Littérature scientifique sur le sujet « Delayed referral »
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Articles de revues sur le sujet "Delayed referral"
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Eadington, D. W. « Delayed referral for dialysis ». Nephrology Dialysis Transplantation 11, no 11 (1 novembre 1996) : 2124–26. http://dx.doi.org/10.1093/oxfordjournals.ndt.a027123.
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ÇAVUŞOĞLU, Y. Hakan, Ayşe KARAMAN, İbrahim KARAMAN, Derya ERDOĞAN et İsmet Faruk ÖZGÜNER. « Delayed Referral of Congenital Anomalies ». Turkiye Klinikleri Journal of Medical Sciences 32, no 3 (2012) : 745–49. http://dx.doi.org/10.5336/medsci.2011-26349.
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Sengar, Mamta, Yousuf Siddiqui, Alisha Gupta et Anup Mohta. « Delayed referral for orchidopexy : Scrutinising the causes ». Tropical Doctor 52, no 1 (17 décembre 2021) : 27–29. http://dx.doi.org/10.1177/00494755211044614.
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Orchidopexy for undescended testis is recommended at a younger age than heretofore; our study aimed to assess delays, and their causes, by retrospective analysis of data from a single tertiary care centre over one year (2015–2016). Almost 80% of children were brought after 1 year of age, mostly because of delayed referral by primary physicians (60%), or missed diagnosis by parents or primary physicians (20%). Misconception about the risk of surgery below 1 year was significant (15%). A timely referral is encouraged.
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Jerónimo, Teresa, Anabela M. Guedes, André Fragoso, Ana Pimentel, Sandra Sampaio, Ana P. Silva, Viriato Santos, Idalécio Bernardo et Pedro L. Neves. « FP350THE ECONOMIC BURDEN OF DELAYED NEPHROLOGY REFERRAL ». Nephrology Dialysis Transplantation 30, suppl_3 (mai 2015) : iii185. http://dx.doi.org/10.1093/ndt/gfv175.32.
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Aklilu, Tamirat Moges. « Referral pattern of children with cardiac diseases : a cross-sectional review of referral documents in three teaching hospitals in Addis Ababa ». Ethiopian Journal of Pediatrics and Child Health 17, no 2 (28 décembre 2022) : 78–92. http://dx.doi.org/10.4314/ejpch.v17i2.2.
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Background: Patients with hemodynamically significant structural heart lesions often become inoperable if early referral and intervention is not done. Contrarily, referring patients with hemo-dynamically-insignificant lesions congest the already busy tertiary centers. The study aim was to determine the proportion of hemodynamically significant cases with delayed presentation and their determinant factors.
Methods: A cross-sectional study design was used to collect data from 369 referral slips sampled using a single population proportion formula (95% CI, 5% margin of error, and 50% cases coming with a referral paper). Data was analyzed using SPSS software package version 25. Binary logistic regression analysis was done to determine factors associated with referral either to the Tikur Anbessa hospital versus Saint Paul and Yekatit 12 hospitals. Odds ratio with their corresponding confidence interval was used to assess the significance of association and statistically significant associations were declared at p-value < 0.05.
Result: The overall magnitude of delayed presentation beyond 1 year of age among patients with hemodynamically-significant lesions was 54%. Saint Paul and Yekatit-12 hospitals combined had higher referral from primary institutions (AOR=2.68 95% CI-1.64-4.38, p<0.001). Tikur Anbessa hospital had higher referral of congenital heart disease and retention of feedback referral slips compared to the two hospitals (AOR=1.86, 95% CI-1.02-3.41, p=0.004) and (AOR=2.78, 95% CI-1.65-4.69, p<0.001). If the referring health worker was a specialist, and initial symptom was chronic and poly, the likely-hood of being referred to Tikur Anbessa Specialized hospital was higher (AOR=10.34, 95% CI-2.20-48.69, p=0.003) and 1.97, 95% CI-1.21-3.22, p=0.007) respectively. The time lapse between referral and reaching at the referral destination was longer in cases referred to TASH (AOR=2.91,95% CI-1.74-4.88), p<0.001). Feedback slips were sent back to the referring health facilities in only 3% of cases.
