Comparative Cost Analysis of Clinical Reminder for HIV Testing at the Veterans Affairs Healthcare System

ObjectiveTo estimate the cost and health outcomes associated with a new HIV testing strategy that utilizes routine-based clinical reminders.MethodsWe conducted an economic analysis of 1) traditional pretest/post-test counseling; 2) counseling and a new clinical reminders system; and 3) only clinical reminder in the veterans’ health care system. A payer-perspective decision model was conducted to calculate the 1-year budget impact of three HIV testing strategies. Parameter values were obtained from the literature, including patients’ probability of accepting test, and costs associated with HIV testing procedures. Deidentified patient data, including total population screened and number of new HIV cases, were collected from one clinic in Los Angeles, California, from August 2004 to December 2011. Annual total costs and costs per new case were calculated on the basis of parameter values and patient data. Sensitivity analyses were conducted to evaluate the robustness of the critical variable on costs.ResultsThe total cost of the clinical reminder system with pretest counseling was $81,726 over 1 year compared with $109,208 for traditional HIV testing. Under a clinical reminder system with no pretest counseling, the number of HIV tests performed and the number of new diagnoses increased for that year. In addition, cost per new diagnoses was the lowest.ConclusionsThe clinical reminder system can reduce the cost per cases identified and promote better performance of HIV testing compared with traditional HIV testing. The fundamental decision model can be used for hospital facilities outside the Veteran Affairs adopting a similar program for improving the HIV testing rate.     

What Can I Do With a Doctoral Degree in Gerontology? Expanding Your Options

An endless number of career trajectories are possible for gerontologists. With a growing aging population, our skills and areas of expertise are of high value to numerous industries. The purpose of this study is to describe the professional development and career trajectories of alumni of U.S. doctoral gerontology programs obtained through the Gerontology Education Longitudinal Study (GELS). Specifically, the authors examine how professional identification, doctoral program career preparation, and perception of job prospects affect alumni decisions to pursue “traditional” (i.e., academic) versus “nontraditional” (i.e., non-academic) careers. Results from the GELS revealed a fairly even split in the alumni sample of careers in traditional and nontraditional settings. The decision to pursue a traditional versus nontraditional career was not significantly associated with personal identification, doctoral program career preparation, or perception of employment options. These results suggest that the skill set obtained in doctoral gerontology programs is useful and is in demand in a variety of careers; therefore, doctoral programs may want to consider tailoring training to meet students’ future career goals in both academic and non-academic settings.     

Acute Heart Failure after Percutaneous Pulmonary Valve (Melody Valve) Implantation

We present a case of a 38‐year‐old male who developed acute heart failure early after percutaneous pulmonary valve implantation with the Melody valve (Medtronic, Minneapolis, MN, USA).     

HRQoL changes,mood disorders and satisfaction after treatment in an unselected population of patients with lung cancer

Objectives: This study intended to explore the impact of the first treatment modality on health‐related quality of life (HRQoL), mood disorders and mastery in an unselected population of patients with primary lung cancer and to judge patient satisfaction with treatment. Materials and Methods: An unselected group of 479 patients with newly diagnosed lung cancer in Southern Norway (Agder counties) were included prospectively from June 2002 to June 2005, collecting data on histology, treatment options, HRQoL, mood disorders and mastery at baseline as well as satisfaction with treatment, and changes in HRQoL and mood disorders after finishing the first treatment modality. Results: After finishing the first treatment modality, patients experienced a worsening of nine HRQoL parameters and an improvement in one. Patients in good performance status experienced reduced physical and role function, and if in reduced performance, improved emotional and role function. Patients with mood disorders experienced reduced anxiety and depression, anxious patients experienced reduced neuropathies, and depressed patients experienced improved social functioning and appetite. Half of the patients treated actively were definitely positive to repeat the same treatment again compared with only 15% in the best supportive care group. Surgery was associated with reduced role function and increased dyspnoea, radiation was associated with increased fatigue, and chemotherapy in small cell lung cancer (SCLC), to a larger extent, was associated with alopecia than in non‐SCLC (NSCLC). Conclusion: The development of many HRQoL parameters after the first treatment modality in an unselected population of patients with primary lung cancer seemed, at large, well correlated to general disease progression and to well‐known treatment side effects. However, reduced role function after lung surgery, and reduced anxiety and depression in patients with mood disorders at baseline might be surprising. Patient satisfaction with treatment was surprisingly good. Several findings in this study may help clinicians to improve their handling of patients with lung cancer. Please cite this paper as: Rolke HB, Bakke PS and Gallefoss F. HRQoL changes, mood disorders and satisfaction after treatment in an unselected population of patients with lung cancer. The Clinical Respiratory Journal 2010; 4: 168–175.