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Eliasson, Sofia, and Shiva Abdollahzadeh. "Sjuksköterskans perspektiv på att använda NEWS2 på vårdavdelning : En enkätstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-103776.
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Bakgrund: NEWS2 är en bedömningsskala som används för att identifiera tidiga tecken på en försämrad patient. Det har tidigare gjorts studier där patientsäkerheten har setts öka med hjälp av NEWS2. Det framkommer dock inte tydligt i tidigare forskning hur vårdpersonalen ställer sig till bedömningsskalan. Därför har vi valt att undersöka sjuksköterskans perspektiv på användningen av NEWS2. Syfte: Att undersöka sjuksköterskans perspektiv på att använda bedömningsskalan NEWS2 på vårdavdelning. Metod: En kvantitativ enkätstudie där urvalet bestod av 124 legitimerade sjuksköterskor från fem olika vårdavdelningar på länssjukhuset i Kalmar. Resultat: Totalt 59 sjuksköterskor (svarsfrekvens 48%) besvarade enkäten. NEWS2 tillför trygghet i sjuksköterskans bedömning av patienten, som ett komplement till den kliniska blicken. Det finns en komplexitet i hur riktlinjerna för NEWS2 följs relaterat till de patienter som har ett högt NEWS2-värde i sitt habitualtillstånd. Det framkommer en signifikant skillnad i hur sjuksköterskor med längre yrkeserfarenhet (>10 år) mäter de vitala parametrar som ingår i NEWS2 jämfört med de som arbetat i mindre än 10 år. Slutsats: NEWS2 bidrar till ökad patientsäkerhet ur ett sjuksköterskeperspektiv. Det finns dock förbättringspotential gällande hur sjuksköterskan använder sig av åtgärdsskalan i NEWS2. Riktlinjerna borde tydliggöras eller anpassas för att NEWS2 ska fungera optimalt på alla vårdavdelningar.
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Miller, Donna Marie. "Establishing Inter Rater Reliability of the National Early Warning Score." Walsh University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=walsh1429472548.
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Figueira, Alexandra. "Avaliação da Pessoa em Situação Crítica: Aplicação do National Early Warning Score (NEWS)." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2015. http://hdl.handle.net/10400.26/10536.
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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica.O presente Relatório de Trabalho de Projeto foi elaborado no âmbito do 3º Curso de Mestrado em Enfermagem Médico-Cirúrgica, da Escola Superior de Saúde, do Instituto Politécnico de Setúbal, como método de avaliação dos módulos de Estágio I, II e III integrados nas Unidades Curriculares de Enfermagem Médico-Cirúrgica I e II. A elaboração do patente relatório consiste num instrumento de aprendizagem que permite uma reflexão sobre o percurso do estudante, refletindo o desenvolvimento de atividades e competências e aprofundamento de conhecimentos ao longo dos estágios. O local dos estágios foi o Serviço de Urgência Geral de um Centro Hospitalar da Margem Sul, no qual desenvolvemos o Projeto de Intervenção em Serviço subordinado ao tema “Avaliação da pessoa em situação crítica – Aplicação do National Early Warning Score (NEWS)”, utilizando a Metodologia de Projeto. No presente relatório é elaborada a descrição, análise crítica e avaliação do desenvolvimento e implementação do Projeto de Intervenção em Serviço bem como a descrição e análise do Projeto de Aprendizagem Clínica, considerando as Competências Comuns do Enfermeiro Especialista, as Competências Específicas do Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crítica, as Competências Específicas do Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crónica e Paliativa e as competências de Mestre em Enfermagem Médico-Cirúrgica. O Projeto de Intervenção em Serviço tem como objetivo geral a promoção da melhoria da qualidade dos cuidados de Enfermagem prestados à pessoa em situação crítica internada no Serviço de Urgência Geral. A qualidade dos cuidados de Enfermagem prestados é essencial, constituindo-se um direito das pessoas e um dever de todos os Enfermeiros. Numa perspetiva de abordagem da qualidade dos cuidados de saúde recorremos ao modelo teórico de Larrabee & Rosswurn designado de “Modelo para Mudança da Prática Baseada em Evidências”.
Abstract: The presented Project’s Work Report was written within the scope of the 3º Curso de Mestrado em Enfermagem Médico-Cirúrgica (Medical-Surgical Nursing Master) of Escola Superior de Saúde - Instituto Politécnico de Setúbal, as an evaluation method of Estágio I, II e III modules, integrated in Unidades Curriculares de Enfermagem Médico-Cirúrgica I e II (Curricular Units I & II of Medical-Surgical Nursing). The preparation of this report constitutes a learning tool that allows for a reflection on the student’s progress, including the development of activities and skills, and enhanced knowledge throughout the internships. These were held in an “Accident and Emergency Department” of a Margem Sul Medical Center, where an Intervention Service Project was developed under the theme “Critical patient’s evaluation – National Early Warning Score’s (NEWS) application", based on the Project Methodology. In this report, we perform a description, critical analysis and evaluation on the development and implementation of the Intervention Project, as well as a description and analysis on the Clinical Service Learning Project. Here, we consider the Expert Nurse Common Skills, the Expert Nurse Specific Skills during “Person in Critical Condition” Nursing, the Expert Nurse Specific Skills during “Person in Chronic and Palliative Condition” Nursing and the Medical-Surgical Nursing master skills. The general purpose of the Intervention Service Project is to encourage improvements on the quality of nursing care provided to the person in critical condition in an “Accident and Emergency Department”. This is essential, as it constitutes each individual’s right and a duty to all nurses. The theoretical model of Larrabee & Rosswurn, entitled “A model for change to evidence-based practice”, was used in this project as a perspective approach to the quality of health care.
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Celind, Michaela, and Elin Blomqvist. "Sjuksköterskors erfarenhet av att använda ”National Early Warning Score” för att bedöma patienters hälsostatus : En litteraturstudie." Thesis, Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-77692.
