scholarly journals A Fully Integrated Real-Time Detection, Diagnosis, and Control of Community Diarrheal Disease Clusters and Outbreaks (the INTEGRATE Project): Protocol for an Enhanced Surveillance System (Preprint)

2019 ◽  
Author(s):  
Kirsty Marie McIntyre ◽  
Frederick J Bolton ◽  
Rob M Christley ◽  
Paul Cleary ◽  
Elizabeth Deja ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real Time ◽  
Surveillance System ◽  
Diarrheal Disease ◽  
Gastrointestinal Disease ◽  
Diagnostic Methods ◽  
Surveillance Systems ◽  
National Implementation ◽  
The Cost ◽  
And Control

BACKGROUND Diarrheal disease, which affects 1 in 4 people in the United Kingdom annually, is the most common cause of outbreaks in community and health care settings. Traditional surveillance methods tend to detect point-source outbreaks of diarrhea and vomiting; they are less effective at identifying low-level and intermittent food supply contamination. Furthermore, it can take up to 9 weeks for infections to be confirmed, reducing slow-burn outbreak recognition, potentially impacting hundreds or thousands of people over wide geographical areas. There is a need to address fundamental problems in traditional diarrheal disease surveillance because of underreporting and subsequent unconfirmed infection by patients and general practitioners (GPs); varying submission practices and selective testing of samples in laboratories; limitations in traditional microbiological diagnostics, meaning that the timeliness of sample testing and etiology of most cases remains unknown; and poorly integrated human and animal surveillance systems, meaning that identification of zoonoses is delayed or missed. OBJECTIVE This study aims to detect anomalous patterns in the incidence of gastrointestinal disease in the (human) community; to target sampling; to test traditional diagnostic methods against rapid, modern, and sensitive molecular and genomic microbiology methods that identify and characterize responsible pathogens rapidly and more completely; and to determine the cost-effectiveness of rapid, modern, sensitive molecular and genomic microbiology methods. METHODS Syndromic surveillance will be used to aid identification of anomalous patterns in microbiological events based on temporal associations, demographic similarities among patients and animals, and changes in trends in acute gastroenteritis cases using a point process statistical model. Stool samples will be obtained from patients’ consulting GPs, to improve the timeliness of cluster detection and characterize the pathogens responsible, allowing health protection professionals to investigate and control outbreaks quickly, limiting their size and impact. The cost-effectiveness of the proposed system will be examined using formal cost-utility analysis to inform decisions on national implementation. RESULTS The project commenced on April 1, 2013. Favorable approval was obtained from the Research Ethics Committee on June 15, 2015, and the first patient was recruited on October 13, 2015, with 1407 patients recruited and samples processed using traditional laboratory techniques as of March 2017. CONCLUSIONS The overall aim of this study is to create a new One Health paradigm for detecting and investigating diarrhea and vomiting in the community in near-real time, shifting from passive human surveillance and management of laboratory-confirmed infection toward an integrated, interdisciplinary enhanced surveillance system including management of people with symptoms. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/13941

scholarly journals A Fully Integrated Real-Time Detection, Diagnosis, and Control of Community Diarrheal Disease Clusters and Outbreaks (the INTEGRATE Project): Protocol for an Enhanced Surveillance System

10.2196/13941 ◽  
2019 ◽  
Vol 8 (9) ◽  
pp. e13941 ◽  
Author(s):  
Kirsty Marie McIntyre ◽  
Frederick J Bolton ◽  
Rob M Christley ◽  
Paul Cleary ◽  
Elizabeth Deja ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real Time ◽  
Surveillance System ◽  
Diarrheal Disease ◽  
Gastrointestinal Disease ◽  
Diagnostic Methods ◽  
Surveillance Systems ◽  
National Implementation ◽  
The Cost ◽  
And Control

