William M Tierney

University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States

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Publications (377)1602.33 Total impact

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    ABSTRACT: Doublecortin-like kinase 1 (DCLK1), a putative tumor stem cell marker has been shown to be highly expressed in the stromal and epithelial compartments in colon and pancreatic cancer as well as Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC).
    Digestive Diseases and Sciences 10/2014; · 2.26 Impact Factor
  • William M. Tierney
    Gastrointestinal Endoscopy. 09/2014; 80(3):492–494.
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    ABSTRACT: Background Anti-spasmodic drugs may facilitate mucosal inspection during colonoscopy. The impact of hyoscine N-butyl-bromide (HBB) on polyp detection rate (PDR) and adenoma detection rate (ADR) is unclear.Methods We conducted a reproducible literature search of multiple databases. Two reviewers independently compared manuscripts for PDR, ADR, advanced adenoma detection rate (AADR), and rates of complications. Pooling was conducted by fixed-effects and random-effects models. Relative risk (RR) estimates were calculated (95% CI). I-squared index (I2) assessed heterogeneity.ResultsPatient demographics were comparable. The pooled analysis showed a trend toward improving PDR and ADR among the HBB group compared with the placebo group but failed to reach statistical significance, (46% vs. 43%, RR = 1.08 [0.94, 1.25], p = 0.27), (31% vs. 28%, RR= 1.12 [0.97, 1.29], p=0.11) respectively.ConclusionsHBB during colonoscopy may provide marginal improvements in ADR and PDR. However, heterogeneity in the available data precludes firm conclusions at this time.
    Digestive Endoscopy 08/2014; · 1.61 Impact Factor
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    ABSTRACT: Background. Removal of large stones can be challenging and frequently requires the use of mechanical lithotripsy (ML). Endoscopic papillary large balloon dilation (EPLBD) following endoscopic sphincterotomy (ES) is a technique that appears to be safe and effective. However, data comparing ES + EPLBD with ES alone have not conclusively shown superiority of either technique. Objective. To assess comparative efficacies and rate of adverse events of these methods. Method. Studies were identified by searching nine medical databases for reports published between 1994 and 2013, using a reproducible search strategy. Only studies comparing ES and ES + EPLBD with regard to large bile duct stone extraction were included. Pooling was conducted by both fixed-effects and random-effects models. Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated. Results. Seven studies (involving 902 patients) met the inclusion criteria; 3 of 7 studies were prospective trials. Of the 902 patients, 463 were in the ES + EPLBD group, whereas 439 underwent ES alone. There were no differences noted between the groups with regard to overall stone clearance (98% versus 95%, RR = 1.01 [0.97, 1.05]; P = 0.60) and stone clearance at the 1st session (87% versus 79%, RR = 1.11 [0.98, 1.25]; P = 0.11). ES + EPLBD was associated with a reduced need for ML compared to ES alone (15% versus 32%; RR = 0.49 [0.32, 0.74]; P = 0.0008) and was also associated with a reduction in the overall rate of adverse events (11% versus 18%; RR = 0.58 [0.41, 0.81]; P = 0.001). Conclusions. ES + EPLBD has similar efficacy to ES alone while significantly reducing the need for ML. Further, ES + EPLBD appears to be safe, with a lower rate of adverse events than traditional ES. ES + EPLBD should be considered as a first-line technique in the management of large bile duct stones.
    Diagnostic and Therapeutic Endoscopy 01/2014; 2014:309618.
  • Matthew Austin, Mark Mellow, William M. Tierney
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    ABSTRACT: In recent years, Clostridium difficile infections has become more frequent, more severe, more refractory to standard treatment, and more likely to recur. Current antibiotic treatment regimens for Clostridium difficile infection alter the normal gut flora, which provide colonization resistance against Clostridium difficile. Over the past few years, there has been a marked increase in the knowledge of the gut microbiota, and its role in health maintenance and disease causation. This has, fortuitously, coincided with the use of a unique microbial replacement therapy, fecal microbiota transplantation, in the treatment of patients with multiple recurrent Clostridium difficile infections. We briefly review current knowledge of the gut microbiota's functions. We then review the indications for use of fecal microbiota transplantation in Clostridium difficile infection, the techniques employed, and results of treatment. Fecal microbiota transplantation has been shown to be efficacious for patients with multiply recurrent Clostridium difficile infections (reported cure rates of 90%), with an excellent short-term safety profile and has been included in the American College of Gastroenterology treatment guidelines for this troublesome disease.
