Biomedical subjects

Thomas C Bailey

Publications and source records attributed to Thomas C Bailey.

6 recordsLinked to original sources

PubMed2003

The association of cytomegalovirus sero-pairing with outcomes and costs following cadaveric renal transplantation prior to the introduction of oral ganciclovir CMV prophylaxis.

Cytomegalovirus (CMV) is an important cause of morbidity, mortality and cost in cadaveric renal transplantation. This study was designed to document the clinical and economic outcomes associated with donor and recipient CMV sero-pairing. Data were drawn from the United States Renal Data System (USRDS) on 17 001 cadaveric renal transplant recipients transplanted between 1995 and 1997 with recorded donor and recipient CMV sero-status. In multivariate analysis, CMV-seropositive recipients were associated with a significantly higher incidence of delayed graft function, a lower incidence of graft loss, and lower costs than CMV-seronegative recipients. CMV-seropositive compared to seronegative donors were associated with significantly higher incidence of CMV disease, graft loss, and higher costs when transplanted into CMV-seronegative recipients. However, CMV-seronegative donors into seropositive recipients had no significant association with outcome beyond a higher incidence of CMV disease compared to CMV-seronegative donor and recipient pairs. The outcomes associated with CMV-seropositive donors and seronegative recipients call for tailored management strategies which may include avoidance of such mismatching, antiviral therapy, immunization, or modified immunosuppression.

Administration, Oral↗

PubMed2003

Monitoring pharmacy expert system performance using statistical process control methodology.

Automated expert systems provide a reliable and effective way to improve patient safety in a hospital environment. Their ability to analyze large amounts of data without fatigue is a decided advantage over clinicians who perform the same tasks. As dependence on expert systems increase and the systems become more complex, it is important to closely monitor their performance. Failure to generate alerts can jeopardize the health and safety of patients, while generating excessive false positive alerts can lead to valid alerts being dismissed as noise. In this study, statistical process control charts were used to monitor an expert system, and the strengths and weaknesses of this technology are presented.

Clinical Pharmacy Information Systems↗

PubMed2003

Validation of automated event triggers using laboratory values related to two problem-prone drugs.

We used computerized alerts to identify patients with laboratory values that could be related to medication errors associated with digoxin and warfarin. Over a six-week period at two inpatient facilities, we generated 62 laboratory-based alerts for warfarin, and 66 for digoxin. The positive predictive value for these alerts representing a preventable event was 71% and 57% for warfarin and digoxin, respectively.

Anticoagulants↗

PubMed2003

Implementing a commercial rule base as a medication order safety net.

A commercial rule base was used to identify drug orders exceeding standard dosage limits at a university hospital. Initially, there were substantial numbers of clinically insignificant alerts. A method for altering the commercial rule base will be implemented to increase rule specificity for problematic drugs. With minor modifications, commercial rule bases can be used to rapidly create a safety net that screens drug orders for excessive dosages, while preserving the rule architecture for more finely tuned clinical decision support.

Drug Therapy, Computer-Assisted↗

PubMed2002

Prospective use of molecular typing of Mycobacterium tuberculosis by use of restriction fragment-length polymorphism in a public tuberculosis-control program.

We performed a prospective, community-based evaluation of molecular typing of Mycobacterium tuberculosis isolates as a method for tuberculosis (TB) control. We performed restriction fragment-length polymorphism (RFLP) analysis of the insertion sequences IS6110 and pTBN12 for isolates recovered from 61 of 62 patients with culture-positive TB in St. Louis during 12 months. Twenty-four (39%) of the 61 patients were infected with an isolate with an RFLP pattern that was shared with >/=1 other isolate, and 11 (46%) also had epidemiologic links with patients in their cluster of cases. One case each of laboratory cross-contamination and occupational transmission were discovered. The patients in clusters were more likely to be younger, black, United States-born, to have substance abuse problems, and to live in poorer areas. A predictive algorithm for molecular identification of clusters had a sensitivity and a specificity of 75%. This study allowed the TB-control program in St. Louis to be redirected toward the affected subpopulations.

Adult↗

PubMed2002

Implementation of an automated guideline monitor for secondary prevention of acute myocardial infarction.

Clinical practice guidelines can be used to help improve health care quality, but they are often not optimally implemented. Practice enabling and reinforcing techniques, such as clinical reminders and academic detailing are effective methods for translating guidelines into practice. Following a study showing that we could improve adherence to secondary prevention guidelines for acute myocardial infarction (AMI) using computerized alerts and academic detailing, we implemented an automated monitor to accomplish the same goal in a less labor-intensive manner. This paper describes the implementation of this production application.

Drug Therapy, Computer-Assisted↗