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Simple Summary: Malignant pleural mesothelioma (MPM) is a cancer affecting the covering of the lung (the pleura). This commonly causes a build-up of fluid around the lung, called a pleural effusion. Draining the pleural effusion can improve breathlessness and tests can be performed on the fluid. However, for most patients with MPM, a sample of tissue from the pleura, called a biopsy, is required in addition to make the diagnosis. Sometimes, due to medical conditions, frailty or personal preference, patients may not be able to have a biopsy. This review article discusses additional tests used in this situation to help doctors make a diagnosis of MPM. These techniques include tests on pleural fluid using "immunocytochemistry" methods, biomarkers and scans. Although, without a biopsy, no test in isolation can diagnose MPM, combining information from different types of tests and reviewing results among a specialist team can enable a consensus diagnosis. For a number of patients presenting with an undiagnosed pleural effusion, frailty, medical co-morbidity or personal choice may preclude the use of pleural biopsy, the gold standard investigation for diagnosis of malignant pleural mesothelioma (MPM). In this review article, we outline the most recent evidence on ancillary diagnostic tests which may be used to support a diagnosis of MPM where histological samples cannot be obtained or where results are non-diagnostic. Immunocytochemical markers, molecular techniques, diagnostic biomarkers and imaging techniques are discussed. No adjunctive test has a sensitivity and specificity profile to support use in isolation; however, correlation of pleural fluid cytology with relevant radiology and supplementary biomarkers can enable an MDT-consensus clinico-radiological-cytological diagnosis to be made where further invasive tests are not possible or not appropriate. Diagnostic challenges surrounding non-epithelioid MPM are recognised, and there is a critical need for reliable and non-invasive investigative tools in this population. [ABSTRACT FROM AUTHOR]

Presents the results of a survey implicating the nonassociation of service levels for Medicaid patients with the manner by which the hospitals were paid. Relationship between Medicaid status and the use of hospital services; Comparison of hospital stays and charges with privately insured patients; Issue on delay in medical treatment and discharging processes.

Objective: To determine whether gender is associated with the use of ancillary services in hospitalized patients.Design: A retrospective study of laboratory and radiology tests ordered for medical and surgical inpatients over 16-month and 20-month periods, respectively. Obstetric patients were excluded.Measurements and Main Results: Number of clinical laboratory and radiology tests per admission, their associated charges, and total charges per admission were measured. In crude analyses, women had 16.5% fewer clinical laboratory tests (p < .0001) with 18.8% lower associated charges (p < .0001) and 24.4% fewer radiology tests (p < .0001) with 15.6% lower associated charges (p < .0001) than men. Total changes for the admission were lower for women in both the clinical laboratory study period ($16,178 vs $18,912, p < .0001) and the radiology study period ($14,621 vs $18,182, p < .0001). When adjusted for age, race, insurance status, service, diagnosis-related-group weight, and length of stay, these differences were smaller but persisted: women had 3.7% fewer laboratory tests performed (p < .001) with 4.8% lower associated charges (p < .001). In similarly adjusted analyses for radiology studies, women received 10.4% fewer radiology examinations (p < .001), with 4.1% lower associated charges (p < .01). There were no significant differences in the adjusted total charges in the laboratory group ($17,450 vs $17,655, p = .20) and only a marginally significant difference in the radiology group ($16,278 vs $16,498, p = .05). When we compared ancillary utilization within the five largest diagnosis-related groups, these differences persisted.Conclusions: Men receive more ancillary services than women, even after adjusting for potential confounders. [ABSTRACT FROM AUTHOR]

In July 1989, New York State adopted new rules that limit the hours worked by residents and mandate continuous, on-site supervision of junior residents. In addition, all New York hospitals must provide 24-hour coverage for intravenous, phlebotomy, and messenger/transporter services. This article examines the impact of New York's landmark changes on hospital staffing, graduate medical education, the demand for ancillary personnel, and hospital expenditures. Based on a statewide survey, the results indicate that implementation of these rules would require hospitals to hire an additional 5358 full-time equivalent personnel at a yearly cost that would exceed $358 million. The broader implications of these rules on financing graduate training are also explored. [ABSTRACT FROM AUTHOR]

A few tips for surgery center administrators looking to cut costs. [ABSTRACT FROM AUTHOR]

Updated several times a week with posts by a wide variety of authors, AJN 's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog will be a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com. [ABSTRACT FROM AUTHOR]

The authors offer views on the advantages and disadvantages of using intense pulse light (IPL) treatment in patients with dry eye disease (DED) and meibomian gland dysfunction (MGD). One mentions how IPL helps patients with persistent symptoms. On the other hand, another author says that IPL is not ideal for patients with skin types darker than Fitzpatrick skin scale level 4.