Self-Study Modules on Tuberculosis
Glossary
This glossary contains the new terms listed at the beginning of
Modules 6-9.
a - b - c
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g - h - i - j - k - l
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u - v - w - x - y - z
action plan – a plan to determine what
information is missing or pending, where and when to collect this
information, and who will need the information
active case finding – identifying unreported cases of TB
disease by actively searching for them through, for example, laboratory
and pharmacy audits
adherence agreement – a written understanding between a
health care worker and a patient that indicates the activities they
both agree to carry out. For some patients, this written commitment
increases the likelihood of adherence
adherence plan – a written plan that is based on the patient’s
understanding and acceptance of the TB diagnosis, that addresses
barriers to adherence, and that details the method chosen to deliver
treatment and monitor adherence for that specific patient
adherence to treatment – following the recommended course
of treatment by taking all the prescribed medications for the entire
length of time necessary
admission note – patient information recorded at the time
of admission to a hospital, usually including the admission diagnosis
and initial plan for diagnostic work-up; usually included in the
progress notes
AFB logbook – a logbook kept in the mycobacteriology laboratory
that contains the results of acid-fast bacilli (AFB) smear examinations;
it may be called a smear mycobacteriology log
alternative medicine – health care other than conventional,
scientifically tested, medicinal treatment; includes herbal remedies,
yoga, meditation, acupuncture, and other practices intended to maintain
or improve health
assessment – talking to a patient to find out about his
or her medical history, knowledge about TB, feelings and beliefs
about TB treatment, and other pertinent information
authorization – permission given by the patient to allow
a third party to have access to the patient’s confidential information
autonomy – the right of a patient to determine what will
be done with his or her body, personal belongings, and personal
information; this concept applies to any adult person who is mentally
competent
barrier – anything that can prevent a patient
from being able to adhere to a TB treatment regimen
behavioral diagnosis – used to find out what is causing
a patient to have problems with adherence and to develop strategies
to improve the patient's treatment plan
case management – a system in which a specific
health department employee is assigned primary responsibility for
the patient, systematic regular review of patient progress is conducted,
and plans are made to address any barriers to adherence
clinic-based DOT – directly observed therapy delivered
in a TB clinic or comparable health care facility
close contact – a person who had prolonged, frequent, or
intense contact with a person with TB while he or she was infectious.
Close contacts are more likely to become infected with M. tuberculosis
than contacts who see the patient less often
combined pill – fixed-dose combination capsule or tablet
that may enhance patient adherence. In the United States, the Food
and Drug Administration has licensed fixed-dose combinations of
isoniazid and rifampin (Rifamate) and of isoniazid, rifampin, and
pyrazinamide (Rifater)
concentric circle approach – a method of testing contacts
in order of their exposure time (close vs. other-than-close) and
their risk (high priority vs. low priority) with close contacts
and other contacts at high risk of developing TB disease tested
first; it includes contacts from environments where contact may
have taken place (household or residential, work or school, and
leisure or recreation environments)
confidentiality – the protection of information revealed
during patient-health care worker encounters, including all written
or electronic records of these encounters
consent – acceptance or approval of what is planned or
done; it involves voluntary agreement to an action, whether it is
a treatment option or a diagnostic test; the patient-health care
worker relationship is founded on the patient’s consent to the care
being provided
contact investigation – a procedure for identifying people exposed
to someone with infectious TB, evaluating them for latent TB infection
(LTBI) and TB disease, and providing appropriate treatment for LTBI
or TB disease (see contacts)
contacts – people exposed to someone with infectious TB
disease, generally including family members, roommates or housemates,
close friends, coworkers, classmates, and others (see close contacts
or other-than-close contacts)
court order – an order issued by a court mandating DOT
or, in very rare cases, detention in a facility until treatment
is completed
court-ordered DOT – directly observed therapy that is administered
to a patient by order of a public health official or a court with
the appropriate authority; used when patients have been nonadherent
despite the best efforts of TB program staff
directly observed therapy for latent TB infection
