Abdominal Imaging Utilization during the First COVID-19 Surge and Utility of Abdominal MRI

We sought to determine relative utilization of abdominal imaging modalities in coronavirus disease 2019 (COVID-19) patients at a single institution during the first surge and evaluate whether abdominal magnetic resonance imaging (MRI) changed diagnosis and management. 1107 COVID-19 patients who had abdominal imaging were analyzed for modality and imaging setting. Patients who underwent abdominal MRI were reviewed to determine impact on management. Of 2259 examinations, 80% were inpatient, 14% were emergency, and 6% were outpatient consisting of 55% radiograph (XR), 31% computed tomography (CT), 13% ultrasound (US), and 0.6% MRI. Among 1107 patients, abdominal MRI was performed in 12 within 100 days of positive SARS-CoV-2 PCR. Indications were unrelated to COVID-19 in 75% while MRI was performed for workup of acute liver dysfunction in 25%. In 1 of 12 patients, MRI resulted in change to management unrelated to COVID-19 diagnosis. During the first surge of COVID-19 at one institution, the most common abdominal imaging examinations were radiographs and CT followed by ultrasound with the majority being performed as inpatients. Future COVID-19 surges may place disproportionate demands on inpatient abdominal radiography and CT resources. Abdominal MRI was rarely performed and did not lead to change in diagnosis or management related to COVID-19 but needs higher patient numbers for accurate assessment of utility.

Utilization and Expenditures of Vertebral Augmentation Continue to Decline: An Analysis in Fee-For-Service (FFS) Recipients from 2009 to 2018

BACKGROUND: Despite the high prevalence of vertebral compression fractures (VCFs) associated with refractory pain, deformity, or progressive neurological symptoms, minimally invasive vertebral augmentation procedures, including vertebroplasty and kyphoplasty, have been declining in their relative utilization, along with expenditures. OBJECTIVES: This investigation was undertaken to assess utilization and expenditures for vertebral augmentation procedures, including vertebroplasty and kyphoplasty, in the fee-for-service (FFS) Medicare population from 2009 to 2018. STUDY DESIGN: The present study was designed to assess utilization and expenditures in all settings, for all providers in the FFS Medicare population from 2009 to 2018 in the United States. In this manuscript: • A patient was described as receiving vertebral augmentation over the course of the year. • An episode was considered as one treatment per region per day utilizing primary codes only. • Services or procedures were considered to be procedures including multiple levels. A standard 5% national sample of the Centers for Medicare and Medicaid Services (CMS) physician outpatient billing claims data for those enrolled in the FFS Medicare program from 2009 to 2018 was utilized. All the expenditures were presented with allowed costs and adjusted for inflation to 2018 US dollars. RESULTS: In 2009, there were 76,860 episodes of vertebral augmentation with a rate of 168 per 100,000 Medicare population, which declined to 58,760, or 99 per 100,000 population for a total decline of 41%, or an annual rate of decline of 5.7% per 100,000 Medicare population. Vertebroplasty interventions declined more dramatically than kyphoplasty from 2009. Total episodes of vertebroplasty were 27,380 with an annual rate of 60 per 100,000 Medicare population, decreasing to 9,240, or 16 per 100,000 Medicare population, a 66% decline in episodes and a 74% decline in overall rate with an annual decline of 11.4% and 13.9%. In contrast, kyphoplasty interventions were 49,480, for a rate per 100,000 population of 108 in 2009 compared to 49,520 in 2018 with a rate of 83, for a decrease of 23% and 2.9% annual decrease. Evaluation of expenditures showed a net decrease of $30,102,809, or 8%, from $378,758,311 in 2009 to $348,655,502 in 2018. However, inflation-adjusted expenditures decreased overall by 21% and 3% annually from $443,147,324 in 2009 to $345,655,502 in 2018. In addition, inflation-adjusted total expenditures per 100,000 Medicare population decreased from $967,549 to $584,992, for an overall decrease of 40%, or an annual decrease of 5%. Per patient expenditures decreased 2% overall with 0% decrease per year. LIMITATIONS: Vertebral augmentation procedures were assessed only in the FFS Medicare service population. This excluded over 30% of the Medicare population, which is enrolled in Medicare Advantage plans. CONCLUSIONS: This study shows a significant decline in relative utilization patterns of vertebroplasty and kyphoplasty procedures, along with reductions in overall expenditures. The inflation-adjusted total expenditures of kyphoplasty and vertebroplasty decreased 21% with an annual decline of 3%. The inflation-adjusted expenditures per 100,000 of Medicare population decreased 40% overall and 5% per year. In addition, vertebroplasty has seen substantial declines in utilization and expenditure patterns compared to kyphoplasty procedures, which showed trends of decline. KEY WORDS: Osteoporosis, osteoporotic compression fracture, vertebroplasty, kyphoplasty, vertebral augmentation, expenditures, inflation-adjusted, utilization

