The market for laboratory accreditation was undergoing significant changes in 2000. About 50% of all physician office laboratories (POLs) in the US in operation in the 1990s were closed or about to close in 2000. The overall laboratory market for accreditation was believed to be shrinking 5% per year. The two most frequently cited reasons for closings were that reimbursement rates from insurers were declining, while costs associated with government licensing and regulatory standards were increasing. The trend was that large laboratory networks would dominate the market. For example, when one healthcare organization acquired six local laboratories, it became cheaper to have each laboratory send its samples to be processed in a central location than to have every laboratory meet the regulatory standards and other costs associated with complex tests. On the other hand, concerns with patient safety and outsourcing costs had led several physician practices to increase the number of laboratory tests performed right at the physician's office laboratory, to facilitate quicker, more efficient and accurate diagnosis. This latter trend could potentially offer additional opportunities for COLA to expand its laboratory accreditation services.

41 What is the difference between transudate and exudate?

42 I wish to ask about Meigs' syndrome. I know that it is an association of pleural effusion, ascites and benign ovarian tumours or fibromas. Is the effusion transudate or exudate?

43 I have read that patients with cystic fibrosis should not meet each other socially. Why is this?

44 I have a young patient with bilateral hilar lymphadenopathy but no other manifestations of sarcoidosis. How can I make a diagnosis?

45 We have read in your book that continuous oxygen therapy at home reduces mortality in chronic obstructive pulmonary disease (COPD). I am concerned that my patient might develop acute respiratory failure.

46 I have a patient with asthma who is on long-term inhaled corticosteroids. She is very concerned about long-term steroid therapy. Could I replace the steroids with a long-acting beta2 agonist?

47 What is the role of leukotriene-modifying agents in asthma?

48 Is it true that the Mantoux test is no longer used?

49 Is there a screening test that is useful for the diagnosis of lung cancer?

50 For how long should treatment be continued for cervical lymphadenopathy and abdominal tuberculosis? What role, if any, do steroids play in the treatment of these conditions?