Journal articles on the topic 'Procedural delays'
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1
Sonnenberg, Amnon, and Bradford R. Crain. "Scheduling Medical Procedures: How One Single Delay Begets Multiple Subsequent Delays." Journal of Theoretical Medicine 6, no. 4 (2005): 235–39. http://dx.doi.org/10.1080/10273660600645345.
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Background: Delay is a common feature of medical disease management. Delays occur because schedules are filled, patients forget their appointment, equipment is unavailable, or because medical and non-medical complications interfere with the planned procedure. The aim of the present analysis is to model how one single delay can lead to multiple subsequent delays.Methods: The consecutive stream of delays is analyzed in terms of a stochastic process comprising of a random sum of random time periods. Any untoward event causes a procedural delay, which provides a time window of opportunity for yet another delaying event to occur.Results: The stochastic model explains why even a single initial delay can easily lead to a multitude of subsequent delays. The expected overall delay is always longer than the initial delay caused by the deferment of the initial procedure. The analysis demonstrates how in individual patients an initially short delay may subsequently expand into days or weeks.Conclusion: Because a single delay can easily burgeon into a lengthy series of multiple delays, the primary goal should be to avoid the precipitating delay at the onset.
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Chaisse, Julien. "Delays Expected but Duration of Delays Unpredictable: Causes, Types, and Symptoms of Procedural Applications in Investment Arbitration." Arbitration International 37, no. 4 (November 29, 2021): 863–901. http://dx.doi.org/10.1093/arbint/aiab035.
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Abstract Delays are becoming a common phenomenon in international investment arbitration and challenging the conventional belief that it is a time-effective mode of dispute resolution. These delays, majorly stemming from interim procedural applications, are known to arise due to the different interests and types of stakeholders involved in the process. This article provides an empirical analysis of such arbitration proceedings to cull out the types, nature, and effects of delay tactics in such proceedings. This article identifies three types of applications that play an increasing role in investment arbitration, namely, applications for ‘security for costs’, applications for disclosure of third-party funding, and the objections of manifest lack of legal merit of claims. Such delays can particularly become a cause of concern for investment arbitration as they have impacts beyond those which are on the parties involved.
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Acosta, Abigail Kathleen M., Julie Mungridis, Frances Bullman, Caroline Estrada, Kurstin Thomas, Deborah Ralph, Heidi Phillips, Susan Ruiz Endoscopy, Antonio Lira, and Kelly Marsh Hogue. "Implementing an Algorithm for Improving Patient Experience with Procedural Delays or Prolonged Pre-Procedural Stays." Journal of PeriAnesthesia Nursing 34, no. 4 (August 2019): e27. http://dx.doi.org/10.1016/j.jopan.2019.05.069.
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Peters, Megan E., Juan P. Boriosi, Daniel J. Sklansky, Gregory A. Hollman, Jens C. Eickhoff, Devon K. Christenson, and Kristin A. Shadman. "Reducing Delays in a Pediatric Procedural Unit With Ultrasound-Guided Intravenous Line Insertion." Hospital Pediatrics 11, no. 11 (November 1, 2021): 1222–28. http://dx.doi.org/10.1542/hpeds.2021-005870.
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OBJECTIVES Delay in vascular access is a leading cause of procedure delay in our pediatric procedure and infusion center. Use of ultrasound decreases time to peripheral intravenous catheter (PIV) insertion; however, ultrasound availability in our center was limited to an external venous access team (VAT). The objective of this project was to reduce PIV-related delays by 25%. METHODS Stakeholders convened and theorized that creating a unit-based nurse team specializing in ultrasound-guided peripheral intravenous catheter (USgPIV) insertion would facilitate faster access and a reduction in delayed procedures. An initial plan-do-study-act cycle was performed, training 2 nurses in USgPIV placement. Subsequent cycles were focused on increasing availability of USgPIV-trained nurses. The outcome measure was the rate of procedures delayed by PIV placement, analyzed on a statistical process control U-chart. The process measure was the percentage of USgPIV placements requiring consultations to the VAT, analyzed on a statistical process control P-chart. The balancing measure was the success rate per method of insertion. Comparisons of success rates were conducted by using a χ2 test and Fisher’s exact test. RESULTS The mean rate of procedures delayed because of vascular access fell by special cause variation from 10.8% to 6.4%. The mean VAT consultation rate fell from 86.4% to 32.0%. The VAT had higher rates of overall success (100% vs 87%; P = .01) and first-attempt success (93% vs 77%; P = .03) compared with unit nurse USgPIV placement. CONCLUSIONS Unit-based USgPIV placement in a pediatric procedural center was successfully implemented, with a significant decline in procedures delayed by PIV access.
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Buscaglia, Edgardo, and José‐Luis Guerrero‐Cusumano. "Benchmarking procedural times: a quality control approach to court delays." Benchmarking for Quality Management & Technology 4, no. 2 (June 1997): 84–95. http://dx.doi.org/10.1108/14635779710174927.
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Glockner, Gregory D. "Effects of Air Traffic Congestion Delays under Several Flow-Management Policies." Transportation Research Record: Journal of the Transportation Research Board 1517, no. 1 (January 1996): 29–36. http://dx.doi.org/10.1177/0361198196151700104.
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Air traffic delays occur when demand for airports or airspace exceeds available capacity. Consequently, these delay effects can be lessened by increasing capacity or by modifying the air traffic demand. Increasing capacity is an important solution, but it is a long-range option involving major changes such as facility construction, fundamental procedural changes, and improvements in navigational equipment. For short-term decision making a tactical-optimization model can suggest alternative flight plans to reduce delays. However, a tactical-optimization model is extremely complex because of the uncertainty in airport-capacity forecasts, which primarily depend on weather. A practical implementation of a tactical-optimization model must therefore make approximations so that a solution may be computed quickly and be of good quality. A practical model framework for the congestion-delay problem is given; this model framework is a generalization of several other flow-management models. Congested situations are simulated, to compare the practical performance of this model to other air traffic management tactics.
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Teeuwen, Aekje. "Procedural Rights Supporting Expeditious Trials for Juveniles." Asia-Pacific Journal on Human Rights and the Law 22, no. 2 (November 29, 2021): 150–85. http://dx.doi.org/10.1163/15718158-22020004.
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Abstract Delays pending trials can negatively impact juveniles. Encouragingly, the right of juvenile defendants to be tried within a reasonable time has been enshrined in international and regional human rights instruments. To support and strengthen the realisation of this specific right, several additional procedural entitlements, to which existing scholarship has paid limited attention, are of importance. This article focuses on how the rights to an effective remedy and legal representation can support the fulfilment of expeditious trials for juveniles. Furthermore, it analyses to what extent these two identified rights have been incorporated into significant international human rights standards and, specifically, in the Cambodian, Philippine and Vietnamese legislative frameworks. It identifies lessons Cambodia can draw from the latter two countries.
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Peterson, Jennifer K. "Supporting Optimal Neurodevelopmental Outcomes in Infants and Children With Congenital Heart Disease." Critical Care Nurse 38, no. 3 (June 1, 2018): 68–74. http://dx.doi.org/10.4037/ccn2018514.
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Improved survival has led to increased recognition of developmental delays in infants and children with congenital heart disease. Risk factors for developmental delays in congenital heart disease survivors may not be modifiable; therefore, it is important that lifesaving, high-technology critical care interventions be combined with nursing interventions that are also developmentally supportive. Implementing developmental care in a pediatric cardiac intensive care unit requires change implementation strategies and widespread support from all levels of health care professionals. This manuscript reviews developmentally supportive interventions such as massage, developmentally supportive positioning, kangaroo care, cue-based feeding, effective pain/anxiety management, and procedural preparation and identifies strategies to implement developmentally supportive interventions in the care of infants and children with congenital heart disease. Improving developmental support for these infants and children at high risk for developmental delay may improve their outcomes and help promote family-centered care.
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Tymoshenko, O. A. "INADMISSIBILITY OF ABUSE OF PROCEDURAL RIGHTS IN THE SYSTEM OF PRINCIPLES OF CIVIL PROCEEDINGS OF UKRAINE." Actual problems of native jurisprudence 3, no. 3 (June 2021): 70–75. http://dx.doi.org/10.15421/392151.
