Have CT and MR Angiography Replaced Catheter Angiography in Diagnosing Peripheral Arterial Disease?

PurposeTo determine whether MR angiography (MRA) and CT angiography (CTA) have replaced diagnostic catheter angiography (DCA) in diagnosing peripheral arterial disease.MethodsMedicare Part B databases for 2002–2013 were reviewed. Current Procedural Terminology codes for extremity MRA, CTA, and DCA were selected. Physician specialty codes were used to classify providers as radiologists, cardiologists, or surgeons. Utilization rates per 100,000 Medicare beneficiaries were calculated.ResultsAmong all specialties, the combined utilization rate of all 3 types of angiography increased from 917 per 100,000 in 2002 to 1,261 in 2006 (+38%), after which it remained stable until 2010, and then declined to 1,010 in 2013. The overall rate of MRA and CTA together increased from 89 in 2002 to 440 in 2006 (+394%), after which it leveled off, and then gradually decreased to 331 in 2013. In 2013, 33% of the total procedures were MRA or CTA, up from 10% in 2002. Radiologists performed >85% of MRA and CTA examinations. Among radiologists, the DCA utilization rate decreased by 75% from 2002 to 2013, whereas among cardiologists and surgeons together, the overall DCA utilization rate increased by 64% from 2002 to 2010 before dropping somewhat in 2011.ConclusionsAmong radiologists, MRA and CTA have replaced DCA in diagnosing peripheral arterial disease. Although overall utilization of DCA has remained steady, it has risen sharply among cardiologists and surgeons, while dropping sharply among radiologists. Given the increased utilization of DCA among cardiologists and surgeons despite noninvasive alternatives, self-referral continues to be of concern in the setting of increasing health care costs.     

关于社区卫生服务中的几个伦理问题

社区卫生服务是我国卫生服务体系的重要组成部分,社区卫生服务在发展过程中受到了多方因素的影响,这其中就包括伦理问题。为了社区卫生服务的长期稳定发展,必须重视社区卫生服务中人性化服务、隐私、弱势群体等伦理问题。     

网络心理咨询业的开展与伦理困境

目前网络心理咨询业正处于高速发展期,而在其发展过程中,却存在一些问题。本文主要分析网络心理咨询业的发展现状、存在问题,并对网络心理咨询业的职业伦理规则进行了探讨。     

Role of Institutional Climate on Underrepresented Faculty Perceptions and Decision Making in Use of Work–Family Policies

The authors examined the institutional challenges that underrepresented minority (URM) faculty perceive in higher education with use of family support workplace policies. Evidence reveals that faculty encounter differences in access to information and explanations of how to use workplace–family statutes. A qualitative study of 58 URM faculty members highlighted five particularly notable themes: (a) faculty perceptions of how the institution views their family caregiving responsibilities, (b) inadequate compensation matters in the utilization of formal policies, (c) informal policies are often inaccessible and invisible, (d) social networks affect the inclusiveness of work–family institutional practices, and (e) fear of being regarded as a “red flag” constrains decisions regarding the use of policies. Given the push in higher education to diversify its faculty ranks, if administrators are to successfully implement diversity, equity, and inclusion and retain URM faculty, institutions need to pay particular attention to how URM faculty experience the academic climate regarding work–family balance.     

Assessing arsenic,cadmium, and lead contents in major crops in Brazil for food safety purposes

The food chain is one of the major sources of human exposure to non-essential trace elements (TEs) present in soils. Human exposure to contaminated food is a worldwide health concern and a food safety issue that threatens agricultural trade. To assess the quality of Brazilian food products with respect to non-essential TEs, we evaluated arsenic (As), cadmium (Cd), and lead (Pb) contents in five major crops grown in Brazil: rice, wheat, corn, soybeans, and potatoes. The samples were collected from field trials with a record of long-term use of phosphate fertilizers in the states of Mato Grosso and Minas Gerais, Brazil. The TE concentrations in soils were all bellow the maximum allowable concentrations for agricultural soils. The mean concentrations of As, Cd, and Pb (μg kg⁻¹ dry weight) were as follows: below the detection limit <15, 29, and <40 for rice; 19, 23, and 64 for wheat; 47, 40, and 95 for corn; 65, 23, and 106 for soybeans; and 59, 22, and <40 for potatoes, respectively. Significant differences were found in the As and Cd contents of the different wheat cultivars. The levels of As, Cd, and Pb found in the studied crops are well below the values reported in the literature and are in accordance with the Codex Alimentarius and the European Union and Brazilian guidelines, indicating that the concentrations of these elements in the crops do not pose a risk to human health.     

Ultra-high-pressure liquid chromatography–solid-phase clean-up for determining aflatoxins in Egyptian food commodities

In this work, we determined the content of regulated aflatoxins (ATs) B1, B2, G1, and G2 in food commodities using solid-phase extraction (SPE) and ultra-high-pressure liquid chromatography with fluorescence detection without derivatization. We extracted ATs from the ground samples by mixing in NaCl and 80% (v/v) methanol. The sample was enriched and cleaned up by SPE technique using Bakerbond^® C18 cartridges. The extract that we obtained was immediately analyzed using isocratic elution with a mobile phase consisting of acetonitrile, methanol and deionized water in a ratio of 64:18:18. Method validation was carried out by determining these ATs in a quality control material consisting of almond T02445QC and with the add-found test. The results provided satisfactory recovery within the range of 89.6–103.3%. Repeatability and intermediate precisions were assessed as RSD (%) which were found in the range of 1.1–11.3% and 1.5–12.0%, respectively. The limit of detection (S/N = 3) was 0.03, 0.02, 0.04, and 0.02 μg kg⁻¹ for B1, B2, G1 and G2, respectively. Finally, the method was successfully applied to determine ATs in raw Egyptian food commodities, namely maize, popcorn, pistachio, corn, peanuts, chilli, wheat, green coffee and almond, and the corresponding RSD did not exceed 11%.     

Diversity and education of the nursing workforce 2006–2016

Background

The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor’s degree, and inter-professional education.

Trends in Outpatient MRI Seem to Reflect Recent Reimbursement Cuts

PurposeTo determine whether recent reimbursement cuts have resulted in a shift of outpatient MRI from private offices to hospital outpatient departments (HOPDs); and to study office MRI utilization trends among radiologists and other specialists.MethodsThe Medicare Part B Physician/Supplier Procedure Summary Master Files were used. MRI codes were aggregated, and total MRI volumes from 2002 to 2012 were studied. Medicare place-of-service codes were used to identify studies performed in private offices and HOPDs and create trend lines. Specialty codes were used to categorize private office MRI users as radiologists, orthopedic surgeons, other physicians, and independent diagnostic testing facilities.ResultsMedicare office and HOPD utilization of MRI (all specialties) rose rapidly from 2002 to 2006, reaching 2,727,807 in offices and 2,355,641 in HOPDs. Thereafter, office volume steadily declined, whereas HOPD volume steadily increased. By 2012, more studies were done in HOPDs than in offices. Over the entire period from 2002 and 2012, office MRI volume among radiologists increased 27%, compared with 216% among orthopedic surgeons and 124% among other physicians.ConclusionsAlthough the majority of Medicare outpatient MRI studies had previously been performed in private offices, recent years brought a shift, with more now being performed in HOPDs. This change will increase costs to payers, because reimbursements to HOPDs are generally higher than those to offices. Although radiologists perform the majority of MRI exams that are conducted in private offices, the rate of growth for such exams from 2002 to 2012 was considerably higher among orthopedic surgeons and other physicians than among radiologists.