Faculty Bibliography

Most clinical decisions involve bridging the inferential gap: Clinicians are required to 'fill in' where they lack knowledge or where no knowledge yet exists. In this context we consider how the inferential gap is a product, in part, of how knowledge is created, the limits to gaining access to such knowledge, and the variable ways in which knowledge is translated into decisions. We consider how electronic health records (EHRs) will help narrow this gap by accelerating the creation of evidence relevant to everyday practice needs and facilitating real-time use of knowledge in practice

OBJECTIVE: Assess the effects of a prototype computerized food portion tutorial (CFPT). DESIGN: Participants were randomly assigned to estimate portion sizes for selected food items either prior to or following CFPT training (between groups), and those estimating before CFPT training re-estimated portions after training (within groups). SETTING: Research offices. PARTICIPANTS: Seventy-six adult participants without dietary restrictions. INTERVENTION: The CFPT is a Web-based food portion training program that displays varied portions of 23 food items with user-controllable reference objects and viewing angles. MAIN OUTCOME MEASURES: Estimated vs. weighed portions of food items selected for a meal. ANALYSIS: Nonparametric tests were performed on estimated vs. weighed portion differences and on accuracy ratios between and within groups. RESULTS: A significant difference was found between conditions, both within and between groups, on the discrepancy between estimated and weighed portions for a number of the food items. Training exposure, however, resulted primarily in a shift from underestimation to overestimation, not more accurate estimation. IMPLICATIONS FOR RESEARCH AND PRACTICE: The CFPT produced a significant impact on food portion estimation but appeared to sensitize participants to underestimation errors, leading to overestimation errors. Computerization of food portion training programs holds promise for providing cost-efficient portion estimation training but requires further development and evaluation before being considered for clinical use.

Bristol-Myers Squibb (BMS) is the pioneer in the area of creating a social program necessary to combat AIDS in the poverty-stricken countries of Africa. Its 'Secure the Future' program focused on developing an infrastructure that would support medicine use, rather than just throwing pills at poor people who did not have food or clean water. The current program does not utilize or market BMS's own drug, but rather provides funding to the communities which allows drugs to be purchased through the countries' own programs. The program has grown to $150 million, supported by over 200 grants

[John W. Mellors], who was not involved in the studies but has been a consultant to the manufacturers of the drugs, said he 'wouldn't be going out on a limb' to say the new results were as exciting as those from the mid-1990s, when researchers first discovered that cocktails of drugs could significantly prolong lives. While there are now 20 approved drugs to treat HIV and AIDS, there are only four different mechanisms by which the drugs work. In many patients, the rapidly replicating virus evolves resistance to one or more drugs, usually because patients don't take their drugs on time as prescribed

A case in point is the effort to encourage formula-feeding instead of breast-feeding to prevent transmission of the virus that causes AIDS from mother to infant. At the 14th Conference on Retroviruses and Opportunistic Infections here on Monday, scientists reported findings from a number of studies citing the dangers of formula-feeding in poor countries that challenged the current recommendations. The findings led participants to urge researchers to find safer ways for breast- feeding and using formula in the battle to stop the AIDS pandemic. Based on earlier studies, the World Health Organization has said that exclusive breast-feeding has a lower risk of transmitting HIV than breast-feeding combined with other fluids or foods

Pfizer's drug works by blocking a protein on human immune system cells that H.I.V. uses as a portal to enter and infect the cell. It would be the first drug that targets the human body rather than the virus. In two Phase 3 studies sponsored by Pfizer involving 1,049 patients, more than 40 percent of patients who received maraviroc had undetectable levels of virus after 24 weeks of a 48-week study. That was about twice the rate of those who received placebo. As in the Merck trials, patients were resistant to three classes of drugs and were receiving an optimized combination of older drugs. About 85 percent of newly infected patients have a virus that uses CCR5 while only about half of highly drug-resistant viruses use that portal. There has been some concern that blocking CCR5 would encourage the development of viruses that use the alternative portal -- and those viruses seem to be associated with worse outcomes

Merck's drug works by inhibiting the action of integrase, an enzyme produced by the virus that incorporates the virus' genetic material into the DNA of a patient's immune cell. Once incorporated, the viral DNA commandeers the cell to make more copies of the virus

Dr. [Moses Sinkala] said health officials ''should strongly encourage breast-feeding into the second year of life for infants found to be HIV-infected.'' The reason was that infected infants had a lower death rate the longer they were breast-fed, said Dr. Donald M. Thea of Boston University, a co-author of the Zambian study. In a main address to the conference, Dr. Hoosen Coovadia, an AIDS expert from Durban, South Africa, pointed out the many well-documented advantages of breast-feeding. Dr. Coovadia pleaded with pediatricians and health officials not to lose sight of the fact that breast-feeding provided one of nature's greatest health benefits. United Nations AIDS estimates that 300,000 infants die each year from becoming infected through breast-feeding. Unicef estimates that 1.5 million infants die each year from mothers who avoided breast-feeding