Evaluation of a cost effective broth and selective agar combination for the detection of MRSA and Staphylococcus aureus from surveillance specimens using regular workflow.

Objective: To evaluate the use of selective agar and broth combination in a regular laboratory daily workflow.

Design: Swabs from 173 surveillance specimens were inoculated onto half of the Bio-Rad MRSASelect (M), SaSelect (S) and Sheep Blood agars (SBA) and the swab placed in the LIM broth. After overnight incubation, 10 microL of the LIM broth was inoculated onto the other half of the three agars and incubated overnight.

The future of imaging biomarkers in radiologic practice: proceedings of the thirteenth annual ACR Forum.

The 2013 ACR Forum focused on the emerging field of imaging biomarkers and how best to integrate imaging biomarkers into clinical practice, promote research into imaging biomarkers, and leverage advances in bioinformatics. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to ensure that radiologists secure a preeminent role in the new era of precision and personalized medicine.

Thumb carpometacarpal joint resurfacing with autologous ear cartilage.

Purpose: A study was designed to ascertain the long-term effectiveness of using autologous full-thickness ear cartilage to resurface the arthritic face of the trapezium, leaving the body of the trapezium intact. The value of injection of the involved carpometacarpal (CMC) joint with local anesthetic in predicting improvement from the surgery was also studied.

Methods: An operation was used to enter the CMC joint of the thumb between the thenar muscles and the abductor tendon.

Atrial lead placement at the lower atrial septum: a potential strategy to reduce unnecessary right ventricular pacing.

Aims: Right ventricular (RV) pacing has been shown to be potentially detrimental to left ventricular function. In conventional dual-chamber pacing the position of the atrial lead could influence duration of the atrio-ventricular (AV) intervals, which is one of the variables that could be associated with an increased percentage of RV pacing. We wanted to see if lead placement at selected atrial septal sites could reduce AV intervals in patients receiving a dual-chamber pacemaker or implantable cardioverter defibrillator.

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.

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.

A nursing journal club thrives through shared governance.

Promoting professional growth within the practice of nursing is a challenge for nurses in staff development. When that growth includes reading research articles and discussing implications for practice, it is even more difficult to spark interest among frontline clinicians. Most nurses struggle to understand research studies and find reading and critiquing the content intimidating.

Comparison of nurse workload approaches.

Background: For hospitals in the United States, the number of patients who lie in beds at midnight is considered to be the standard indicator of nursing workload; relatively little attention is given to the total number of patients cared for in a 24-hour day. Staffing decisions are related to cost of care. Such decisions are made on a per-shift basis, calculating hours per patient day (HPPD) based upon midnight census provides little decision-making support about variable staffing needs over a 24-hour period.

Impact of a preventive program on amputation rates in the diabetic population.

Diabetic neuropathy and the resulting wounds often result in economic and social hardships for those afflicted. Simple steps such as routine foot inspection, fitting of appropriate shoes and orthotics, combined with patient education about the importance of self-care, can decrease the incidence of wounds in the diabetic population. Consistent follow-up with prompt treatment of wounds and management of callous formation to prevent further injury can result in fewer lower extremity amputations in the diabetic population.

Perceptions of children with HIV/AIDS from the USA and Kenya: self-concept and emotional indicators.

Perceptions of children's self-concept and associated emotional indicators were assessed in two populations, United States and Kenya, in children living with HIV/AIDS. Assessment of the self-concept mode of the Roy Adaptation Model used both verbal and nonverbal strategies. The sample of children (N = 48), ages 7 to 12 years who were HIV-positive, was recruited from a family clinic that cares for children with chronic illness in the United States (n = 6) and an orphanage that provides for HIV-positive children in Kenya (n = 42).

The current status of local medicare payment policy: how specialty societies can influence local coverage determinations.