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Introduktion: Minskat antal vårdplatser och en ökad ålder på befolkningen gör att trycket på vården ökar. I takt med detta ökar också risken för att patientsäkerheten inte kan upprätthållas. NEWS är ett bedömnings- och screeninginstrument var syfte är att öka patientsäkerheten genom att standardisera bedömningar av vitala parametrar för att effektivt kunna förhindra kritiska tillstånd. Sjuksköterskor kan använda NEWS tillsammans med sin kliniska bedömning för att utföra en adekvat bedömning av patienters aktuella hälsotillstånd. Syfte: Litteraturstudiens syfte var att undersöka sjuksköterskors erfarenhet av att använda National Early Warning Score som bedömningsinstrument för att bedöma patienters hälsostatus. Metod: Litteraturstudien bygger på Polit och Becks (2017) nio steg med induktiv ansats. Relevanta sökord mot syftet identifierades och systematiska artikelsökningar genomfördes i Cinahl och PubMed. Sökningarna resulterade i 11 artiklar relevanta för studien som kvalitetsgranskades utifrån Polit och Becks (2017) granskningsmallar. I databearbetningen framkom tre teman. Resultat: Tre teman framkom utifrån sjuksköterskors erfarenhet av att använda NEWS som bedömningsinstrument för att bedöma patienters hälsostatus, dessa var NEWS som stöd och hinder i klinisk bedömning, NEWS påverkan på arbetsbelastningen, samt hur sjuksköterskors utbildning och yrkeserfarenhet kunde kombineras med NEWS. Resultatet visade att NEWS är ett bra stöd till sjuksköterskors kliniska bedömning. Detta stödjer främst sjuksköterskor med kortare erfarenhet, men kan ändå vara ett bra stöd till sjuksköterskor med längre erfarenhet. Slutsats: Erfarna sjuksköterskor ansåg att sjuksköterskor med kortare erfarenhet än de själva kan behöva stöd i sin kliniska helhetsbedömning samt kommunikation, och då är NEWS ett bra komplement. Sjuksköterskorna i litteraturstudien var inte enade om arbetsbelastningen ökade eller inte vid användandet av NEWS.
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Fjällborg, Jenny, and Susanne Johansson. "Sjuksköterskors erfarenheter av att använda bedömningsinstrumentet NEWS : en integrerad litteraturöversikt." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-81777.
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National Early Warning Score (NEWS) är ett bedömningsinstrument som används inom vården för att upptäcka och varna när en patient blir kraftigt försämrad. Syftet med litteraturöversikten var att sammanställa kunskap om sjuksköterskors erfarenheter av att använda bedömningsinstrumentet NEWS. En integrerad litteraturöversikt genomfördes där 12 vetenskapliga artiklar togs ut efter en systematisk litteratursökning i PubMed och CINAHL. Av dessa var det sex med kvalitativ metod, fyra kvantitativ metod och två mixad metod, som granskades och analyserades. Analysen resulterade i fyra kategorier. Dessa var ”NEWS användes av sjuksköterskan för att observera, bedöma och planera vård”, ”NEWS kunde både vara ett stöd och skapa merarbete”, ”NEWS förbättrade kommunikationen med andra kollegor” och ” NEWS kunde främja sjuksköterskan i sin profession”. Slutsatserna som drogs var att sjuksköterskorna ansåg NEWS som användbart vid att uppfatta en patients försämring, instrumentet användes även som ett sätt att stödja en egen klinisk bedömning. Sjuksköterskorna ansåg att NEWS behövde anpassas för olika sjukdomstillstånd eftersom falska höga värden ledde till onödiga kontroller och larmutmattning. Kommunikationen mellan kollegor blev bättre och sjuksköterskorna fick stöd och bättre respons när vitalparametrar kommunicerades. Sjuksköterskorna ansåg att NEWS ökade fokuset på vitalparametrar vilket ledde till ökad kunskap om avvikelser samt stimulerade till egna bedömningar. Författarna anser att det finns behov av att arbeta särskilt med kommunikationsmetoder som införlivas med NEWS, där alla parter i vårdkedjan förstår instrumentets relevans. Detta kan förslagsvis göras i samband vid implementering av NEWS med tydliga riktlinjer kring bedömnings-instrumentet, hur det ska användas och varför.
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Wiles, Brenda L. "Using The National Early Warning Score As A Set Of Deliberate Cues To Detect Patient Deterioration And Enhance Clinical Judgment In Simulation." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1458074763.
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Dahlgren, Ida. "Identification of risk factors associated withunplanned readmission, palliative decision ormortality within 30 days at the acute admissionsunit during 2019 – a retrospective cohort study." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-86724.
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Introduction: A recent study at the acute admission unit (AAU), revealed that 13.5 percent ofall patients discharged from the department, were readmitted within 30 days during 2018. Inthe group of 80 years and above, the cause for re-admission was multifactorial. Aim: To identify factors that are associated with unplanned re-admission, palliative decision,or death within 30 days after discharge from the AAU, in patients of 80 years or above. Anotheraim is to examine if longer hospital stay, patient discharge planning and fast follow-up canprotect against these outcomes. Methods: A retrospective cohort study comprising 287 patients. Data on age, sex, length ofstay, comorbidities (Elixhauser comorbidity index), frailty (Clinical frailty scale), NationalEarly Warning Score (NEWS), social status, home care, lab values and outcome were collected.All variables were analyzed using Chi-square test with univariate and multivariate logisticregression, and a p-value < 0.05 was considered statistically significant. Results: 276 patients were included. A NEWS ≥ 3 was associated with significantly increasedrisk for poor outcome (odds ratio 2.4). Living with someone without municipal support wasassociated with a significantly decreased risk for poor outcome (odds ratio 0.21). Conclusions: The results indicate that it is crucial to stabilize patients of 80 years or abovebefore discharge. And that living with someone without municipal support is a protective factor.
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Rust, Sunchlar M. "Collaborative network evolution the Los Angeles terrorism early warning group." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2006. http://library.nps.navy.mil/uhtbin/hyperion/06Mar%5FRust.pdf.
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Isemann, James Louis. "To detect, to deter, to defend: the Distant Early Warning (DEW) line and early cold war defense policy, 1953-1957." Diss., Kansas State University, 2009. http://hdl.handle.net/2097/2161.