Background Diarrheal disease, which affects 1 in 4 people in the United Kingdom annually, is the most common cause of outbreaks in community and health care settings. Traditional surveillance methods tend to detect point-source outbreaks of diarrhea and vomiting; they are less effective at identifying low-level and intermittent food supply contamination. Furthermore, it can take up to 9 weeks for infections to be confirmed, reducing slow-burn outbreak recognition, potentially impacting hundreds or thousands of people over wide geographical areas. There is a need to address fundamental problems in traditional diarrheal disease surveillance because of underreporting and subsequent unconfirmed infection by patients and general practitioners (GPs); varying submission practices and selective testing of samples in laboratories; limitations in traditional microbiological diagnostics, meaning that the timeliness of sample testing and etiology of most cases remains unknown; and poorly integrated human and animal surveillance systems, meaning that identification of zoonoses is delayed or missed. Objective This study aims to detect anomalous patterns in the incidence of gastrointestinal disease in the (human) community; to target sampling; to test traditional diagnostic methods against rapid, modern, and sensitive molecular and genomic microbiology methods that identify and characterize responsible pathogens rapidly and more completely; and to determine the cost-effectiveness of rapid, modern, sensitive molecular and genomic microbiology methods. Methods Syndromic surveillance will be used to aid identification of anomalous patterns in microbiological events based on temporal associations, demographic similarities among patients and animals, and changes in trends in acute gastroenteritis cases using a point process statistical model. Stool samples will be obtained from patients’ consulting GPs, to improve the timeliness of cluster detection and characterize the pathogens responsible, allowing health protection professionals to investigate and control outbreaks quickly, limiting their size and impact. The cost-effectiveness of the proposed system will be examined using formal cost-utility analysis to inform decisions on national implementation. Results The project commenced on April 1, 2013. Favorable approval was obtained from the Research Ethics Committee on June 15, 2015, and the first patient was recruited on October 13, 2015, with 1407 patients recruited and samples processed using traditional laboratory techniques as of March 2017. Conclusions The overall aim of this study is to create a new One Health paradigm for detecting and investigating diarrhea and vomiting in the community in near-real time, shifting from passive human surveillance and management of laboratory-confirmed infection toward an integrated, interdisciplinary enhanced surveillance system including management of people with symptoms. International Registered Report Identifier (IRRID) DERR1-10.2196/13941

In-line filtration reduced phlebitis associated with peripheral venous cannulation: Focus on cost-effectiveness and patients’ perspectives

2019 ◽  
Vol 21 (2) ◽  
pp. 154-160
Author(s):  
Gianluca Villa ◽  
Rosa Giua ◽  
Timothy Amass ◽  
Lorenzo Tofani ◽  
Cosimo Chelazzi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vascular Access ◽  
Cost Effective ◽  
Causative Factor ◽  
Control Group ◽  
Previous Trial ◽  
Venous Cannulation ◽  
Group A ◽  
The Cost ◽  
And Control

Background: In a previous trial, in-line filtration significantly prevented postoperative phlebitis associated with short peripheral venous cannulation. This study aims to describe the cost-effectiveness of in-line filtration in reducing phlebitis and examine patients’ perception of in-hospital vascular access management with and without in-line filtration. Methods: We analysed costs associated with in-line filtration: these data were prospectively recorded during the previous trial. Furthermore, we performed a follow-up for all the 268 patients enrolled in this trial. Among these, 213 patients responded and completed 6 months after hospital discharge questionnaires evaluating the perception of and satisfaction with the management of their vascular access. Results: In-line filtration group required 95.60€ more than the no-filtration group (a mean of € 0.71/patient). In terms of satisfaction with the perioperative management of their short peripheral venous cannulation, 110 (82%) and 103 (76.9%) patients, respectively, for in-line filtration and control group, completed this survey. Within in-line filtration group, 97.3% of patients were satisfied/strongly satisfied; if compared with previous experiences on short peripheral venous cannulation, 11% of them recognised in-line filtration as a relevant causative factor in determining their satisfaction. Among patients within the control group, 93.2% were satisfied/strongly satisfied, although up to 30% of them had experienced postoperative phlebitis. At the qualitative interview, they recognised no difference than previous experiences on short peripheral venous cannulation, and mentioned postoperative phlebitis as a common event that ‘normally occurs’ during a hospital stay. Conclusion: In-line filtration is cost-effective in preventing postoperative phlebitis, and it seems to contribute to increasing patient satisfaction and reducing short peripheral venous cannulation–related discomfort

scholarly journals Governmental surveillance system of healthcare-associated infection in Brazil

2014 ◽  
Vol 48 (4) ◽  
pp. 657-662 ◽  
Author(s):  
Cassimiro Nogueira Junior ◽  
Maria Clara Padoveze ◽  
Rúbia Aparecida Lacerda
Keyword(s):  
Surveillance System ◽  
Surveillance Systems ◽  
Healthcare Associated Infection ◽  
Cross Sectional ◽  
Southern States ◽  
Governmental Surveillance ◽  
Minimum Requirements ◽  
Two Phases ◽  
Healthcare Associated ◽  
And Control


Objective: This study aimed to describe the structure of governmental surveillance systems for Healthcare Associated Infection (HAI) in the Brazilian Southeastern and Southern States. Method: A cross-sectional, descriptive and exploratory study, with data collection by means of two-phases: characterization of the healthcare structure and of the HAI surveillance system. Results: The governmental teams for prevention and control of HAI in each State ranged from one to six members, having at least one nurse. All States implemented their own surveillance system. The information systems were classified into chain (n=2), circle (n=4) or wheel (n=1). Conclusion: Were identified differences in the structure and information flow from governmental surveillance systems, possibly limiting a nationwide standardization. The present study points to the need for establishing minimum requirements in public policies, in order to guide the development of HAI surveillance systems.