    The American journal of medicine 01/2014; · 5.30 Impact Factor
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    ABSTRACT: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a "Points to Consider" (P2C) document, and convened a national expert panel to review and critique the P2C. We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions ("Points") that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. The P2C is intended to clarify what is at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion.
    International Journal of Medical Informatics 09/2013; · 2.06 Impact Factor
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    ABSTRACT: The Indiana Global Health Research Working Conference of October 2012 was convened by a planning committee representing Indiana's research-intensive universities (Indiana University, Purdue University, and the University of Notre Dame). The event was organized as an open-space meeting with six thematic emphases and pre-conference keynote papers. Within their domains of common interest, attendees developed forme fruste research project abstracts that represent a future-oriented agenda for global health research. The organizational principles and purposes of this meeting are explicated with a concluding commentary on the agenda for research.
    Journal of General Internal Medicine 06/2013; · 3.28 Impact Factor
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    ABSTRACT: In the context of a long-term institutional 'twinning' partnership initiated by Indiana and Moi Universities more than 22 years ago, a vibrant program of research has arisen and grown in size and stature. The history of the AMPATH (Academic Model Providing Access to Healthcare) Research Program is described, with its distinctive attention to Kenyan-North American equity, mutual benefit, policies that support research best practices, peer review within research working groups/cores, contributions to clinical care, use of healthcare informatics, development of research infrastructure and commitment to research workforce capacity. In the development and management of research within our partnership, we describe a number of significant challenges we have encountered that require ongoing attention, many of which are "good problems" occasioned by the program's success and growth. Finally, we assess the special value a partnership program like ours has created and end by affirming the importance of organizational diversity, solidarity of purpose, and resilience in the 'research enterprise.'
    Journal of General Internal Medicine 06/2013; · 3.28 Impact Factor
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    ABSTRACT: To evaluate the impact of clinician-targeted computer-generated reminders on compliance with HIV care guidelines in a resource-limited setting. We conducted this randomized, controlled trial in an HIV referral clinic in Kenya caring for HIV-infected and HIV-exposed children (<14 years of age). For children randomly assigned to the intervention group, printed patient summaries containing computer-generated patient-specific reminders for overdue care recommendations were provided to the clinician at the time of the child's clinic visit. For children in the control group, clinicians received the summaries, but no computer-generated reminders. We compared differences between the intervention and control groups in completion of overdue tasks, including HIV testing, laboratory monitoring, initiating antiretroviral therapy, and making referrals. During the 5-month study period, 1611 patients (49% female, 70% HIV-infected) were eligible to receive at least 1 computer-generated reminder (ie, had an overdue clinical task). We observed a fourfold increase in the completion of overdue clinical tasks when reminders were availed to providers over the course of the study (68% intervention vs 18% control, P < .001). Orders also occurred earlier for the intervention group (77 days, SD 2.4 days) compared with the control group (104 days, SD 1.2 days) (P < .001). Response rates to reminders varied significantly by type of reminder and between clinicians. Clinician-targeted, computer-generated clinical reminders are associated with a significant increase in completion of overdue clinical tasks for HIV-infected and exposed children in a resource-limited setting.
    PEDIATRICS 03/2013; 131(3):e789-96. · 4.47 Impact Factor
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    ABSTRACT: Background and study aims: It is uncertain if needle gauge impacts the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic mass lesions. Our aim was to use meta-analysis to more robustly define the diagnostic accuracy of EUS-FNA for pancreatic masses using 22 G and 25 G needles. Patients and methods: Studies were identified by searching nine medical databases for reports published between 1994 and 2011, using a reproducible search strategy comprised of relevant terms. Only studies comparing the overall diagnostic accuracy of 22 G vs. 25 G EUS needles that used surgical histology or at least 6 months clinical follow up for a gold standard were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. When required, the original investigators were contacted to provide additional data. Pooling was conducted by both fixed-effects and random-effects models. Diagnostic characteristics (sensitivity, specificity, positive and negative likelihood ratios) with 95 % confidence intervals (CIs) were calculated.Results: Eight studies involving 1292 subjects met the defined inclusion criteria. Of the 1292 patients, 799 were in the 22 G group and 565 were in the 25 G group (both needles were used in 72 patients). The pooled sensitivity and specificity of the 22 G needle were 0.85 (95 %CI 0.82 - 0.88) and 1 (95 %CI 0.98 - 1) respectively. The pooled sensitivity and specificity of the 25 G needle were 0.93 (95 %CI 0.91 - 0.96) and 0.97 (95 %CI 0.93 - 0.99) respectively. The bivariate generalized linear random-effect model indicated that the 25 G needle is associated with a higher sensitivity (P = 0.0003) but comparable specificity (P = 0.97) to the 22 G needle.Conclusions: This meta-analysis suggests 25 G needle systems are more sensitive than 22 G needles for diagnosing pancreatic malignancy.