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Doctor of PhilosophyDepartment of History
Mark P. Parillo
The Distant Early Warning (DEW) Line, a key program under President Dwight D. Eisenhower’s “New Look” policy, prepared the United States defense posture for “the long haul” in the Cold War. Eisenhower wanted to prevent the escalation of military costs while still providing an adequate defense. Eisenhower emphasized a retaliatory capability and improved continental defenses, the so-called “sword and shield,” which are key features of the New Look. The DEW Line would prove to be a vital component of both. Whereas the initial emphasis of the DEW Line was to warn against attack providing for both active and passive defense measures, soon there was a definite “counter-offensive” role for the DEW Line as well—the protection of the primary retaliatory capability of the United States: the Strategic Air Command (SAC). The place of the DEW Line in the history of the Cold War has been an under appreciated topic. With the exception of the scholarship from the 1950s and early 1960s, only recently have continental defense and particularly the DEW Line been removed from the shadows of other Cold War events, strategies, and military programs. This doctoral thesis is an account of the DEW Line’s conception, implementation, and position in Eisenhower’s New Look and deterrent strategy. The DEW Line proved to be a cardinal feature of Eisenhower’s New Look strategy: it strengthened overall U.S. defenses and defense posture as the one element of U.S. defense policy (“New Look”) that improved and connected both the active and passive measures of continental defense by providing early warning against manned bombers flying over the polar region; it bolstered the deterrent value of SAC; and it was instrumental in developing closer peacetime military cooperation between the United States and Canada. In fact, U.S.- Canadian diplomacy during the 1950s offers an important case study in “superpowermiddle power” interaction. However, despite the asymmetry in their relationship, U.S.- Canadian defense policies proved to be analogous. All of these objectives could not have been accomplished without the technological and logistical abilities necessary to construct successfully the DEW Line.
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Ingschöld, Johanna. "De nationella parlamenten och EU : En studie av motiverade yttranden inom ramen för subsidiaritetsgranskningen." Thesis, Uppsala universitet, Statsvetenskapliga institutionen, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-295693.
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This essay studies the national parliaments' reasoned opinions at the early warning mechanism. The study aim to declare if there is any variation in which national parliaments who is active in the early warning mechanism, and if there is a variation in type of bills in the early warning mechanism. These study also wants to describe some variation in how the national parliaments argued in the reasoned opinions. The study gives an enhanced understanding of the importance and legitimacy of the early warning mechanism and the reasoned opinions. The result shows that there is a certain group of parliaments who are more active and these are with few exceptions EU 15 countries. The study also shows that there is some kind of bills that is more prevalent than others, there is however some variation. There is also a wide variation in the arguments raised in the reasoned opinions. The results indicate that the national parliaments varies greatly in managing the reasoned opinions and it gives a negatively impacton the early warning mechanism.Studien granskar de nationella parlamentens motiverade yttranden inom ramen för EU:s subsidiaritetsgranskning. Studiens syfte är att beskriva en möjlig variation angående vilka nationella parlamenten som är aktiva inom subsidiaritetsgranskningen. Studiens syfte är även att beskriva variationen i vilka lagförslag som återfinns i subsidiaritetsgrankningen, samt om de nationella parlamenten varierar i argumentering i de motiverade yttrandena. Studien visar att det finns nationella parlament som är vanligare förekommande inom granskningen, samt att vissa typer av lagförslag föranleder fler yttranden än andra. Beträffande argumenteringen i de motiverade yttrandena fanns en stor variation.
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IANNI, PIERPAOLO. "IL RUOLO DEI PARLAMENTI NAZIONALI NEL PROCESSO DI INTEGRAZIONE GIURIDICA EUROPEA DOPO IL TRATTATO DI LISBONA." Doctoral thesis, Università Cattolica del Sacro Cuore, 2017. http://hdl.handle.net/10280/17948.
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Questa tesi di ricerca si occupa del ruolo rivestito dai parlamenti nazionali italiano, britannico e tedesco. Analizza il modo in cui questi parlamenti partecipano al processo decisionale ed implementano il diritto dell'Unione europea dopo il Trattato di Lisbona. La ricerca si concentra su un'analisi comparata delle leggi, delle procedure e consuetudini parlamentari al fine di esaminare il ruolo rivestito dai parlamenti nazionali nel contesto europeo. Il nuovo quadro giuridico previsto dal Trattato di Lisbona promuove la creazione di un sistema parlamentare integrato, basato sulle istituzioni europee e sui parlamenti nazionali cui è attribuito un ruolo più incisivo nel processo decisionale europeo, nella convinzione che un loro maggiore coinvolgimento possa contribuire a garantire un livello più efficace di democrazia nel funzionamento complessivo dell'Unione. I parlamenti nazionali possono contribuire a rendere l'U.E. più o meno efficiente. Essi sono chiamati a svolgere un ruolo rilevante nel processo legislativo europeo, in particolare nella fase di formazione delle politiche e del diritto dell’Unione europea (c.d. fase ascendente) e nel monitoraggio dell'esecuzione del principio di sussidiarietà. Il Trattato di Lisbona introduce norme di partecipazione diretta dei parlamenti nazionali nel processo legislativo europeo, trasformandoli in "guardians of subsidiarity". Il Trattato di Lisbona e i relativi Protocolli riconoscono il ruolo della cooperazione interparlamentare, affidando ai parlamenti nazionali il compito di promuovere e organizzare la sua realizzazione all'interno dell'Unione europea. In questa prospettiva le competenze delle commissioni specializzate in affari europei e della COSAC (Conference of Parliamentary Committees for Union Affairs of Parliaments of the European Union) sono ulteriormente potenziate.This research thesis deals with the role of national parliaments in Italy, United Kingdom and Germany. It analyses the way in which these Parliaments participate in the European Union and implement the Law of the European Union after the Treaty of Lisbon. The research focuses on a comparative analysis of parliamentary procedures, instruments, and practices in order to examine the respective roles of the European Institutions and the national parliaments within the European framework. The new legal framework laid down the Treaty of Lisbon encourages the creation of an integrated parliamentary system, based on the European Parliament and on the national parliaments which are assigned a more incisive role in the European decision-making process, in the belief that these innovations may contribute to guaranteeing a more effective level of democracy in the overall functioning of the Union. The national parliaments can contribute to making Europe more or less effective. They will be called on to play a more important role in the European law-making process, specifically in the pre-legislative dialogue with European institutions and particularly in the monitoring of the enforcement of the subsidiarity principle in European legislation proposals. The Treaty of Lisbon regulations introduce direct participation of national parliaments in the European law-making process, transforming them into the "guardians of subsidiarity". The Treaty of Lisbon and the related protocols recognise and encourage interparliamentary cooperation, entrusting national parliaments with the task of promoting and organising its achievement within the European Union. In this perspective, the competences of the Conference of Community and European Affairs Committees of Parliaments of the European Union (COSAC) are further enhanced. In this thesis, the reasons for overall inclusion of national parliaments in the European Union activities are analysed. The role of national parliaments in the EU according to the specific provisions of the EU treaties is also discussed and the largest part of the work is devoted to the ex ante subsidiarity principle control mechanism (the Early Warning System), which gives the right for the national parliaments to influence the EU legislative process.
