How Do Publicly Reported Medicare Quality Metrics for Radiologists Compare With Those of Other Specialty Groups?

PurposeTo characterize and compare the performance of radiologists in Medicare’s new Physician Compare Initiative with that of other provider groups.MethodsCMS Physician Compare data were obtained for all 900,334 health care providers (including 30,614 radiologists) enrolled in Medicare in early 2015. All publicly reported metrics were compared among eight provider categories (radiologists, pathologists, primary care, other medical subspecialists, surgeons, all other physicians, nurse practitioners and physician assistants, and all other nonphysicians).ResultsOverall radiologist satisfaction of all six Physician Compare Initiative metrics differed significantly from that of nonradiologists (all P ≤ .005): acceptance of Medicare-approved amount as payment in full, 75.8% versus 85.0%; Electronic Prescribing, 11.2% versus 25.1%; Physician Quality Reporting System (PQRS), 60.5% versus 39.4%; electronic health record participation, 15.8% versus 25.4%; receipt of the PQRS Maintenance of Certification Program Incentive, 4.7% versus 0.3%; and Million Hearts initiative participation, 0.007% versus 0.041%. Among provider categories, radiologists and pathologists demonstrated the highest and second-highest performance levels, respectively, for the two metrics (PQRS and MOC) with specialty-specific designs, but they ranked between fifth and eighth in all remaining non–specialty-specific metrics.ConclusionsThe performance of radiologists and pathologists in Medicare’s Physician Compare Initiative may relate to the extent to which metrics are tailored to the distinct aspects of their practices as diagnostic information specialists. If more physician participation in these programs is desired, more meaningful specialty-specific (rather than generic) metrics are encouraged.     

Management of breast cancer: basic principles

Breast cancer is the most common cancer in the UK predominately affecting women. The majority of breast cancer patients present with symptoms, but approximately 40% are diagnosed in asymptomatic women through the NHS Breast Screening Programme. Most breast cancers are now diagnosed non-operatively by triple assessment (the combination of clinical, radiological and pathological assessment) in specialist breast clinics. Breast cancer management is provided by a multidisciplinary team of breast specialists including surgeons, radiologists, pathologists, breast care nurses and clinical/medical oncologists. Breast cancer patients now receive individualized treatment plans that may include surgery to both the breast and axilla (including breast reconstruction when appropriate), radiotherapy, endocrine treatment, chemotherapy and targeted treatments such as trastuzumab.     

1,25‐Dihydroxyvitamin D Alone Improves Skeletal Growth,Microarchitecture, and Strength in a Murine Model of XLH,Despite Enhanced FGF23 Expression

X‐linked hypophosphatemia (XLH) is characterized by impaired renal tubular reabsorption of phosphate owing to increased circulating FGF23 levels, resulting in rickets in growing children and impaired bone mineralization. Increased FGF23 decreases renal brush border membrane sodium‐dependent phosphate transporter IIa (Npt2a) causing renal phosphate wasting, impairs 1‐α hydroxylation of 25‐hydroxyvitamin D, and induces the vitamin D 24‐hydroxylase, leading to inappropriately low circulating levels of 1,25‐dihydroxyvitamin D (1,25D). The goal of therapy is prevention of rickets and improvement of growth in children by phosphate and 1,25D supplementation. However, this therapy is often complicated by hypercalcemia and nephrocalcinosis and does not always prevent hyperparathyroidism. To determine if 1,25D or blocking FGF23 action can improve the skeletal phenotype without phosphate supplementation, mice with XLH (Hyp) were treated with daily 1,25D repletion, FGF23 antibodies (FGF23Ab), or biweekly high‐dose 1,25D from d2 to d75 without supplemental phosphate. All treatments maintained normocalcemia, increased serum phosphate, and normalized parathyroid hormone levels. They also prevented the loss of Npt2a, α‐Klotho, and pERK1/2 immunoreactivity observed in the kidneys of untreated Hyp mice. Daily treatment with 1,25D decreased urine phosphate losses despite a marked increase in bone FGF23 mRNA and in circulating FGF23 levels. Daily 1,25D was more effective than other treatments in normalizing the growth plate and metaphyseal organization. In addition to being the only therapy that normalized lumbar vertebral height and body weight, daily 1,25D therapy normalized bone geometry and was more effective than FGF23Ab in improving trabecular bone structure. Daily 1,25D and FGF23Ab improved cortical microarchitecture and whole‐bone biomechanical properties more so than biweekly 1,25D. Thus, monotherapy with 1,25D improves growth, skeletal microarchitecture, and bone strength in the absence of phosphate supplementation despite enhancing FGF23 expression, demonstrating that 1,25D has direct beneficial effects on the skeleton in XLH, independent of its role in phosphate homeostasis. © 2016 American Society for Bone and Mineral Research.     