Conclusion: Delayed presentation of patients with hemodynamically significant cardiac lesions was tremendous. and unsent or retained feedback referral slips were significant. Future research should focus on active searching for causes of delayed presentation using a well-designed and validated tool.
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Zammit, Marthaclaire, Jackline Nyaberi, Susan Mambo et Careena Otieno. « A hospital-based survey assessing the health facility-level factors that contribute to delayed diagnosis of cervical cancer ; patients views ». Open Research Europe 4 (13 août 2024) : 175. http://dx.doi.org/10.12688/openreseurope.17697.1.
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Background In Kenya, Cervical Cancer is the 2nd commonly diagnosed type of cancer and the leading cause of cancer-related death among women. Globally, more than 50% of Cervical Cancer diagnoses are made late, with this proportion rising to 80% in developing countries. Poor Health systems can cause delays in diagnosis; thus, this study focused on determining the health facility level factors that contribute to delayed diagnosis among Cervical Cancer patients at Kenyatta National Hospital (KNH). Methods An analytical cross-sectional mixed method study was adopted to collect data on hospital and referral experiences from 139 Cervical Cancer patients systematically sampled at the KNH, using a semi-structured questionnaire. Associations between stage at diagnosis and hospital and referral experience were tested using a logistic regression model at a 95% Confidence Interval. Results 86 (61.9%) patients were diagnosed with advanced stages III and IV. The potential predictors for delayed diagnosis were a higher number of hospital referrals (p =0.000), facing referral challenges (p =0.041), longer time taken for diagnosis appointment (p =0.059), and longer time taken for diagnostic results (p =0.007) in the bivariate analysis. A higher number of hospital referrals (p =0.001) and longer time taken for diagnostic results (p =0.025) were significantly associated with delayed diagnosis of cervical cancer in the multivariate logistic regression test model. Referral challenges include misdiagnosis, cost of diagnosis, and prolonged diagnosis appointments. The study concluded that the advanced stage at presentation for most patients was due to poor health and referral systems, inadequate medical personnel, and diagnostic equipment. Conclusion This study recommends improving referral systems and encouraging partnerships to decentralize diagnostic centers and equipment and to train more experts on Cervical Cancer.
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Sved, Paul D., Michael K. Morgan et Neville C. Weber. « Delayed referral of patients with aneurysmal subarachnoid haemorrhage ». Medical Journal of Australia 162, no 6 (mars 1995) : 310–11. http://dx.doi.org/10.5694/j.1326-5377.1995.tb139907.x.
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Trevathan, E., et F. Gilliam. « Lost years : Delayed referral for surgically treatable epilepsy ». Neurology 61, no 4 (25 août 2003) : 432–33. http://dx.doi.org/10.1212/wnl.61.4.432.
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Cass, Alan, Joan Cunningham, Paul Snelling, Zhiqiang Wang et Wendy Hoy. « Urban disadvantage and delayed nephrology referral in Australia ». Health & ; Place 9, no 3 (septembre 2003) : 175–82. http://dx.doi.org/10.1016/s1353-8292(02)00037-0.
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A, Cass, Cunningham J, Snelling P, Wang Z et Hoy W. « DELAYED REFERRAL WORSENS LONG-TERM SURVIVAL ON DIALYSIS ». Nephrology 7, no 1 (février 2002) : A109. http://dx.doi.org/10.1046/j.1440-1797.2002.00007-1-109.x.
Texte intégralThèses sur le sujet "Delayed referral"
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Bungay, Hilary. « Pathways in the diagnosis and treatment of breast cancer : the significance of delay ». Thesis, University of Kent, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369686.
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Atkins, Kristi Laurine. « Early Intervention Referral Outcomes for Children at Increased Risk of Experiencing Developmental Delays ». PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/5100.