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Quifica, Valter Bongo Guange. "Impacto do contributo da cruz vermelha internacional no desempenho da missão humanitária, com realce em Angola e na Namíbia." Master's thesis, Universidade de Évora, 2011. http://hdl.handle.net/10174/14120.
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A iniciativa assumida neste trabalho visa procurar, recolher, analisar e apresentar, de maneira clara e objectiva, dados sobre o trabalho da Cruz Vermelha Internacional e do Crescente Vermelho ao longo dos tempos em torno do mundo, com particular destaque em Angola e na Namíba, países situados na Região da África Austral, no Continente Africano.
A análise constitui uma reflexão sobre o impacto das actividades humanitárias da Cruz vermelha e documenta algumas políticas e práticas que afectam os fluxos de serviços de ajudas de alívio na zona mais a sul do continente Berço da; A iniciativa assumida neste trabalho visa procurar, recolher, analisar e apresentar, de maneira clara e objectiva, dados sobre o trabalho da Cruz Vermelha Internacional e do Crescente Vermelho ao longo dos tempos em torno do mundo, com particular destaque em Angola e na Namíba, países situados na Região da África Austral, no Continente Africano.
A análise constitui uma reflexão sobre o impacto das actividades humanitárias da Cruz vermelha e documenta algumas políticas e práticas que afectam os fluxos de serviços de ajudas de alívio na zona mais a sul do continente Berço da humanidade.O presente trabalho integra seis (6) capítulos diferentes, onde o primeiro versa sobre origem, os componentes e o processo de integração do movimento, assim como os objectivos, missão, trabalhos, importância do voluntariado e algumas políticas e regulações da Cruz Vermelha Internacional. O segundo capítulo trata de enfatizar a importância e desafios da Cruz Vermelha Internacional na aplicação do Direito Internacional Humanitário, assim como de alguns direitos fundamentais dos cidadãos, no processo de realização do trabalho humanitário da Cruz Vermelha. De igual modo, é nesta parte do texto onde o autor aborda, com certo destaque, a questão das Convenções de Genebra e dos seus Protocolos adicionais.
Os desafios e os obstáculos verificados na implementação da estratégica da missão humanitária da Cruz Vermelha Internacional encontram-se reflectidos no Capítulo 3. Mais concretamente, este capítulo destaca o conceito da missão humanitária, os actuais desafios do movimento face as fortes mudanças climáticas e outros desastres e, mobilidades populacionais, bem como uma tabela estatística que reflecte alguns impactos provenientes de desastres naturais.
No quarto e quinto capítulos encontram-se reflectidas algumas experiências humanitárias, desafios e prioridades estratégicas das Sociedades Nacionais da Cruz Vermelha Internacional em Angola e na Namíbia, no processo de protecção de vidas de famílias, através da implementação de programas e projectos direccionados à identificação de riscos, redução de vulnerabilidade, prevenção sobre o HIV e SIDA, saúde social e outros tendentes a melhoria do estado de vivência das populações mais desfavorecidas.
Finalmente, o último ou sexto capítulo contém as conclusões que integram algumas lições aprendidas, bem como principais sugestões e ou recomendações, visando, futuramente, melhorar o desenvolvimento do trabalho da organização, facto que grandemente proporcionará positivo impacto na vida de comunidades vulneráveis de vários países do mundo, particularmente em Angola e na Namíbia; ABSTRACT:The initiative assumed on this work tend to search, collect, analyze and present, in a clear and objective manner, data about the work of International Red Cross and Red Crescent all over the times around the world, with particular emphasis in Angola and Namibia, countries located in the Southern African Region, in the African Continent. The analysis constitutes a reflection on the impact of the humanitarian activities of the Red Cross and document some politics and practices that affect the flowing of services and relief aids on the zones more in the Southern African continent, the Cradle of Humanity.
The present work integrates six (6) different chapters, where the first deals with the origin, the components and the process of the movement integration, as well as the objectives, mission, works, importance of volunteering and some politics and regulations of the International Red Cross.The Second Chapter manages to emphasize the importance and challenges of the International Red Cross on the application of the International Humanitarian Law, as well as of some fundamental rights of citizens, in the process of implementation of Red Cross Humanitarian work. Similarly, it is on this part of the text where the Author approaches, with some outstanding, the issue of the Geneva Conventions and its Additional Protocols.The challenges and obstacles observed on the implementation of the strategy of the humanitarian mission of International Red Cross are reflected in Chapter 3. More precisely, this chapter points out the concept of the humanitarian mission, the actual challenges of the movement due to the strong climate changes and other disasters and the populations mobility’s, as well as a statistical table that reflects some impacts proceeding from natural disasters.
On the fourth and fifth Chapters are reflected some humanitarian experiences, challenges and strategic priorities of the International Red Cross and Red Crescent National Societies in Angola and in Namibia, in the process of protecting the lives of families, through the implementation of projects and programs aimed to identify risks, reduce vulnerability, prevent HIV and AIDS, and social health and others tending to improve the living status of the most unfavorable populations.
Finally, the sixth or last Chapter contains the conclusions which integrates some lessons learned, as well as the main suggestions and or recommendations, tending to improve the development of the organization’s work in the future, fact that greatly will provide positive impact on the lives of the most vulnerable communities in various countries of the world, particularly in Angola and in Namíbia.
