Markov modelling of HIV infection evolution in the HAART era.

The aim was to investigate the impact of the main prognostic factors on HIV evolution. A multi-state Markov model was applied in a cohort of 2126 patients to estimate impact of these factors on patients' clinical and immunological evolutions. Clinical progression and immunological deterioration shared most of their prognostic factors: male gender, intravenous drug use, weight loss, low haemoglobin level (<110 g/l), CD8 cell count (<500/mm(3)) and HIV viral load (>5 log(10) copies/ml). Highly active retroviral therapy reduced the risks of clinical progression and immune deterioration whatever patients' CD4 cell count. Risk reductions were 41-60% for protease inhibitor-based and 27-68% for non-nucleoside reverse transcriptase inhibitor-based regimens. Three-year transition probabilities showed that only patients with a CD4 cell count >or=350 CD4/mm(3) could in most cases maintain their immunity. This model provides 'real life' transition probabilities from one immunological stage to another, allowing decision analyses that could help determine the beneficial therapeutic strategies for HIV-infected patients.

Incorporation of the Tidal Model into the interdisciplinary plan of care--a program quality improvement project.

The Tidal Model was utilized in the development and implementation of an Interdisciplinary Care Plan (IPC) on an inpatient psychiatric unit at St. Joseph's Healthcare Hamilton, Canada. Recovery, client-centered care and interdisciplinary team function were important concepts that were also integrated in the creation of a new care plan. The Tidal Model honors the person and the person's story. This model focuses on engaging the person rather than an illness, with the goal of understanding the person's present situation and his or her relationship with health and illness. Recovery focuses on moving beyond illness, and client centred care acknowledges clients as participants in their own care. As a program quality improvement initiative, the impact of the new IPC was evaluated. Feedback demonstrated that the IPC had a positive impact on both client and caregiver satisfaction, provided a better understanding of the client's situation, and improved the team's ability to document a care plan that reflected the client's specific goals and the goals of the interdisciplinary team. The outcomes achieved through this project have provided support for the IPC along with the need for further evaluation. Our experience with the Tidal Model and the IPC has given voice to the patient's story and helped facilitate their journey towards recovery.