Biomedical subjects

Stephen J Huot

Publications and source records attributed to Stephen J Huot.

4 recordsLinked to original sources

PubMed2002

Utility of captopril renal scans for detecting renal artery stenosis.

BACKGROUND: Captopril renal scanning (CRS) is commonly recommended as a noninvasive method for detecting renal artery stenosis (RAS), based on performance characteristics determined in research settings. Scant data are available, however, regarding the utility of CRS in clinical practice. METHODS: We evaluated the performance characteristics (sensitivity, specificity, and predictive values) of CRS in a consecutive series of 90 patients who underwent both CRS and renal arteriography within a 6-month period (January 1, 1991, through December 31, 1995) at a university hospital. RESULTS: Among 86 eligible patients (and 169 kidneys), the prevalence of RAS was 43%. The sensitivity of CRS was 74% (95% confidence interval [CI], 62%-83%); the specificity was 59% (95% CI, 49%-69%); the positive predictive value was 58% (95% CI, 47%-68%); and the negative predictive value was 75% (95% CI, 64%-84%). Also, there was evidence of spectrum bias, because the sensitivity and specificity (as well as the positive and negative predictive values) were different for groups with and without vascular disease. CONCLUSIONS: The results of CRS were substantially worse in a clinical practice setting than previously reported in research settings, despite a similar prevalence of RAS. Captopril renal scanning should not be used as an initial screening test for diagnosing RAS, even among patients with high clinical likelihood of disease.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2002

Developing an Internet-based communication system for residency training programs.

Administrative communication is increasingly challenging for residency programs as the number of training sites expands. The Internet provides a cost-effective opportunity to address these needs. Using the World Wide Web, we developed a single, reliable, accurate, and accessible source of administrative information for residents, faculty, and staff in a multisite internal medicine residency at reduced costs. Evaluation of the effectiveness of the website was determined by tracking website use, materials and personnel costs, and resident, staff, and faculty satisfaction. Office supply and personnel costs were reduced by 89% and personnel effort by 85%. All users were highly satisfied with the web communication tool and all reported increased knowledge of program information and a greater sense of "connectedness." We conclude that an internet-based communication system that provides a single, reliable, accurate, and accessible source of information for residents, faculty, and staff can be developed with minimum resources and reduced costs.

Adult↗

PubMed2002

An organizational innovation: the Yale Primary Care Residency Program's experience with a firm system.

BACKGROUND: Integrated inpatient-outpatient firms developed in residencies with single institutions may not be applicable to residency programs with multiple inpatient and outpatient training sites. Our objective was to develop a firm in a multisite residency program that improved education and patient care. DESCRIPTION: One ward team was restructured into a firm that included two interns, three residents, and four private practice internists whose patients were admitted to the firm. Educational impact, length of stay, hospital charges, and in-hospital mortality were evaluated. EVALUATION: The firm experience increased outpatient training, fostered mentoring relationships, and increased attending availability. Mean length of stay (5.7 vs. 6.5 days, p = .2) and mean hospital charges ($10,888 vs. $12,316, p = .8) for firm and nonfirm patients, respectively, were not different. In-hospital mortality was lower for firm patients (9 of 348, 3%, vs. 87 of 1,565, 6%; p = .02). CONCLUSIONS: Firm structures with educational and patient care advantages can be instituted in multisite residencies.

Adolescent↗

PubMedDate not supplied

Cardiovascular disease in neurofibromatosis 1: report of the NF1 Cardiovascular Task Force.

PURPOSE: Patients with neurofibromatosis 1 (NF1) are at increased risk for a variety of cardiovascular disorders, but the natural history and pathogenesis of these abnormalities are poorly understood. METHODS: The National Neurofibromatosis Foundation convened an expert task force to review current knowledge about cardiovascular manifestations of NF1 and to make recommendations regarding clinical management and research priorities related to these features of the disease. RESULTS: This report summarizes the NF1 Cardiovascular Task Force's current understanding of vasculopathy, hypertension, and congenital heart defects that occur in association with NF1. Recommendations are made regarding routine surveillance for cardiovascular disease and diagnostic evaluation and management of cardiovascular disorders in individuals with NF1. CONCLUSION: Our understanding of the natural history and pathogenesis of cardiovascular disease in NF1 has improved substantially in the past few years, but many clinically important questions remain unanswered.

Advisory Committees↗