    Endoscopy 01/2013; · 5.74 Impact Factor
  • Gastrointestinal endoscopy 01/2013; 77(1):1-6. · 6.71 Impact Factor
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    ABSTRACT: Electronic Medical Records (EMR) are thought to improve healthcare through a variety of means. However, the study of EMR implementation in resource-poor settings has been minimal. Moi Teaching and Referral Hospital (MTRH) is the second largest tertiary care centre in Kenya, hosting a busy antenatal clinic serving Eldoret and surrounding regions. The recent transition from written to electronic antenatal records at MTRH permits the opportunity to study whether this change improves quality of care, in terms of: Time: Does the patient or healthcare worker spend the same amount of time at the encounter? Satisfaction: Is the patient or healthcare worker more or less satisfied with the encounter? Completeness: Does the antenatal record do a better job of recording key information in the antenatal history? Our Objective wasto determine the effects of EMR implementation on an antenatal clinic in a resource-limited setting.
    Studies in health technology and informatics 01/2013; 192:1222.
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    ABSTRACT: This cohort study utilized data from a large HIV treatment program in western Kenya to describe the impact of active tuberculosis (TB) on clinical outcomes among African patients on antiretroviral therapy (ART). We included all patients initiating ART between March 2004 and November 2007. Clinical (signs and symptoms), radiological (chest radiographs) and laboratory (mycobacterial smears, culture and tissue histology) criteria were used to record the diagnosis of TB disease in the program's electronic medical record system. We assessed the impact of TB disease on mortality, loss to follow-up (LTFU) and incident AIDS-defining events (ADEs) through Cox models and CD4 cell and weight response to ART by non-linear mixed models. We studied 21,242 patients initiating ART-5,186 (24%) with TB; 62% female; median age 37 years. There were proportionately more men in the active TB (46%) than in the non-TB (35%) group. Adjusting for baseline HIV-disease severity, TB patients were more likely to die (hazard ratio - HR = 1.32, 95% CI 1.18-1.47) or have incident ADEs (HR = 1.31, 95% CI: 1.19-1.45). They had lower median CD4 cell counts (77 versus 109), weight (52.5 versus 55.0 kg) and higher ADE risk at baseline (CD4-adjusted odds ratio = 1.55, 95% CI: 1.31-1.85). ART adherence was similarly good in both groups. Adjusting for gender and baseline CD4 cell count, TB patients experienced virtually identical rise in CD4 counts after ART initiation as those without. However, the overall CD4 count at one year was lower among patients with TB (251 versus 269 cells/µl). Clinically detected TB disease is associated with greater mortality and morbidity despite salutary response to ART. Data suggest that identifying HIV patients co-infected with TB earlier in the HIV-disease trajectory may not fully address TB-related morbidity and mortality.
    PLoS ONE 01/2013; 8(1):e53022. · 3.53 Impact Factor
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    ABSTRACT: Introduction: Electronic health records (EHRs) are receiving a lot of attention for their potential to improve care. Objective: To develop and implement EHRs in the antenatal clinic (ANC) of a teaching and referral hospital in Western Kenya. Results: A multidisciplinary team developed a phased implementation of EHRs in the ANC as part of a CDC-funded effort to develop and implement primary care EHRs in lower level and referral facilities in Kenya comprising a clinic registration system and initial- and return-visit encounter forms that captured and reported data required for reporting. This was successfully done, the EHR fully implemented in the ANC including a reminder system to enhance adherence to care guidelines. Conclusions: It is possible to implement EHRs in a referral hospital ANC.
    Studies in health technology and informatics 01/2013; 192:1126.
