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RISS 인기검색어
- 검색키워드
- 저자 : Plipat, Tanarak (검색결과 2 건)
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Plipat, Tanarak University of California, Los Angeles 2007 해외박사(DDOD)
소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.
Background. In this study, different antiretroviral drug prophylaxis regimens in three scenarios will be evaluated economically. The objective of the study is to assess the cost effectiveness of antiretroviral therapy to prevent mother to infant transmission of HIV in Thai pregnant women. Methods. The design used in this study is cost-effectiveness analysis using decision analysis framework and a simple deterministic model to calculate the outcome. The outcomes in this study are HIV cases prevented, disability adjusted life years (DALYs) averted, and life years saved. Based on input data reflecting realities in Thailand, the decision tree used in the analysis was developed. The cost, effectiveness and cost effectiveness for a hypothetical annual cohort of 810,000 pregnant women was calculated. The time frame for the antiretroviral program to prevent mother to child transmission of HIV is 1 year. The analytic horizon includes all of the future costs associated with long-term health effects from cases of HIV infected infants that occur within a 1-year frame. A societal perspective is taken. Results. The largest expense involved in PMTCT is not the program cost itself, but the cost of treatment of pediatric AIDS patients as a consequence of not being able to prevent the spread of infection. Since the treatment cost of perinatal acquired HIV infection is a lot more than the cost of antiretroviral program, an antiretroviral regimen that can prevent more infections, in general, is found to be more cost-effective in this analysis. When compared to no intervention, all of the antiretroviral regimens analyzed in this study can save lives and are cost-saving. HAART in Scenario 1, zidovudine plus lamivudine in Scenario 2, zidovudine plus nevirapine in Scenario 3 and HAART in all 3 parts of the program are more favorable than the other regimen options, since they save more lives and save more money than any other regimens. Conclusions. The Thai Ministry of Public Health should reconsider its antiretroviral recommendations for use in pregnant women to prevent mother to child transmission of HIV and should invest to improve program coverage.
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Methicillin-Resistant Staphylococcus aureus (MRSA) Exposure Assessment in Hospital Environment
Plipat, Nottasorn University of Michigan 2012 해외박사(DDOD)
소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.
Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of healthcare-associated infections. Contaminated hands of healthcare workers (HCW) are vectors of transmission, but the contribution of the contaminated environment is not well characterized. The goal of this dissertation is to provide insights into the role of the hospital environment in MRSA exposure to patients. First, a 20-month prospective study was conducted using nasal swab surveillance data in an intensive care unit (ICU) to examine MRSA acquisition risk associated with having MRSA-positive patients in the ICU during the ICU stay. The study showed that the more recent exposure to MRSA-positive patients in the ICU and the greater number of MRSA-positive patients in the ICU led to a greater hazard of MRSA acquisition among MRSA-negative patients. Second, we developed an MRSA fate and transport model for two hypothetical hospital rooms based on the Environmental Infection Transmission System (EITS) framework. We demonstrated a significant role of environmental surfaces in contaminating and re-contaminating nurses. The model revealed the effect of S. aureus continuous shedding from the colonized patient onto room surfaces. The surfaces are quickly re-contaminated with MRSA even after the most efficacious decontamination. Our findings highlight the importance of decontamination frequency in addition to decontamination efficacy. Third, we constructed a stochastic agent based model using the same structure as the previous model, but with more realistic features. We demonstrated that HCW's compliance is essential in determining the effectiveness of hand hygiene, although the time when it is performed and its efficacy are also important. The model emphasizes the significance of the hand hygiene opportunity before and after touching a patient's surrounding environment, in addition to at the entry and exit of a patient's room. Despite 100% compliance at the entry and exit of a patient's room, we show that contaminated environmental surfaces are the dominant contamination sources to HCWs' hands. Additionally, this model shows the value of hand hygiene efficacy. With 100% compliance and 70% efficacy, HCWs' hands remain contaminated enough to subsequently contaminate the uncolonized patient's environment, which later become another exposure route to the patient.
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