Adolescent Deliveries in a Secondary-Level Care Hospital of Cameroon: A Retrospective Analysis of the Prevalence, 6-Year Trend,and Adverse Outcomes

Study ObjectiveAdolescents are generally ill-equipped to deal with the burden of a pregnancy. A high prevalence of adolescent pregnancies is among the indicators of limitations toward the achievement of the Millennium Development Goals in most developing countries. We sought to determine the prevalence, 6-year trend, and adverse outcomes of adolescent deliveries. We also tested whether being married decreased the risk of adverse fetal outcomes in these adolescents.DesignA 6-year retrospective register analysis.SettingBuea Regional Hospital.ParticipantsBirth records from 2007 to 2012.InterventionsNone.Main Outcome MeasuresPrevalence and 6-year trend in the rate of adolescent deliveries; adverse fetal outcomes.ResultsThe overall prevalence of adolescent deliveries was 9.9% (491 of 4941). There was no significant change in the annual prevalence of adolescent deliveries over 6 years (P trend = .8). Adolescent pregnancies were at higher risk of preterm deliveries (deliveries at gestational age <37 completed weeks; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .01), low birth weight (defined as birth weight <2600 g; OR, 1.8; 95% CI, 1.4-2.3; P < .01), and neonatal asphyxia (OR, 1.4; 95% CI, 1.1-1.7; P < .01). There was no significant difference in the frequency of adverse outcomes between married and single adolescents.ConclusionOne of every 10 babies is born from adolescent mothers in the Buea Regional Hospital. Whether these mothers are married or not, their neonates are exposed to higher morbidity. This emphasizes the need for more adolescent-friendly public health policies geared toward reducing the prevalence of this condition to improve the chances of attaining the Millennium Development Goals in Cameroon.     

������֧�������ż�����Ӧ��

??Nebulized bronchodilator can relieve the airway to improve the ventilation.In order to standardize the use of nebulized bronchodilators in children. In this paper we focus on drugs currently used asnebulization bronchodilators in children??evaluate the requirement for nebulized bronchodilator in children and the effect of nebulized bronchodilator therapy on the patients with different respiratory disease.     

Pediatric granulomatous orchitis: Case report and review of the literature

An 11‐year‐old boy presented with fever and abdominal pain, and was diagnosed with retroperitoneal lymphadenitis. At the same time, a painless right scrotal mass was observed. On imaging the testis and the epididymal mass both had abundant blood flow, although tumor markers were negative. Although the right testis had shrunk after antibiotic treatment, swelling was persistent and incisional biopsy was therefore performed, resulting in diagnosis of granulomatous orchitis (GO). No recurrence was found. In cases of scrotal swelling in both the testis and the epididymis of an older child, it is necessary to consider the possibility of inflammatory GO, and orchiectomy should not be performed without careful consideration.     

Nationwide survey of neonatal transportation practices in Japan

Rapid resuscitation and appropriate transportation of sick infants can greatly improve infant survival and neurological prognosis. To gain an understanding of the status of neonatal transport in Japan, we conducted a survey of neonatal transportation capabilities at perinatal medical centers across the country. Survey content included the number of neonatal transportation cases and the method of transportation. Twenty percent of infants admitted to neonatal intensive care units were transported to the medical centers from other institutions. Half of the level III perinatal medical centers owned an ambulance specialized for neonatal transport. A total of 36% of sick newborns, however, were transported by fire department ambulances that are ill‐equipped to care for infants. Thirteen percent of centers reported problems with the emergency transportation of newborns in fire department ambulances. Centers lacked specialized ambulances primarily because of financial constraints. Adequate medical insurance coverage is needed to increase the number of specialized ambulances at perinatal medical centers.