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The scientific work is devoted to the fundemental of civil procedure in Ukraine such as inadmissibility of abuse of procedural rights. The goal of our scientific research is definition of theoretic aspects of the princilple of inadmissibility of abuse of civil procedural rights, analisis of the main kinds and forms of such abuse, problems of legal reglamentation and realization of this fundemental and effective ways to overcome and prevent the abuse of procedural rights in civil procedure. The high level of this scientific research's actuality depends on different factors, bit we will admit the main ones: 1) the urgent need in Ukraine to supply the access to effective, as fast as possible (without unreasonble delays) justice against the backdropof european integration processes; 2) the large number of complaints against Ukraine to European Court of Human Rights because of violation right to a fair trial; 3)the direct connection between the effective realization of the right to a fair trial and the good faith conduct of parties in the civil case; 4) frequent cases of abuse of procedural rights by parties in the civil cases in order to delay the consideration of a case. The author researched the term of abuse of civil procedural rights through the Ukrainian laws and law doctrine. Also it was differed from other similar legal categories. There were defined the main kinds and forms of abuse of procedural rights in national legal practice. Also there were given the characteristics to the most popular kinds of abuse of procedural rights in Ukraine. The author paid attention to legal gears of overcomming of abuse of procedural rights in civil procedure in Ukraine.
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Blanco, Federico, Jorge Szarfer, Alejandro García Escudero, Federico Albornoz, Analía Alonso, Vielka Yurko, Susana Affatato, Matías Feldman, and Gerardo Gigena. "Detección de barreras e implementación de procedimientos para reducir la demora en el tratamiento del síndrome coronario agudo con elevación del segmento ST mediante angioplastia primaria. Experiencia de 20 años de un centro de referencia en una ciudad de alta densidad demográfica." Revista Argentina de Cardiologia 89, no. 2 (April 2021): 107–14. http://dx.doi.org/10.7775/rac.es.v89.i2.19989.
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Background: The delay to reperfusion of ST-segment elevation acute coronary syndrome (STEACS) is a key factor in its prognosis, and its reduction could reduce morbidity and mortality. Objective: The aim of this study was to identify and modify the barriers detected in 20 years of STEACS treatment in a tertiary care center of a densely populated city to evaluate their effect on the outcome of the procedure. Methods: A total of 3007 patients with STEACS within 12 hours of symptoms onset were prospectively and consecutively included to undergo primary percutaneous coronary intervention (PCI) from January 1, 2000 to December 31, 2019. Time from symptoms onset to balloon inflation was divided into intervals. After barriers were identified (2000-2009), the procedure was changed. The population was divided into two groups (G) G1: pre-implementation (2000-2009) and G2: post-implementation (2010-2019) of changes. Results: G1 included 1409 and G2 1598 patients with no demographic differences except for the type of PCI. Delays were identified in diagnosis, communication between physicians, transfer and admission of the patient to the hemodynamics lab. Procedural changes decreased first medical contact-hemodynamic team contact interval [G1: 90 min (36-168) vs. G2: 77 min (36-144) p –0.01] and hemodynamic team contact-hemodynamics lab admission interval [G1: 75 min (55-100) vs. G2: 51 min (34-70) p –0.01] and reduced in-hospital (G1: 9,2% vs. G2: 6,7% p –0,01) and 6-month (G1: 13.1% vs. G2: 7.5% p –0. 01) mortality. Conclusions: Delay in diagnosis, difficulty in communication and type of transfer were the most important causes of delay. Implementing a procedural protocol reduced delays. Continuous evaluation of results and permanent education constitute the fundamental cornerstones for optimizing network care programs
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DONATI-BOURNE, JACK, Shahd Seifeldin Nour, Zain Siddiqui, and Richard Viney. "The Burden on a Urologist of Percutaneous Nephrostomies and Antegrade Ureteric Stents: should Trainee Urologists Learn to Perform these Procedures?" Journal of Endoluminal Endourology 2, no. 4 (November 28, 2019): e23-e28. http://dx.doi.org/10.22374/jeleu.v2i4.71.
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Abstract
Background and Objective
Renal obstruction is a common urological emergency potentially requiring urgent decompression by percutaneous nephrostomy (PCN) or antegrade ureteric stent (AUrS), procedures performed by interventional radiologists, or retrograde stenting in theatre by a urologist.
The study aimed to assess the burden of PCN / AUrS on the overall workload of a urology department and evaluate impact of procedural delays in terms of bed-occupancy and cost.
The findings serve to explore whether formal PCN / AUrS training would be desirable for UK trainees in urology.
Material and Methods
Prospective study of all patients admitted under urology at Queen Elizabeth Hospital Birmingham (QEHB) between 20thOctober - 18thNovember 2018.
Electronic records to retrieve data pertaining to admission, treatment provided, length of in-patient stay and delay awaiting PCN / AUrS.
Results
n=148 patients identified.
n=22 (14.8% of total) primary admission reason and/or main treatment provided related to PCN / AUrS.
601 urology in-patient days occupied for all causes, 166 (27.6%) related to PCN / AUrS and 66 (10.9%) awaiting PCN / AUrS (delays cost £11,361 / month).
Conclusion
PCN / AUrS constituted a noteworthy proportion of all admissions and in-patient bed days in QEHB urology.
Clinically non-urgent patients experienced notable cumulative delays whilst awaiting PCN / AUrS which adversely impacted bed occupancy.
A suitably trained urologist competent at PCN / AUrS may positively address these issues.
The findings merit consideration of a call for UK urology trainees to be trained in PCN / AUrS as part of CCT requirements.
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Fortese, Fabricio, and Lotta Hemmi. "Procedural Fairness and Efficiency in International Arbitration." Groningen Journal of International Law 3, no. 1 (May 29, 2015): 110. http://dx.doi.org/10.21827/5a86a89d8e651.
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Procedural due process requires all legal proceedings to be fair and that every party involved is given notice of the proceedings, are treated equally, and are given an opportunity to be heard and to deal with the case of its opponent before a decision is made by a lawfully constituted tribunal or decision maker. However, while the mandatory due process requirements are of utmost importance within international arbitration, where are its limits? How far shall the equal treatment and procedural fairness go, and can it happen at the expense of procedural efficiency? The users of international arbitration tend to be concerned on the delays and high expenses of arbitration. A recurrent complaint is the ‘judicialisation’ of arbitration; that the procedure is becoming as equally formal dispute resolution proceeding as litigation. Simultaneously, the international arbitration field has been promoting arbitral cost and time efficiency, by incorporating relevant provisions to national arbitration laws, institutional arbitration rules and to other soft law elements. This contribution addresses the balance between the requirements of due process and efficiency within international arbitration
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Zhou, Wusi, Adekunle Oyegoke, and Ming Sun. "Causes of Delays during Housing Adaptation for Healthy Aging in the UK." International Journal of Environmental Research and Public Health 16, no. 2 (January 11, 2019): 192. http://dx.doi.org/10.3390/ijerph16020192.
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Housing adaptation is a rehabilitation intervention that removes environmental barriers to help older people accommodate changing needs and age in place. In the UK, funding application for home adaptations to local authorities is subject to several procedural steps, including referral, allocation, assessment, funding and installation. The five stages need to complete in a sequential manner, often cause long delays. This study aims to investigate the timelines across these key stages of the adaptation process and examine the main causes of delays in current practice. A mixed-methods research strategy was employed. A questionnaire survey was first undertaken with all 378 local authorities in England, Scotland and Wales; it was followed by 5 semi-structured interviews and 1 focus group meeting with selected service providers, and 2 case studies of service users. The results showed that the average length of time taken to complete the whole process is relatively long, with the longest waiting time being observed at the funding decision stage. Delays were found in each of the key stages. Main causes of delay include insufficient resources, lack of joint work, legal requirements, shortage of competent contractors and the client’s decisions. These issues need to be addressed in order to improve the efficiency and effectiveness of future housing adaptation practice.
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S. Nayak, Nayanatara, Narayan Billava, and Ashalata K.V. "Agriculture Insurance’s outreach constrained by Procedural delays and Norms: Reflections from North Karnataka, India." Research on World Agricultural Economy 1, no. 1 (December 1, 2020): 39. http://dx.doi.org/10.36956/rwae.v1i1.242.
