Kekkaku : [Tuberculosis]
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Kekkaku : [Tuberculosis] · Dec 2012
Case Reports[A case of miliary tuberculosis complicated by disseminated intravascular coagulation and acute respiratory distress syndrome successfully treated with recombinant human soluble thrombomodulin].
A 67-year-old woman was referred to our hospital for persistent fever and dyspnea. Chest X-ray revealed diffuse reticulonodular shadows and high-resolution computed tomography showed randomly distributed small nodules. Examination of sputum and urine revealed acid-fast bacilli, which were later confirmed as Mycobacterium tuberculosis sensitive to all drugs. ⋯ It is generally thought that prognosis of miliary tuberculosis complicated by DIC and ARDS is very poor. A recent report suggested that rTM is effective for DIC and ARDS secondary to sepsis. This is the first report of miliary tuberculosis complicated by DIC and ARDS successfully treated with rTM.
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The 2011 edition of Specific Guiding Principles for Tuberculosis Prevention calls for a streamlined medical services system capable of providing medical care that is customized to the patient's needs. The new 21st Century Japanese version of the Directly Observed Treatment Short Course (DOTS) expands the indication of DOTS to all tuberculosis (TB) patients in need of treatment. Hospital DOTS consists of comprehensive, patient-centered support provided by a DOTS care team. ⋯ The second is how find infectious one, especially from high burden countries, before they spread it. Final, unspecific symptoms suffer the patients and medical staff. It's the key of implementation that spread of tuberculosis must be caused by delayed diagnosis.
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Kekkaku : [Tuberculosis] · Dec 2012
[Follow-up discussion on restructuring the medical-service system].
The Japan Tuberculosis Society organized symposia on restructuring the medical-service system at the 84th and 86th annual meetings. These symposia clarified the following issues and concerns. It is becoming difficult to maintain tuberculosis beds in wards in many areas, since beds required for tuberculosis are declining due to the decreasing incidence of tuberculosis and shortened hospitalization periods. ⋯ TB hospitals and health centers, both major role players in the collaboration scheme, should maintain good ties and share responsibilities. Through establishing close collaboration, medical service for TB patients will be a part of primary practice. It is expected to raise TB awareness among general medical staff and result in early case detection in the area.
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Kekkaku : [Tuberculosis] · Sep 2012
[Medical service systems for tuberculosis in low-incidence countries].
Currently, Japan has a near low incidence of tuberculosis (TB); the incidence is below 20/100,000. Considering this incidence, the medical service provision system needs to be restructured and related policies need to be revised. The Revised National Guidelines for TB Control, issued in May 2011 by the Ministry of Health, Labour, and Welfare, provided the policy towards achieving a low incidence of TB. This study aims to provide suggestions for restructuring the medical service system in Japan by analyzing the systems in selected countries with low incidence. ⋯ The study tours were conducted over 6 years, but no follow-up surveys were conducted. In each visit, we visited only a limited number of medical facilities, which may not be representative of that country. Obviously, this report does not aim to be a comparative study but to provide useful information for discussing the future direction of the medical service system in Japan. In Japan, TB is diagnosed and treated in hospitals and clinics, but contact surveys and other preventive activities are conducted in health centers. In this regard, Japan seems to be unique in that the ways to achieve collaboration among hospitals, health centers, and related organizations are emphasized in the revised National Guidelines for TB Control. Regardless of the DOT target group of a patient, healthcare providers in Japan are expected to ensure patient's adherence through patient-centered support in order to achieve successful treatment. In Japan, the central Government is expected to take responsibility to prevent infection. We suggest that the standards for lengths of hospital stay of TB patients should be revised such that the lengths are based on each patient's bacteriological condition and social setting. The revised National Guidelines for TB Control provide frameworks for ensuring the quality of medical services, but further discussions are warranted in order to plan and implement an effective strategy.
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Current tuberculosis (TB) problems are reflections of Japanese society. Living or dying alone among the elderly, difficulty in finding jobs or withdrawal into themselves among the youths are features of modem society. The future needs for TB care were discussed on specific topics of TB among the elderly, foreigners and the homeless. ⋯ The strong public health infrastructure is necessary to maintain tuberculosis control towards the low incidence situation. The role of the local government should be more important. This symposium has also shown that the tuberculosis services must be patients-centered and supported by the people, addressing a new horizon of public health in Japan through tuberculosis control.