Only Hyperuricemia with Crystalluria,but not Asymptomatic Hyperuricemia,Drives Progression of Chronic Kidney Disease

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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.     

Lack of Borrelia burgdorferi DNA in synovial samples from patients with antibiotic treatment-resistant Lyme arthritis

OBJECTIVE: To determine whether Borrelia burgdorferi DNA may be detected in synovial tissue from patients with Lyme arthritis who have persistent synovial inflammation after antibiotic treatment. METHODS: Synovial specimens obtained at synovectomy from 26 patients with antibiotic treatment-resistant Lyme arthritis and from 10 control subjects were tested for B burgdorferi DNA using 3 primer-probe sets that target genes encoding outer surface proteins A or B or a flagellar protein (P41) of the spirochete. RESULTS: The 26 patients with Lyme arthritis, who had received antibiotic therapy for a mean total duration of 8 weeks prior to synovectomy, and the 10 control subjects each had negative polymerase chain reaction (PCR) results in synovial samples. When the samples were spiked with approximately 1-10 B burgdorferi, all but 1 had positive PCR results, suggesting that spirochetal DNA could have been detected in most of the unspiked samples if it had been present. CONCLUSION: These results indicate that synovial inflammation may persist in some patients with Lyme arthritis after the apparent eradication of the spirochete from the joint with antibiotic therapy.