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Anil Jain

Publications and source records attributed to Anil Jain.

At least 19 recordsLinked to original sources
PubMed2005

Effect of a clinical trial alert system on physician participation in trial recruitment.

BACKGROUND: Failure to recruit a sufficient number of eligible subjects in a timely manner represents a major impediment to the success of clinical trials. Physician participation is vital to trial recruitment but is often limited. METHODS: After 12 months of traditional recruitment to a clinical trial, we activated our electronic health record (EHR)-based clinical trial alert (CTA) system in selected outpatient clinics of a large, US academic health care system. When a patient's EHR data met selected trial criteria during the subsequent 4-month intervention period, the CTA prompted physician consideration of the patient's eligibility and facilitated secure messaging to the trial's coordinator. Subjects were the 114 physicians practicing at selected EHR-equipped clinics throughout our study. We compared differences in the number of physicians participating in recruitment and their recruitment rates before and after CTA activation. RESULTS: The CTA intervention was associated with significant increases in the number of physicians generating referrals (5 before and 42 after; P < .001) and enrollments (5 before and 11 after; P = .03), a 10-fold increase in those physicians' referral rate (5.7/mo before and 59.5/mo after; rate ratio, 10.44; 95% confidence interval, 7.98-13.68; P<.001), and a doubling of their enrollment rate (2.9/mo before and 6.0/mo after; rate ratio, 2.06; 95% confidence interval, 1.22-3.46; P = .007). CONCLUSIONS: Use of an EHR-based CTA led to significant increases in physicians' participation in and recruitment rates to an ongoing clinical trial. Given the trend toward the EHR implementation in health care centers engaged in clinical research, this approach may represent a much-needed solution to the common problem of inadequate trial recruitment.

Adult↗
PubMed2005

Responding to the rofecoxib withdrawal crisis: a new model for notifying patients at risk and their health care providers.

BACKGROUND: We decided to inform our patients of the withdrawal of rofecoxib, one of the largest drug withdrawals in United States history, and instruct them to contact their providers for guidance. OBJECTIVE: To identify and inform patients and providers affected by the rofecoxib withdrawal. DESIGN: Descriptive observational study. SETTING: Tertiary care center with an electronic medical record (EMR) system. PATIENTS: Patients with an active rofecoxib prescription within the EMR. INTERVENTION: Existing information technology and traditional communication resources were used to automate the identifying and notifying of patients and providers and to deactivate rofecoxib prescriptions in the EMR. MEASUREMENTS: Characteristics of patients receiving rofecoxib at our institution, details of their prescription and provider, number of EMR alerts, and medication discontinuations. RESULTS: The 11,699 patients with a rofecoxib prescription in our practice were sent notifications within 24 hours of the withdrawal. LIMITATIONS: We did not directly measure the effect of our notification on patients or providers. CONCLUSIONS: Information technology enabled our institution to rapidly identify and notify individual patients and their providers about an important drug withdrawal. The methods modeled a feasible way for health care organizations with EMRs to participate in notification processes that may be applicable in a variety of situations.

Adult↗
PubMed2005

Evaluation of plasma ammonia levels in patients with acute liver failure and chronic liver disease and its correlation with the severity of hepatic encephalopathy and clinical features of raised intracranial tension.

OBJECTIVES: The present study was designed to (a) evaluate and compare plasma ammonia levels (PAL) in patients with acute liver failure (ALF) and chronic liver disease (CLD) with or without hepatic encephalopathy (HE); (b) correlate the severity of HE with PAL; and (c) correlate PAL with clinical features of raised intracranial tension in ALF. DESIGN AND METHODS: A total of 40 patients, comprised of 20 patients with ALF (Group A) and 20 patients with CLD (Group B, which was comprised of 8 patients with HE (subgroup B1) and 12 patients without HE (subgroup B2)), were studied. PAL was estimated using an enzymatic UV-method (RANDOX). The clinical and biochemical profile of all the patients was recorded. Correlation between the grade of HE and PAL was derived using Pearson's correlation coefficient. The mean PAL of ALF patients with and without raised intracranial tension was compared using the standard error of difference between the two means. RESULTS: The mean PAL (micromol/L) +/- SD was as follows: Group A: 172.1 +/- 52.55, subgroup B1: 58.75 +/- 29.38, subgroup B2: 42.17 +/- 18.19 (normal levels = 10-47 micromol/L). All patients with ALF showed PAL more than the upper limit of the normal range, and there was good correlation between the severity of HE and PAL [r = 0.91 at P < 0.05]. In subgroup B1 (CLD with HE), 3/8 patients (37.5%), and in subgroup B2 (CLD with HE), 4/12 patients (33.3%) patients had PAL more than the upper limit of normal range. Within Group A, 14 patients had clinical features of raised intracranial tension/cerebral edema, and the mean PAL of these patients (188.21 +/- 49.15 micromol/L) was significantly higher than those who did not have features of raised intracranial tension (134.5 +/- 42.36 micromol/L) (SE of difference between two means). CONCLUSIONS: Raised PAL appears to be an important laboratory abnormality seen in patients with ALF, and there seems to be a significant correlation between the severity of encephalopathy and PAL in these patients. However, among patients with CLD, the proportion of patients with PAL more than the upper limit of normal range is not significantly different between those with or without HE. Our study also suggests that high PAL in ALF patients appears to correlate with clinical features of cerebral edema and raised intracranial tension.

