OBJECTIVE -To evaluate diabetes outcomes under a national "pay-for-performance" program.RESEARCH DESIGN AND METHODS -Data were analyzed for 98% of all English family practices. For each practice, the proportion of diabetic subjects with A1C Յ7.5%, blood pressure Յ145/85 mmHg, and cholesterol Յ5 mmol/l was determined. Practices achieving less than the 25th centile for the A1C target for 2006 -2007 were classified as low performing. RESULTS

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Background: Bilioma is a rare abnormal localized collection of bile outside biliary tree due to an injury or biliary leak postoperatively. Case: A 15 years old male presented to us with a complaint of greenish discharge from abdominal scar with generalized abdominal pain. There was supra-umbilical localized bulging and generalized guarding and rigidity since three days. The patient was giving a history of blunt abdominal trauma three months back for which he had undergone laparotomy, but he is not aware of which procedure done. At laparotomy we found a loculated collection of bile measuring 20 x 15 cm. which was drained and its wall sent for histopathological examination. The histopathological report is suggestive of the fibrous wall. Conclusion: Intra-abdominal collection points towards traumatic injury to the biliary system.. The biliary injury is to be thoroughly investigated which had led to the formation of the bilioma. The management depends on whether there is an ongoing bile leak or just an old collection (infected/sterile).

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