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Mohammad, Mohammad A., Muhammad Faisal, D. Richardson, Andy J. Scally, R. Howes, K. Beatson, S. Irwin, and K. Speed. "The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals." 2019. http://hdl.handle.net/10454/17032.
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YesBackground The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.
The full-text of this article will be released for public view at the end of the publisher embargo on 2 Mar 2020.
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Faisal, Muhammad, A. Mohammed Mohammed, D. Richardson, E. W. Steyerberg, M. Fiori, and K. Beatson. "Predictive accuracy of enhanced versions of the on-admission National Early Warning Score in estimating the risk of COVID-19 for unplanned admission to hospital: a retrospective development and validation study." 2021. http://hdl.handle.net/10454/18599.
Full textAbstract:
YesThe novel coronavirus SARS-19 produces 'COVID-19' in patients with symptoms. COVID-19 patients admitted to the hospital require early assessment and care including isolation. The National Early Warning Score (NEWS) and its updated version NEWS2 is a simple physiological scoring system used in hospitals, which may be useful in the early identification of COVID-19 patients. We investigate the performance of multiple enhanced NEWS2 models in predicting the risk of COVID-19. Our cohort included unplanned adult medical admissions discharged over 3 months (11 March 2020 to 13 June 2020 ) from two hospitals (YH for model development; SH for external model validation). We used logistic regression to build multiple prediction models for the risk of COVID-19 using the first electronically recorded NEWS2 within ± 24 hours of admission. Model M0' included NEWS2; model M1' included NEWS2 + age + sex, and model M2' extends model M1' with subcomponents of NEWS2 (including diastolic blood pressure + oxygen flow rate + oxygen scale). Model performance was evaluated according to discrimination (c statistic), calibration (graphically), and clinical usefulness at NEWS2 ≥ 5. The prevalence of COVID-19 was higher in SH (11.0 %=277/2520) than YH (8.7 %=343/3924) with a higher first NEWS2 scores ( SH 3.2 vs YH 2.8) but similar in-hospital mortality (SH 8.4 % vs YH 8.2 %). The c-statistics for predicting the risk of COVID-19 for models M0',M1',M2' in the development dataset were: M0': 0.71 (95 %CI 0.68-0.74); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.78 (95 %CI 0.75-0.80)). For the validation datasets the c-statistics were: M0' 0.65 (95 %CI 0.61-0.68); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.72 (95 %CI 0.69-0.75) ). The calibration slope was similar across all models but Model M2' had the highest sensitivity (M0' 44 % (95 %CI 38-50 %); M1' 53 % (95 %CI 47-59 %) and M2': 57 % (95 %CI 51-63 %)) and specificity (M0' 75 % (95 %CI 73-77 %); M1' 72 % (95 %CI 70-74 %) and M2': 76 % (95 %CI 74-78 %)) for the validation dataset at NEWS2 ≥ 5. Model M2' appears to be reasonably accurate for predicting the risk of COVID-19. It may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions.
The Health Foundation (Award No 7380) and the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC) (Award No PSTRC-2016-006)
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Faisal, Muhammad, D. Richardson, Andy J. Scally, R. Howes, K. Beatson, K. Speed, and Mohammad A. Mohammad. "Computer-aided National Early Warning Score to predict the risk of sepsis following emergency medical admission to hospital: a model development and external validation study." 2019. http://hdl.handle.net/10454/17028.
Full textAbstract:
YesBackground: In English hospitals, the patient’s vital signs are monitored and summarised into a National Early Warning Score (NEWS). NEWS is more accurate than the quick sepsis related organ failure assessment (qSOFA) score at identifying patients with sepsis. We investigate the extent to which the accuracy of the NEWS is enhanced by developing computer-aided NEWS (cNEWS) models. We compared three cNEWS models (M0=NEWS alone; M1=M0 + age + sex; M2=M1 + subcomponents of NEWS + diastolic blood pressure) to predict the risk of sepsis. Methods: All adult emergency medical admissions discharged over 24-months from two acute hospitals (YH–York Hospital for model development; NH–Northern Lincolnshire and Goole Hospital for external model validation). We used a validated Canadian method for defining sepsis from administrative hospital data. Findings: The prevalence of sepsis was lower in YH (4.5%=1596/35807) than NH (8.5%=2983/35161). The c-statistic increased across models (YH: M0: 0.705, M1:0.763, M2:0.777; NH:M0: 0.708, M1:0.777, M2:0.791). At NEWS 5+, sensitivity increased (YH: 47.24% vs 50.56% vs 52.69%; NH: 37.91% vs 43.35% vs 48.07%)., the positive likelihood ratio increased (YH: 2.77 vs 2.99 vs 3.06; NH: 3.18 vs 3.32 vs 3.45) and the positive predictive value increased (YH: 11.44% vs 12.24% vs 12.49%; NH: 22.75% vs 23.55% vs 24.21%). Interpretation: From the three cNEWS models, Model M2 is the most accurate. Since it places no additional data collection burden on clinicians and can be automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
The Health Foundation, National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre
Research Development Fund Publication Prize Award winner, April 2019.
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Campos, Bruno Filipe Sequeira. "Uso sistemático de scores de alerta precoce como discriminadores de risco em doentes no serviço de urgência." Master's thesis, 2020. http://hdl.handle.net/10400.6/10683.
Full textAbstract:
Os doentes após darem entrada nos serviços de Urgência podem ver a sua situação clínica
a ser agravada durante ou após a observação médica, sem que haja grandes alterações
facilmente percecionadas pelas equipas multidisciplinares. Por estas razões, surgiu a
necessidade de uma solução de deteção precoce de deterioração aguda do estado geral
de doentes durante a observação clínica.
Os Early Warning Scores são protocolos de atuação que visam melhorar a deteção e o
tempo de resposta perante situações de deterioração clínica em adultos ou crianças, (4)
para os Serviços de Urgências, Equipas de Emergências Pré-hospitalar e Equipas de
Emergência Intra-Hospitalar. Estes foram criados com a premissa de que a deteção
tardia, a circunstância e a resposta da equipa clínica comprometem os outcomes de saúde
em pessoas com doença aguda. Assim, surgem para uniformizar um conjunto de medidas
para diagnosticar e para comunicar rapidamente a deterioração do estado de doentes
numa linguagem comum.