Adult↗
PubMed2005

Seroprevalence of hepatitis D virus in patients with hepatitis B virus-related liver diseases.

BACKGROUND AND OBJECTIVE: Several reports indicated a declining trend in the occurrence of hepatitis D virus (HDV) infection in some geographical areas. However, no study has been conducted in India to evaluate whether a similar epidemiological change is occurring in this part of the world. The present study was undertaken to evaluate the seroprevalence of HDV in patients with hepatitis B virus (HBV) related liver diseases attending a Government hospital in New Delhi, and to assess any change in its epidemiology by comparing the results with seroprevalence figures reported in the past. METHODS: A total of 123 patients with HBV-related liver diseases comprising 32 cases of acute viral hepatitis (AVH), 5 of fulminant hepatic failure (FHF), 37 of chronic hepatitis (CH), 46 of cirrhosis and 3 of hepatocellular carcinoma (HCC). All patients were evaluated for the presence of delta antibodies using commercially available ELISA kits. Both IgM and IgG anti-delta assays were performed to differentiate between active and convalescent infection. RESULTS: The mean age of the patients was 35.6 +/- 3.3 yr with a male : female ratio of 11:5. Of the 123 patients, serological evidence of delta virus infection was seen in 13 subjects (10.6%); 9 (7.3%) had evidence of past infection (IgG positive, IgM negative) and the remaining 4 (3.3%) recent infection (IgM anti-delta antibody positive). Evidence of HDV infection in acute viral hepatitis, fulminant hepatitis, chronic hepatitis, cirrhosis and hepatocellular carcinoma groups was found in 3.1, 20, 8.1, 15.2 and 33.3 patients, respectively. INTERPRETATION AND CONCLUSION: Our results suggest that delta infection may not be very common in Indian patients with HBV-related liver diseases. It is also possible that HDV epidemiology in this part of the world may be undergoing a transition towards decreasing prevalence.

Adult↗
PubMed2005

Development of an electronic health record-based Clinical Trial Alert system to enhance recruitment at the point of care.

Clinical trials are essential to the progress of medical science. Physician participation in trial recruitment is vital, but most do not participate. Few approaches to improve physician participation in trial recruitment have been described or proven successful. Previously described approaches have largely relied on locally developed technology or been designed for use in specialized settings, thereby limiting their generalizability. We describe the design, operation and initial testing of a new Clinical Trial Alert (CTA) system built upon the existing capabilities of a commercial EHR in use across a large academic healthcare system. Given the trend toward implementation of similarly capable EHRs in institutions engaged in clinical research, this approach should be widely applicable and may represent a solution to the common problem of inadequate clinical trial recruitment. Further study of this system is ongoing.

Clinical Trials as Topic↗
PubMed2005

Drug-age alerting for outpatient geriatric prescriptions: a joint study using interoperable drug standards.

For more than a decade, the Beers criteria have identified specific medications that should generally be avoided in the geriatric population. Studies that have shown high prevalence rates of these potentially inappropriate medications have used disparate methodologies to identify these medications and hence are difficult to replicate and generalize. In an effort to improve prescribing behavior, we are building a drug-age alerting system utilizing standard drug coding systems for use in our Electronic Health Record (EHR) systems.

Aged↗
PubMed2005

Development and psychometric validation of a brief instrument to measure satisfaction with online training.