(LTBI) – a strategy devised to help patients at especially high
risk of developing TB disease adhere to treatment for LTBI; a health
care worker or another designated person watches the patient swallow
each dose of the prescribed drugs
discharge planning – the preparation of a detailed plan
for comprehensive care of a hospitalized or institutionalized patient
after that patient's discharge
discharge summary – a document written by the patient’s
physician upon discharge; contains a brief summary of all important
information from the entire hospitalization or stay in the institution,
including the discharge diagnosis and often a plan for follow-up
care
disclosure – the act of revealing or distributing personal
information
due process – an established course for governmental activities
or procedures, designed to safeguard the legal rights of the individual
emergency room/department assessment form
– patient information recorded when a patient is brought to an emergency
room; may be used instead of an admission note and is usually included
in the progress notes
enablers – those things that can make it possible or easier
for the patients to receive treatment
exposure to TB – time spent with or near someone who has infectious
TB disease
field-based DOT – directly observed therapy
delivered in a setting outside the TB clinic or a comparable health
care facility; possible sites for field DOT include a doctor’s office,
the patient’s home or workplace, a school, a public park, or a restaurant
field investigation – visiting the patient’s home or shelter,
workplace (if any), and the other places where the patient said
he or she spent time while infectious. The purpose of the field
investigation is to identify contacts and evaluate the environmental
characteristics of the place in which exposure occurred
first-line TB drugs – the initial drugs used for treating
TB disease. Include isoniazid (INH), rifampin (RIF), pyrazinamide
(PZA), and either ethambutol (EMB) or streptomycin (SM)
folk medicine – medicinal beliefs, knowledge, and practices
associated with a particular culture or ethnic group. Folk medicine
is usually handed down by cultural tradition and practiced by health
care workers specially trained in that tradition; not all members
of a given culture or ethnic group will use its folk medicine practices
health care worker – any member of a team
of health professionals who care for and manage a TB patient, including
physicians, nurses, outreach workers, hospital discharge planners,
pharmacists, and social workers
high-priority contacts – the contacts who are at most risk
for TB infection or disease; contacts who are most likely to be
infected and high-risk contacts (see high-risk contacts)
high-risk contacts – the contacts (either close or other-than-close)
who are at a particularly high risk of developing TB disease if
they become infected with M. tuberculosis (e.g., young children
less than 4 years of age, HIV-infected and other immunosuppressed
persons, and persons with certain medical conditions)
history and physical exam form – a standardized form sometimes
used to record patient information at the time of the patient’s
first evaluation; may be used instead of an admission note and is
usually included in the progress notes; it is also referred to as
the H&P
hospital epidemiologist – a specially trained person who
studies the causes of outbreaks and other health problems in a health
care setting
identification data – includes the patient’s
name, address, social security number, date of birth, and other
demographic information (may be a separate registration form)
incentives – small rewards given to patients to encourage
them to either take their own medicines or keep their clinic or
field DOT appointments
index patient – a person with suspected or confirmed TB
disease who is the initial case reported to the health department.
The index case may or may not be the source case (see source
patient)
infection control practitioner – a trained health care
professional (often a nurse) who is responsible for controlling
and preventing the spread of infectious diseases in a hospital or
other health care setting
infection rate – the percentage of contacts with a similar
amount of exposure (e.g., close, other-than-close) who have a newly
identified positive skin test reaction (5 or more millimeters of
induration)
informed consent – a patient’s written consent to a surgical
or medical procedure or other course of treatment, given after the
health care worker has informed the patient about the potential
benefits, risks, and alternatives involved
institutions – residential facilities where groups of people
live, such as nursing homes, correctional facilities, or homeless
shelters, as well as out-patient facilities, such as drug treatment
centers or health department clinics
laboratory results – records presenting
the results of every laboratory test that has been done on the patient,
such as AFB smear examinations, cultures, and drug susceptibility
tests performed in a laboratory
latent TB infection (LTBI) – also referred to as TB infection.
Persons with latent TB infection carry the organism that causes
TB but do not have TB disease, are asymptomatic, and noninfectious.