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    ABSTRACT: Pancreatic cancer is one of the deadliest cancers, mostly diagnosed at late stages. Patients with pancreatic cysts are at higher risk of developing cancer and their surveillance can help to diagnose the disease in earlier stages. In this retrospective study we collected a corpus of 1064 records from 44 patients at Indiana University Hospital from 1990 to 2012. A Natural Language Processing (NLP) system was developed and used to identify patients with pancreatic cysts. NegEx algorithm was used initially to identify the negation status of concepts that resulted in precision and recall of 98.9% and 89% respectively. Stanford Dependency parser (SDP) was then used to improve the NegEx performance resulting in precision of 98.9% and recall of 95.7%. Features related to pancreatic cysts were also extracted from patient medical records using regex and NegEx algorithm with 98.5% precision and 97.43% recall. SDP improved the NegEx algorithm by increasing the recall to 98.12%.
    Studies in health technology and informatics 01/2013; 192:822-6.
  • Gastrointestinal endoscopy 10/2012; 76(4):725-9. · 6.71 Impact Factor
  • Gastrointestinal endoscopy 09/2012; 76(3):476-81. · 6.71 Impact Factor
  • Clement J McDonald, William M Tierney
    Health Affairs 06/2012; 31(6):1365; atuhor reply 1366. · 4.64 Impact Factor
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    ABSTRACT: Small numbers of tests with pending results are documented in hospital discharge summaries leading to breakdown in communication and medical errors due to inadequate followup. Evaluate effect of using a computerized provider order entry (CPOE) system to enforce documentation of tests with pending results into hospital discharge summaries. We assessed the percent of all tests with pending results and those with actionable results that were documented before (n = 182 discharges) and after (n = 203 discharges) implementing the CPOE-enforcement tool. We also surveyed providers (n = 52) about the enforcement functionality. Documentation of all tests with pending results improved from 12% (87/701 tests) before to 22% (178/812 tests) (p = 0.02) after implementation. Documentation of tests with eventual actionable results increased from 0% (0/24) to 50% (14/28)(p<0.001). Survey respondents felt the intervention improved quality of summaries, provider communication, and was not time-consuming. A CPOE tool enforcing documentation of tests with pending results into discharge summaries significantly increased documentation rates, especially of actionable tests. However, gaps in documentation still exist.
    Applied Clinical Informatics 01/2012; 3(2):154-63. · 0.39 Impact Factor

Publication Stats

9k Citations
1,602.33 Total Impact Points


  • 2005–2014
    • University of Oklahoma Health Sciences Center
      • • Department of Internal Medicine
      • • Section of Gastroenterology and Nutrition
      Oklahoma City, Oklahoma, United States
    • Portland VA Medical Center
      Portland, Oregon, United States
  • 2013
    • University of Toronto
      Toronto, Ontario, Canada
    • Moi Teaching and Referral Hospital
      Olteret, Uasin Gishu, Kenya
  • 1987–2013
    • Regenstrief Institute, Inc.
      Indianapolis, Indiana, United States
  • 2011
    • Kansas State University
      Kansas, United States
  • 2010
    • University of California, Davis
      Davis, California, United States
  • 2003–2010
    • Moi University
      • • Department of Medicine
      • • Department of Epidemiology and Nutrition
      Nairobi, Nairobi Province, Kenya
    • Indiana University-Purdue University Fort Wayne
      Fort Wayne, Indiana, United States
  • 1985–2010
    • Indiana University-Purdue University Indianapolis
      • Department of Medicine
      Indianapolis, Indiana, United States
  • 2009
    • Philadelphia ZOO
      Philadelphia, Pennsylvania, United States
    • University of Chichester
      Chichester, England, United Kingdom
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
  • 2008
    • VA Puget Sound Health Care System
      Washington, Washington, D.C., United States
    • Brigham and Women's Hospital
      • Center for Brain Mind Medicine
      Boston, MA, United States
  • 1998–2008
    • Saint Louis University
      • College for Public Health & Social Justice
      Saint Louis, MI, United States
  • 2007
    • West Chester University
      • Department of Health
      West Chester, PA, United States
  • 1991–2007
    • Richard L. Roudebush VA Medical Center
      Indianapolis, Indiana, United States
  • 2006
    • American Society for Gastrointestinal Endoscopy
      Oak Brook, Illinois, United States
  • 1994–2005
    • Indiana University-Purdue University School of Medicine
      • Department of Medicine
      Indianapolis, IN, United States
  • 1998–2003
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
  • 1999
    • University of Texas MD Anderson Cancer Center
      Houston, Texas, United States
  • 1990–1998
    • Purdue University
      • Department of Pharmacy Practice
      West Lafayette, Indiana, United States
  • 1997
    • Eli Lilly
      Indianapolis, Indiana, United States
    • University of Washington Seattle
      • Department of Family Medicine
      Seattle, WA, United States