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COVID-19 and the Consequences of Anchoring Bias

Horowitz, Harold W; Behar, Caren; Greene, Jeffrey
Suspicion of coronavirus disease in febrile patients might lead to anchoring bias, causing misdiagnosis of other infections for which epidemiologic risks are present. This bias has potentially severe consequences, illustrated by cases of human granulocytic anaplasmosis and Lyme disease in a pregnant woman and human granulocytic anaplasmosis in another person.
PMCID:8314836
PMID: 34287136
ISSN: 1080-6059
CID: 4965362

To Assess the Success of Computerized Order Sets and Pharmacy Education Modules in Improving Antiretroviral Prescribing

Mehta, Dhara; Kohn, Bella; Blumenfeld, Michael; Horowitz, Harold W
PURPOSE/OBJECTIVE:To assess the success of order set and pharmacist training improvement (OSPTI) in improving prescription of antiretroviral therapy (ART) in a tertiary care, public, teaching hospital. METHODS:In this pre-OSPTI (January 2012 through June 2013) and post-OSPTI study (July 2013 through September 2014), an infectious disease pharmacist reviewed all patients on ART. A review of intervention data in July 2013 led to order-set changes in the hospital's computerized order entry system for frequently intervened on antiretrovirals: ritonavir, tenofovir, emtricitabine/tenofovir disoproxil fumarate (FTC/TDF), and lamivudine. Concurrently, case-based education modules were conducted to help pharmacists identify ART errors. The number of patients on ART, number of interventions, and types of ritonavir interventions were compared between pre- and post-OSPTI periods. RESULTS:In the pre-OSPTI period, an average of 239 patients were reviewed per quarter compared to an average of 216 per quarter in the post-OSPTI period. After implementing enhanced order sets, the number of interventions decreased by approximately 34% ( P < .0001). The number of ritonavir interventions decreased on average by 45% ( P < .0001), although the types of ritonavir interventions were similar. CONCLUSION/CONCLUSIONS:Enhanced antiretroviral order sets and pharmacy education modules improved ART prescription by reducing the overall number of antiretroviral interventions required per quarter. This modality was effective in improving prescribing of ART and reducing the need for pharmacist interventions.
PMID: 28877642
ISSN: 1531-1937
CID: 3301372

Adherence to Antiretroviral Therapy in Hospitalized HIV-Positive Patients

Decano, Arnold; Dubrovskaya, Yanina; Horowitz, Harold; Mehta, Dhara; Scipione, Marco R
ORIGINAL:0015352
ISSN: 2328-8957
CID: 5032842

Infection control II: A practical guide to getting to zero

Horowitz, Harold W
PMID: 27158090
ISSN: 1527-3296
CID: 2107452

Errors in isolation of patients with infectious tuberculosis at a public teaching hospital in New York

Bhatraju, P; Patrawalla, P; Trieu, L; Ahuja, S D; Marchione, S; Douyon, F; Horowitz, H W; Leibert, E
BACKGROUND: Studies report variability in the rates and causes of isolation errors among in-patients with active tuberculosis (TB). We reviewed our experience with delays or premature discontinuation of airborne infection isolation (AII). METHODS: Medical records of patients admitted to the Bellevue Hospital Center, New York City Health & Hospitals, New York, NY, USA, between January 2006 and July 2012 with a positive respiratory culture for Mycobacterium tuberculosis were reviewed. Patients who were out of AII despite being infectious were identified, as the episodes had prompted a contact investigation. RESULTS: Of 246 admissions with positive respiratory cultures, 35 AII errors were identified among 27 patients. Most patients had signs or symptoms of TB on admission. Only four patients had positive sputum smears. In 16 (46%) episodes, the patients had never been isolated, 11 (31%) had delayed isolation, and 8 (23%) were prematurely taken off AII. The most common reasons for patients being off AII while infectious were an incorrect alternative diagnosis (15/35, 43%) or a dual diagnosis (9/35, 26%). CONCLUSIONS: Particularly in smear-negative cases, AII errors due to TB may occur when providers conclude that another diagnosis explains their findings. In many cases, that diagnosis is correct, but TB is also present. This error rate might be a useful quality indicator.
PMID: 27510241
ISSN: 1815-7920
CID: 2211742

Are Mandatory Electronic Prescriptions in the Best Interest of Patients?

Wormser, Gary P; Erb, Markus; Horowitz, Harold
PMID: 26584970
ISSN: 1555-7162
CID: 1848742

Infection control: Public reporting, disincentives, and bad behavior

Horowitz, Harold W
PMID: 26116332
ISSN: 1527-3296
CID: 1641112

Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Chapter by: Segal, Leopoldo N; Weiden, Michael D; Horowitz, Harold W
in: Mandell, Douglas, and Bennett by Bennett, John E; Dolin, Raphael; Blaser, Martin J [Eds]
Philadelphia, PA : Elsevier/Saunders, 2015
pp. 810-817.e3
ISBN: 9780323263733
CID: 1686882

Reporting Biases for Hospital-acquired Infections [Letter]

Horowitz, Harold
PMID: 23410578
ISSN: 0002-9343
CID: 223232

Differences and Similarities between Culture-Confirmed Human Granulocytic Anaplasmosis and Early Lyme Disease

Wormser, Gary P; Aguero-Rosenfeld, Maria E; Cox, Mary E; Nowakowski, John; Nadelman, Robert B; Holmgren, Diane; McKenna, Donna; Bittker, Susan; Zentmaier, Lois; Cooper, Denise; Liveris, Dionysios; Schwartz, Ira; Horowitz, Harold W
Lyme disease is transmitted by the bite of certain Ixodes ticks, which can also transmit Anaplasma phagocytophilum, the cause of human granulocytic anaplasmosis (HGA). Although culture can be used to identify patients infected with A. phagocytophilum and is the microbiologic gold standard, few studies have evaluated culture-confirmed patients with HGA. We conducted a prospective study in which blood culture was used to detect HGA infection in patients with a compatible clinical illness. Early Lyme disease was defined by the presence of erythema migrans. The epidemiologic, clinical, and laboratory features of 44 patients with culture-confirmed HGA were compared with those of a convenience sample of 62 patients with early Lyme disease. Coinfected patients were excluded. Patients with HGA had more symptoms (P = 0.003) and had a higher body temperature on presentation (P < 0.001) than patients with early Lyme disease. HGA patients were also more likely to have a headache, dizziness, myalgias, abdominal pain, anorexia, leukopenia, lymphopenia, thrombocytopenia, or elevated liver enzymes. A direct correlation between the number of symptoms and the duration of illness at time of presentation (rho = 0.389, P = 0.009) was observed for HGA patients but not for patients with Lyme disease. In conclusion, although there are overlapping features, culture-confirmed HGA is a more severe illness than early Lyme disease.
PMCID:3592036
PMID: 23303504
ISSN: 0095-1137
CID: 241312