Date of Award

January 2016

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Kathleen M. Akgün

Abstract

Symptom interpretation for HIV-infected patients in the critical care setting may be of increased clinical significance since the introduction of antiretroviral therapy. This study compares the documentation of symptom prevalence between HIV-infected and uninfected Veterans during Medical Intensive Care Unit (MICU) admissions. We hypothesize that the documentation of symptoms by MICU providers can be identified by chart reviews and that documentation varies with HIV status. This analysis focuses on common MICU symptoms selected based on literature review and preliminary chart abstractions (pain, delirium, dyspnea, anxiety, disrupted sleep, pruritus, thirst). The database of reviewed progress notes is a random sample from the VACS virtual cohort of HIV-infected Veterans matched 1:2 to uninfected controls (1). We reviewed 2,828 MICU progress notes from 83 patients (36 HIV-infected, 47 HIV-uninfected) using an electronic chart abstraction form. Overall documentation of symptoms ranged from 11% of patients (thirst) to 99% (pain). Pruritus was the only symptom with a significant difference in documentation by HIV status (31% HIV-infected, 2% HIV-uninfected, p=0.0003). Our analysis conveys the importance of developing or refining standardized descriptive language for the investigated symptoms. Our results also suggest under-documentation of disrupted sleep, pruritus, and thirst. These findings convey a need for implementation of patient-centered assessment instruments for these symptoms given their prevalence or intensity in the reviewed literature (2-8).

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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