Cost-Effectiveness of Paving Fabrics Used to Control Reflective Cracking

2000 ◽  
Vol 1730 (1) ◽  
pp. 139-149 ◽  
Author(s):  
William G. Buttlar ◽  
Diyar Bozkurt ◽  
Barry J. Dempsey
Keyword(s):  
Life Cycle ◽  
Cost Effectiveness ◽  
Department Of Transportation ◽  
Reflective Cracking ◽  
Crack Control ◽  
Condition Rating ◽  
System A ◽  
Rigid Pavements ◽  
The Cost ◽  
And Control

The Illinois Department of Transportation (IDOT) spends $2 million annually on reflective crack control treatments; however, the cost-effectiveness of these treatments had not been reliably determined. A recent study evaluated the cost-effectiveness of IDOT reflective crack control System A, which consists of a nonwoven polypropylene paving fabric, placed either in strips longitudinally over lane-widening joints or over the entire pavement (area treatment). The study was limited to projects constructed originally as rigid pavements and subsequently rehabilitated with one or more bituminous overlays. Performance of 52 projects across Illinois was assessed through crack mapping and from distress and serviceability data in IDOT’s condition rating survey database. Comparisons of measured reflective cracking in treated and control sections revealed that System A retarded longitudinal reflective widening crack development, but it did not significantly retard transverse reflective cracking, which agrees with earlier studies. However, both strip and area applications of these fabric treatments appeared to improve overall pavement serviceability, and they were estimated to increase rehabilitation life spans by 1.1 and 3.6 years, respectively. Reduction in life-cycle costs was estimated to be 4.4 and 6.2 percent when placed in medium and large quantities, respectively, and to be at a break-even level for small quantities. However, life-cycle benefits were found to be statistically insignificant. Limited permeability testing of field cores taken on severely distressed transverse joints suggested that waterproofing benefits could exist even after crack reflection. This was consistent with the observation that, although serviceability was generally improved with area treatment, crack reflection was not retarded relative to untreated areas.

scholarly journals Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Jorge A. H. Arroz ◽  
Baltazar Candrinho ◽  
Chandana Mendis ◽  
Melanie Lopez ◽  
Maria do Rosário O. Martins
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Universal Coverage ◽  
Cost Effectiveness Ratio ◽  
Net Benefit ◽  
Incremental Net Benefit ◽  
The Cost ◽  
And Control ◽  
Delivery Models ◽  
Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs. new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

scholarly journals Risks and Challenges of Arboviral Diseases in Sudan: The Urgent Need for Actions

Viruses ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 81 ◽  
Author(s):  
Ayman Ahmed ◽  
Isabelle Dietrich ◽  
A. Desiree LaBeaud ◽  
Steve W. Lindsay ◽  
Ahmed Musa ◽  
...  
Keyword(s):  
Viral Genome ◽  
Surveillance System ◽  
Prevention And Control ◽  
Research Capacity ◽  
Diagnostic Tools ◽  
Published Data ◽  
Surveillance Systems ◽  
Factors Associated ◽  
Arboviral Diseases ◽  
And Control

The risk of emergence and/or re-emergence of arthropod-borne viral (arboviral) infections is rapidly growing worldwide, particularly in Africa. The burden of arboviral infections and diseases is not well scrutinized because of the inefficient surveillance systems in endemic countries. Furthermore, the health systems are fully occupied by the burden of other co-existing febrile illnesses, especially malaria. In this review we summarize the epidemiology and risk factors associated with the major human arboviral diseases and highlight the gap in knowledge, research, and control in Sudan. Published data in English up to March 2019 were reviewed and are discussed to identify the risks and challenges for the control of arboviruses in the country. In addition, the lack of suitable diagnostic tools such as viral genome sequencing, and the urgent need for establishing a genomic database of the circulating viruses and potential sources of entry are discussed. Moreover, the research and healthcare gaps and global health threats are analyzed, and suggestions for developing strategic health policy for the prevention and control of arboviruses with focus on building the local diagnostic and research capacity and establishing an early warning surveillance system for the early detection and containment of arboviral epidemics are offered.

Utility of Ambulance Data for Real-Time Syndromic Surveillance: A Pilot in the West Midlands Region, United Kingdom

2017 ◽  
Vol 32 (6) ◽  
pp. 667-672 ◽  
Author(s):  
Dan Todkill ◽  
Paul Loveridge ◽  
Alex J. Elliot ◽  
Roger A. Morbey ◽  
Obaghe Edeghere ◽  
...  
Keyword(s):  
United Kingdom ◽  
Real Time ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Lessons Learned ◽  
Surveillance Systems ◽  
Preliminary Assessment ◽  
The West ◽  
Syndromic Surveillance System ◽  
West Midlands

