six cases presented within 2 months. Most common presentation was painless lump breast. One patient presented with discharging sinus. Lumps mostly favored right breast with predominance of upper outer quadrant. All except one were found to be positive for AFB.ConclusionsIncidences of tuberculous mastitis are increasing, can mimic carcinoma or abscess and should always be kept in differential diagnosis of lump breast. FNAC is helpful and ZN staining is gold standard in diagnosing acid fast bacilli.     

Feasibility and variability of measuring the Lung Clearance Index in a multi-center setting

The Lung Clearance Index (LCI) is superior to spirometry in detecting early lung disease in cystic fibrosis (CF) and correlates with structural lung changes seen on CT scans. The LCI has the potential to become a novel outcome parameter for clinical and research purposes. However longitudinal studies are required to further prove its prognostic value. Multi-center design is likely to facilitate realization of such studies. Therefore the aim of the present study was to assess multi-center feasibility and inter-center variability of LCI measurements in healthy children and adolescents. Comparative measurements were performed in unselected patients with CF to confirm previous single-center results. LCI measurements were performed in eight centers using the EasyOne Pro, MBW Module (ndd Medical Technologies, Zurich, Switzerland). The overall success rate for LCI measurements was 75.5%, leaving 102/151 measurements in healthy volunteers and 139/183 measurements in patients with CF for final analysis. Age ranged between 4 and 24 years. Mean LCI (range of means among centers) was 6.3 (6.0-6.5) in healthy volunteers and thus normal. Inter-center variability of center means was 2.9%, ANOVA including Schffé procedure demonstrated no significant inter-center differences (P > 0.05). Mean LCI (range of means among centers) was 8.2 (7.4-8.9) in CF and thus abnormal. Our study demonstrates good multi-center feasibility and low inter-center variability of the LCI in healthy volunteers when measured with the EasyOne Pro MBW module. Our data confirm published LCI data in CF. However, central coordination, quality control, regular training, and supervision during the entire study appear essential for successfully performing multi-center trials.     

Personalised electronic messages to improve sun protection in young adults

We studied the acceptability and feasibility of delivering sun protection messages via electronic media such as short message services (SMS) to people aged 18-40 years. An online survey was conducted using a pre-established panel of volunteers. We compared the characteristics of those who indicated that they would like to be alerted to the UV index, with those who would not, using bivariate logistic regression. Characteristics found to be associated with a desire to receive such advice were entered into a multivariate logistic regression analysis. The median age of the 141 participants was 34 years. Overall, 80% of participants agreed that they would like to receive some form of sun protection advice. Of these, 20% preferred to receive it via SMS and 42% via email. Willingness to receive electronic messages about the UV index was associated with being unsure about whether a suntanned person would look healthy and greater use of sun protection in the past. Careful attention to message framing and timing of message delivery, and focus on the short-term effects of sun exposure such as sunburn and skin ageing should increase the acceptability of such messages to young people. Sun protection messages delivered to young adults via electronic media appear to be feasible and acceptable.     

Confidence in receiving medical care when seriously ill: a seven‐country comparison of the impact of cost barriers

Objective This paper examines how negative experiences with the health‐care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country‐wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co‐payments, have a negative effect on overall public support and therefore on the legitimacy of health‐care systems.     

From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking

ABSTRACT: Objectives: Resource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors. Objectives of this study were to identify decision criteria reported in the literature on healthcare decisionmaking. METHOD: An extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured. RESULTS: Out of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 39 were included in the study. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 338 different terms were identified. These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context. The most frequently mentioned criteria were: equity/fairness (33 times), efficacy/effectiveness (28), healthcare stakeholder interests and pressures (28), cost-effectiveness (24), strength of evidence (20), safety (19), mission and mandate of health system (18), need (16), organizational requirements and capacity (18) and patient-reported outcomes (16). CONCLUSION: This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-setting.