Nowadays, health care institutions are increasingly challenged with the need for perennial workforce training and documentation for regulatory compliance. Hence, more and more institutions are looking at online training solutions to train their workforce. We developed and validated a brief instrument designed to measure user satisfaction with online training. We present the results of psychometric analysis of our instrument that was validated in an online HIPAA training course by over 13,000 employees of our integrated delivery network.

Attitude to Computers↗
PubMed2005

Physician perceptions of an Electronic Health Record-based Clinical Trial Alert system: a survey of study participants.

Physicians play a vital role in the clinical trial recruitment process, but most do not participate. We developed a new Clinical Trial Alert (CTA) system and studied its effect on a cohort of physicians across a health system. Following this study, we surveyed our physician subjects. Their responses offer insights into the CTA's utility, their attitudes toward trial recruitment, and suggest areas for CTA refinement.

Attitude of Health Personnel↗
PubMed2005

Using computerized physician order entry to decrease insurance denials.

Insurance denials delay payments for tests to medical institutions and can decrease patient satisfaction due to unexpected billing. Our institution utilizes an ambulatory electronic health record (EHR) for routine clinical care that includes computerized physician order entry (CPOE). At our institution as well as others, considerable cost is associated with inappropriate diagnostic coding of needed procedures and tests by the physician. We developed a series of CPOE alerts and order sets targeting specific tests to address this problem. As a result, preliminary data shows that insurance denials fell by up to 37% for the targeted tests.

Ambulatory Care Information Systems↗
PubMed2003

Incidence of side-effects associated with high-dose ferric gluconate in patients with severe chronic renal failure.

Ferric gluconate complex in sucrose (Ferrlecit) has been associated with less side-effects than iron dextran; however, the recommended dose of 62.5-125 mg per treatment is only suitable for haemodialysis (HD) patients. We retrospectively analysed the incidence of the side-effects associated with a high dose of Ferrlecit infusion (20 treatments in 13 patients; 10 treatments of 250 mg/3-4 h, and 10 treatments of 500 mg/5 h infusion). The patients were in the age range of 32-75 years old, seven with chronic renal failure (CRF), and six on dialysis treatment. One (10%) of the 10 treatments using a 250 mg dose was complicated with severe nausea/vomiting, diarrhoea and a burning sensation in the feet. Three (30%) of the 10 treatments using a 500 mg dose were complicated with: chills, severe nausea/vomiting, hypotension and syncope in one; severe nausea/vomiting, diarrhoea and hypotension in one; and an episode of vomiting in one patient. A single treatment with a 250 mg dose resulted in no significant change in haematological parameters. A single treatment with a 500 mg dose resulted in a significant increase in haemoglobin (Hgb) and haematocrit (Hct), but only a rising trend in serum iron,% transferrin saturation and ferritin pre versus 1-2 months postinfusion. In conclusion, Ferrlecit doses of 250 or 500 mg are complicated with significant untoward reactions in 10-30% of patients, in a dose-dependent fashion.

Adult↗
PubMedDate not supplied

Massive hepatomegaly: a presenting manifestation of multiple myeloma.

We report a 50-year-old woman presenting with isolated massive hepatomegaly. Liver histology showed dilated sinusoids within which some atypical cells, probably of hematopoeitic origin, were identified. Bone marrow was densely packed with similar atypical cells with high nucleo-cytoplasmic ratio, which tested positive for plasma cell markers. Plasma protein electrophoresis showed a distinct M spike in the gamma globulin fraction and skeletal survey revealed multiple lytic lesions in the skull and pelvic bones. Thus, a final diagnosis of multiple myeloma was made. The patient has received six cycles of chemotherapy and is doing well.

Blood Protein Electrophoresis↗
PubMedDate not supplied

Cronkhite-Canada syndrome with adenomatous and carcinomatous transformation of colonic polyp.

We describe a 70-year-old woman who presented with watery diarrhea and was found to have gastric and colonic polyposis, cutaneous hyperpigmentation, alopecia and onychodystrophy (Cronkhite-Canada syndrome). Histology of a polyp from the stomach showed features of juvenile or retention type (hamartomatous) polyp. One colonic polyp revealed features of tubular adenoma, with moderate dysplasia. Another large pedunculated colonic polyp showed a tubulovillous adenoma with a focus of well-differentiated adenocarcinoma confined to the submucosa of the stalk. Adenomatous and carcinomatous epithelial changes can occur in Cronkhite-Canada syndrome.

Adenocarcinoma↗