The Medicare Fee-for-Service Program is in the midst of numerous administrative and regulatory changes that may affect the way local Medicare payment policy is implemented. These changes involve redefining the contractors' jurisdictions, competitive bidding for the contractor selection process, combining the administration of Part A and Part B services, and error rate auditing. In addition, the roles of the Contractor Medical Directors and Contractor Advisory Committees are yet to be defined, and the future of the existing advisory process, while currently unchanged, remains uncertain.

Placement of a pacing lead at the inferior portion of the interatrial septum without special tools.

Introduction: Previous studies have suggested that, among septal sites, the inferior portion of the interatrial septum (IAS) is the most likely to prevent atrial fibrillation, though inserting an active fixation lead at this site can be tedious and time consuming. We describe a relatively straightforward technique to insert a lead at this site without special tools.

Method: We studied 117 consecutive patients (mean age = 76 +/- 8 years, 69% men) with ACC/AHA class I and II pacing indications and histories of paroxysmal or permanent atrial fibrillation, undergoing implantation of a dual chamber pacing system.

Transvenous dual site left ventricular pacing plus biventricular pacing for the management of refractory ventricular tachycardia.

This is a case report of a male patient with nonischemic cardiomyopathy who had severely depressed left ventricular systolic function and functional class III congestive heart failure (CHF). He also had left bundle branch block (LBBB) and recurrent ventricular tachycardia (VT). Though the patient's CFH functional class improved after implantation of a transvenous biventricular ICD system, recurrent VT episodes required the initiation of amiodarone.

AutoCapture with dual-coil leads of implantable cardioverter defibrillator.

AutoCapture (AC) can confirm ventricular capture with true bipolar single coil leads of implantable cardioverter defibrillators (ICD). The compatibility of AC with a new, true bipolar, dual-coil ICD lead needed to be evaluated. This multicenter study enrolled 46 patients (69 +/- 10 years, 37 men) undergoing ICD implantation.

Start a freestanding emergency center.

Community need sparked the concept for a freestanding emergency center. Key first steps: new legislation, construction, and education.

Determining the efficacy of a pressure ulcer prevention program by collecting prevalence and incidence data: a unit-based effort.

Pressure ulcer prevention falls within the domain of nursing practice. When the results of a quality improvement survey indicated both an increase in the number of pressure ulcers and a higher prevalence than the national average, the nursing staff of a 500-bed Midwest hospital developed a pressure ulcer prevention program guided by the AHCPR guidelines. The literature supports collecting prevalence and incidence data as indicators of prevention program effectiveness, and the best indicator of the effectiveness of prevention strategies to reduce nosocomial pressure ulcers is incidence.

The role of the infection control professional in the intensive care unit.

By design, multiple invasive procedures are performed in the intensive care unit (ICU). Although great care is taken to control morbidity and forestall mortality, this invasive environment places ICU patients and staff at immense risk of nosocomial (hospital-acquired) infection. The role of the infection control professional (ICP) within the ICU involves data collection, dissemination of data with feedback, expertise in the investigation of outbreaks, product evaluation proficiency, and fluid consultation aptitude.

A survey of patient education postdischarge.

Through a telephone survey, the Discharge Call Service (DCS) was instituted with 206 patients discharged from two medical-surgical nursing units. The purposes of the survey were to (1) improve patient outcomes by assessing patient perceptions of their recuperation progress after discharge, (2) assess the patient's post discharge educational needs, (3) provide additional information concerning diagnosis, treatment, or medications requested by the patient, and (4) direct patients to the appropriate medical center or community resource as needed for further assistance or education. In general, patients believed their medical status was progressing as expected; nevertheless almost half of the patients surveyed needed additional information or specific directions concerning their self-care.

Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature.

Object: The authors aimed to develop management strategies for the treatment of herniated thoracic discs and to define indications for selection of surgical approaches. Symptomatic thoracic discs requiring surgery are rare. Between 1971 and 1995, 71 patients with 82 herniated thoracic discs were surgically treated by the authors.