True durability: HIV virologic suppression in an urban clinic and implications for timing of intensive adherence efforts and viral load monitoring.

Although the majority of HIV-infected patients who begin potent antiretroviral therapy should expect long-term virologic suppression, the realities in practice are less certain. Durability of viral suppression was examined to define the best timing of targeted adherence strategies and intensive viral load monitoring in an urban clinic population with multiple challenges to ART adherence. We examined the risk of viral rebound for patients who achieved two consecutive viral loads lower than the lower limit of quantification (LLOQ) within 390 days. For 791 patients with two viral loads below the LLOQ, viral rebound >LLOQ from the first viral load was 36.9 % (95 % CI 32.2-41.6) in the first year, 26.9 % (95 % CI 21.7-32.1) in the year following one year of viral suppression, and 24.6 % (95 % CI 18.4-30.9) in the year following 2 years of viral suppression. However, for patients with CD4 ≥300 cells/µl who had 3-6 years of virologic suppression, the risk of viral rebound was very low. At the population level, the risk of viral rebound in a complex urban clinic population is surprisingly high even out to 3 years. Intensified monitoring and adherence efforts should target this high risk period. Thereafter, confidence in truly durable virologic suppression is improved.

Reflection as a Tool for Personal and Professional Development.

PURPOSE: To evaluate the use of reflection by radiography students and radiographers. METHODS: Radiography students and radiographers completed reflection assignments as a part of capstone courses, which were taken near graduation in an entry-level bachelor of science radiography program (BSRS) and a bachelor of science completion program (registered technologist to BSRS). Responses were evaluated to determine achievement of predetermined outcomes and objectives. RESULTS: There were 115 students and 25 radiographers who completed the reflection assignments. The mean scores of radiography students and current radiographers were measured to address the achievement of 2 student learning outcomes. Student learning outcome 1 contained 6 objectives, and it was found that radiographers scored significantly higher than did radiography students on 5 of the 6 objectives. Student learning outcome 2 had 5 objectives, and it was found that radiographers also scored significantly higher on each objective. DISCUSSION: Although most radiography students and radiographers were able to link theory with practice through reflection to some degree, it was discovered that radiographers scored significantly higher than did radiography students in 10 of the 11 objectives, using these same outcome assessments. The results seem to indicate that the additional clinical experiences of radiographers, compared with radiography students, enabled radiographers to better reflect on their previous learning and apply it to new and different situations. Despite differences in the ability to critically reflect on previous learning, however, it is thought that students and technologists can use what they learn through reflection for continued professional development. In addition, educators can use this information to identify areas for improvement in their programs. CONCLUSION: Radiographers and radiography students were able to apply knowledge gained through critical reflection in clinical practice. Compared with radiography students, radiographers have a greater capacity to reflect critically. The ability for greater reflection is partly due to having more clinical experiences to use as a frame of reference for reflection. Therefore, guided and critical reflection is useful for students and radiographers to apply theory learned to the clinical environment.

Better but not ideal acceptance of routine inpatient HIV point-of-care testing among veterans in a high prevalence area.

BACKGROUND: The most recent guidance statement from The American College of Physicians recommends that clinicians adopt human immunodeficiency virus screening as part of routine medical care. Inpatient HIV testing at the Vetarns Affairs Medical Center in Washington, DC has been predominantly targeted at patients with disclosed risk factors. METHOD: We implemented the first voluntary inpatient HIV testing program within a Veterans Affairs hospital using the OraQuick Advance Rapid HIV-1/2 Antibody Test on both oral secretion and whole blood samples. RESULTS: During a 17 month period we offered 3,467 inpatients testing and performed 824 rapid HIV tests. All reactive results were Western blot confirmed. Ten patients (1.2%) had reactive test results. Seven (0.8%) represented new HIV diagnoses, and three had been previously diagnosed outside the VA. Five patients had AIDS at the time of testing by CD4 criteria. Nine patients were linked to care and six patients were started on antiretroviral therapy. There were no false-positive results. CONCLUSION: We have demonstrated how expanding HIV-POC testing among hospitalized patients can enhance patients' acceptance for screening, can detect HIV-infected individuals who might not have been tested with conventional targeted testing, and can improve linkage to care for those with HIV infection.