A evidência científica atual mostra que os Aggregate Weighted Scoring System, como o
Modified Early Warning Score, VitalPAC™ Early Warning Score e National Early
Warning Score, parecem ser mais eficazes que os Single Parameter Systems. Destes
scores agregados, o National Early Warning Score é sucessivamente demonstrado como
o melhor sistema de deteção, inclusivamente para o Serviço de Urgência.
Atualmente, existe uma nova tendência – em crescimento - que passa pela conjugação
de scores fisiológicos com algum tipo de critério metabólico. A literatura aponta para
conjugação com valores séricos de lactato, d-dímeros, cálcio, entre outros. O National
Early Warning Score-Recetor do Ativador de Plasminogénio do Tipo Uroquinase
Solúvel surge como um forte candidato.
Perante um elevado número de possibilidades de biomarcadores disponíveis para esta
fusão, surge o desafio de aumentar a capacidade dos scores fisiológicos sem, ao mesmo
tempo, os tornar complexos e de cálculo demorado, de modo a garantir a sua
aplicabilidade nos Serviços de Urgências. Nestas condições, todos estes têm limitações,
desde especificidade para patologias cardiovascular, sepsis e Pancreatite Aguda (lactato,
d-dímeros e cálcio) à demora no cálculo do score (Recetor do Ativador de Plasminogénio
do tipo Uroquinase Solúvel e Pro-adrenomedulina medio-regional), pelo que serão
necessários mais estudos para se encontrar o biomarcador que cumpra todos os critérios.Patients after being admitted to the Emergency Departments can have their clinical situation being aggravated during or after medical observation, without major changes perceived by multidisciplinary teams. For these reasons, the need arose for a solution for the early detection of acute detioration in the general condition of patients during clinical observation. Early Warning Scores are action protocols that aim to improve detection and response time of clinical deterioration in adults or children, for the Emergency Services, Prehospital Emergency Teams and In-Hospital Emergency Teams. These were created with the premise that late detection, the circumstance and the responde of the clinical team compromise the health outcomes in people with acute illness. Thus, they appear to standarize a set of measures to diagnose and rapidly communicate the deterioration of the patients’ condition in a common language. Current scientific evidence shows that Aggregate Weighted Scoring System, such as the Modified Early Warning Score, VitalPAC™ Early Warning Score and National Early Warning Score, appear to be more effective than Single Parameter Systems. Of these aggregated scores, National Early Warning Score is successively demonstrated as the best detection system, even for the emergency department. Currently, there is a new trend in growth that envolves the combination of physiological scores with some type of metabolic criteria. The literature points to conjugation with sérum values of lactate, d-dimers, calcium amog others. The National Early Warning Score – Soluble Urokinase-type Plasminogen Activator Receptor emerges as a strong candidate. Given the high number of possibilities of biomarkers available for this fusion, the challenge arises to increase the capacity of physiological scores without, at the same time, making them complex and time-consuming, in order to guarantee their applicability in the Emergency Services. In these conditions, all of these have limitations, from specificity for cardiovascular pathologies, sepsis and Acute Pancreatitis (lactate, d-dimers and calcium) to the delay in the calculation of the score (Soluble Urokinase-type Plasminogen Activator Receptor and Mid-Regional Pro-Adrenomedullin), so further studies are needed to find the biomarker that meets all the criteria.
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Faisal, Muhammad, Andy J. Scally, M. A. Elgaali, D. Richardson, K. Beatson, and Mohammed A. Mohammed. "The National Early Warning Score and its subcomponents recorded within ±24 hours of emergency medical admission are poor predictors of hospital-acquired acute kidney injury." 2017. http://hdl.handle.net/10454/14183.
Full textAbstract:
YesBackground: Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. Aim: To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity.
The Health Foundation
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Mohammed, Mohammed A., Muhammad Faisal, D. Richardson, R. Howes, K. Beatson, J. Wright, and K. Speed. "Impact of the level of sickness on higher mortality in emergency medical admissions to hospital at weekends." 2017. http://hdl.handle.net/10454/18011.
Full textAbstract:
YesRoutine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods: We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time. Results: Emergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p
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Faisal, Muhammad, Andy J. Scally, D. Richardson, K. Beatson, R. Howes, K. Speed, and Mohammed A. Mohammed. "Development and external validation of an automated computer-aided risk score for predicting sepsis in emergency medical admissions using the patient’s first electronically recorded vital signs and blood test results." 2017. http://hdl.handle.net/10454/14800.
Full textAbstract:
YesObjectives: To develop a logistic regression model to predict the risk of sepsis following emergency medical admission using the patient’s first, routinely collected, electronically recorded vital signs and blood test results and to validate this novel computer-aided risk of sepsis model, using data from another hospital. Design: Cross-sectional model development and external validation study reporting the C-statistic based on a validated optimized algorithm to identify sepsis and severe sepsis (including septic shock) from administrative hospital databases using International Classification of Diseases, 10th Edition, codes. Setting: Two acute hospitals (York Hospital - development data; Northern Lincolnshire and Goole Hospital - external validation data). Patients: Adult emergency medical admissions discharged over a 24-month period with vital signs and blood test results recorded at admission. Interventions: None. Main Results: The prevalence of sepsis and severe sepsis was lower in York Hospital (18.5% = 4,861/2,6247; 5.3% = 1,387/2,6247) than Northern Lincolnshire and Goole Hospital (25.1% = 7,773/30,996; 9.2% = 2,864/30,996). The mortality for sepsis (York Hospital: 14.5% = 704/4,861; Northern Lincolnshire and Goole Hospital: 11.6% = 899/7,773) was lower than the mortality for severe sepsis (York Hospital: 29.0% = 402/1,387; Northern Lincolnshire and Goole Hospital: 21.4% = 612/2,864). The C-statistic for computer-aided risk of sepsis in York Hospital (all sepsis 0.78; sepsis: 0.73; severe sepsis: 0.80) was similar in an external hospital setting (Northern Lincolnshire and Goole Hospital: all sepsis 0.79; sepsis: 0.70; severe sepsis: 0.81). A cutoff value of 0.2 gives reasonable performance. Conclusions: We have developed a novel, externally validated computer-aided risk of sepsis, with reasonably good performance for estimating the risk of sepsis for emergency medical admissions using the patient’s first, electronically recorded, vital signs and blood tests results. Since computer-aided risk of sepsis places no additional data collection burden on clinicians and is automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
Health Foundation
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Faisal, Muhammad, D. Richardson, Andy J. Scally, R. Howes, K. Beatson, and Mohammed A. Mohammed. "Performance of externally validated enhanced computer-aided versions of the National Early Warning Score in predicting mortality following an emergency admission to hospital in England: a cross-sectional study." 2019. http://hdl.handle.net/10454/18010.
