Physician-led thoracic ultrasound (TUS) has substantially changed how respiratory disorders, and in particular pleural diseases, are managed. The use of TUS as a point-of-care test enables the respiratory physician to quickly and accurately diagnose pleural pathology and ensure safe access to the pleural space during thoracentesis or chest drain insertion. Competence in performing TUS is now an obligatory part of respiratory speciality training programmes in different parts of the world. Pleural physicians with higher levels of competence routinely use TUS during the planning and execution of more sophisticated diagnostic and therapeutic interventions, such as core needle pleural biopsies, image-guided drain insertion and medical thoracoscopy. Current research is gauging the potential of TUS in predicting the outcome of different pleural interventions and how it can aid in tailoring the optimum treatment according to different TUS-based parameters.

OBJECTIVE

To investigate factors related to glycemic management among members of a professional cycling team with type 1 diabetes over a 7-day Union Cycliste Internationale World Tour stage race.

OBJECTIVE

Diabetes is a chronic health condition contributing to a substantial burden of disease. According to the Robert Wood Johnson Foundation, 10.9 million people were newly insured by Medicaid between 2013 and 2016. Considering this coverage expansion, the Affordable Care Act (ACA) could significantly affect people with diabetes in their management of the disease. This study evaluates the impact of the Medicaid expansion under the ACA on diabetes management.

BackgroundSelf-harm is a serious risk factor for suicide, a major public health concern, and a significant burden on the NHS. Rates of self-harm presentation in primary care are rising and GPs interact with patients both before and after they have self-harmed. There is significant public and political interest in reducing rates of self-harm, but there has been no robust synthesis of the existing literature on the role of GPs in the management of patients who self-harm.AimThis study aimed to explore the role of the GP in the management of patients with self-harm behaviour.Design and settingA systematic review and narrative synthesis of primary care literature.MethodThis systematic review was conducted and is reported in line with PRISMA guidance. Electronic databases systematically searched were MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and AMED. Two independent reviewers conducted study screening and selection, data extraction, and quality appraisal of all included studies. Thematic analysis was conducted.ResultsFrom 6976 unique citations, 12 studies met eligibility criteria and were included. These 12 studies, published from 1997–2016, of 789 GPs/family medicine physicians from Europe, the US, and Australia were of good methodological quality. Five themes were identified for facilitating GP management of self-harm: GP training, improved communication, service provision, clinical guidelines, and young people. Four barriers for GP management of self-harm were identified: assessment, service provision, local, and systemic factors.ConclusionGPs recognise self-harm as a serious risk factor for suicide, but some feel unprepared for managing self-harm. The role of the GP is multidimensional and includes frontline assessment and treatment, referral to specialist care, and the provision of ongoing support.

BackgroundUrinary tract infections (UTIs) are one of the most common bacterial infections managed in general practice. Many women with symptoms of uncomplicated UTI may not benefit meaningfully from antibiotic treatment, but the evidence base is complex and there is no suitable shared decision-making resource to guide antibiotic treatment and symptomatic care for use in general practice consultations.AimTo develop an evidence-based, shared decision-making intervention leaflet to optimise management of uncomplicated UTI for women aged <65 years in the primary care setting.Design and settingQualitative telephone interviews with GPs and patient focus group interviews.MethodIn-depth interviews were conducted to explore how consultation discussions around diagnosis, antibiotic use, self-care, safety netting, and prevention of UTI could be improved. Interview schedules were based on the Theoretical Domains Framework.ResultsBarriers to an effective joint consultation and appropriate prescribing included: lack of GP time, misunderstanding of depth of knowledge and miscommunication between the patient and the GP, nature of the consults (such as telephone consultations), and a history of previous antibiotic therapy.ConclusionConsultation time pressures combined with late symptom presentation are a challenge for even the most experienced of GPs: however, it is clear that enhanced patient–clinician shared decision making is urgently required when it comes to UTIs. This communication should incorporate the provision of self-care, safety netting, and preventive advice to help guide patients when to consult. A shared decision-making information leaflet was iteratively co-produced with patients, clinicians, and researchers at Public Health England using study data.

