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Colorectal cancer (CRC) diagnosed following a cancer-negative colonoscopy is termed as post-colonoscopy CRC (PCCRC). The World Endoscopy Organization has recently standardized the definition of PCCRC-3Y (CRC developing within 3 years of a cancer-negative colonoscopy). In the present study, we sought to assess PCCRC-3Y rate, perform root-cause analyses, and identify factors associated with development of PCCRC at a tertiary referral hospital in Australia.All patients undergoing colonoscopy from 2011 to 2018 were matched to a population-based cancer register. PCCRC-3Y rate was assessed for years 2011-2015. All PCCRC cases that developed within 6-48 months after a cancer-negative colonoscopy underwent root-cause analyses. Descriptive statistics were used to summarize data.Among 17 828 patients undergoing colonoscopy, 367 CRC cases were diagnosed during the study period. This included nine PCCRC cases, which developed at a median of 14 months (range 7-34 months) after cancer-negative colonoscopy. The PCCRC-3Y rate for years 2011-2015 was 2.16% (95% CI 0.91-5.15). All nine PCCRC cases were moderately or poorly differentiated adenocarcinomas; seven of nine were early-stage CRC (stages I and II) and six of nine probably represented missed lesions at index colonoscopy despite an apparently adequate examination. History of inflammatory bowel disease (IBD) (odds ratio [OR] 21.9, 95% confidence interval [CI] 4.6-103.7, P 0.001) and diverticulosis (OR 5.4, 95% CI 1.4-20.5, P = 0.01) were significantly associated with development of missed CRC.In our tertiary referral colonoscopy cohort, PCCRC-3Y rate was 2.16% (95% CI 0.91-5.15). IBD and diverticulosis were significantly associated with risk of PCCRC. The majority of PCCRC lesions were likely missed at index colonoscopy, despite an apparently adequate examination.

Objective: Early recognition and treatment for sepsis is critical in improving patient outcomes. The present study sought to examine whether triage location was associated with time to appropriate antibiotics in a cohort of ED patients with septic shock. Methods: Septic shock patients were identified from a database of ED patients admitted with infection. Demographic, clinical and outcome data were reported by triage location. Time to event analyses sought to identify the association between triage location and time to appropriate antibiotic. Secondary outcome variables included ED and hospital length of stay (LOS), 30-day mortality, and ICU admission. Results: Time to appropriate antibiotic administration was longer for those patients triaged to lower acuity (242 min) compared to higher acuity (98 min, P < 0.01) locations. After adjustment for severity of illness, hospital LOS, ED LOS and 30-day mortality were similar regardless of the triaged location. Admission to ICU was lower for patients triaged to lower (7.3%) compared to higher (47.3%) acuity treatment locations. Conclusions: We identified a sub-group of septic shock patients triaged to a lower acuity treatment location who received significant delays to antibiotics. This research area deserves closer examination to potentially recognise septic shock earlier in the continuum.

Purpose: To examine if demographic factors influence patients' self reports of satisfaction with care provided by nurse practitioners (NPs) in rural urgent care centers (UCCs). Data sources: Data were collected between December 2009 and February 2010 using an 18-item self-report survey from a convenience sample of 53 patients in two rural UCCs. Conclusions: No statistical significance was noted in regards to patient satisfaction for the demographic factors age, gender, country of upbringing, or education level. Presence of health insurance was a significant factor, with uninsured patients rating higher levels of satisfaction. However, based on patients' responses to role clarity for this survey, it is evident that there continues to be insufficient public understanding of the role of NPs. Implications for practice: The future of the NP relies on patient approval as well as acceptance of the role. This study joins the pioneering efforts towards describing what patient satisfaction is and supports NPs serving as providers in rural, nonprimary care venues. By identifying influential factors of satisfaction, NPs can bridge the gap between availability of quality care versus a lack of access and inform policy changes in the future.

Although earnings per share is the most widely used financial statistic, procedures for computing it remain complex, arbitrary, and inconsistent. The authors say we need a fresh look at the issue, and explore current change proposals by the ISASC and the FASB.

Up to now, employers have used a variety of methods to account for postemployment benefits. But FAS 112 changes all that. Employers now must accrue the expected cost of benefits likely to be paid.