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.     

Effects of Smallmouth Buffalo,Ictiobus bubalus Biomass on Water Transparency,Nutrients, and Productivity in Shallow Experimental Ponds

The smallmouth buffalo Ictiobus bubalus is a native benthivore to floodplain lakes in the Yazoo River Basin, USA. Based on evidence from other benthivorous fish studies we hypothesized high biomasses of I. bubalus contribute to poor water quality conditions. We tested this hypothesis in shallow (<1.5 m) 0.05 ha earthen ponds at three stocking biomasses over a 10-week period during the summer of 2012. The most notable results from the permutational multivariate analysis of variance suggest I. bubalus at high and moderate biomasses significantly (p < 0.05) enhanced turbidity and suspended solid levels while decreasing Secchi depth. Our results suggest that effects of I. bubalus on water clarity may have considerable ecological implications in natural habitats such as shallow floodplain lakes.     

Actualit��s en phytoth��rapie

This editorial review of medicinal plant publications, focusing on pharmacological and clinical research, was written for its pharmaceutical and medical value. It is hoped that it will help advance additional studies that could lead to therapeutic applications. Readers must, however, be aware that a pharmacological breakthrough or the demonstration of pharmacological activity does not immediately justify medical use.