scholarly journals The Impact of Absolute CD4 Count and Percentage Discordance on Pneumocystis Jirovecii Pneumonia Prophylaxis in HIV-Infected Patients

2018 ◽  
Vol 17 ◽  
pp. 232595821875919 ◽  
Author(s):  
Henry Anyimadu ◽  
Chandra Pingili ◽  
Vel Sivapalan ◽  
Yael Hirsch-Moverman ◽  
Sharon Mannheimer
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Secondary Prophylaxis ◽  
Cd4 Count ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Oropharyngeal Candidiasis ◽  
Cd4 Percentage ◽  
The Impact ◽  
Current Guidelines

Current guidelines suggest that HIV-infected patients should receive chemoprophylaxis against Pneumocystis jirovecii pneumonia (PJP) if they have a cluster determinant 4 (CD4) count <200 cells/mm3 or oropharyngeal candidiasis. Persons with CD4 percentage (CD4%) below 14% should also be considered for prophylaxis. Discordance between CD4 count and CD4% occurs in 16% to 25% of HIV-infected patients. Provider compliance with current PJP prophylaxis guidelines when such discordance is present was assessed. Electronic medical records of 429 HIV-infected individuals who had CD4 count and CD4% measured at our clinic were reviewed. CD4 count and percentage discordance was seen in 57 (13%) of 429. Patients with CD4 count >200 but CD4% <14 were significantly less likely to be prescribed PJP prophylaxis compared with those who had CD4 count <200 and CD4% >14 (29% versus 86%; odds ratio = 0.064, 95% confidence interval: 0.0168-0.2436; P < .0001). We emphasize monitoring both the absolute CD4 count and percentage to appropriately guide PJP primary and secondary prophylaxis.

Electronic Medical Records and Public Perceptions

2013 ◽  
Vol 8 (3) ◽  
pp. 38-57
Author(s):  
Tarik Abdel-Monem ◽  
Mitchel N. Herian ◽  
Nancy Shank
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Online Survey ◽  
Public Attitudes ◽  
Public Perceptions ◽  
Deliberative Discussion ◽  
The Impact ◽  
Opinion Polls

Public attitudes about electronic medical records (EMRs) have been primarily gauged by one-time opinion polls. The authors investigated the impact of an interactive deliberative polling process on general attitudes towards EMRs and perceptions of governmental roles in the area. An initial online survey was conducted about EMRs among a sample of respondents (n = 138), and then surveyed a sub-sample after they had engaged in a deliberative discussion about EMR issues with peers and policymakers (n = 24). Significant changes in opinions about EMRs and governmental roles were found following the deliberative discussion. Overall support for EMRs increased significantly, although concerns about security and confidentiality remained. This indicates that one way to address concerns about EMRs is to provide opportunities for deliberation with policymakers. The policy and theoretical implications of these findings are briefly discussed within.

scholarly journals Pneumocystis jirovecii Pneumonia in a HIV-Infected Patient with a CD4 Count Greater Than 400 Cells/μL and Atovaquone Prophylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Abigayle Sullivan ◽  
Theresa Lanham ◽  
Ronald Krol ◽  
Shilla Zachariah
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Lung Biopsy ◽  
Cd4 Count ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Silver Stain ◽  
Highly Active ◽  
History Of ◽  
Methenamine Silver ◽  
Methenamine Silver Stain

We describe a rare case of Pneumocystis jirovecii pneumonia (PCP) in a heterosexual man with a pertinent medical history of well-controlled human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and PCP prophylaxis with atovaquone. The patient presented with recurrent shortness of breath, worsening malaise, and fever, following treatment for hypersensitivity pneumonitis one month prior, including a twenty-four-day course of 40 milligrams daily glucocorticoid with taper. However, transbronchial biopsies, lavage, and cytology from prior admission were inconclusive. The patient refused video-assisted thoracic surgery (VATS) at that time. Upon readmission, bronchoscopy with right VATS and lung biopsy were performed. Grocott’s methenamine silver stain of right lung biopsy was positive for Pneumocystis jirovecii. This case is a rare example of PCP in a patient with a normal CD4 count (>487 cells/μL) and a low viral load (<20 copies/mL) despite PCP prophylactic antibiotics in the setting of recent iatrogenic immunosuppression.

The Impact of Electronic Medical Records on Timeliness of Diagnosis of Asthma

2007 ◽  
Vol 44 (9) ◽  
pp. 753-758 ◽  
Author(s):  
Kwang Ha Yoo ◽  
Whitney E. Molis ◽  
Amy L. Weaver ◽  
Robert M. Jacobson ◽  
Young J. Juhn
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
The Impact

The Impact of Web 2.0 on the Doctor-Patient Relationship

2010 ◽  
Vol 38 (1) ◽  
pp. 17-26 ◽  
Author(s):  
Bernard Lo ◽  
Lindsay Parham
Keyword(s):  
Health Information ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Digital Health ◽  
The Internet ◽  
Office Visits ◽  
Internet Users ◽  
The Impact ◽  
E Mail ◽  
Stimulus Package

The hypothetical case of Mr. Jenkins illustrates innovations in digital health information technology that may profoundly change medical care and the doctorpatient relationship. The Internet contains enormous amounts of health information, and about threequarters of Internet users look online for health information. 1 Sometimes patients bring information they found on the Internet to their physicians. Physicians and patients can also now communicate by e-mail rather than by telephone or office visits, although these e-mail communications may not be integrated into the patient’s medical record. Furthermore, electronic medical records are slowly being adopted, particularly in hospitals and large integrated health systems. Funding to promote the adoption of electronic medical records (EMRs) has been included in the 2009 federal stimulus package under the Obama Administration.

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