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Tuberculosis in specialty training: How it should be?

Tuberculosis in specialty training: How it should be?. Haluk C.Çalışır M.D. P neumology Public Health Microbiology Internal Medicine Pediatrics Infection Disease. Associations have assemblies. Turkish Thoracic Society KLİMİK. Tuberculosis in specialty training. Tuberculosis training.

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Tuberculosis in specialty training: How it should be?

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  1. Tuberculosis in specialty training: How it should be? Haluk C.Çalışır M.D.

  2. Pneumology Public Health Microbiology Internal Medicine Pediatrics Infection Disease Associations have assemblies. Turkish Thoracic Society KLİMİK Tuberculosis in specialty training

  3. Tuberculosis training • Patient Care Seminars • Literature clubs • Conferences • Courses • Congress • Research

  4. Pneumology TrainingTURKISH PNEUMOLOGY BOARD • Knowledge: to provide an opportunity having knowledge and experience for the diagnosis, management and prevention of lung disease • Tuberculosis and control • Skills: Knowledge and experience for microbiological examinations of respiratory secretions. • Medicine for community, Health Politics, Occupational diseases of health care workers. http://www.toraks.org.tr/board/prog_taslak.php

  5. Training for pneumologyTurkish Pneumology BOARD • Internal rotations (35 mounts) • RespiratoryIntensive Care (3 months) • Sleep laboratory (1 month) • Allergology (3 months) • In patients and out patients (28 months) • Tuberculosis (3 months) • TB Ward (2 months) • TB Dispensary (1 month) http://www.toraks.org.tr/board/prog_taslak.php

  6. Pneumolog(UEMS)UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES • Having experience for the epidemiology, prevention and management of both pulmonary and extra-pulmonary tuberculosis. www.uems.net

  7. Pneumolog(UEMS)UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES • The specialist in pneumology must have gained broad theoretical and scientific knowledge of respiratory disease and conditions affecting the lung, as well as having a wide clinical experience. www.uems.net

  8. Globally • Diagnosis • Management of treatment • TB in Immunosuppressive patients • Latent tuberculosis infection treatment Infection Control

  9. Tuberculosis Control and Medical SchoolsWHO/TB/98.236 Report of a WHO WorkshopRome, Italy29-31 October 1997

  10. WHO/CDS/TB/2002.301 Distribution: General Original: English

  11. The Ministry of HealthNational Tuberculosis Control Programme • 620 GP • 70 Specialist • 1303 Health Care Workers • 343 Administrative • 355 Office staff • 2691 Total

  12. Turkish Pneumology BOARD Questionnaire (Kocabaş A, İtil O.) • 41 University Hospital • 9 Teaching Hospital

  13. 2004 • 59 specialists were graduated from University Hospitals • Two of them working in TB dispensaries. • 35 specialists were graduated from Teaching hospitals • Six of them working in TB dispensaries.

  14. Clinical Rotation in TB ward • Peripheral University 26.7% • Centrally located University 45.5% • Teaching Hospital 22.2%

  15. Rotation in TB dispensary • Peripheral University % 10 3 (0-3)months • Centrally located University % 90.9 1month • Teaching Hospital % 0 0

  16. To TB Ward University (41) 13 (%31.7) Average:1.3 months To TB dispensary University 4(%9.8) Avarage:15 months To TB Ward Teaching Hospitals (9) 2 (%22.2) Average: 3 months To TB dispensary Teaching Hospital 0 Clinical Rotations

  17. University AFB Microscopy Average: 72 (0-500) Tuberculin test Average : 82 (0-500) Teaching hospital AFB microscopy Average: 99 (0-400) Tuberculin test Average :54 (0-150) Procedures during residency

  18. In 16 University hospitals Average 11.2 beds Total. 180 beds In 5 teaching hospitals Average 155,4 beds Total 777 beds. TB Beds (2004)

  19. University (13) Average 122,8 (2-916) Total: 1591 Staying in hospital: 21 days (10-33) AFB: 532 Teaching Hospital (5) Average: 1785 (20-3748) Total: 8926 Staying in hospital:25 (17-35) AFB: 27333 In patient TB Cases (2004)

  20. TB managed in tertiary care in 2004 • University hospital: 1591 • Teaching hospital: 8926 • Total: 10517 • TB cases in Turkey: approx. 16000 • Percentage : 65%

  21. Specialists may prescribe non standardized regimens. Specialists may give little importance to treatment supervision. Medical specialists should not be involved in the management of non complicated Smear (+) cases. Specialists may play roles for the management of complicated tb cases,preparing guidelines and advising to NTP Specialist and tuberculosis control* *Caminero. JA. Is the DOTS strategy sufficient to achieve tuberculosis control in low and middle income countries?2.Need for interventions among private physicians, medical specialists and scientific societies. INT J TUBERC LUNG DIS 7(7):623-30

  22. Training …is a behavior changing process in a person İnayet Aydın. Eğitim ve Öğretimde Etik. Pegem Yayıncılık. Kasım 2003,5

  23. What we want to change ? • Diagnosis • Treatment • Side effect management • Prevention • Infection Control • Tuberculosis control • Tuberculosis epidemiology • TB Policy

  24. Questions • What is the role of specialist for tuberculosis control? • Why Tuberculosis is important for Turkey? • If tuberculosis took part in training program which indicator will change? • What is the importance of tuberculosis training for health care? • What is the aim of TB training for the resident? What kind of skills and knowledge will be changed?

  25. Why Tuberculosis is important for Turkey? • Tuberculosis is a public health priority due to epidemiologic results. • Tuberculosis very common among young generations • Diagnosis • Management • Case finding • Morbidity, mortality and disability • Drug resistance problem • Wasting resources

  26. If tuberculosis took part in training program which indicator will change? • Reliable and sustainable partnership for NTP • Research • Advise • Patient care • Providing training activities for NTP

  27. WHO IUATLD KNCV ATS CDC www.nationaltbcenter.edu/international

  28. International Standards for Tuberculosis Care* • Any practitioner treating a patient for tuberculosis is assuming an important public health responsibility. • To fulfill this responsibility, the practitioner must not only prescribe an regimen but, also, be capable of assessing the adherence of the patient to the regimen and addressing poor adherence when it occurs. • By so doing, the provider will be able to ensure adherence to the regimen until treatment is completed. *Tuberculosis Coalition for Technical Assistance. International Standarts for Tuberculosis Care (ISTC). The Hague: Tuberculosis Coalition for Technical Assistance. 2006

  29. 65-75% of the treatments initiated at the secondary and tertiary level. Complicated and non complicated patient management. Tuberculosis control training (?) Tuberculosis can be managed at the primary health care level. There is no systematic training program for primary health care providers. (Doctors, nurses, lab. Technicians and others) Conclusion

  30. Recommendations • National tuberculosis control program and its priorities should be prepared with wide consensus. • A human resources development plan should be prepared based on the priorities. • Epidemiology of disease, control and NTP priorities should be covered with clinical tuberculosis in the specialty training.

  31. Clinical tuberculosis Pathogenesis Diagnosis Treatment Tuberculosis Control Epidemiology Disease control Statistics NTP Operational research Tuberculosis in residency training

  32. Acknowledgments • Prof. Dr. Ali Kocabaş • Prof.Dr.Oya İtil • Yrd. Doç. Dr. Hatice Şahin

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