Biomedical subjects

Henry Chueh

Publications and source records attributed to Henry Chueh.

8 recordsLinked to original sources

PubMed2007

Predictors of antiretroviral treatment failure in an urban HIV clinic.

BACKGROUND: Predictors of antiretroviral treatment (ART) failure are not well characterized for heterogeneous clinic populations. METHODS: A retrospective analysis was conducted of HIV-infected patients followed in an urban HIV clinic with an HIV RNA measurement < or =400 copies/mL on ART between January 1, 2003, and December 31, 2004. The primary endpoint was treatment failure, defined as virologic failure (> or =1 HIV RNA measurement >400 copies/mL), unsanctioned stopping of ART, or loss to follow-up. Prior ART adherence and other baseline patient characteristics, determined at the time of the first suppressed HIV RNA load on or after January 1, 2003, were extracted from the electronic health record (EHR). Predictors of failure were assessed using proportional hazards modeling. RESULTS: Of 829 patients in the clinic, 614 had at least 1 HIV RNA measurement < or =400 copies/mL during the study period. Of these, 167 (27.2%) experienced treatment failure. Baseline characteristics associated with treatment failure in the multivariate model were: poor adherence (hazard ratio [HR] = 3.44; 95% confidence interval [CI]: 2.34 to 5.05), absolute neutrophil count <1000/mm (HR = 2.90, 95% CI: 1.26 to 6.69), not suppressed on January 1, 2003 (HR = 2.69, 95% CI: 1.78 to 4.07) or <12 months of suppression (HR = 1.64, 95% CI: 1.10 to 2.45), CD4 count <200 cells/mm (HR = 1.90, 95% CI: 1.31 to 2.76), nucleoside-only regimen (HR = 1.75, 95% CI: 1.08 to 2.82), prior virologic failure (HR = 1.70, 95% CI: 1.22 to 2.39) and > or =1 missed visit in the prior year (HR = 1.56, 95% CI: 1.13 to 2.16). CONCLUSIONS: More than one quarter of patients in a heterogeneous clinic population had treatment failure over a 2-year period. Prior ART adherence and other EHR data readily identify patient characteristics that could trigger specific interventions to improve ART outcomes.

Adult↗

PubMed2005

An open source model for open access journal publication.

We describe an electronic journal publication infrastructure that allows a flexible publication workflow, academic exchange around different forms of user submissions, and the exchange of articles between publishers and archives using a common XML based standard. This web-based application is implemented on a freely available open source software stack. This publication demonstrates the Dermatology Online Journal's use of the platform for non-biased independent open access publication.

Access to Information↗

PubMed2005

Web-based residency training program reviews influence applicants who use them.

Scutwork.com is an online, peer-based residency review system. We report preliminary results of an online survey designed to investigate the impact of Scutwork on the residency application process. Overall, 68% of respondents believe that the reviews influenced their decision-making and 91% would use Scutwork again. These results and others reported below suggest that Scutwork may play a significant role in the residency selection process.

Attitude to Computers↗

PubMed2004

Facilitated lipid management using interactive e-mail: preliminary results of a randomized controlled trial.

We describe the design and implementation of a clinical decision support system for ambulatory hyperlipidemia management. Despite readily available and evidence-based guidelines, cholesterol control remains persistently sub-optimal in clinical practice. "FastTrack" is an integrated, multi-faceted informatics tool to reduce barriers to effective cholesterol management by proactively integrating pertinent clinical information, evidence-based decision support and a simple means to act via a single FastTrack e-mail. We tested the intervention in a randomized, controlled trial involving 14 physicians and 276 patients. In an interim analysis, we found that physicians on average were able to review and act upon 9 patient e-mails in less than 15 minutes. Significantly more intervention patients were initiated on a statin therapy or had their dose increased (15.3% vs. 2.3%, p < 0.001). Impact of the intervention on LDL levels will be assessed at trial completion.

Aged↗

PubMed2004

Transforming clinical dictation into structured notes in an ambulatory care practice.

Structured clinical encounter notes offer many advantages compared to free text notes. However, cost and other issues limit their widespread use. At our institution, the electronic medical record (EMR) used by an Internal Medicine practice was designed years ago to utilize structured data. This paper describes a technique to improve the process by which structured notes are dictated and transcribed. We outsourced transcription services and then passed the files through parsing software to structure the data to the granularity required for our database. Software was built to handle all aspects of the process including file validation, parsing, and review. During our pilot project, more than 10,000 notes were parsed, reviewed and uploaded into the EMR.

Ambulatory Care↗

PubMed2004

A submission model for use in the indexing, searching, and retrieval of distributed pathology case and tissue specimens.

This paper describes the Shared Pathology Informatics Network (SPIN) submission model for uploading de-identified XML annotations of pathology case and specimen information to a distributed peer-to-peer network architecture. SPIN use cases, architecture, and technologies, as well as pathology information design is described. With the architecture currently in use by six member institutions, SPIN appears to be a viable, secure methodology to submit pathology information for query and specimen retrieval by investigators

Abstracting and Indexing↗

PubMed2003

A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project.

OBJECTIVE: To test effects of a web-based decision support tool, the diabetes Disease Management Application (DMA), developed to improve evidence-based management of type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a group randomized controlled trial of 12 intervention and 14 control staff providers and 307 intervention and 291 control patients with type 2 diabetes in a hospital-based internal medicine clinic. Providers were randomly assigned from May 1998 through April 1999 to have access to the DMA (intervention) or not to have access (control). The DMA displays interactive patient-specific clinical data, treatment advice, and links to other web-based care resources. We compared patients in the intervention and control groups for changes in processes and outcomes of care from the year preceding the study through the year of the study by intention-to-treat analysis. RESULTS: The DMA was used for 42% of scheduled patient visits. The number of HbA(1c) tests obtained per year increased significantly in the intervention group (+0.3 tests/year) compared with the control group (-0.04 tests/year, P = 0.008), as did the number of LDL cholesterol tests (intervention, +0.2 tests/year; control, +0.01 tests/year; P = 0.02) and the proportions of patients undergoing at least one foot examination per year (intervention, +9.8%; control, -0.7%; P = 0.003). Levels of HbA(1c) decreased by 0.2 in the intervention group and increased by 0.1 in the control group (P = 0.09); proportions of patients with LDL cholesterol levels <130 mg/dl increased by 20.3% in the intervention group and 10.5% in the control group (P = 0.5). CONCLUSIONS: Web-based patient-specific decision support has the potential to improve evidence-based parameters of diabetes care.

Adult↗

PubMed2003

QuickSilver clinical tracker - a risk-management approach.

While many guidelines strive to automate the high-granular clinical thought process, the resulting risk stratification is often a low-granular management class (i.e. low, medium or high risk). Furthermore, the "low hanging fruit" of guidelines is not in decision support, rather in the subsequent action tracking. Therefore, we believe that only a small amount of data is required to produce significant reminders. In our approach, the clinician risk-stratifies the patient and enters the guideline at the management level. We do not attempt to replicate the clinical thought process; rather we ask the question, "Now that you have decided, how can we help track your decisions?" A risk-management approach encapsulates salient guideline features and provides a framework for basic decision support and data tracking.

Decision Support Systems, Clinical↗