Abstract:
BACKGROUND:Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to rank ARV combinations based upon a composite objective of achieving viral suppression and maximizing tolerability. OBJECTIVE:To evaluate concordance of HIV-ASSIST recommendations with ARV selections of experienced HIV clinicians. DESIGN:Retrospective cohort study. PATIENTS:New and established patients at the Johns Hopkins Bartlett HIV Clinic and San Francisco Veterans Affairs HIV Clinic completing clinic visits were included. Chart reviews were conducted of the most recent clinic visit to generate HIV-ASSIST recommendations, which were compared to prescribed regimens. MAIN MEASURES:For each provider-prescribed regimen, we assessed its corresponding HIV-ASSIST "weighted score" (scale of 0 to 10 +, scores of < 2.0 are preferred), rank within HIV-ASSIST's ordered listing of ARV regimens, and concordance with the top five HIV-ASSIST ranked outputs. KEY RESULTS:Among 106 patients (16% female), 23 (22%) were ARV-naïve. HIV-ASSIST outputs for ARV-naïve patients were 100% concordant with prescribed regimens (median rank 1 [IQR 1-3], median weighted score 1.1 [IQR 1-1.2]). For 18 (17%) ARV-experienced patients with ongoing viremia, HIV-ASSIST outputs were 89% concordant with prescribed regimens (median rank 2 [IQR 1-3], median weighted score 1 [IQR 1-1.2]). For 65 (61.3%) patients that were suppressed on a current ARV regimen, HIV-ASSIST recommendations were concordant 88% of the time (median rank 1 [IQR 1-1], median weighted score 1.1 [IQR 1-1.6]). In 18% of cases, HIV-ASSIST weighted score suggested that the prescribed regimen would be considered "less preferred" (score > 2.0) than other available alternatives. CONCLUSION:HIV-ASSIST is an educational decision support tool that provides ARV recommendations concordant with experienced HIV providers from two major academic centers for a diverse set of patient scenarios.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Ramirez JA,Maddali MV,Budak JZ,Li JZ,Lampiris H,Shah Mdoi
10.1007/s11606-019-05531-4subject
Has Abstractpub_date
2020-05-01 00:00:00pages
1498-1503issue
5eissn
0884-8734issn
1525-1497pii
10.1007/s11606-019-05531-4journal_volume
35pub_type
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abstract:OBJECTIVE:To determine the frequency with which an acute confusional state is caused by a stroke and to evaluate the usefulness of obtaining computed tomography scans in this setting. DESIGN:Retrospective analysis. SETTING:Tertiary referral center. PATIENTS:The authors reviewed 127 neurology consultations requested ...
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abstract::While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical hea...
journal_title:Journal of general internal medicine
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更新日期:2014-01-01 00:00:00
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更新日期:2009-11-01 00:00:00
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更新日期:2008-02-01 00:00:00
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更新日期:2019-02-01 00:00:00