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Surrogacy involves a woman (surrogate) who consents to carry a pregnancy on behalf of an individual or a couple who cannot conceive for medical reasons. Surrogacy is gaining popularity in Nigeria among infertile couples, partly because surrogacy provides an easier means to having children than adoption. Surrogacy can be either gestational or traditional. Though surrogacy gives hope to infertile individuals, it also comes with peculiar challenges that affect the newborn with medical, ethical, and legal dimensions that caregivers need to be aware of. We present three sets of preterm triplets conceived by Invitro fertilization (IVF), carried by gestational surrogacy, and managed in our facility. This case report highlights challenges encountered while managing these neonates to create awareness and suggest solutions and guidance to neonatal practitioners. Topmost challenges include the unsustainability of feeding with the mother's own milk, lack of kangaroo mother care, abandonment of care by commissioning parents, delay in getting consent for treatment/procedures, determining the legal status of the child vis-à-vis simple issues such as changing the name of the child from that of the surrogate to that of the commissioning parents. The hospital's legal and welfare departments were key resource units and were involved early in managing these neonates. One baby from each set of triplets was successfully discharged home to the commissioning parents. In conclusion, surrogacy is becoming increasingly common as a means of becoming parents for infertile individuals. There is an urgent need for proper regulation and legal framework for surrogacy and assisted reproduction in Nigeria., (Copyright © 2024 Nigerian Medical Association.)

Background: Continuity of care (CoC) is an important component of health care delivery that can have cost implications and improve patient outcomes. We analysed data obtained from the Department of Veterans Affairs to examine the relationship between CoC and use of image-oriented diagnostic tests in patients with comorbid chronic conditions., Methods: A longitudinal, retrospective cohort study involving participants ≥18 years old, with comorbid diabetes and chronic kidney disease. We used a multivariate linear regression model to test whether greater care continuity, measured using a care continuity index (CCI), is associated with less frequent use of diagnostic tests., Results: Total of 267,442 patients and 8,142,036 tests were included. Of the diagnostic tests we chose to evaluate, the 4 most frequently ordered tests were X-ray (45.6%), electrocardiogram (EKG, 16.8%), computerized tomography (CT, 13.4%), and magnetic resonance imaging (MRI, 3.4%). Overall, greater CCI was associated with fewer use of tests (P < 0.001). A 1 standard deviation (SD, 0.27) increase in CCI was associated with 4.2% decrease (P < 0.001) in number of tests. But a mixed pattern existed. For X-ray and EKG, greater continuity was associated with less testing, 6.2% (P < 0.001) and 3.3% (P < 0.05) reductions, respectively. Whereas, for CT and MRI, greater continuity was associated with more testing, 2.3% (P < 0.001) and 1.4% increases (P < 0.01), respectively., Conclusion: Overall, greater CoC was associated with fewer use of tests, representing a greater presumed efficiency of care. This has implications for designing health care delivery., (Published by Oxford University Press 2022.)

Introduction: The HyFlex course structure allows students to attend class in-person or via synchronous videoconferencing technology. This model has been described, but no data are available in pharmacy curricula., Methods: Students enrolled in Grand Rounds (GR) were eligible. The GR Engagement Assessment Tool (GREAT) measured engagement three times during the semester. Eighteen statements across four domains were rated using a five-point Likert scale (1 = not true at all and 5 = completely true). Free-text responses were collected for qualitative analysis. The primary outcome was the difference in GR engagement between students attending in-person vs. remotely. Descriptive statistics were used for demographic information. Wilcoxon rank-sum tests compared Likert-scale responses between in-person and remote attendance., Results: Surveys included 128 responses from 88 unique students. There were no differences between remote and in-person attendance for the boredom and elaboration domains. In-person students reported listening more intently (median 4, IQR [3,4]; P = .03). In-person students felt the material was more practical (median 4, IQR [4,5]) than remote students (median 4, IQR [3,4]; P = .002) and more applicable to other situations (median 3, IQR [3,5]) than remote students (median 3, IQR [2,4]; P = .04). Qualitative analysis of the entire cohort demonstrated five themes for satisfaction: safety, flexibility, convenience, technology, and professionalism., Conclusions: There were subtle differences in student engagement or satisfaction using the HyFlex model. This study supports the expansion of this methodology to similar courses where remote instruction is needed., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)