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Karnataka is one of the states, which experienced severe drought continuously for four years since 2014. In addition, heavy rainfall for the past two years has adversely affected agriculture produce in the entire state putting farmers into debt trap as most of them are not covered by crop insurance for crop failure. Although crop insurance was available to farmers in India since 1972, the coverage across the states including Karnataka was not found to be satisfactory. The average percentage of farmers covered under crop insurance was less than 10% during 1999-2015,both for India and Karnataka. It was 11.3% under NAIS 2015 kharif,increased to 12.2% in 2016, 17.1% in 2017 going down to 15.6% in 2018 and to 14.1% in 2019 under Pradhan Mantri Fasal Bima Yojana (PMFBY)kharif in Karnataka. PMFBY was one new kind of agriculture insurance company and introduced throughout the country in 2016.This paper examines the performance of this scheme with specific reference to north Karnataka based on primary data collected from farmers’ survey in four districts, secondary data collected from official documents and first-handinformation gathered from regional stakeholder workshops organized in six selected districts of north Karnataka. The study tries to look into the extent of coverage and, flaws and merits of crop insurance schemes with reference to problems faced by farmers in getting insurance coverage and claims. The study covered around 1000 stakeholders including farmers,officials of banks, department of economics and statistics, agriculture department and insurance agencies, representatives of gram panchayats and cooperative societies. Three agricultural crop seasons have passed since then. Central government has brought in some changes in guidelines and is likely to make further changes in procedures in response to concerns expressed by States and farmers’ representatives. Follow up discussions with key stakeholders in Karnataka held after the initial farmers’ survey reveal that while a few of the anomalies in applying for crop insurance have been addressed by the concerned departments, major obstacles in assessment and claims continue to exasperate farmers who are miffed bythese procedural lapses. This paper throws light on some of these issues and discusses measures to make crop insurance, particularly PMFBY farmers’ friendly.
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Mertens, Jessica, Raveena Singh, Arno Reich, Sven Dekeyzer, Martin Wiesmann, and Omid Nikoubashman. "A competitive clinical environment improves procedural times in endovascular stroke treatment." Journal of NeuroInterventional Surgery 11, no. 8 (May 14, 2019): 781–84. http://dx.doi.org/10.1136/neurintsurg-2019-014768.
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Background and purposeDespite numerous optimization attempts, time delays are still a relevant problem in endovascular stroke treatment. We hypothesized that public display of the fastest procedural times in our institution would raise awareness, which would result in improved procedural times.MethodsWe established a competition, which lasted 6 months, in which the fastest neurovascular team in terms of procedural times (image to reperfusion) was displayed on a public board in our institution and rewarded with public praise. During this time no other relevant procedural or infrastructural means for improvement of procedural times were introduced in our institution. We prospectively evaluated procedural times in 496 patients who received endovascular stroke treatment 9 months before the competition, during the competition, and during the four 6-month time periods for 2 years after the competition.ResultsMedian image-to-reperfusion times improved significantly from 98 min before the competition to 85 min during the competition (p=0.005) and remained stable with a median of 81 min 2 years after the competition (p=0.837).ConclusionWe were able to improve our procedural times significantly with a simple and cost-efficient competition. This effect was sustained 2 years after the competition was completed, implying that the improvement in procedural times was probably due to raised awareness.
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Kan, Fock-Kui, and Abdul-Ghani Khalid. "Public procurement in Malaysian local authorities: Antecedents of procedural rationality in decision making." International Journal of Construction Supply Chain Management 11, no. 2 (December 31, 2021): 121–43. http://dx.doi.org/10.14424/ijcscm110221-121-143.
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The Malaysian public sector is oversaturated with comprehensive procurement procedures. These measures aim to deter unwarranted behaviours from public officers. Nevertheless, there have been recurring irregularities over the past decade in Malaysian local authorities, including work delays, non-compliance with regulations, wasteful purchasing, substandard workmanship etc. This study aimed to investigate factors undermining rationality in public procurement decision making from the cognitive perspective. The cognitive and behavioural science literature was reviewed systematically, focusing on procedural rationality to develop a predictive model of procurement irregularities. This research adopted a quantitative approach. A total of 289 datasets were collected from the procurement officers of Malaysian local authorities and analysed using the Partial Least Square Structural Equation Modelling technique. The empirical findings showed that work experience, prior knowledge, and accountability correlate directly with procedural rationality in procurement decision-making, which would impact the procurement outcome. The research offered insights into the decision-making behaviour of procurement officers from the cognitive psychology perspective. From the managerial standpoint, public procurement procedures should incorporate the elements of accountability, experience, and prior knowledge as part of the quality assurance and control measures.
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Loftus, I. M., K. I. Paraskevas, A. Johal, S. Waton, K. Heikkila, A. R. Naylor, and D. A. Cromwell. "Delays to Surgery and Procedural Risks Following Carotid Endarterectomy in the UK National Vascular Registry." Journal of Vascular Surgery 64, no. 5 (November 2016): 1529. http://dx.doi.org/10.1016/j.jvs.2016.09.002.
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Psychogios, Marios-Nikos, Ilko L. Maier, Ioannis Tsogkas, Amélie Carolina Hesse, Alex Brehm, Daniel Behme, Marlena Schnieder, et al. "One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome." Journal of Clinical Medicine 8, no. 12 (December 11, 2019): 2185. http://dx.doi.org/10.3390/jcm8122185.
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Background and purpose: Rapid thrombectomy for acute ischemic stroke caused by large vessel occlusion leads to improved outcome. Optimizing intrahospital management might diminish treatment delays. To examine if one-stop management reduces intrahospital treatment delays and improves functional outcome of acute stroke patients with large vessel occlusion. Methods: We performed a single center, observational study from June 2016 to November 2018. Imaging was acquired with the latest generation angiography suite at a comprehensive stroke center. Two-hundred-thirty consecutive adults with suspected acute stroke presenting within 6 h after symptom onset with a moderate to severe National Institutes of Health Stroke Scale (≥10 in 2016; ≥7 since January 2017) were directly transported to the angiography suite by bypassing multidetector CT. Noncontrast flat-detector CT and biphasic flat-detector CT angiography were acquired with an angiography system. In case of a large vessel occlusion patients remained in the angiography suite, received intravenous rtPA therapy and underwent thrombectomy. As primary endpoints, door-to-reperfusion times and functional outcome at 90 days were recorded and compared in a case-control analysis with matched prior patients receiving standard management. Results: A total of 230 patients (123 women, median age of 78 years (Interquartile Range (IQR) 69–84)) were included. Median symptom-to-door time was 130 min (IQR 70–195). Large vessel occlusion was diagnosed in 166/230 (72%) patients; 64/230 (28%) had conditions not suitable for thrombectomy. Median door-to-reperfusion time for M1 occlusions was 64 min (IQR 56–87). Compared to 43 case-matched patients triaged with multidetector CT, median door-to-reperfusion time was reduced from 102 (IQR 85–117) to 68 min (IQR 53–89; p < 0.001). Rate of good functional outcome was significantly better in the one-stop management group (p = 0.029). Safety parameters (mortality, sICH, any hemorrhage) did not differ significantly between groups. Conclusions: One-stop management for stroke triage reduces intrahospital time delays in our specific hospital setting.
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Kapur, Ajay, and Louis Potters. "Surveillance and evidence-based safety initiatives in radiation medicine." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 247. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.247.
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247 Background: Moving towards safer radiation medicine requires an active surveillance of associated failures, their causes and effects, and evidence-based approaches for mitigation. In this study, by using retrospective and prospective surveillance, we have implemented evidence-based risk mitigation strategies in our radiation medicine practice. Methods: Incident learning has shown us that failures occur due to delays or defects in the radiation medicine process and that cultural error-provoking conditions raise these risks. Our initiatives were directed towards mitigation of defects in the high-risk process steps identified through a planning process FMEA. These included the standardization of care pathways and grading scale for assessing toxicity; pre-planning contour, directive peer review; electronic whiteboard for planning coordination and incident reporting, a process interlock policy to thwart delay-rushed processes; and the use of 6 sigma metrics to monitor individual staff operational efficiencies. Results: There has been a 3-fold increase over a 9 month period in incident reporting relative to the previous 6 previous years, by the peer group historically least likely to report, with no increase in adverse events. Evidence-based care pathways have been used with under 5% clinical non-compliance rates. The implementation of contour and directive pre-planning peer review has enhanced early defect detection. There has been a twofold drop in the occurrence of high-risk procedural delays. Patient treatment start delays are routinely enforced on cases that would have historically been rushed. Temporal trends demonstrate over 30% improvement in process Z-scores over the past three years. Conclusions: Driving these risk mitigation initiatives has challenged traditional norms such as expediting treatment initiation in delay-rushed environments or sustaining care pathways that are more experience rather than evidence-based. Therefore their implementation has met with substantial barriers. It is the focus on patient safety, statistical process control, policy enforcement, regular incident reviews, and use of quantitative metrics that has been instrumental in realizing these changes and crossing barriers.
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Loftus, I. M., K. I. Paraskevas, A. Johal, S. Waton, K. Heikkila, A. R. Naylor, and D. A. Cromwell. "Editor's Choice – Delays to Surgery and Procedural Risks Following Carotid Endarterectomy in the UK National Vascular Registry." European Journal of Vascular and Endovascular Surgery 52, no. 4 (October 2016): 438–43. http://dx.doi.org/10.1016/j.ejvs.2016.05.031.
