Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

https://www.medpagetoday.com/upload/2011/4/4/Clin%20Infect%20Dis.-2002-O'Grady-1281-307.pdf

Guidelines for the Prevention of Intravascular Catheter-related Infections

https://www.medpagetoday.com/upload/2008/3/6/CRC.pdf

Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

Naomi P. O'Grady, M.D., Mary Alexander, R.N. Lillian A. Burns, M.T., M.P.H., C.I.C. E. Patchen Dellinger, M.D. Jeffery Garland, M.D., S.M. Stephen O. Heard, M.D. Pamela A. Lipsett, M.D. Henry Masur, M.D. Leonard A. Mermel, D.O., Sc.M. Michele L. Pearson, M.D. Issam I. Raad, M.D. Adrienne Randolph, M.D., M.Sc. Mark E. Rupp, M.D. Sanjay Saint, M.D., M.P.H. and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

/pdf/guidelines-for-the-prevention-of-intravascular-catheter-4xarsoczlz.pdf

Guidelines for the prevention of intravascular catheter-related infections, 2011

Cost Effectiveness in Health and Medicine.

Purpose Converting the nation’s International Classification of Diseases (ICD) diagnosis coding system, from 14,025 ICD-9 to 69,823 ICD-10 codes, is projected to have enormous financial and operational implications. We aimed to assess the magnitude of impact that this code conversion will have on radiology claims. Methods The most frequently billed ICD-9 diagnosis codes for 588,523 radiology claims from five hospitals and affiliated outpatient sites during a 12-month period were mapped to matching ICD-10 codes using a Medicare-endorsed tool. The code-conversion impact factor was calculated for the entire radiology system, and each individual subspecialty division. Results Of all ICD-9 codes, only 3,407 (24.3%) were used to report any primary diagnosis. Of all claims, 50% were billed using just 37 (0.3%) primary codes; 75% with 131 (0.5%), and 90% with 348 (2.5%). Those 348 ICD-9 codes mapped onto 2,048 ICD-10 codes (5.9-fold impact), representing just 2.9% of all ICD-10 codes. By subspecialty, the conversion impact factor varied greatly, from 1.1 for breast (11 ICD-9 to 12 ICD-10 codes) to 28.8 for musculoskeletal imaging (146 to 4,199). The community division, reflecting a general practice mix, saw a conversion impact factor of 5.8 (254 to 1,471). Conclusions Fewer than 3% of all ICD-9 and ICD-10 codes are used to report an overwhelming majority of all radiology claims. Although the number of commonly used codes will expand 5.9-fold overall, musculoskeletal imaging will experience a projected 28.8-fold explosion. Radiology practices should target their ICD educational and operational conversion efforts in an evidence-based manner.

Magnitude of Impact, Overall and on Subspecialties, of Transitioning in Radiology from ICD-9 to ICD-10 Codes

In a previous article in this series, we stressed that the ultimate product of the imaging value chain is the timely delivery of actionable information to the requesting referrer— and now increasingly to the patient [1]. For this to occur, radiologists must optimize each value activity within the value chain (examination request, protocoling, image production, and presentation for interpretation). Suboptimal performance in any one of these domains limits the ability to compose an actionable report. Actionable reporting is one of the key tenets of Imaging 3.0 , whereby radiologists present both referrers and patients with information they can act upon. That information must minimize ambiguity and equivocation and be succinct, appropriately directional (ie, minimizing unnecessary additional tasks, tests, and time), and precise. In other words, reports should answer specific contextual questions that then facilitate care in the most expeditious, least harmful, and most cost-effective manner. In this penultimate article in the “Imaging Value Chain” series, we focus on what strategies and tools radiologists can exploit to optimize their reporting performance (through interpretation, composition, and communication) to meet the objective of actionable reporting. For the sake of this discussion, it can be assumed that imaging appropriateness, protocol

Structured Reporting and Communication

CT colonography and virtual reimbursement

Background:Multiple sclerosis (MS) results in considerable financial burdens due to expensive treatment and high rates of disability, which could both impact care non-adherence.Objective:To measure...

Patient-reported financial toxicity in multiple sclerosis: Predictors and association with care non-adherence.

Background Pneumocephalus usually results from trauma, infection, neoplasm, or iatrogenic causes. Barotrauma-induced spontaneous pneumocephalus is extremely rare, usually seen in divers or occassionally with air travel. Case report We report a case of a 61-yr-old female presenting with confusion, fever, and respiratory failure one day after developing sudden nausea, vomiting, and headache during descent on a commercial airliner. Pneumocephalus and meningitis were present on admission. Sinus computed tomography (CT) showed pansinusitis and a tiny bone defect in the posterior wall of the right sphenoid sinus, through which a cisternogram later showed free communication with the prepontine cistern. An orbital CT 2 yr earlier after a fall showed the bone defect, with no other areas of abnormality or fracture. After repair of defects by otolaryngology and appropriate antibiotics, she did well and was eventually discharged. Discussion Changes in aircraft cabin pressure likely resulted in rupture of dura and arachnoid layers beneath the pre-existing bony defect, predisposed by existing sinus disease. The pathophysiology, implications, and potential sources of spontaneous pneumocephalus, as well as risks of postcraniotomy and post-trauma air-travel, are discussed.

Richard Duszak

Papers

Magnitude of Impact, Overall and on Subspecialties, of Transitioning in Radiology from ICD-9 to ICD-10 Codes

Structured Reporting and Communication

CT colonography and virtual reimbursement

Patient-reported financial toxicity in multiple sclerosis: Predictors and association with care non-adherence.

Spontaneous pneumocephalus after commercial air travel complicated by meningitis.