Positive FOB testing occurred in a majority of VLBW infants, with higher odds in the more preterm and IUGR. However, the sensitivity, specificity, and predictive value of routine FOB testing for identifying NEC were all very poor. Our data demonstrates that this test offers no advantages in the early diagnosis of NEC.
CONTINUITY OF CARE (or simply, 'continuity'), which Haggerty et al define as the degree to which a patient experiences their care as 'coherent[, …] connected and consistent with [their] medical needs and personal context', has been recognised as a feature of high-quality medical care, especially primary care, for more than half a century. 1 Recent studies have reinforced this consensus, with data associating continuity with increased patient 2 and provider 3 satisfaction, decreased cost of care 4 and even decreased mortality. 5 However, measuring, tracking and improving continuity remains a significant challenge, in part because of the subjectivity and complexity of the patient-provider relationship. In addition, technological advancements in healthcare delivery may threaten the validity of existing measures of continuity. Here we review existing measures of patientexperienced continuity of care, discuss how they are affected by technologyrelated changes to healthcare and suggest avenues for future research on continuity.
ObjectivesEmergency care services are rapidly expanding in Africa; however, development must focus on quality. The African Federation of Emergency Medicine consensus conference (AFEM-CC)-based quality indicators were published in 2018. This study sought to increase knowledge of quality through identifying all publications from Africa containing data relevant to the AFEM-CC process clinical and outcome quality indicators.DesignWe conducted searches for general quality of emergency care in Africa and for each of 28 AFEM-CC process clinical and five outcome clinical quality indicators individually in the medical and grey literature.Data sourcesPubMed (1964—2 January 2022), Embase (1947—2 January 2022) and CINAHL (1982—3 January 2022) and various forms of grey literature were queried.Eligibility criteriaStudies published in English, addressing the African emergency care population as a whole or large subsegment of this population (eg, trauma, paediatrics), and matching AFEM-CC process quality indicator parameters exactly were included. Studies with similar, but not exact match, data were collected separately as ‘AFEM-CC quality indicators near match’.Data extraction and synthesisDocument screening was done in duplicate by two authors, using Covidence, and conflicts were adjudicated by a third. Simple descriptive statistics were calculated.ResultsOne thousand three hundred and fourteen documents were reviewed, 314 in full text. 41 studies met a priori criteria and were included, yielding 59 unique quality indicator data points. Documentation and assessment quality indicators accounted for 64% of data points identified, clinical care for 25% and outcomes for 10%. An additional 53 ‘AFEM-CC quality indicators near match’ publications were identified (38 new publications and 15 previously identified studies that contained additional ‘near match’ data), yielding 87 data points.ConclusionsData relevant to African emergency care facility-based quality indicators are highly limited. Future publications on emergency care in Africa should be aware of, and conform with, AFEM-CC quality indicators to strengthen understanding of quality.
Objectives
Karoli Lwanga Hospital and Global Emergency Care, a 501(c)(3) nongovernmental organization, operate an Emergency Department (ED) in Uganda’s rural Rukungiri District. Despite available emergency care (EC), preventable death and disability persist due to delayed patient presentations. This study seeks to understand the emergency care seeking behavior of community members utilizing the established ED.
Methods
We purposefully sampled and interviewed patients and caregivers presenting to the ED more than 12 hours after onset of chief complaint in January-March 2017 to include various ages, genders, and complaints. Semistructured interviews addressing actions taken before seeking EC and delays to presentation once the need for EC was recognized were conducted until a diverse sample and theoretical saturation were obtained. An interdisciplinary and multicultural research team conducted thematic analysis based on descriptive phenomenology.
Results
The 50 ED patients for whom care was sought (mean age 33) had approximately even distribution of gender, as well as occupation (none, subsistence farmers and small business owner). Interviews were conducted with 13 ED patients and 37 caregivers, on the behalf of patients when unavailable. The median duration of patients’ chief complaint on ED presentation was 5.5 days. On average, participants identified severe symptoms necessitating EC 1 day before presentation. Four themes of treatment delay before and after severity were recognized were identified: 1) Cultural factors and limited knowledge of emergency signs and initial actions to take; 2) Use of local health facilities despite perception of inadequate services; 3) Lack of resources to cover the anticipated cost of obtaining EC; 4) Inadequate transportation options.
Conclusions
Interventions are warranted to address each of the four major reasons for treatment delay. The next stage of formative research will generate intervention strategies and assess the opportunities and challenges to implementation with community and health system stakeholders.
Industrial bladder cancer SIR,-In a leading article on industrial bladder cancer (27 February, p 614) Robin Glashan claims that evidence from a study by Vineis et al purports to show that engineering workers using lubricating oil are at risk.'The paper by Vineis gives the results of a study into the incidence of larynx, bladder, and infantile tumours occurring among residents of towns in the province of Turin in the period 1965-9 and is in Italian. A careful reading of the paper, and the English abstract, reveals no reference to lubricating oil, greases, or lubricant in any form. I feel it is important to put this correction on record as there is no evidence either from this article or elsewhere that workers using lubricant oils are at any special risk of bladder cancer.
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