At a false-positive rate (FPR) of 5%, specificity for R5-tropic virus was also high (range: 85.7%-95.3%), but came at the expense of sensitivity for X4-using virus (range: 36.7%-66.7%). One study compared the effectiveness of both genotypic tropism testing and ESTA in predicting virological response to the CCR5-antagonist maraviroc. The study found in each screening group, a similar proportion of patients achieved a viral load Ͻ 50 HIV-1 RNA copies/mL by Week 48. CONCLUSIONS: In the absence of a 'gold standard', clinical response to CCR5-anatagonist therapy offers the best measure of diagnostic performance in HIV-1 tropism testing. The results of this review indicate that genotypic sequencing of the V3 loop is as capable of predicting response to CCR5-antagonist therapy as the current diagnostic standard, ESTA. In addition, of the bioinformatic algorithms reviewed here, the geno2pheno model set at 5-10% FPR offered the best balance between sensitivity and specificity. This evidence provides further support for the use of genotypic tropism testing in routine clinical practice.

OBJECTIVES:The aims of this study are to evaluate significance of pharmacist interventions, probability value of adverse drug events (ADE) if no pharmacist recommendations, and to analyze economic impact of pharmacist recommendations. METHODS: Data of this retrospective study were collected between December 2010 and May 2011. The pharmacist recommendations documented in the electronic system were included in this study, while the recommendations which were incomplete, were duplications, or did not require the pharmacist to use clinical judgment were excluded. Data analysis included probability value of ADE if no pharmacist recommendations (0 to 1.0, 0 defined as completely unlikely, 0.5 as neither likely nor unlikely, 1.0 defined as very likely), severity of potential ADE (potentially lethal, serious, significant, minor, or no error), and significance of the intervention (extremely significant, very significant, significant, somewhat significant, nonsignificant, adverse significance) were determined by two evaluators (one physician and one is senior pharmacist). The cost analysis mainly looked at cost avoidance. RESULTS: Seven hundreds and seventy-six pharmacist interventions were documented in the electronic system from December 2010 to May 2011. 285 recommendations were excluded since there was no specific intervention, the recommendations were not accepted or categorized as duplication. Finally, 491 interventions were included in this study. The average probability value of ADE was 0.41. The assumption that cost of prolonged length of hospital stay due to ADE is about NT 5,000. Therefore, cost avoidance was NT 1,006,550 in this study. On the other hand, most pharmacist interventions as percentage of 65.4% were classified as "very significant" by the two evaluators. CONCLUSIONS: The study illustrated that the pharmacists' interventions were able to prevent potential adverse drug events and to decrease medical expenditure thereafter. In conclusion, patient-centered pharmaceutical intervention should be provided continuously to improve quality of medical care.

OBJECTIVES: Emergency Department [ED] overcrowding is a national problem. This study evaluates the effect of a provider/nurse triage model (Rapid Evaluation Unit, REU) designed to improve the efficiency of the ED on ED patient volume and ambulance diversion hours. METHODS: Data on daily patient counts [inpatient, ED] and ambulance diversion hours for a single hospital in Baltimore were used to evaluate the impact of REU on hospital performance. Data covered 2008, the year before the REU was implemented, and 2009 during which the REU was implemented incrementally. The REU was operating on Monday-Wednesday from January 1 st through March 31 st , and then Monday through Friday from April 1 st through December 31 st . Regression models were estimated for the daily counts for admissions, ED visits and ambulance diversion days controlling for time trend effects, day of the week and month of the year. A spline functional form was used to test the effects of the REU on pre-2009 time trends and to improve model fit. Models were adjusted for autocorrelation and heteroskedasticity as needed. RESULTS: The REU significantly increased ED patient visit counts by 5.5 visits per day [pϽ0.01] without increasing the number of hours the hospital was diverting ambulances due to over crowding [Ϫ0.83 hours per day, pϾ0.05]. For ED visits, all months exhibited significantly higher daily ED visit counts than in December, ranging from ϩ9 to ϩ28 visits per day. The early work week [Monday-Wednesday] also exhibited significantly higher rates of ED visits than Saturday [range: 5-12 visits per day]. CONCLUSIONS: The REU was effective at increasing ED visits without increasing ambulance diversion hours. We theorize that this may be due to a reduction in the time spent by patients waiting for treatment.