AbstractIntroductionThe Public Health England (PHE; United Kingdom) Real-Time Syndromic Surveillance Team (ReSST) currently operates four national syndromic surveillance systems, including an emergency department system. A system based on ambulance data might provide an additional measure of the “severe” end of the clinical disease spectrum. This report describes the findings and lessons learned from the development and preliminary assessment of a pilot syndromic surveillance system using ambulance data from the West Midlands (WM) region in England.Hypothesis/ProblemIs an Ambulance Data Syndromic Surveillance System (ADSSS) feasible and of utility in enhancing the existing suite of PHE syndromic surveillance systems?MethodsAn ADSSS was designed, implemented, and a pilot conducted from September 1, 2015 through March 1, 2016. Surveillance cases were defined as calls to the West Midlands Ambulance Service (WMAS) regarding patients who were assigned any of 11 specified chief presenting complaints (CPCs) during the pilot period. The WMAS collected anonymized data on cases and transferred the dataset daily to ReSST, which contained anonymized information on patients’ demographics, partial postcode of patients’ location, and CPC. The 11 CPCs covered a broad range of syndromes. The dataset was analyzed descriptively each week to determine trends and key epidemiological characteristics of patients, and an automated statistical algorithm was employed daily to detect higher than expected number of calls. A preliminary assessment was undertaken to assess the feasibility, utility (including quality of key indicators), and timeliness of the system for syndromic surveillance purposes. Lessons learned and challenges were identified and recorded during the design and implementation of the system.ResultsThe pilot ADSSS collected 207,331 records of individual ambulance calls (daily mean=1,133; range=923-1,350). The ADSSS was found to be timely in detecting seasonal changes in patterns of respiratory infections and increases in case numbers during seasonal events.ConclusionsFurther validation is necessary; however, the findings from the assessment of the pilot ADSSS suggest that selected, but not all, ambulance indicators appear to have some utility for syndromic surveillance purposes in England. There are certain challenges that need to be addressed when designing and implementing similar systems.TodkillD, LoveridgeP, ElliotAJ, MorbeyRA, EdeghereO, Rayment-BishopT, Rayment-BishopC, ThornesJE, SmithG. Utility of ambulance data for real-time syndromic surveillance: a pilot in the West Midlands region, United Kingdom. Prehosp Disaster Med. 2017;32(6):667–672.

The Cost-Effectiveness of Helicobacter pylori Diagnostic Methods in the Age of Clarithromycin Resistance

2016 ◽  
Vol 111 ◽  
pp. S1289
Author(s):  
Fumio Omata ◽  
Takuro Shimbo ◽  
Sachiko Ohde ◽  
Gautam Deshpande ◽  
Tsuguya Fukui
Keyword(s):  
Helicobacter Pylori ◽  
Cost Effectiveness ◽  
Diagnostic Methods ◽  
Clarithromycin Resistance ◽  
The Cost

ECONOMIC EVALUATION OF AN INFLUENZA IMMUNIZATION STRATEGY OF HEALTHY CHILDREN

2014 ◽  
Vol 30 (4) ◽  
pp. 394-399 ◽  
Author(s):  
Meghann Gregg ◽  
Gordon Blackhouse ◽  
Mark Loeb ◽  
Ron Goeree
Keyword(s):  
Cost Effectiveness ◽  
Vulnerable Groups ◽  
Healthy Population ◽  
Sample Population ◽  
Healthy Children ◽  
Community Members ◽  
Influenza Immunization ◽  
Influenza Prevention ◽  
The Cost ◽  
And Control

Objectives: Vaccinating healthy children is proposed as a strategy to produce a herd effect and protect vulnerable groups. The Hutterite Influenza Prevention Study investigated this strategy, comparing communities with or without childhood influenza immunization programs. There are costs associated with vaccination therefore there may be a trade-off between these costs and the benefits of avoiding influenza cases. This evaluation estimates the cost-effectiveness of immunizing only healthy children in preventing cases of influenza within entire communities.Methods: Effect data and resource utilization were collected during the trial. Cost data were collected from payer, literature and Internet sources. A two-stage bootstrap (TSB) with shrinkage correction was used to estimate average costs and effects. The incremental cost effectiveness ratio (ICER) and sample uncertainty around this estimate were calculated from the TSB results.Results: Mean costs per patient for the treatment and control arms were $69.07 and $32.66 (difference $36.41). Mean number of influenza cases for the treatment and control arms were 0.04 and 0.27 (difference 0.23). ICER was $164.12 ($28.38, $2767.75) per case of influenza averted.Conclusions: Immunizing healthy children for influenza is more costly, yet more effective than no immunization in preventing cases in the sample. At a cost of $164.12 to prevent a case of influenza, immunizing healthy children to protect all community members may be considered costeffective. Estimated results are conservative as the influenza season was mild and the sample population was healthy. In a more severe season with a less healthy population the ICER is expected to decrease.

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