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Eckstein, H. H. "Editorial on “Delays to Surgery and Procedural Risks Following Carotid Endarterectomy in the UK National Vascular Registry”." European Journal of Vascular and Endovascular Surgery 52, no. 4 (October 2016): 425–26. http://dx.doi.org/10.1016/j.ejvs.2016.07.085.
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Wilson, Taylor A., Thabele Leslie-Mazwi, Joshua A. Hirsch, Casey Frey, Teddy E. Kim, Alejandro M. Spiotta, Reade de Leacy, et al. "A multicenter study evaluating the frequency and time requirement of mechanical thrombectomy." Journal of NeuroInterventional Surgery 10, no. 3 (June 9, 2017): 235–39. http://dx.doi.org/10.1136/neurintsurg-2017-013147.
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IntroductionThere are few published data evaluating the incidence of mechanical thrombectomy among stroke centers or the times at which they occur.MethodsA multicenter retrospective study was performed to identify all patients undergoing emergent thrombectomy for acute ischemic stroke during a 3-month period (June through August 2016). Consultations that did not undergo thrombectomy were not included.ResultsTen institutions participated in the study. During the 92-day study period, a total of 189 patients underwent mechanical thrombectomy. The average number of procedures per hospital over the study period was 18.9 (average of 0.2 cases per day per or 75.6 cases per year). This ranged from 0.09 cases per day at the lowest volume center to 0.49 cases per day at the highest volume center. Procedures were more common on weekdays (p<0.001) and during non-work hours (p<0.001). The most common period for thrombectomy procedures was between 20:00 and 21:00 hours. The median time from notification to groin puncture was 84 min (IQR 56–145 min) and from puncture to closure was 57 min (IQR 33–80 min). The median time from imaging completion to procedural start was 52 min longer for non-work hours than during work hours (p<0.001). There were no differences in procedural length based on day of the week or time of day.ConclusionsThese findings indicate that the majority of mechanical thrombectomy cases occur during non-work hours, with associated off-hours delays, which has important operational implications for hospitals implementing stroke call coverage.
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Gomes, Raphael Haidar. "A Inovadora Tutela Provisória de Urgência Satisfativa em Caráter Antecedente Oriunda da Lei nº. 13.105/2015." Revista de Ciências Jurídicas e Empresariais 19, no. 1 (August 8, 2018): 48–57. http://dx.doi.org/10.17921/2448-2129.2018v19n1p48-57.
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ResumoO grande marco do ano de 2015 foi a elaboração do novo Código de Processo Civil oriundo da Lei nº 13.105/ 2015, trazendo ao âmbito jurídico diversas polêmicas em razões da criação de novos institutos e da implementação e modificações de outros que já estavam dispostos no Código de Processo Civil revogado. A antiga tutela antecipada sofreu diversas alterações, ensejando dúvidas e insatisfação por grande parte dos processualistas clássicos, entretanto, com o estudo aprofundado do instrumento processual sucessor da tutela antecipada, mostrouse um novo instituto eficiente quanto às suas funções e finalidades. A tutela de urgência inaugurada pelo novo Código de Processo Civil se materializou repleta de detalhes, estes que a tornaram eficientes para a aplicação em casos concretos, que abrem ensejo para tal dispositivo. A novidade do mundo jurídico apresentou mudanças tão importantes que adotaram a tutela de urgência em determinados casos como um rito, que embora pertencente ao procedimento comum, tem seu trâmite processual próprio até a solução da pretensão urgente em discussão. Ensejada na eficiência das decisões processuais em casos de urgência, bem como no combate à morosidade processual, a tutela de urgência foi, gradativamente, se solidificando no mundo prático processual de forma própria e simples dentro de suas peculiaridades.Palavras-chave: Tutela Antecipada. Código de Processo Civil. Mora Processual. Tutela de Urgência.AbstractThe biggest legal landmark of the year 2015 was the elaboration and the sanction of the new civil procedure code, derived from the law 13.105 / 2015, bringing to the juridical scope some controversies from the creation of new institutes, or the implementation of others institutes that were already provided in the revoked civil procedure code. The old interlocutory injunction has undergone several profound changes, provoking doubts and dissatisfaction by a large part of the classic procedurals doctrinaires, however, with a hard and technical study about the successor of the preventive injunction, the new institute seemed efficient according to its functions and purposes. The interim relief inaugurated by the new civil procedure code was materialized full of details that have made its application efficient in concrete cases that have an opportunity to use that institute. The novelty of the juridical world presented such important changes that adopted the interim relief in certain cases as a rite that although originating from the common civil procedure, has its special pending until the merit judgment of the urgency pretension. Inspired on the efficiency of procedural decisions in urgent cases, as well as in combating the procedural delays, the interim relief was gradually solidified in the procedural practical world, in a proper and simple form within its peculiarities.Keywords: Interlocutory Injunction. Civil Procedure Code. Procedural Delay. Interim Relief.
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Ahmed, Jamil. "Indigenous Dispute Resolution Mechanism (IDRM) in Sindh: A Case Study of Fatehpur Village, Larkana." University of Wah Journal of Social Sciences 5, no. 1 (June 8, 2022): 205–22. http://dx.doi.org/10.56220/uwjss2022/0501/12.
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Pakistan's justice delivery mechanism is based on formal, informal, and sharia laws. The basic purpose of these mechanisms is to facilitate the masses in getting better access to justice for various reasons. Generally, courts involved procedural delays, away from community, foreign language, expansive, and nepotism, thus courts decrease the trust level of people. While IDRM has a speedy justice delivery mechanism, native language, efficient and cost-effective. Earlier, IDRM was not recognized as a law: however, various efforts have been made at national and provincial level to reduce the burden of courts by legitimatizing the IDRM. This research is designed to find how it works and evaluate its role through local narrative/perceptions and whether it has the ability to cater to the aspirations of aggrieved families. The (N=92) interviews were carried out with a purposive sampling technique to collect data from ChangoMurs, local actors, disputants, and their families. A further 4 FGD’s were conducted with the people of the villages at Otak of ChangoMurs, and village hotel. The study concludes that the courts are overwhelmed, with less staffing and their own procedural issues, resulting in delays, sluggish processes, nepotism, and high costs. While IDRM gains familiarity, easy accessibility, low cost, attentiveness, personal affiliation, and suitability in nearly every dispute, villagers interpret conflicts as cultural activities and want mechanisms that comprehend the socio-cultural significance and understand the context of dispute. Moreover, the IDRM resolves disputes while taking into account the political, social, legal, economic, and humanitarian viewpoints of the community. Keywords: Dispute, IDRM, family aspirations, cost and time efficacy
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Khumalo, Bongani. "Procedural unfairness occasioned by unreasonable delay in finalising a disciplinary inquiry: Stokwe v Member of the Executive Council: Department of Education, Eastern Cape [2018] ZACC 3." Obiter 41, no. 3 (January 1, 2021): 651–61. http://dx.doi.org/10.17159/obiter.v41i3.9588.
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“Justice delayed is justice denied” is a legal maxim which denotes that if legal redress is available to a party that has suffered, or is suffering an injustice but is not dispensed timeously, it has the same effect as having no redress at all (see Steenkamp J sentiments in Road Accident Fund v Commission for Conciliation, Mediation and Arbitration [2016] ZALCJHB 139 par 5; see also the definition at Definitions and Translations https://www.definitions.net/definition/justice+delayed+is+justice+denied (accessed 2019-09-12)). In this context, the maxim is used to emphasise that delays in finalising employment disciplinary processes may amount to a denial of justice. Research shows that unreasonable delays in finalising disciplinary cases affect the health and can even cause excruciating distress on the employees concerned (Van der Bank, Engelbrecht and Strumpher “Perceived Fairness of Disciplinary Procedures in the Public Service Sector: An Exploratory Study: Empirical Research” 2008 6(2) SA Journal of Human Resource Management 8).
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Rueda-Orozco, Pavel E., Corinne J. Montes-Rodriguez, Edgar Soria-Gomez, Mónica Méndez-Díaz, and Oscar Prospéro-García. "Impairment of endocannabinoids activity in the dorsolateral striatum delays extinction of behavior in a procedural memory task in rats." Neuropharmacology 55, no. 1 (July 2008): 55–62. http://dx.doi.org/10.1016/j.neuropharm.2008.04.013.