BackgroundPolycystic ovary syndrome (PCOS) is a common lifelong metabolic condition with serious associated comorbidities. Evidence points to a delay in diagnosis and inconsistency in the information provided to women with PCOS.AimTo capture women’s experiences of how PCOS is diagnosed and managed in UK general practice.Design and settingThis was a mixed-methods study with an online questionnaire survey and semi-structured telephone interviews with a subset of responders.MethodAn online survey to elicit women’s experiences of general practice PCOS care was promoted by charities and BBC Radio Leicester. The survey was accessible online between January 2018 and November 2018. A subset of responders undertook a semi-structured telephone interview to provide more in-depth data.ResultsA total of 323 women completed the survey (average age 35.4 years) and semi-structured interviews were conducted with 11 women. There were five key themes identified through the survey responses. Participants described a variable lag time from presentation to PCOS diagnosis, with a median of 6–12 months. Many had experienced mental health problems associated with their PCOS symptoms, but had not discussed these with the GP. Many were unable to recall any discussion about associated comorbidities with the GP. Some differences were identified between the experiences of women from white British backgrounds and those from other ethnic backgrounds.ConclusionFrom the experiences of the women in this study, it appears that PCOS in general practice is not viewed as a long-term condition with an increased risk of comorbidities including mental health problems. Further research should explore GPs’ awareness of comorbidities and the differences in PCOS care experienced by women from different ethnic backgrounds.

Background and objectives

Bioelectrical impedance analysis (BIA) devices can help assess volume overload in patients receiving maintenance peritoneal dialysis. However, the effects of BIA on the short-term hard end points of peritoneal dialysis lack consistency. This study aimed to test whether BIA-guided fluid management could improve short-term outcomes in patients on peritoneal dialysis.

BACKGROUND AND PURPOSE:

The use of invasive cerebral angiography with CTA for active treatment of patients with suspected ischemic strokes has been increasing recently. This study aimed to identify the incidence of postcontrast acute kidney injury using baseline renal function when CTA and cerebral angiography were performed sequentially.

Wirecard Chief Executive Markus Braun apologised to shareholders on Friday as the company announced a reshuffle of its management board and appointed a new compliance officer, days after the hedge fund TCI demanded Braun's removal.

What is Value Stream Management? Value Stream Management (VSM) is the TLA du jour among software development tools, so is it relevant…

The NRL announces it expects to restart the premiership season late next month, while the league comes under attack from one of its broadcast partners, who says it has "squandered" its finances.

The Japanese pharma development firm will harness risk-based quality management solutions to help sponsors improve trial quality and safety.

Developing, executing and overseeing clinical trials is a complex process. Yet it is essential to gain reliable evidence from clinical trials to...

The United States has recovered more than $19 million from AMEC Construction Management Inc. (ACMI) to resolve allegations of fraud, false claims and kickbacks on four General Services Administration (GSA) construction contracts, as well as litigation over claims by the GSA for excess re-procurement costs incurred by GSA after it terminated ACMI’s contract to build the Thomas F. Eagleton United States Courthouse in St. Louis, Missouri. ACMI was formerly known as Morse Diesel International Inc.

A federal judge in Corpus Christi, Texas, has sentenced General Maritime Management (Portugal), the operator of a fleet of tanker vessels, and two crewmembers of the motor tanker Genmar Defiance for making false statements to the U.S. Coast Guard and failing to maintain an accurate Oil Record Book designed to prevent pollution of the world’s oceans as required by United States and international law.

“Over the past thirteen years, the parties have tried to settle this case many, many times, each time unsuccessfully,” said Attorney General Holder.

The United States alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care.

A federal grand jury in Corpus Christi, Texas, returned an indictment today charging Fleet Management Limited with obstruction of agency proceedings, making false statements and failing to keep accurate pollution control records.

Cooperative Success Maritime S.A., the operator of the M/T Chem Faros, a 21,145 gross-ton ocean-going cargo ship that regularly transported cargo between foreign ports and the United States, pleaded guilty and was sentenced today in federal court for violating the Act to Prevent Pollution from Ships (APPS), and to making material false statements.

Irika Shipping S.A., a ship management corporation registered in Panama and doing business in Greece, pleaded guilty on July 8, 2010, before Maryland U.S. District Court Judge Frederick J. Motz, to felony obstruction of justice charges and violation of the Act to Prevent Pollution from Ships related to concealing deliberate vessel pollution from the M/V Iorana, a Greek flagged cargo ship that made port calls in Baltimore, Tacoma, Wash., and New Orleans. 

A former residential sales manager at a Florida property management company pleaded guilty to wire fraud in connection with housing repair contracts for the U.S. Department of Veterans Affairs.

The Justice Department today announced a $1.25 million agreement with Warren Properties Inc., Warren Village (Mobile) Limited Partnership, and Frank R. Warren, to settle allegations that the defendants violated the Fair Housing Act by refusing to grant a tenant’s requests for a reasonable accommodation.

Lieze Associates, dba Eagle Recycling of New Jersey, pleaded guilty today in federal court in Utica, N.Y., for conspiring to violate the Clean Water Act and to defraud the United States.

The owner of a New Jersey solid waste management company and three of his associates were arrested today on federal charges that they conspired to transport and dump thousands of tons of asbestos contaminated debris at an upstate New York farm containing wetlands.

The United States has intervened and filed a complaint in a whistleblower suit pending under the False Claims Act against Education Management Corp. (EDMC) and several affiliated entities.

