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Recent advances in next-generation sequencing (NGS) technologies have moved whole genome sequencing from large centres to small research groups and even individual scientists.
The use of SNB has thus spread rapidly from large academic surgical centres to small community hospitals, but many aspects of patient selection criteria and some technical details of the procedure still need to be better defined and are currently open to personal interpretation.
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Rapid scale-up necessitates broadening of services to the primary healthcare level facilitating both initiation of new patients and down-referral of stable patients from hospitals and large community health centres to smaller PHC clinics as has been effective in the Lusikisiki sub-district [12].
The frequencies in the control sample did not differ between centres due to small sample size (Table S1 in Additional file 3).
Stockholm and Naples were grouped as one centre, due to small numbers.
These emphasise the development of clinical networks with larger, tertiary centres linked to smaller paediatric services.
Twenty patients (5 male, median age 31 years (range 19 48)) were included in a randomised, controlled, crossover design at our tertiary centre to assess small intestinal motility after four weeks of each SNS (ON) and placebo (OFF).
Compared to small centres, medium-sized centres (50 – 199 incident patients) and large centres (200+ incident patients) had lower rates of peritonitis (sub-hazard ratio [95% CI] for time to first peritonitis 0.64 [0.50-0.81], P < 0.001; and 0.60 [0.45-0.74], P < 0.001 respectively).
Marks & Spencer, a posh supermarket, will go from having over 100 small centres to four big regional hubs.
The first three were 'patient-diversion' interventions which send patients from small centres to larger centres with different assumptions about the effect on volumes.
Ismail has since been transferred by Save the Children to Sicily, where he will be placed into smaller centres to be integrated into Italian life.
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