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Euvrard, Elsa, and Chloe Leclerc. "Pre-trial detention and guilty pleas: Inducement or coercion?" Punishment & Society 19, no. 5 (October 4, 2016): 525–42. http://dx.doi.org/10.1177/1462474516670153.
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This article examines why accused persons in pre-trial detention decide to plead guilty. Relying on the understanding of coercion proposed by Brunk, the article go beyond his analysis to show how pre-trial detention can exert pressure on an accused individual, who then feels coerced into pleading guilty. Interviews with 12 accused and 12 lawyers showed that in certain situations pre-trial detention can be a source of coercion, particularly if there are lengthy procedural delays and eventual sentences can be expected to be fairly short. However, there are other situations in which custodial remand acts as an inducement rather than as coercion or does not exert any pressure on the accused.
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Williams, Sope. "The Use of Exclusions for Corruption in Developing Country Procurement: The Case of South Africa." Journal of African Law 51, no. 1 (April 2007): 1–38. http://dx.doi.org/10.1017/s002185530600026x.
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AbstractThe South African public procurement system is regulated by a constitutional framework and legislation applicable to all tiers of government. An interesting feature of the system is that suppliers may be excluded from government contracts for breaches of procurement or anti-corruption legislation. This article critically examines corruption-related exclusions. It is suggested that there is likely to be a number of problems with the implementation of these exclusions. First, it is not clear how effective they will be in meeting the government's anti-corruption policy. Secondly, in respect of the exclusions imposed through a non-judicial process, there are no guidelines to ensure procedural safeguards, and furthermore, these exclusions may lead to delays and costs in the procurement process – especially when it comes to deciding whether persons or firms related to an excluded firm ought to be excluded. Thirdly, there are issues regarding proportionality of the measures. Fourthly, it may be difficult to maintain a consistent approach in deciding whether to exclude under the non-judicial exclusions. In view of these, for the regime to be effective, the South African government must be prepared to bear the attendant financial and procedural burden.
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Baraniskin, Alexander, and Roland Schroers. "Liquid Biopsy and Other Non-Invasive Diagnostic Measures in PCNSL." Cancers 13, no. 11 (May 28, 2021): 2665. http://dx.doi.org/10.3390/cancers13112665.
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Primary central nervous system lymphoma is a rare but highly aggressive form of non-Hodgkin lymphoma that remains confined to the CNS neuroaxis. The diagnosis of PCNSL requires a high level of suspicion as clinical presentation varies depending on the involved CNS areas. Neurological symptoms and MRI findings may mimic gliomas, demyelinating lesions, or infectious and granulomatous diseases. Almost all PCNSL patients undergo invasive surgical procedures for definite diagnosis. Stereotactic biopsy is still the gold standard in achieving a diagnostic accuracy of 73–97%. Both the potential procedural morbidity and mortality, as well as the time to definite histopathologic diagnosis resulting in delays of treatment initiation, have to be considered. On the contrary, minimally invasive procedures, such as MRI, CSF cytology, and flow cytometry, still have limited value due to inferior specificity and sensitivity. Hence, novel diagnostic approaches, including mutation analyses (MYD88) in circulating tumor DNA (ctDNA) and the determination of microRNAs (miR-21, miR-19b, and miR-92) as well as cytokine levels (IL10 and IL6) in blood, cerebrospinal fluid (CSF), and vitreous fluid (VRF), move into the focus of investigation to facilitate the diagnosis of PCNSL. In this review, we outline the most promising approaches that are currently under clinical consideration.
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Mbuyi, N., S. Reinert, R. Hilliard, A. Reginato, and D. Dalal. "AB1179 EMERGENCY DEPARTMENT LENGTH OF STAY FOR PATIENTS WITH ACUTE GOUT." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1880.1–1881. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2682.
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Background:Emergency department (ED) visits for acute gout increased by approximately 20% between 2006 and 2014 in the United States. (1) Reducing ED length of stay (LOS) can help improve health outcomes, and reduce ED crowding and cost of care for patients with gout.Objectives:The aim of our study was to assess ED LOS and to identify factors associated with prolonged ED LOS in patients with acute gout.Methods:In this retrospective analysis, we included the first ED visit of adult patients (>18years) with acute gout who presented to the 3 EDs affiliated with Lifespan Health Systems, the largest healthcare provider in Rhode Island. Our study period was 3/30/2015 to 9/30/2017.We calculated ED LOS as the time spent by patients in the ED until they were discharged. Patients presenting to the ED and subsequently admitted to the hospital were excluded given the differential effect of systems factors in these patients. We assessed the following factors’ association with being in the upper quartile of ED LOS: (a) Patient factors – demographics, comorbidities and clinical presentation of gout (number of joints involved, severity as gauged by an ED triage nurse on a scale of 1 to 5; 1 being the worst) and (b) systems factors – time of day, day of the week, and time of year at presentation to the ED, teaching versus non-teaching hospital setting, and performing an arthrocentesis. We performed univariate and multivariable analyses to identify factors associated with prolonged ED LOS in patients with acute gout.Results:A total of 355 patients (mean age 56.6 ± 16.03 years, 81.3% males) were included. The median ED LOS was 2.65 hours (1.75, 4.3 hours). A quarter of the patients spent more than 4.3 hours in the ED; the national average across all medical illnesses being 3.7 hours (2). In the univariate analysis, older age (> 65 years), comorbidities (hypertension, congestive heart failure), worse ED severity score, procedural delays, and teaching hospital setting were associated with being in the upper quartile of ED LOS. In a multivariable analysis, age >65 years, procedural delays, and worse ED acuity score continued to be associated with longer ED LOS.Conclusion:In our study settings, patients with acute gout spent a longer time in the ED than the national median of 120-150 minutes. (2) We noted that older age and higher acuity score in addition to procedural delays led to longer length of stay in the ED. The results of our study should guide future interventions to reduce ED LOS for patients with acute gout.References:[1] Mithal, A., & Singh, G. (2018). OP0185 Emergency department visits for gout: a dramatic increase in the past decade[2]Centers for Disease Control and Prevention. (2014). QuickStats: median emergency department (ED) wait and treatment times, by triage level–National Hospital Ambulatory Medical Care Survey, United States, 2010-2011. Morb Mortal Wkly Rep, 63,439. (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6319a8.htm)Disclosure of Interests:None declared
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Wu, Angela, Matthew Schliep, Ameer Abutaleb, Sharon Gallaher, Christina Bisser, James McGowan, and Eric Goldberg. "S1232 Patient Tardiness, Physician Tardiness, and Procedural Nurse Pre-Operative Workflow Drive Delays in the First and Second Procedure Start Times in a Tertiary Care Endoscopy Unit." American Journal of Gastroenterology 115, no. 1 (October 2020): S618—S619. http://dx.doi.org/10.14309/01.ajg.0000706976.90746.b9.
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Yadav, Sarika. "Implementation of Metro Rail Project in Pune City." International Journal for Research in Applied Science and Engineering Technology 10, no. 3 (March 31, 2022): 1891–96. http://dx.doi.org/10.22214/ijraset.2022.41008.
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Abstract: In India, around 26 metro rail projects are in various phases of planning, construction, and operation. A number of new metro rail phases are being planned and will be operational in the near future. Various studies have revealed delays in metro rail project planning and execution in India and around the world. This research will attempt to comprehend a wide range of subjects. There are numerous alternatives for dealing with problems or impediments that the metro rail corporation encounters when constructing metro rail projects. Variables that may impede project execution, such as government funding capability, financial arrangements, and so on. To name a few, competing technologies, a workable operating plan, and stakeholder issues. The factors that determine metro rail operations The Pune Metro Rail Project will be utilized to examine potential projects. The scope of the study will be limited to mobilization. The study approach is centered on formal contacts with participants from the planning phase to the commissioning phase. The study's conclusions are crucial in various ways for Pune Metro Rail Corporation decision makers and project execution group. Developing procedural routines to help metro rail projects be completed more quickly and effectively. Keywords: Implementation of Pune Metro, Delay in the project, Infrastructure of the project, cost
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Abbas, Azhar, and Karol Teovani Lodan. "Peran Pengawasan Ombudsman Dalam Penyelenggaraan Pelayanan Publik." Dialektika Publik : Jurnal Administrasi Negara Universitas Putera Batam 5, no. 1 (August 24, 2020): 17–23. http://dx.doi.org/10.33884/dialektikapublik.v5i1.2414.