A former owner and operator of a Florida-based airline fuel supply service company and a former owner and operator of an Indiana-based flight management services company pleaded guilty today to participating in separate schemes to defraud Ryan International Airlines, a charter airline company located in Rockford, Ill.

Ignacia S. Moreno, Assistant Attorney General for the Justice Department’s Environment and Natural Resources Division, today announced two new members of her senior leadership team.

A former owner and operator of a Florida-based airline fuel supply service company and a former owner and operator of an Indiana-based flight management services company were sentenced today to serve prison time and to pay restitution for conspiring to commit wire fraud and honest services fraud in separate schemes to defraud Ryan International Airlines.

Eagle Recycling was sentenced to pay a $500,000 criminal fine and more than $70,000 in restitution and cleanup costs.

A Rockford, Ill., grand jury today indicted a former residential sales manager and two former contractors of a Florida property management company in connection with housing repair contracts for the U.S. Department of Veterans Affairs.

A former residential sales manager and a former contractor at a Florida property management company pleaded guilty today to wire fraud in connection with housing repair contracts for the U.S. Department of Veterans Affairs.

The Justice Department will require Humana Inc. and Arcadian Management Services Inc. to divest assets relating to Arcadian’s Medicare Advantage business in parts of five states in order for Humana to proceed with its acquisition of Arcadian.

The Justice Department today filed a lawsuit against the homeowners association and former manager of a 249-townhome community in Gibsonton, Fla., for violating the Fair Housing Act by discriminating against families with children.

Mark J. Titus, former Chief Operations Officer of Garner Services Ltd. (GSL), and his brother-in-law Dominick Fazzio, have been charged in a second superseding indictment returned today by a federal grand jury in New Orleans for defrauding GSL of over $1 million.

The owner of a 28-acre piece of property on the Mohawk River and the owner of a New Jersey solid waste management company were found guilty by a federal jury in Utica, N.Y., today of charges that they conspired to defraud the United States and violate the Clean Water Act by illegally dumping thousands of tons of asbestos-contaminated construction debris on the property in upstate New York.

The Justice Department today reached an agreement with Milestone Management Company, a nationwide residential property management firm headquartered in Dallas, resolving claims that the staffing company violated the anti-discrimination provision of the Immigration and Nationality Act.

The Justice Department announced today that the Townhomes of Kings Lake HOA Inc. (HOA) and Vanguard Management Group Inc. have agreed to pay $150,000 to settle a lawsuit alleging violations of the Fair Housing Act (FHA).

The former owner of a Los Angeles medical clinic management company has been indicted for his role in a $13 million scheme to defraud Medicare.

A former residential sales manager of a Florida property management company was sentenced to serve 24 months in prison today in the U.S. District Court for the Middle District of Florida, in Orlando, for his participation in a wire fraud scheme involving housing repair contracts for the U.S. Department of Veterans Affairs (VA), the Department of Justice announced.

The Justice Department filed a lawsuit today against the homeowner’s association, management company and property manager of a Minnetonka, Minn., condominium complex, alleging that they discriminated against families with children in violation of the Fair Housing Act.

A former repair contractor of a Florida property management company was sentenced to serve time in prison for his participation in a wire fraud scheme related to housing repairs made under a contract between Ocwen Loan Servicing LLC, and the U.S. Department of Veterans Affairs (VA).

The government has intervened in eight False Claims Act lawsuits against Health Management Associates Inc. (HMA) alleging that HMA billed federal health care programs for medically unnecessary inpatient admissions from the emergency departments at HMA hospitals and paid remuneration to physicians in exchange for patient referrals.

The government has intervened in a False Claims Act lawsuit against Tenet Healthcare Corp. (Tenet) and four of its hospitals in Georgia and South Carolina, as well as a hospital in Monroe, Ga., owned by Health Management Associates Inc. (HMA), alleging that the hospitals paid kickbacks to obstetric clinics serving primarily undocumented Hispanic women in return for referral of those patients for labor and delivery at the hospitals.

Through their hard work, each of our awardees has helped to leverage vital resources and improve the way we do business. You have shown the power of innovation, energy, and creativity by uniting a broad array of partners to streamline the Department’s operations and bolster information-sharing. Some of you have worked to identify and implement opportunities for savings through mail processing, facilities, and technology enhancements – as well as a wide range of consolidation projects.

Andreas Bachmann, 56, of Switzerland, pleaded guilty today to conspiring to defraud the Internal Revenue Service in connection with his work as a banking and investment adviser for U.S. customers.

Swisspartners Investment Network AG, a Swiss-based asset management firm, and three of its wholly-owned subsidiaries (collectively, the Swisspartners Group), entered into a non-prosecution agreement (NPA) with the U.S. Attorney’s Office for the Southern District of New York and agreed to pay $4.4 million to the United States.