Full textAbstract:
YesOBJECTIVES: In the English National Health Service, the patient's vital signs are monitored and summarised into a National Early Warning Score (NEWS) to support clinical decision making, but it does not provide an estimate of the patient's risk of death. We examine the extent to which the accuracy of NEWS for predicting mortality could be improved by enhanced computer versions of NEWS (cNEWS). DESIGN: Logistic regression model development and external validation study. SETTING: Two acute hospitals (YH-York Hospital for model development; NH-Northern Lincolnshire and Goole Hospital for external model validation). PARTICIPANTS: Adult (≥16 years) medical admissions discharged over a 24-month period with electronic NEWS (eNEWS) recorded on admission are used to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) using the first electronically recorded NEWS (model M0) versus a cNEWS model which included age+sex (model M1) +subcomponents of NEWS (including diastolic blood pressure) (model M2). RESULTS: The risk of dying in-hospital following emergency medical admission was 5.8% (YH: 2080/35 807) and 5.4% (NH: 1900/35 161). The c-statistics for model M2 in YH for predicting mortality (in-hospital=0.82, 24 hours=0.91, 48 hours=0.88 and 72 hours=0.88) was higher than model M0 (in-hospital=0.74, 24 hours=0.89, 48 hours=0.86 and 72 hours=0.85) with higher Positive Predictive Value (PPVs) for in-hospital mortality (M2 19.3% and M0 16.6%). Similar findings were seen in NH. Model M2 performed better than M0 in almost all major disease subgroups. CONCLUSIONS: An externally validated enhanced computer-aided NEWS model (cNEWS) incrementally improves on the performance of a NEWS only model. Since cNEWS places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated to determine if it can improve care in hospitals that have eNEWS systems.
This research was supported by the Health Foundation. The Health Foundation is an independent charity working to improve the quality of healthcare in the UK. This research was also supported by the National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre (YHPSTRC).
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Andrade, Yara Samira Silva. "Previsão do risco de complicações na admissão numa unidade de cuidados de nível intermédio utilizando pontuação de escala de alerta precoce." Master's thesis, 2016. http://hdl.handle.net/10400.6/5417.
Full textAbstract:
Introdução: A deterioração de doentes hospitalizados é muitas vezes precedida, em horas, por alterações de parâmetros fisiológicos. As Escalas de Alerta Precoce são instrumentos que permitem reconhecer, precocemente, quais os doentes em risco de deterioração. Estudos realizados demonstram que uma maior pontuação está relacionada com uma maior probabilidade de desfechos desfavoráveis. Porém, a maioria destas análises centra-se em pontuações seriadas, interessando investigar se uma única pontuação inicial correlaciona-se com a ocorrência de eventos adversos.
Objetivos: Correlacionar a pontuação obtida na escala National Early Warning Score no momento de admissão na Unidade de Cuidados Agudos Diferenciados do Centro Hospitalar Cova da Beira com a ocorrência de eventos adversos, nomeadamente, maior tempo de internamento, internamento na Unidade de Cuidados Intensivos, paragem cardiorrespiratória e morte.
Material e métodos: Trata-se de um estudo observacional transversal no qual participaram 265 dos 844 doentes que estiveram internados, no período compreendido entre o dia 01 de setembro de 2013 e o dia 30 de setembro de 2014, na Unidade de Cuidados Agudos Diferenciados do Centro Hospitalar Cova da Beira. Para fazer o levantamento dos dados necessários para a realização do estudo, analisou-se o episódio de internamento na Unidade de Cuidados Agudos Diferenciados, recorrendo ao programa SClínico. A escala de alerta precoce utilizada foi a National Early Warning Score. Para responder ao objetivo do estudo utilizou-se o coeficiente de correlação de Spearman.
Resultados: Verificaram-se correlações estatisticamente significativas entre uma maior pontuação obtida na escala e os seguintes eventos adversos: ocorrência de morte na Unidade de Cuidados Agudos Diferenciados (escala completa: Rho=0,328; escala incompleta: Rho=0,170), necessidade de maior tempo de internamento (escala completa: Rho=0,219; escala incompleta: Rho=0,215), ocorrência de morte 48h após alta da Unidade de Cuidados Agudos Diferenciados (escala completa: Rho=0,291; escala incompleta: Rho=0,238) e ocorrência de morte na Unidade de Cuidados Agudos Diferenciados ou 48h após alta da mesma (escala completa: Rho=0,451; escala incompleta: Rho=0,278). O nível de confiança foi de 95% para os dois primeiros eventos adversos e de 99% para os dois últimos. Não se verificaram relações significativamente estatísticas entre uma maior pontuação obtida na escala e a necessidade de transferência para a Unidade de Cuidados Intensivos ou ocorrência de paragem cardiorrespiratória.