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Public Service which regulates the principles of good governance which is the effectiveness of government functions itself. The forms of maladministration that we often encounter are abuse of authority, prolonged delays, neglect of legal obligations, procedural irregularities, nontransparency, negligence, discrimination, extortion, unprofessionalism, unclear information, arbitrary acts, legal uncertainty, and mismanagement. Ombudsman supervision is a representation of the supervision carried out by the community or civil society groups. The way the Ombudsman works is also similar to the way civil society works, free of charge, and various other conveniences. In addition to being largely determined by the political will of state administrators and political support in parliament, the effectiveness of the work of the Ombudsman is also largely determined by how far the community has an understanding of the Ombudsman.
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Hoepner, Robert, Ralph Weber, Gernot Reimann, Klaus Berger, Martin Kitzrow, Sebastian Fischer, Christian Weimar, Jens Eyding, and Christos Krogias. "Stroke admission outside daytime working hours delays mechanical thrombectomy and worsens short-term outcome." International Journal of Stroke 14, no. 5 (July 19, 2018): 517–21. http://dx.doi.org/10.1177/1747493018790079.
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Background and purpose Rapid therapeutic decisions in acute stroke patients leading to earlier initiation of revascularization therapies are associated with better outcome. An association between regular working hours and reduced time to initiation of intravenous thrombolysis has been reported. However, its influence on mechanical thrombectomy (MT) remains uncertain. We aimed to analyze the effects of admission time on door-to-groin time and stroke outcome in a large prospective stroke registry of the Neurovascular Net Ruhr in Germany. Methods Procedural times of a total of 512 patients treated with MT were analyzed. Admission to hospital during regular working days and hours (Monday to Friday, 8 am to 4 pm) was compared with admission outside these times. Door-to-groin time and the difference in NIH Stroke Scale between admission and discharge served as primary outcome parameters. Long-term functional outcome was centrally assessed with modified Rankin scale. Results MT outside regular working hours was associated with a significant mean initiation delay of 20 min. By multivariate regression analysis, every 20 min delay of MT reduced the difference in NIHSS score between admission and discharge by 0.76 points (95% CI −1.24 to −0.28, p = 0.002). Favorable long-term outcome did not differ between both treatment groups. Conclusions Treatment outside regular working hours caused a significant delay in the initiation of MT, which was associated with a decreased short-term clinical efficacy of thrombectomy. Strategies like compulsory attendance of the interventional neuroradiologist at the hospital 24/7 might result in shorter door-to-groin times and consecutive in better stroke outcome.
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Yan, Stephanie, and Sooraj Tejaswi. "Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study." Therapeutic Advances in Gastrointestinal Endoscopy 12 (January 2019): 263177451985316. http://dx.doi.org/10.1177/2631774519853160.
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Aims: Endoscopic management of indeterminate strictures and complex stones remains a challenge, for which the latest generation single-operator digital cholangioscope (SpyGlass DS) has shown promising results. We aimed to study the clinical impact of single-operator digital cholangioscope at our tertiary academic center. Methods: We retrospectively reviewed all digital cholangioscopies performed from June 2015 to May 2018. Patient characteristics, procedure characteristics, and post-procedural patient outcomes were recorded. Results: A total of 50 patients (26 men, average age 61.4 years) underwent 67 procedures. Indications were biliary stones (21/50, 42%), strictures and primary sclerosing cholangitis surveillance (22/50, 46%), and miscellaneous (7/50, 14%). The average procedure time was 82 ± 29 min (99.5 min for stones and 74.2 min for strictures). Stone clearance was achieved in 19/21 (90.47%) cases, with electrohydraulic lithotripsy employed in 16/21 and repeat cholangioscopy necessary in 9/21. Malignant strictures (10) were differentiated from benign (12) in all cases both in patients with primary sclerosing cholangitis (9) and in those without (13), based on visual cholangioscopic features (sensitivity and specificity 100%), single-operator digital cholangioscope–directed biopsies (sensitivity 60% and specificity 100%), and brush cytology (sensitivity 37.5% and specificity 100%). Complications included one post-sphincterotomy bleeding and one post-procedural cholangitis despite antibiotic prophylaxis, but no procedure-related mortality. Conclusion: Single-operator digital cholangioscope had a high success rate and a low rate of complications for management of indeterminate strictures and difficult biliary stones. Visual cholangioscopic features of biliary strictures had excellent diagnostic accuracy, and targeted biopsies outperformed brush cytology. Early implementation of cholangioscopy for select indications leads to successful patient outcomes and reduces diagnostic delays, cost, and risks of repeat endoscopic retrograde cholangiopancreatographies.
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Menon, Sundaresh. "Arbitration’s Blade: International Arbitration and the Rule of Law." Journal of International Arbitration 38, Issue 1 (January 1, 2021): 1–26. http://dx.doi.org/10.54648/joia2021001.
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The legitimacy of a system of dispute resolution depends intrinsically on the trust and confidence of its users in its decision-making processes, and that in turn rests on the general adherence of those processes to the values and principles that constitute the rule of law. While international arbitration has long been a close partner of the courts in sustaining the rule of law, some of arbitration’s key features and practices – such as its consent-based limitations, its predisposition toward confidentiality, its longstanding practice of permitting parties to unilaterally appoint arbitrators, and its philosophy that parties have no right to a right answer – mean that arbitration supports an attenuated model of the rule of law. That is largely the result of conscious decisions to forgo certain rule of law values in order to realize other goals. But the problem of rising costs and delays, underpinned by arbitration’s growing procedural rigidity and lack of agility, exacts a heavy price on arbitration’s users and their confidence in arbitration, without obvious returns. We must be cognizant of arbitration’s sacrifice in terms of rule of law values when seeking to advance other objectives, and regularly reflect on whether those gains are still worth their cost. International arbitration, Rule of law, Consent, Arbitrability, Confidentiality, Multiparty disputes, Party appointment of arbitrators, Accessibility, Costs, Delays
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Bhattacharya, Srobana. "Institutional Review Board and International Field Research in Conflict Zones." PS: Political Science & Politics 47, no. 04 (October 2014): 840–44. http://dx.doi.org/10.1017/s1049096514001140.
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ABSTRACTResearch on political conflict can benefit immensely from fieldwork. However, the Institutional Review Board (IRB) process is elaborate and daunting that discourages rather than encourages this type of research. Existing policies often are insensitive to the many uncertainties related to field research abroad, especially in conflict zones. Three reasons for this are identified in this article. First, the federal regulations to protect human subjects of social science research are most suitable for biomedical sciences. Second, there is huge gap between “procedural ethics” and “ethics in practice.” Third, there is a lack of communication or dialogue between researchers and IRBs. After discussing these reasons, I offer the following suggestions: bridging the gap between the researcher and the IRB; reducing delays in the IRB approval and revision process; encouraging collaboration and dialogue among researchers; and advocating a proactive stance by academic associations.
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Dowson, Philip. "Shoulder Reduction Bench Project: improving care for patients with shoulder dislocations." BMJ Open Quality 8, no. 2 (June 2019): e000366. http://dx.doi.org/10.1136/bmjoq-2018-000366.
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This paper presents the background, methodology and results of a quality improvement project undertaken at a district general hospital. The project was launched in response to the concerning results from audit data which showed significant delays in the treatment of patients with shoulder dislocations and a high percentage of patients receiving procedural sedation. Using ‘Plan-Do-Study-Act’ cycles involving training sessions, written protocols and an online video, we were able to train a large cohort of nurse practitioners in the use of the Shoulder Reduction Bench. This is a relatively novel, evidence-based technique for reducing shoulder dislocations without the need for sedation. The new shoulder dislocation protocol was successful in reducing the average time from presentation to shoulder relocation by 31 min and the average time from presentation to discharge by 52 min. It also resulted in a 68% reduction in the number of patients receiving procedural sedation over a 6-month period. This project inspired the practitioners, most of whom had never reduced a shoulder dislocation before. The success of the new shoulder reduction bench protocol prompted interest from the trust’s innovation department and has been publicised both within the trust and regionally. This publicity and the satisfaction gained by the staff from this effective new skill have helped to anchor the change in departmental culture. Link to training video: https://www.youtube.com/watch?v=40aCqhfQXD4&feature=youtu.be
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Roth O’Brien, Diana, Phillip Poppas, Sydney Kaye, Sean Mahase, Anjile An, Paul Christos, Benjamin Liechty, et al. "43. DELAYS IN ADJUVANT STEREOTACTIC RADIOSURGERY REDUCE LOCAL CONTROL FOR RESECTED BRAIN METASTASES." Neuro-Oncology Advances 2, Supplement_2 (August 2020): ii8. http://dx.doi.org/10.1093/noajnl/vdaa073.031.
