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An Online Method for Diagnosis of Difficult TB Cases for Developing Countries

机译：发展中国家结核病疑难病例的在线诊断方法

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Optimal use of limited human, technical and financial resources is a major concern for tuberculosis (TB) control in developing nations. Further impediments include a lack of trained physicians, and logistical difficulties in arranging face-to-face (f-2-f) TB Diagnostic Committee (TBDC) consultations. Use of e-Health for virtual TBDCs (Internet and "iPath"), to address such issues is being studied in the Philippines and Pakistan. In Pakistan, radiological diagnosis of 88 sputum smear negative but suspected TB patients has been compared with the 'gold standards' (TB culture, and 2-month clinical follow up). Of 88 diagnostic decisions made by primary physicians at the spoke site and electronic TBDC (e-TBDC) at hub site, there was agreement in 71 cases and disagreement on 17 cases. The turn-around time (TAT; patient registration at spoke site for f-2-f diagnosis to receiving the electronic diagnosis), averaged 34.6 hours; ranging 9 minutes to 289.2 hours. Average TAT at the rural site (59.15 hours) was more than the urban site (15.9 hours). Comparison of e-TBDC and f-2-f diagnosis with the gold standards showed only slight differences. Using culture as the gold standard, e-TBDC decisions showed greater accuracy (sensitivity - 32.4%) as compared to f-2-f (27.6%); using 2-month clinical follow-up as the gold standard, f-2-f diagnosis showed slightly better improvement in patient symptoms and weight as compared to e-TBDC. In Philippines "iPath" was trialed and demonstrated that e-TBDCs have potential. Such groups could review cases, diagnose, and write comments remotely, reducing the diagnosis and treatment delay compared to usual care.
机译：最佳使用有限的人力，技术和财政资源是发展中国家控制结核（TB）的主要问题。进一步的障碍包括缺乏训练有素的医生，以及在面对面（f-2-f）结核病诊断委员会（TBDC）咨询中安排后勤方面的困难。菲律宾和巴基斯坦正在研究将电子卫生保健用于虚拟TBDC（互联网和“ iPath”）以解决此类问题。在巴基斯坦，将88例痰涂片阴性但可疑的结核病患者的放射学诊断与“黄金标准”（结核病培养和2个月的临床随访）进行了比较。在口头现场的主治医生和枢纽站点的电子TBDC（e-TBDC）做出的88项诊断决定中，有71例达成了共识，而17例存在分歧。平均周转时间（TAT；在轮辐现场进行f-2-f诊断的患者登记到接受电子诊断的时间）平均为34.6小时； 9分钟到289.2小时之间。农村地区（59.15小时）的平均TAT高于城市地区（15.9小时）。 e-TBDC和f-2-f诊断与金标准的比较显示只有细微的差异。与f-2-f（27.6％）相比，使用文化作为黄金标准，e-TBDC决策显示出更高的准确性（灵敏度-32.4％）；使用2个月的临床随访作为金标准，与e-TBDC相比，f-2-f诊断显示患者症状和体重的改善稍好。在菲律宾，对“ iPath”进行了试验，并证明了电子TBDC具有潜力。这样的小组可以远程审查病例，诊断并发表意见，与常规护理相比，可以减少诊断和治疗延迟。

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