Bibb Allen

A selective oleic acid albumin agar medium for tubercle bacilli.

Summary A selective medium for Mycobacterium tuberculosis and Myco. bovis has been developed containing polymyxin B 200 units per ml, carbenicillin 100 γ per ml, amphotericin B 10 γ per ml and trimethoprim 10 or 20 γ per ml in 7H10 oleic acid albumin agar. When the centrifuged deposit from sputum, liquefied by treatment with dithiothreitol, was plated directly on to the selective medium, less than 1 per cent. of plates were contaminated and the viable counts were about 240 per cent. higher than parallel counts after treatment of the deposit with NaOH and plating on 7H10 medium without drugs. A comparison of results on medium with and without the selective drugs showed that the drugs slowed the early growth of Myco. tuberculosis in slide culture and reduced viable counts by, at most, 10 per cent. Improved anti-fungal cover could be obtained with no reduction in viable counts by increasing the concentration of amphotericin B to 50 γ per ml.

ACR White Paper: Strategies for Radiologists in the Era of Health Care Reform and Accountable Care Organizations: A Report From the ACR Future Trends Committee

Accountable care organizations have received considerable attention as a component of health care reform and have been specifically addressed in recent national legislation and demonstration projects by CMS. The role or roles of radiologists in such organizations are currently unclear, as are changes to the ways in which imaging services will be delivered. The authors review concepts fundamental to accountable care organizations and describe roles for radiologists that may facilitate their success in such health care delivery systems.

Strategies for Managing Imaging Utilization

Imaging represents a substantial and growing portion of the costs of American health care. When performed correctly and for the right reasons, medical imaging facilitates quality medical care that brings value to both patients and payers. When used incorrectly because of inappropriate economic incentives, unnecessary patient demands, or provider concerns for medical-legal risk, imaging costs can increase without increasing diagnostic yields. A number of methods have been tried to manage imaging utilization and achieve the best medical outcomes for patients without incurring unnecessary costs. The best method should combine a prospective approach; be transparent, evidence based, and unobtrusive to the doctor-patient relationship and provide for education and continuous quality improvement. Combining the proper utilization of imaging and its inherent cost reduction, with improved quality through credentialing and accreditation, achieves the highest value and simultaneous best outcomes for patients.

Delivery of Appropriateness, Quality, Safety, Efficiency and Patient Satisfaction

Although radiology’s dramatic evolution over the last century has profoundly affected patient care for the better, the current system is too fragmented and many providers focus more on technology and physician needs rather than what really matters to patients: better value and outcomes. This latter dynamic is aligned with current national health care reform initiatives and creates both challenges andopportunitiesforradiologiststo find ways to deliver new value for patients. The ACR has responded to this challenge with the introduction of Imaging 3.0 TM , which represents a call to action to all radiologists to assume leadership roles in shaping America’s future health care system through 5 key pillars: imaging appropriateness, quality, safety, efficiency, and satisfaction. That enhanced value will require modulation of imaging work processes best understood through the concept of the imaging value chain, which is introduced in this first of a 7-part series. Further articles will then prescribe in detail the pathway forward at each link in the value chain to effect the work process changes necessary for radiologists to deliver better value and outcomes for patients.

Comparison of Chinese and Western rifapentines and improvement of bioavailability by prior taking of various meals

Bioavailability was measured by rifapentine (RPE) serum concentrations and by the urinary ratio between RPE and creatinine, in specimens obtained 4-50 h after 600 mg RPE preceded by food. The bioavailabilities of RPEs manufactured in China and by a Western manufacturer were similar after a standard English breakfast, and serum concentrations were also similar to those obtained in an earlier Italian study following a complex meal. Although absorption of RPE was unsatisfactory after lipid-rich biscuits or shortbread, absorption after egges and toast was excellent and was nearly as good after a fast-food sandwich. The urinary measure of bioavailability at 26 h appeared as efficient as peak serum estimations at 6, 8 and 26 h. Fast-food sandwiches are being taken before RPE in a current clinical trial of Chinese RPE in Hong Kong.