Such persons usually have a positive reaction to the tuberculin
skin test
local community – the geographic area where a person lives
and spends time; may be a residential area or an ethnic community
(i.e., groups of people who emigrated from the same geographic area)
medical records department – a department
in a hospital or other health care facility that houses the records
of patients who have been admitted to the hospital and subsequently
have been discharged, transferred to ambulatory care services, left
against medical advice, or died
medication record – an information sheet on which the nurses
record the date, time, and amount of prescribed medications given
to the patient during hospitalization or care in a facility; may
not be included in patient’s medical record (for example, may be
kept in a separate medication logbook)
nonadherence – the patient’s inability
or refusal to take TB drugs as prescribed
nurses’ notes – a record in which the nurses who directly
care for the patient continuously record information, including
the patient’s symptoms, medications given, and scheduled procedures
or activities and may be included in the progress notes section
open-ended question – a question that cannot
be answered with a simple "yes" or "no." Open-ended
questions are designed to elicit the patient’s knowledge, feelings
and beliefs, by beginning with words such as "What," "Why,"
"Who," "How," and "When," that demand
an explanation. Such questions are used to explore complex issues
that do not have a finite or predetermined set of responses
other-than-close contacts – contacts with less intense,
less frequent, or shorter durations of contact to the TB patient
than close contacts (see close contacts)
out-patient clinic – a clinic that cares for non-hospitalized
patients with a particular type of problem (for example, chest,
infectious disease, AIDS, pediatric)
partner notification – an activity conducted
by HIV/AIDS programs to identify and counsel the sexual and needle-sharing
contacts of HIV-infected persons; this notification is confidential
and depends on the voluntary cooperation of the patient
pathology laboratory – a laboratory that performs tests
and examinations on tissue and biopsy specimens
patient-health care worker relationship – the basis for
sharing information, communicating beliefs and feelings that affect
care, and building trust in the value of the interaction
patient-identifiable information – information in which
the identity of the patient is directly included or can be deduced
period of infectiousness – time period during which a person
with TB disease is capable of transmitting M. tuberculosis;
usually estimated by determining the date of onset of the patient’s
symptoms (especially coughing)
physician’s orders – a record in which the physician(s)
prescribes medications, orders laboratory tests or procedures (for
example, bronchoscopy or gastric aspiration), and delivers other
patient-care instructions to staff. Medication orders specify date,
name of medication, dosage, and duration of treatment (in days or
in number of doses)
privileged information – personal information shared by
the patient with his or her health care worker
progress notes – a record in which all physicians and other
specialists continuously record patient information during a patient’s
hospital stay and may include nurses’ notes and notes from other
ancillary staff
public health worker – an employee of the health department
(often a public health advisor, DOT outreach worker, or a nurse)
whose duties may include either surveillance, case management, or
some combination of these activities
radiology reports - reports summarizing
all radiology procedures performed on the patient (for example,
chest radiographs or CT scans); part of the medical record
routine case reporting – the required reporting of suspected
or confirmed TB cases to a public health authority
secondary case – a contact who has developed
TB disease as a result of transmission from an index patient
second-line TB drugs – drugs used to treat TB that is resistant
to first-line TB drugs (for example, capreomycin, kanamycin, ethionamide,
cycloserine, ciprofloxacin, amikacin)
skin test conversion for contacts – defined differently
from a standard skin test conversion; for contacts, a skin test
conversion is defined as a change from less than 5 mm on the initial
skin test to a reaction of greater than or equal to 5 mm on the
second test, 10 to 12 weeks after exposure
SOAP notes – Progress notes can also be referred to as
SOAP notes: subjective progress, objective progress, assessment,
and plans
source case investigation – conducted to find the source
of transmission when recent transmission is likely; used to determine
who transmitted M. tuberculosis to an index patient or infected
child or persons in the cluster of skin test conversions, whether
this person is still infectious, whether the case of TB in this
person was reported to the health department, and whether others
were infected by the source patient (see source patient)
source patient – a person with infectious TB disease
who is responsible for transmitting M. tuberculosis to another
person or persons. He or she is identified through either a contact
or source case investigation and may or may not be the index patient
(see index patient)
statement of disagreement – a statement filed by the patient
stating there is a disagreement with the health care worker or institution
regarding the patient’s record
surveillance – the ongoing systematic collection, analysis,
and interpretation of health data essential to the planning, implementation,
and evaluation of public health practice, closely integrated with
the timely dissemination of these data to those who need to know
in public health programs
third party – a person or an organization
not directly involved in the care of a patient’s health problem
treatment for LTBI – medication that is given to people
who have latent TB infection to prevent them from developing TB
disease
treatment plan – a written plan detailing the medical regimen
as ordered by the physician, including periodic monitoring for adverse
reactions and other follow-up care
waiver – a form that patients are often
asked to sign to allow their health information to be used by third
parties
window period – the time span between the date of an initial
tuberculin skin test with a negative reaction and the date of the
follow-up tuberculin skin test that should take place 10 to 12 weeks
after exposure; after the window period has ended, a repeat skin
test should be administered to each contact who had an initial negative
reaction
window period prophylaxis – the practice of providing treatment
for latent TB infection to high-risk contacts (including young children
under 4 years of age, and HIV-infected and other immunosuppressed
persons) with an initial negative skin test reaction less than 10
to 12 weeks after their exposure; if the contact has a negative
skin test reaction after the window period, treatment for latent
TB infection is usually stopped (see window period)
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