Teaching clinics are an important source of care for urban, minority, underserved communities and face great challenges to improve quality of care for diabetics. This study examined the impact of continuity with the same primary care provider on health care process and outcome measures for patients with diabetes treated at an urban, family medicine resident teaching practice. The Modified Modified Continuity of Care Index was used to measure care continuity. The diabetes care quality measures were based on the NCQA HEDIS and Diabetes Recognition Program. Low levels of care continuity were associated with poor HbA1c control and higher levels of care continuity were associated with good LDL control. These findings suggest that improving care continuity should be considered in a systems-based approach to address disparities in diabetes care. Additional research is needed to include the patient's perspective in measuring care continuity and patient outcomes.

This study had two aims: to measure patient preferences for medical appointment reminder systems and to assess the predictive value of patient usage and familiarity with other service providers contacting them on responsiveness to appointment reminder systems. We used a cross-sectional design wherein patients' at an urban, primary-care clinic ranked various reminder systems and indicated their usage of technology and familiarity with other service providers contacting them over text messages and e-mails. We assessed the impact of patient usage of text messages and e-mails and patient familiarity with other service providers contacting them over text messages and e-mails on effectiveness of and responsiveness to appointment reminder systems. We found that patient usage of text messages or e-mails and familiarity with other service providers contacting them are the best predictors of perceived effectiveness and responsiveness to text message and e-mail reminders. When these variables are accounted for, age and other demographic variables do not predict responsiveness to reminder systems.

After a rectal biopsy, a 3-week-old boy developed centripetally progressive distal limb gangrene. This was accompanied by transient hypertension and high levels of circulating immune complexes. The ischemia was reversed by prostacyclin infusion, oral corticosteroids and multiple exchange transfusions.

Hyponatraemia is not unusual in the immediate newborn period. Inappropriate antidiuretic hormone secretion(S1ADH) secondary to an intracranial injury is a recognized cause; hyponatraemia and SIADH in association with maternal drug abuse is poorly documented (I). Clinical features of hyponatraemia and hypoosmolality may resemble those of neonatal abstinence syndrome; appropriate management requires early diagnosis.A male Caucasian infant of 41 weeks gestation, weighing 3.58 kg was found, at 7 h of age, to have a serum sodium concentration of 11 1 mmol/l, potassium 5-6 mmol/l, plasma osmolality 249 mosmol/kg (normal range 270-285 mosmol/kg), creatinine 87 pmol/l; urinary sodium was 1 mmol/l and urinary osmolality 227 mosmol/kg (expected urinary osmolality < 100 mosmol/kg) (2). The mother was a poly-drug misuser who regularly took temazepam, diazepam and methadone (30 ml/day); cannabis, barbiturates, chlormethiazole, alcohol, heroin, amphetamines, diethylpropion HCl and dihydrocodeine tartrate were taken intermittently, while cocaine misuse was denied. Urinary toxicology analysis confirmed the above drug misuse. Maternal electrolytes were normal and iv fluids during labour were routine. Labour was augmented with parenteral oxytocin (Syntocinon) at therapeutic doses (5 mU/min).Serum arginine vasopressin (AVP) concentration was increased at 3.4 pg/ml in relation to plasma osmolality. The hyponatraemia resolved by day 4 following fluid restriction of 40 ml/kg/day; plasma and urinary osmolality were 227 and 359 mosmol/kg, respectively. Drug withdrawal symptoms were noted from day 3 requiring treatment with chlorpromazine and phenobarbitone to control convulsions. Electroencephalography suggested a multifocal cortical epilepsy and cranial computerized tomography (CT) showed normal ventricles and bilateral hypoplasia/atrophy of the frontal, temporal and cerebellar areas. At two months of age the child still required chlorpromazine and phenobarbitone but was otherwise thriving and developing normally.An AVP surge is seen during birth (3), levels then decrease rapidly in the first week. In this case, AVP was inappropriately elevated with hyponatraemia, hypoosmolality and less than maximally dilute urine indicating SIADH. Maternal electrolytes were normal and this suggests that the hyponatraemia was not due to injudicious fluid therapy or the use of high-dose synthetic oxytocins (4).