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Biomedical subjects

M M Kitahata

Publications and source records attributed to M M Kitahata.

5 recordsLinked to original sources
PubMed2005

Developing a relational XML schema for sharing HIV clinical data.

Access to multi-site clinical data regarding treatment and outcomes of HIV-infected patients in routine care is required to support clinical research to improve the treatment of HIV. As part of the NIAID-funded CFAR Network of Integrated Clinical Systems (CNICS), we have developed a relational XML Schema to extend the existing observational research repository and to integrate real-time clinical information from electronic medical records (EMRs) at six Centers for AIDS Research (CFAR) into the repository. The schema will aid the expansion of the research repository beyond the initial sites, and the development process may facilitate the use of multi-site repositories to study other chronic diseases.

Databases as Topic↗
PubMed2000

Physician experience in the care of HIV-infected persons is associated with earlier adoption of new antiretroviral therapy.

OBJECTIVE: Recent advances in antiretroviral therapy have led to effective but increasingly complex strategies for the treatment of HIV infection. In a previous study, we demonstrated that physicians' experience in the care of patients with AIDS improves survival. We conducted this study to determine whether greater physician experience is associated with earlier adoption and appropriate use of new antiretroviral treatment regimens. DESIGN: Retrospective medical record review of a population-based sample of HIV-infected individuals who received antiretroviral treatment between December 1995 and May 1997 by primary care physicians practicing throughout the state of Washington. We classified antiretroviral regimens observed into one of four categories based on national treatment guidelines. RESULTS: The use of new antiretroviral treatment regimens significantly increased during the study period; 22% of patients were treated with a protease inhibitor (PI)-based regimen or an alternative PI- or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen between December 1995 and November 1996, compared with 57% between April and May 1997 (p < .001). After controlling for CD4 count and the calendar period of treatment, patients cared for by physicians with greater HIV experience were significantly more likely to receive PI-based regimens or alternative PI- or NNRTI-based antiretroviral regimens (p = .02). Use of PI-based regimens was also associated with lower CD4 count (p < .001) and treatment after January 1997 (p = .02), but independent of patient demographic characteristics and the geographic location of physicians' practices. CONCLUSIONS: Greater physician experience in the care of persons with HIV infection is associated with earlier adoption of new antiretroviral treatment regardless of whether physicians practice in a rural or urban area.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Performance measures for guidelines on preventing opportunistic infections in patients infected with human immunodeficiency virus.

This article serves as a complement to the 1999 US Public Health Service/Infectious Diseases Society of America guidelines on the prevention of opportunistic infections in persons infected with HIV, published in this issue of Clinical Infectious Diseases [1]. A number of performance measures to assess compliance with the guidelines and to aid in their implementation are proposed.

AIDS-Related Opportunistic Infections↗
PubMed1996

Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival.

BACKGROUND: Previous studies have found that patients with the acquired immunodeficiency syndrome (AIDS) who are admitted to hospitals that admit many such patients have lower mortality rates than patients in hospitals with less experience with AIDS. We examined the relation between physicians' experience with AIDS and the survival of their patients with AIDS. METHODS: We studied 403 adult male patients enrolled in a staff-model health maintenance organization in whom first AIDS-defining illnesses were diagnosed from 1984 through mid-1994; we determined that these illnesses met the 1987 case definition of the Centers for Disease Control. We defined three levels of experience for the patients' 125 primary care physicians according to their experience with AIDS during residency training and the cumulative number of patients with AIDS they had cared for in their practices. RESULTS: The median survival of the patients of physicians with the least experience in the management of AIDS was 14 months, as compared with 26 months for the patients of physicians with the most experience (P<0.001). Controlling for the severity of illness and the year of diagnosis, we found that the patients cared for by physicians with the most experience had a 31 percent lower risk of death than the patients cared for by physicians with the least experience (P<0.02). Among 244 patients with an AIDS-defining illness diagnosed from 1989 through 1994, after adjustment for the CD4+ cell count and the severity of illness, the risk of death was 44 percent lower for patients of the most experienced physicians than for patients of the least experienced (P<0.02). CONCLUSIONS: The experience of primary care physicians in the management of AIDS is significantly associated with survival among their patients.

Acquired Immunodeficiency Syndrome↗