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Abstract OBJECTIVE For resected brain metastases (BM), stereotactic radiosurgery (SRS) is often offered to minimize local recurrence (LR). Although the aim is to deliver SRS within a few weeks of surgery, a variety of socioeconomic, medical, and procedural issues can cause delays. We evaluated the relationship between timing of postoperative SRS and LR. METHODS We retrospectively identified a consecutive series of BM patients managed with resection and adjuvant SRS, recommended within two weeks of surgery, at our institution from 2012–2018. We assessed the correlation between time to SRS, as well as other demographic, disease, and treatment variables, and LR, distant recurrence (DR), and overall survival (OS). RESULTS 133 patients met inclusion criteria. Median age was 64.5 years. Approximately half of patients had a single BM, and median BM size was 2.9 cm. Gross total resection was achieved in 111 (83.6%) patients, and >90% received fractionated SRS. Median time to adjuvant SRS was 37.0 days and LR rate was 16.4%. The factor most predictive of LR was time from surgery to SRS. Median time from surgery to SRS was 34.0 days for patients without LR, versus 61.0 days for those with LR (p<0.01). LR was 2.3% with SRS administered ≤4 weeks postoperatively, compared to 23.6% if delayed >4 weeks (p<0.01). Local recurrence-free survival (LRFS) was also improved for patients who had SRS at ≤4 weeks (p=0.02). Delayed SRS was also predictive of DR (p=0.02), but not OS. CONCLUSIONS We demonstrate that the strongest predictor of failure of postoperative SRS for BM is the delay to SRS. A cut-off of 4 weeks is a reliable predictor of increased LR. Every effort should be made to perform SRS within 4 weeks of surgery, and if this cannot be achieved, other RT modalities, such as brachytherapy or preoperative SRS, should be strongly considered.
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Williams, Michelle M., Taylor A. Wilson, Thabele Leslie-Mazwi, Joshua A. Hirsch, Ryan T. Kellogg, Alejandro M. Spiotta, Reade De Leacy, et al. "The burden of neurothrombectomy call: a multicenter prospective study." Journal of NeuroInterventional Surgery 10, no. 12 (April 20, 2018): 1143–48. http://dx.doi.org/10.1136/neurintsurg-2018-013772.
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IntroductionNeurothrombectomy frequency is increasing, and a better understanding of the neurothrombectomy call burden is needed.MethodsNeurointerventional physicians at nine participating stroke centers prospectively recorded time requirements for all neurothrombectomy (NT) consultations over 30 consecutive 24 hour call periods.ResultsData were collected from a total of 270 days of call. 214 NT consultations were reported (mean 0.79 per day), including 130 ‘false positive’ consultations that ultimately did not lead to thrombectomy (mean 0.48 per day). 84 NT procedures were performed at the nine centers (0.32 per day, or 1 every 3 days). Most (59.8%) consultations occurred between 5pm and 7am. 30% of thrombectomy procedures resulted in delays in scheduled cases; treating physicians had to emergently travel to the hospital for 51.2% of these cases. A median of 27 min was spent on each false positive consultation and 171 min on each thrombectomy. Overall, the median physician time spent on NT responsibilities per 24 hour call period was 69 min (mean 85 min; IQR 16–135 min).ConclusionsNT consultations are frequent and often disrupt physician schedules, requiring physicians to commute in from home after hours in the majority of cases. As procedural and consultation volumes increase, it is crucial to understand the significant burden of call on neurointerventional physicians and develop strategies that reduce the potential for burnout. Importantly, this study was performed prior to the completion of the DAWN and DEFUSE3 trials; NT consultations are expected to continue to increase in the future.
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Stone, Alexander, Andrew J. Goldsmith, Charles N. Pozner, and Kamen Vlassakov. "Ultrasound-guided regional anesthesia in the emergency department: an argument for multidisciplinary collaboration to increase access while maintaining quality and standards." Regional Anesthesia & Pain Medicine 46, no. 9 (May 5, 2021): 820–21. http://dx.doi.org/10.1136/rapm-2020-102416.
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The practice of ultrasound-guided regional anesthesia (UGRA) by emergency medicine physicians in the emergency department (ED) is increasing. The need for effective alternatives to opioid analgesia in the acute care setting likely exceeds the current capacity of UGRA-trained anesthesia teams. In this daring discourse, we outline several matters of relevance to be considered as protocols are put into place to facilitate the practice of UGRA by emergency medicine physicians in the ED. There are opportunities for collaboration between anesthesiology and emergency medicine societies in guideline development as well as educational resources. The sustained interest in UGRA shown by many emergency medicine physicians should be viewed open-mindedly by anesthesiologists. Failure to collaborate on local and national scales could lead to delays in the development and implementation of patient-centered, safe procedural care, and limit patient access to the benefits of regional anesthesia.
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Stadelmann-Steffen, Isabelle, Dominique Oehrli, and Adrian Vatter. "Do governments delay the implementation of parliamentary requests? Examining time variation in implementing legislative requests in Switzerland." Policy Sciences 54, no. 3 (July 13, 2021): 663–90. http://dx.doi.org/10.1007/s11077-021-09432-4.
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AbstractThis paper investigates time variations in the implementation of legislative requests by the Swiss government. Combining the literature on executive–legislative relations with findings from implementation research, we focus on the procedural level and argue that implementation delays can occur because the government does not want to, cannot or should not implement faster. We test these mechanisms using a unique database, which enables us to analyse a systematic collection of all legislative requests that have been approved between the parliament’s 2003 winter session and its 2018 spring session. Our results show that the considerable variation in the time needed for the legislative mandates’ implementation is mostly related to the Swiss government’s inability to transpose faster, i.e. to factors like highly busy administrative offices or complex and controversial issues. In contrast, there is no support for the ideas that the government “shall not” or “does not want to” transpose faster.
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Ambos, Kai. "International criminal procedure: "adversarial", "inquisitorial" or mixed?" International Criminal Law Review 3, no. 1 (2003): 1–37. http://dx.doi.org/10.1163/156753603767877084.
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AbstractThe article analyses whether international criminal procedure is "adversarial", "inquisitorial" or mixed. It examines the law of the ICTY and the ICC, including the relevant case law. This law has developed from an adversarial to a truly mixed procedure by way of various amendments of the ICTY's Rules of Procedure and Evidence (RPE) and the drafting of the Rome Statute merging civil and common law elements in one international procedure. It is no longer important whether a rule is either "adversarial" or "inquisitorial" but whether it assists the Tribunals in accomplishing their tasks and whether it complies with fundamental fair trial standards. As to an efficient trial management an UN Expert Group called for a more active role of the judges, in particular with regard to the direction of the trial and the collection of evidence. In this context, it is submitted that a civil law like judge-led procedure may better avoid delays produced by the free interplay of the parties. Ultimately, however, the smooth functioning of a judicial system depends on its actors, procedural rules provide only a general framework in this regard. A truly mixed procedure requires Prosecutors, Defence Counsel and Judges who have knowledge of both common and civil law and are able to look beyond their own legal systems.
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Третьяков, А. А. "PROCEDURAL GENERATION OF MASSIVE 3D GEOMETRY USING IMPROVED MARCHING CUBES ALGORITHM." Южно-Сибирский научный вестник, no. 4(38) (August 31, 2021): 8–15. http://dx.doi.org/10.25699/sssb.2021.38.4.012.