AN ATTEMPT TOWARDS THE APPROPRIATE METHODS FOR QUALITATIVE RESEARCH

An analysis of research process indicates that it comprises in combination, the following elements: creative mentalities, properly defined problems, semantic problem –solving procedures, and certain types of possible solutions. All these elements are necessary and sufficient. Therefore, the most efficient relative utilization of each will make for the most desirable research procedure in any given application. The purpose of this paper is to discuss possible principles to be used in arranging these elements in an efficient manner, which will be useful in comprehending the present practice and the future of research. It should be noted at the start that these principles, intuitively and deductively inferred from an investigation of the characteristics of the research elements are to be considered tentative; the implication is not that they are necessarily invariant in research, but that the elements from which they stem are the same within any reference frame.

Pengaruh Suhu Dan Waktu Tinggal Terhadap Kecenderungan Menguning Pada Proses Produksi Alumunium Fasad

Painting using paint powder is one of the techniques of protection against corrosion are evolving rapidly. Powder paints have aesthetic value approaching liquid paint as well as durability and relative utilization is better than liquid paint. The process of maturation of the paint powder that is only done with the process of warming at a certain temperature and a certain span of time. Standard maturation process known as maturation curve (curing folder). The difference in temperature and time against standard value ranges of risk occurrence of color change especially in white color (light). Therefore, do the research to find out the influence of temperature and time of warming up against the tendency of yellowing in white powder paint. Colour measurement is performed using a colorimeter in units of CIE Lab. Value b in CIE lab color trend show the yellowish or bluish. Temperature and time of warming up is the variable factor research determined 5.Keyword : paint powder, maturation, temperature, color. Pengecatan menggunakan cat bubuk merupakan salah satu teknik perlindungan terhadap korosi yang berkembang secara pesat. Cat bubuk memiliki nilai estetika mendekati cat cair serta daya tahan dan utilisasi yang relative lebih baik dibanding cat cair. Proses pematangan cat bubuk yang hanya dilakukan dengan proses pemanasan pada suhu tertentu dan rentang waktu tertentu. Standard proses pematangan dikenal dengan kurva pematangan (curing map). Perbedaan suhu dan waktu terhadap rentang nilai standard menimbulkan resiko terjadinya perubahan warna khususnya pada warna putih (terang). Oleh sebab itu dilakukan penelitian untuk mengetahui pengaruh suhu dan waktu pemanasan terhadap kecenderungan menguning pada cat bubuk warna putih. Pengukuran warna dilakukan dengan menggunakan colorimeter dalam satuan CIE Lab. Nilai b pada CIE lab menunjukan kecenderungan warna kekuningan atau kebiruan. Suhu dan waktu pemanasan merupakan variabel penelitian yang faktornya ditentukan 5⁰C dan 5 menit diluar kurva pematangan. Kata kunci: cat bubuk, pematangan, suhu, warna.

The Utilization of Medicines beyond Patent Expiration

BACKGROUND: The utilization of a medicine, both before and after patent expiration, is one of the key determinants of its long-run value to society, as consumer and producer surplus accumulate as utilization occurs. However, while utilization during the years of patent protection is followed fairly closely, usage after that is generally not, as multiple manufacturers are usually involved in the production and sale of generic alternatives. Since utilization beyond patent expiration is poorly understood, we selected a random sample of 60 drugs and assessed their long-term, post-patent use during the period of generic competition.METHODS: At five-year intervals beginning with the year generic competition began (YGCB), we estimated the U.S. utilization of each drug (including all generic and branded formulations) based on the number of prescriptions dispensed as projected by the National Prescription Audit™ (1964 to 2006) conducted by IMS™. These estimates were then compared to each medicine's baseline utilization, defined as the drug's usage during the last full year of patent protection – one year prior to the year generic competition began (YGCB-1). The absolute utilization levels were converted into relative utilization levels, whereby a measure of 1.0 indicates that utilization in that year was equal to utilization in the baseline year.RESULTS: Many drugs continued to be prescribed long after patent protection ended. Even after excluding one medicine that had unusually high utilization 15 to 30 years after generic competition began, relative utilization averaged between 0.64 and 0.99 for the 5-year intervals starting with YGCB+5 and ending with YGCB+30. This was true even though several of the medicines were available over-the-counter (OTC) during some of those years and we did not have data reflecting OTC utilization. After excluding those OTC years (to focus on medicines that had more complete data), relative utilization averaged between 0.88 and 1.15.CONCLUSION: Many medicines continue to be used far beyond their period of patent protection, somewhat countering the view that newer drugs quickly replace older ones. This extended, post-patent utilization can yield additional surplus for society that is over and above the surplus generated during the period of patent protection.