Conclusão: Uma maior pontuação obtida na escala National Early Warning Score relacionou-se com um maior tempo de internamento e com a ocorrência de morte na Unidade de Cuidados Agudos Diferenciados e nas 48h após alta da referida unidade.Introduction: The deterioration of hospitalized patients is often preceded by changes in physiological parameters. The Early Warning Scores are instruments that allow to recognize early such signs of deterioration. Studies show that a higher score is associated with a greater likelihood of unfavourable outcomes. However, most of these analyses focuses on serial scores, interesting to investigate whether a single initial score correlates with the occurrence of adverse events. Objectives: Correlate the score obtained on the National Early Warning Score on admission at the Acute Differentiated Care Unity with the occurrence of adverse events, in particular, increased hospitalization time, hospitalization in the intensive care unit, cardiac arrest and death. Material and methods: This is a cross-sectional observational study which involved 265 of the 844 patients who were hospitalized in the period between September 01, 2013 and September 30, 2014, at the Differentiated Acute Care Unit of Hospital Center of Cova da Beira. To make the collection of data needed for the study, we analysed the inpatient episode, using the SClínico programme. The early warning score used was the National Early Warning Score. To meet the objective of the study was used the Spearman correlation coefficient. Results: There were statistically significant correlations between a higher score on the scale and the following adverse events: occurrence of death at the Differentiated Acute Care Unit (complete scale: Rho = 0.328; incomplete scale: Rho = 0.170), increased hospital stay (complete scale: Rho = 0.219; incomplete scale: Rho = 0.215), occurrence of death 48 hours after discharge from the Differentiated Acute Care Unit (complete scale: Rho = 0.291; incomplete scale: Rho = 0.238) and occurrence of death Differentiated Acute Care Unit or 48 hours after discharge (complete scale: Rho = 0.451; incomplete scale: Rho = 0.278). The confidence level was 95% for the first two adverse events and 99% for the last two. There were no significant statistical relationships between a higher score on the scale and the need to transfer to the Intensive Care Unit or the occurrence of cardiac arrest. Conclusion: A higher score on the National Early Warning Score was related to an increased length of stay at the Acute Differentiated Care Unity and to occurrence of death at that unity and 48 hours after discharge.
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Chen, Yin-Jui, and 陳引瑞. "A Study on Establishing the Early Warning System for the National Health Insurance in Taiwan." Thesis, 1998. http://ndltd.ncl.edu.tw/handle/98910448097726257621.
Full textAbstract:
碩士國立臺灣大學
會計學系
86
Abstract Graduate Institute of Accounting National Taiwan University Title：A Study on Establishing the Early Warning System for the National Health Insurance in Taiwan Name：Yin-Jui Chen Advisor：Shuen Zen Liu, Ph.D. Month/Year：June, 1998 National Health Insurance, Early Warning System, and Accounting System National Health Insurance(NHI) is a social program of immense magnitude and will have a significant impact on the life of every citizen in Taiwan. The purpose of the study is to propose an early warning system for the Supervisory Commission of NHI and wish the system can be used as a standard to monitor the operations of the NHI. In the first part of the study, we identify several problems on the financial statements of Bureau of the NHI. For example, the valuation of accounts receivable is not appropriate because of the under-estimation of the bad debt expenses. Besides, the difference between the reserve fund under cash basis and under accrual basis is too large. This may affect the public*s understanding of the insurer*s financial position. In the second part of the study, we establish an early warning system for the NHI. The system is divided into three broad categories-liquidity tests, profitability tests and long term early warning tests. We developed 16 key financial tests to evaluate the financial performance of Bureau of National Health Insurance, including current ratio, quick ratio, cash ratio, accounts receivable turnover, return on the reserved fund, medical expenses to the reserved fund, etc.
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NI, HAN-CHIEH, and 倪漢傑. "A Study on the Monitoring System and early Warning Methods of Slope Stability in Taroko National Park." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/9htqju.
Full textAbstract:
碩士大漢技術學院
土木工程與環境資源管理研究所
105
In order to forecast the collapsible rocky slopes that would refrain from occurrence of disaster at the Toroko National Park, by adopting a non-contactable surveying instrument, its selection is basing at national park’s easily collapsible rocky sections to conduct field monitoring. During the period of monitoring, it is discovered that part of sections have the propensity of rock collapsing. Furthermore, there have been few major incidences of rock collapsing at the period of monitoring. Therefore, in considerations of personnel incapable to reach certain areas, and requirements of scenery remain unharmed and conservation of water and soil, it is evident that the monitoring technique of application of non-contactable surveying instrument at national park’s precipitous and exposed pebble slopes requires further investigation and research.
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Duchev, Zhivko [Verfasser]. "Management support and early warning system for national biodiversity databases in a network of national, regional (EAAP) and international (FAO) structures / by Zhivko Ivanov Duchev." 2006. http://d-nb.info/983646333/34.
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Nováčková, Kateřina. "Parlament České republiky a kontrola legislativního procesu Evropské unie." Master's thesis, 2019. http://www.nusl.cz/ntk/nusl-405528.
Full textAbstract:
Aim of this Diploma Thesis is to have a closer look at current powers of National Parliaments of the Member States to influence legislative process of the European Union. The main question is how do National Parliaments control legislative process in practise. Theoretical Framework is based on a debate about Democratic Legitimacy of the European Union. First the term needs to be defined and basic arguments about the (non)existence of Democratic deficit need to be introduced, then the research question can be introduced. The main focus is on Early Warning Mechanism and a process of issueing of reasoned opinions. An assumption is that through a process of issueing those reasoned opinions by National Parliaments that consist of a democratic elected political parties a Democratic Legitimacy of the European Union could be strenghtened. It is a one-case study of Czech Parliament. All the reasoned opinions, that Czech Senate and Czech Chamber of Deputies issued, will be analysed.
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Poletika, Nicole Marie. ""Wake up! Sign up! Look up!" : organizing and redefining civil defense through the Ground Observer Corps, 1949-1959." Thesis, 2013. http://hdl.handle.net/1805/4081.
Full textAbstract:
Indiana University-Purdue University Indianapolis (IUPUI)In the early 1950s, President Dwight Eisenhower encouraged citizens to “Wake Up! Sign Up! Look Up!” to the Soviet atomic threat by joining the Ground Observer Corps (GOC). Established by the United States Air Force (USAF), the GOC involved civilian volunteers surveying the skies for Soviet aircraft via watchtowers, alerting the Air Force if they suspected threatening aircraft. This thesis examines the 1950s response to the longstanding problem posed by the invention of any new weapon: how to adapt defensive technology to meet the potential threat. In the case of the early Cold War period, the GOC was the USAF’s best, albeit faulty, defense option against a weapon that did not discriminate between soldiers and citizens and rendered traditional ground troops useless. After the Korean War, Air Force officials promoted the GOC for its espousal of volunteerism and individualism. Encouraged to take ownership of the program, observers appropriated the GOC for their personal and community needs, comprised of social gatherings and policing activities, thus greatly expanding the USAF’s original objectives.