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.
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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