Michael H. Zaroukian

Report of the AMIA EHR 2020 task force on the status and future direction of EHRs

Over the last 5 years, stimulated by the changing healthcare environment and the Health Information Technology for Economic and Clinical Health (HITECH) Meaningful Use (MU) Electronic Health Record (EHR) Incentive program, EHR adoption has increased remarkably, and there is early evidence that such adoption has resulted in healthcare safety and quality benefits.1,2 However, with this broad adoption, many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction,3 new and burdensome data entry tasks being transferred to front-line clinicians,4,5 and lengthened clinician workdays.6–8 Additionally, interoperability between different EHR systems has languished despite large efforts towards that goal.9,10 These challenges are contributing to physicians’ decreased satisfaction with their work lives.11–13 In professional journals,14 press reports,15–17 on wards, and in clinics, we have heard of the difficulties that the transition from paper records to EHRs has created.18 As a result, clinicians are seeking help to get through their work days, which often extend into evenings devoted to writing notes. Examples of comments we have received from clinicians and patients include: “Computers always make things faster and cheaper. Not this time,” and “My doctor pays more attention to the computer than to me.” Ultimately the healthcare systems goal is to create a robust, integrated, and interoperable healthcare system that includes patients, physician practices, public health, population management, and support for clinical and basic sciences research. This ecosystem has been referred to as the “learning health system.”19 EHRs are an important part of the learning health system, along with many other clinical systems, but future ways in which information is transformed into knowledge will likely require all parts of the system working together. Potentially every patient encounter could present an …

Respiratory Syncytial Virus Infection: A Cause of Respiratory Distress Syndrome and Pneumonia in Adults

Respiratory syncytial virus (RSV) infection, an important and sometimes lethal disease of infants and children, generally causes a milder and self-limited syndrome of cough, nasal congestion and fever in adults. While some evidence suggests that RSV may be responsible for more serious respiratory illness in the elderly and chronically ill, it has not been shown to cause life-threatening respiratory tract disease in previously healthy adults. This report describes a previously healthy woman who experienced the acute onset of right lower lobe pneumonia which rapidly progressed to the adult respiratory distress syndrome (ARDS). Acute and convalescent serology showed RSV was the cause of the respiratory tract illness. Michigan Department of Public Health records revealed six additional cases of adult bilateral pneumonia with diagnostic antibody titers to RSV, with or without coinfection with a second organism. These data suggest that RSV may be an under-recognized cause of lower respiratory tract disease in adults.

Medline Computerized Literature Searching Using Grateful Med: A Pilot Instructional Project for Entering Medical Students

Teaching computer‐assisted bibliographic retrieval skills to medical students is becoming an increasingly important charge of medical educators. We presented and evaluated a pilot educational project in which MEDLINE searching using GRA TEFUL MED was taught to an entire entering medical‐school class of 112 students. Training was followed by incorporation of a MEDLINE searching exercise into an early phase of the medical school curriculum and monitoring of subsequent spontaneous use. Project effectiveness was indicated by student ratings on questionnaires, faculty evaluations of student performance and spontaneous searching by students. These novice GRA TEFUL MED users retrieved relevant citations at a low cost per relevant citation when compared to published reports of other end‐user programs for MEDLINE searching. We conclude that computerized searching of the biomedical literature using GRATEFUL MED can be successfully taught to entering medical students and provides a productive and structured learning...

Comorbidity, but not age, predicted hospital and 2-year mortality for patients hospitalized with community-acquired pneumonia

Source Citation Brancati FL, Chow JW, Wagener MM, Vacarello SJ, Yu VL. Is pneumonia really the old mans friend? Two-year prognosis after community-acquired pneumonia. Lancet. 1993 Jul 3;342:30-3.

Decreasing the incidence of ventilator-associated pneumonia

Source Citation Pugin J, Auckenthaler R, Lew DP, Suter PM. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clini...

Surface Ly-5 glycoprotein in murine natural killer (NK) cell development, target binding and cytotoxicity.

The role of surface Ly-5 glycoprotein expression in the binding and lysis of susceptible tumor targets by natural killer cells was studied using NK cell-enriched splenocytes from 6-8 week old C57BL/6 mice which were reacted with anti-Ly-5 serum in the presence or absence of a source of complement. A conjugate assay was used to demonstrate that abrogation of tumor cell lysis by anti-Ly-5 serum involved the inhibition of NK cell binding to susceptible YAC-1 targets. Additionally, reconstituted membrane vesicles from NK cell-enriched splenocyte populations blocked binding of effector cells to YAC-1 lymphoma targets, a phenomenon which was abrogated by pretreatment of vesicles with anti-Ly-5 serum. Indirect immunofluorescent labeling and cell sorting were used in the physical separation of Ly-5+ and Ly-5- cells to examine the effect of interferon and interleukin preparations on Ly-5 expression and Nk activity. Three hour treatment of sorted Ly-5- cells with murine alpha + beta interferon resulted in conversion of 22% of the cells to an Ly-5+ phenotype, as well as a significant increase in the percent specific lysis of NK-susceptible YAC-1 targets when compared to freshly sorted Ly-5- cells (29.5 +/- 1.9 vs 2.6 +/- 4.0; p less than .001). In vitro proliferation of sorted Ly-5- cells was induced by three week culture in an interferon- and interleukin-containing supernatant from ConA stimulated BALB/c splenocytes (CM), followed by repeat analysis of Ly-5 expression and cytotoxic activity. Cell sorter purified Ly-5- cells cultured in CM acquired substantial surface Ly-5 with concomitant high levels of cytotoxic activity that remained partially susceptible to inhibition by anti-Ly-5 serum. The data presented suggest that surface Ly-5 glycoprotein expression is important for binding of freshly isolated NK cells to YAC-1 targets. In addition, Ly-5- precursors of NK cells are present in murine splenic tissues and can be induced by CM to become highly active effector cells with increased surface Ly-5 expression. The persistent susceptibility of a subset of these cells to inhibition of cytotoxic activity by anti-Ly-5 serum provides additional evidence of an important role for the Ly-5 glycoprotein in the natural killer cell cytolytic mechanism against certain targets.