Assay of rifampicin in serum.

Two methods for the assay of rifampicin in serum are described. The first is a conventional plate diffusion method, measuring concentrations down to 0·02 μg/ml, and the second a chemical extraction followed by measurement of the inhibition of uptake of 14C-uridine by Staphylococcus aureus, which estimates in the range of 0·02 to 0·001 μg/ml. The methods were used to measure serum concentrations in man following doses of about 1050 mg and 75 mg rifampicin.

Professional Component Payment Reductions for Diagnostic Imaging Examinations When More Than One Service Is Rendered by the Same Provider in the Same Session: An Analysis of Relevant Payment Policy

PURPOSE The aim of this study was to assess potential physician work efficiencies when more than one diagnostic imaging study is interpreted by the same provider during the same session. METHODS Medicare Physician Fee Schedule data from the American Medical Association Resource-Based Relative Value Scale Data Manager for 2011 were analyzed to quantify relative contributions of preservice, intraservice, and postservice physician work to the total work of rendering diagnostic imaging services. An expert panel review identified potential duplications in preservice and postservice work when multiple examinations are performed on the same patient during the same session. Maximum potential percentage work duplication for various diagnostic imaging modalities was calculated and compared to US Government Accountability Office estimates. RESULTS The relative contributions of preservice and postservice work to total work varied by modality, ranging from 20% [computed tomography (CT)] to 33% (ultrasound). The maximum percentage of potentially duplicated preservice and postservice activity ranged from 19% (nuclear medicine) to 24% (ultrasound). Maximum mean potentially duplicated work relative value units ranged from 0.0212 for radiography to 0.0953 for magnetic resonance imaging (MRI). Maximum percentage work reduction ranged from 4.32% for CT to 8.15% for ultrasound. This corresponds to maximum professional Physician Fee Schedule reductions of only 2.96% (CT) to 5.45% (ultrasound), approximating an order of magnitude less than the Government Accountability Offices recommendations. CONCLUSION Although potential efficiencies in physician work occur when multiple services are provided to the same patient during the same session, these are highly variable and considerably less than previously estimated.

Five Reasons Radiologists Should Embrace Clinical Decision Support for Diagnostic Imaging

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Professional Efficiencies for Diagnostic Imaging Services Rendered by Different Physicians: Analysis of Recent Medicare Multiple Procedure Payment Reduction Policy

36. On March 28, 2014, with the Doctors Caucus notably absent from the House chamber and using a somewhat controversial voice vote, the House of Representatives passed yet another patch to Medicare’s sustainable growth rate (SGR) formula. HR 4302, the Protecting Access to Medicare Act of 2014, provides a 12-month patch to the SGR formula and prevents a 24% cut in Medicare reimbursement to physicians and other health care professionals. The Senate passed the same bill by a vote of 65 to 34 on March 31, and after the Senate vote, President Obama signed the bill into law, ending the 133th Congress’s yearlong effort to finally reform the SGR formula. With the

Emergency Department CT of the Abdomen and Pelvis: Preferential Utilization in Higher Complexity Patient Encounters

138 billion cost of permanent SGR repeal at a multiyear low, we are all disappointed that there is no permanent reform, but unfortunately, election-year politics prevented Congress from developing a solution that would pay for a permanent fix. On a more positive note, this year’s SGR patch legislation is different from previous iterations because instead of just providing for a clean SGR patch, the bill contains a number of health care policy provisions designed to provide incentives to move our health care system from volume-based care to value-based care. At the urging of the ACR, HR 4302 includes a provision that creates an imaging clinical decision support program in Medicare using appropriate use criteria developed or endorsed by national professional medical specialty societies or other provider-led entities. The program, to be implemented in 2017, effectively prevents Medicare from adopting call-in prior authorization for imaging utilization