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Процедурная генерация, или создание контента во время работы программы, это сложное направление, которое требует не только понимания 3D-графики, но и навыков программирования графики, что часто сводится к изучению работы графических процессоров. Из-за такой сложности разработчики часто используют уже готовые инструменты для создания контента. Такие инструменты обобщают и упрощают работу, предоставляя большой заготовленный набор функции, который можно использовать не зная программирования вовсе. К сожалению, обобщение часто приводит к уменьшению гибкости и вводит новые ограничения. Статистика показывает, что использование процедурной генерации, для создания массивной 3D-геометрии, невозможно при использовании готовых инструментов с уже заготовленными функциями. Такие инструменты не позволяют воплотить огромные масштабы массивной геометрии в жизнь из-за различных ограничений. Кроме того, существующие алгоритмы создания 3D-геометрии часто не учитывают применение этих алгоритмов для создания массивной 3D-геометрии, например, планет. Рассматриваемый в этой работе алгоритм Marching Cubes также не учитывает применение алгоритма для создания массивной геометрии, из-за чего применение этого алгоритма в таких целях будет иметь много ограничений и много недостатков. Но данный алгоритм выбран не случайно, он обладает большой популярностью и мы поговорим почему. Данная работа фокусируется на представлении новой модификации на уже существующий алгоритм Marching Cubes в целях применения его в рамках массивной геометрии. Данный алгоритм найдет применение в компьютерных играх с космической тематикой, наш алгоритм позволяет создавать массивную 3D-геометрию планетарных масштабов даже на слабых компьютерах без особых затрат по ресурсам. Кроме того, наш алгоритм позволяет изменять сгенерированную геометрию в реальном времени, без задержек по времени, что так важно компьютерным играм. Procedural generation, or the creation of content while a program is running, is a complex area that requires not only an understanding of 3D graphics, but also graphics programming skills, which often boils down to learning how GPUs work. Because of this complexity, developers often use off-the-shelf content creation tools. Such tools generalize and simplify work by providing a large pre-built set of functions that can be used without knowing programming at all. Unfortunately, generalization often reduces flexibility and introduces new constraints. Statistics show that using procedural generation to create massive 3D geometry is impossible when using ready-made tools with already prepared functions. Such tools do not allow the huge scales of massive geometry to be brought to life due to various constraints. In addition, existing 3D geometry creation algorithms often do not account for the application of these algorithms to create massive 3D geometry such as planets. The Marching Cubes algorithm considered in this work also does not take into account the use of the algorithm for creating massive geometry, which is why the use of this algorithm for such purposes will have many limitations and many disadvantages. But this algorithm was not chosen by chance, it is very popular and we will talk why. This work focuses on modifying the existing Marching Cubes algorithm to apply it to massive geometry. This algorithm will find application in computer games with a space theme, our algorithm allows to create massive 3D geometry of planetary scales even on a low-end computers without special resource costs. In addition, our algorithm allows to change the generated geometry in real time, without time delays, which is so important for computer games.
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Alves, Mônica de Souza, Alexandre Túlio Amaral Nascimento, and Alberto de Freitas Castro Fonseca. "The experience of the municipalities of Minas Gerais State (Brazil) that implemented local environmental licensing." Sustainability in Debate 13, no. 1 (April 29, 2022): 50. http://dx.doi.org/10.18472/sustdeb.v13n1.2022.41539.
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The objective of this study was to explore the experience of the municipalities of the state of Minas Gerais that implemented local environmental licensing. For this purpose, representatives of the state administration were interviewed, and an electronic questionnaire was sent to analysts of 121 municipalities that took up environmental licensing, from which 39 responses were obtained. The key drivers of local environmental licensing were concerns over licensing procedural delays by the state government and the need for administrative efficiency. Knowledge of local conditions and the proximity between the local government, communities and developers were identified as facilitators of licensing. Shortage of staff, precarious hiring processes, and lack of infrastructure were identified as the main barriers to local environmental licensing. The municipalities that have implemented local environmental licensing perceive planning, administrative capacity, competent technical and legal teams, and capacity-building as essential elements of an effective local environmental licensing system. The study concludes with suggestions of future research avenues.
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Shkedy, Gary G., Dalia Shkedy, and A. Herlinda Sandoval-Norton. "Early Intervention for an At-Risk 16-Month Old Using Visual Communication Analysis (VCA) Leads to Gifted Performance." Journal of Educational and Developmental Psychology 12, no. 1 (April 19, 2022): 76. http://dx.doi.org/10.5539/jedp.v12n1p76.
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Many developmental screeners focus heavily on receptive and expressive language skills, and the extent to which an infant can maneuver their environment. Research with young children typically involve motor skills, language, and occasionally simple procedural or problem solving tasks. The current study explores skills infants are expected to attain, and other skills that have never been tested in an infant who is considered “at-risk” due to moderate developmental delays.
Researchers collected data via specialized VCA software, video recordings, and the Vineland-3 pre- and post-study. The participant improved in all areas measured by the Vineland-3. Additionally, despite the participant being introduced to novel and progressively more difficult tasks, his average attention span throughout the entirety of the study was significantly longer than previous research suggests for infants. Researchers also implemented the detour box as a gross measure of frontal function. The participant successfully completed the detour task and multi-step problem solving.
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Stooss, Tanja, and Dorothee Ruckteschler. "International Commercial Courts: A Superior Alternative to Arbitration?" Journal of International Arbitration 36, Issue 4 (July 1, 2019): 431–49. http://dx.doi.org/10.54648/joia2019022.
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International commercial arbitration has long been the hallmark of international dispute resolution. However, with the increasing establishment of specialized English-speaking courts dealing solely with commercial disputes (‘International Commercial Courts’) the popularity of arbitration is being called into question. The phenomenon of International Commercial Courts is not completely new, but their number has significantly increased in recent times. In 2018 alone, China, the Netherlands, France, and Germany have, among others, announced the opening of specialized English-speaking courts and others are preparing to shortly follow their example. Whilst the arbitral process is often criticized for its costs, procedural delays, or lack of power against third parties, the question remains whether International Commercial Courts will be able to deal with these issues any better. This article first examines the history and the features of International Commercial Courts, with a special focus on those recently established in Europe, before evaluating whether they are – or might be in future – better suited to service the needs of international commerce.
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AH, Sandoval-Norton. "Early Intervention for an AtRisk 16-Month Old Using Visual Communication Analysis (VCA) Leads to Gifted Performance." Current Research in Psychology and Behavioral Science (CRPBS) 3, no. 1 (February 15, 2022): 1–5. http://dx.doi.org/10.54026/crpbs/1036.
Full textAbstract:
Many developmental screeners focus heavily on receptive and expressive language skills, and the extent to which an infant can maneuver their environment. Research with young children typically involve motor skills, language, and occasionally simple procedural or problem solving tasks. The current study explores skills infants are expected to attain, and other skills that have never been tested in an infant who is considered “at-risk” due to moderate developmental delays. Researchers collected data via specialized VCA software, video recordings, and the Vineland-3 pre- and post-study. The participant improved in all areas measured by the Vineland-3. Additionally, despite the participant being introduced to novel and progressively more difficult tasks, his average attention span throughout the entirety of the study was significantly longer than previous research suggests for infants. Researchers also implemented the detour box as a gross measure of frontal function. The participant successfully completed the detour task and multi-step problem solving
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Bola, S., A. Munnings, and R. Corbridge. "Preventing trauma during rigid oesophagoscopy in the edentulous patient: how I do it." Journal of Laryngology & Otology 134, no. 5 (May 2020): 458–59. http://dx.doi.org/10.1017/s0022215120000985.
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AbstractBackgroundRigid oesophagoscopy is a widely used therapeutic and diagnostic procedure. Smooth friction-free insertion of the rigid scope is important to prevent oral and oesophageal mucosal damage, as such damage can cause delays in oral intake or more serious complications such as perforation. Protection appliances such as gum guards are useful adjuncts to cushion the teeth in rigid oesophagoscopy; however, there are no specific adjuncts for the edentulous patient.MethodsIn order to investigate different adjuncts, the force required to pull a standard adult rigid oesophagoscope from a metal clamp whilst enclosed in dry gauze, wet gauze, a gum guard or sleek on gauze was recorded, and a prospective audit of post-procedural trauma was performed.Results and conclusionLess force was required to create movement of the scope against sleek on gauze, with a lower rate of oral trauma (8 per cent) compared to that reported in the literature. Sleek on gauze is recommended for the edentulous patient.
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Horwitz, Henry, and Patrick Polden. "Continuity or Change in the Court of Chancery in the Seventeenth and Eighteenth Centuries?" Journal of British Studies 35, no. 1 (January 1996): 24–57. http://dx.doi.org/10.1086/386095.
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No reader of Bleak House is likely to forget its scathing portrayal of the excesses of the unreformed Court of Chancery in the handling of Jarndyce v. Jarndyce. From its publication in 1852–53, it has created an indelible image of the Court, so powerfully influencing historians as well as laymen that it is sometimes hard to remember that it is fiction, and polemical fiction at that. The fiction, however, is built on a secure bedrock of fact; the voluminous testimony and submissions made by Dickens's contemporaries to a series of parliamentary inquiries on the legal system furnish ample backing for much of his “bill of complaint” on such scores as delay and expense, procedural technicality, and inconclusiveness of outcome. Thus, John Forster, a partner in one of the biggest firms in Lincoln's Inn, called the Court's delays “heart-sickening” and characterized its “modes of proceedings … as little adapted to the ordinary duration of human life as they are calculated for the determination of differences and the quiet of possessions”; in the same vein, a future master of the rolls averred that “cases have occurred, within my knowledge, in which the whole property to be administered in Chancery, has proved insufficient to pay the costs of the suit.”As with the early nineteenth-century attacks on the unreformed House of Commons and the traditional electoral system, denunciations of the Court of Chancery's failings have a long history and, often, a repetitive quality.