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Research has shown that children born low birth weight (i.e., ≤2500 grams) and/or premature (i.e., birth prior to 37 weeks gestation) are at increased risk of experiencing developmental delays, as well as long-standing executive functioning and academic challenges. Despite these well-known risks, children born low birth weight are under-enrolled nationally in Part C Early Intervention (EI) services intended to support developmentally vulnerable children. Little is known regarding why EI enrollment is low in this high risk population, especially given children born LBW are readily identifiable as at increased risk of delays at birth. This study explored EI referral outcomes from a high risk infant follow up program serving children with complex early medical histories that place them at increased risk of experiencing developmental delays to determine how many children referred to EI were ultimately evaluated and enrolled in the program. This explanatory sequential mixed methods study included a quantitative phase characterizing the EI referral outcome and a qualitative phase consisting of interviews with families to explore the parent/caregiver's experience of the EI referral process. Data analysis included descriptive statistics to characterize the sample and Pearson Chi Square and independent samples t-tests to investigate child characteristics associated with successful referral. Qualitative interviews were transcribed and coded for themes in an iterative and cyclical fashion. Results indicate that only 62% of the children who were referred for EI services were evaluated by the program, with about the same percentage of those evaluated being found eligible (67%). Of those who were not found eligible, about a third of children should have qualified based on previous testing and/or medical conditions. However, these qualifying medical conditions were often not clearly documented on the referral form, and not all forms included documentation of the scores from developmental testing. There were also a significant number (71%) of Oregon children referred to EI but never evaluated who were likely to have qualified based on medical history and/or results from developmental testing. There were several key themes identified following analysis of the qualitative interviews. Most critically, the parent/caregiver's perception of the need for the EI referral was identified as an essential factor in facilitating a successful connection to EI. Other key themes included the need to honor the many different demands placed on the caregivers of these high risk children, as well as the necessity of providing clear explanation of the purpose of both the visit to the high risk infant follow up program and the EI referral. The Chronic Care Model is used as a framework for discussing implications for practice.
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Chausset, Aurélie. « Accès aux centres de rhumatologie pédiatrique pour les patients atteints d’arthrite juvénile idiopathique : parcours diagnostique et évaluation des facteurs prédictifs d’un retard de prise en charge ». Electronic Thesis or Diss., Lyon 1, 2024. http://www.theses.fr/2024LYO10267.
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L'arthrite juvénile idiopathique (AJI) est la maladie rhumatologique pédiatrique chronique la plus fréquente. L’intérêt d’une prise en charge précoce et d’une orientation rapide vers un centre de rhumatologie pédiatrique (RP) a largement été démontré pour réduire le risque de lésions articulaires et/ou oculaires et améliorer la qualité de vie des enfants. Dans le monde, le délai d'accès (DA) médian au centre de RP varie de 3 à 10 mois, néanmoins il existe une grande variabilité avec des délais extrêmes de plusieurs années pour certains patients. Des travaux antérieurs ont porté sur l’identification des facteurs associés à un accès retardé au centre de RP, principalement sur des caractéristiques cliniques et biologiques. Cependant ils ne peuvent pas expliquer à eux-seuls les disparités constatées de parcours et de délais. Il nous a paru important d’étudier tous les paramètres pouvant rendre ces parcours complexes. Une première étude a été réalisée auprès de patients suivis en France et en Suisse à partir d’une cohorte internationale, la JIR-cohorte. Cette étude visait à identifier les déterminants individuels et environnementaux impactant le DA. Sur les 250 enfants de la cohorte avec un diagnostic d’AJI, le DA médian était assez court par rapport à la littérature (2,4 mois). Cependant, des disparités existaient : les enfants avec une arthrite associée aux enthésites ou ayant consulté un chirurgien orthopédique avaient des délais plus longs. L’éloignement par rapport au centre de RP et le lieu de résidence (urbain ou rural) n’avaient pas d’influence sur le DA. Bien que l'étude n'ait pas trouvé de lien direct entre le statut socio-économique et le DA, une tendance montrait que le niveau d'éducation des mères pouvait jouer un rôle dans un adressage plus rapide au centre de RP (favorisant une consultation plus rapide avec un médecin de premier recours). La deuxième étude, toujours à partir de la JIR-cohorte, s’intéressait aux différences de prise en charge entre la France et la Suisse et leur lien possible avec le DA. Les patients présentaient des DA médians similaires en France et en Suisse, bien que la Suisse présente un parcours moins complexe avec nombre plus faible d’intermédiaires médicaux avant l’accès au centre de RP. En France, les enfants voyaient souvent un généraliste en premier recours (60%), tandis qu’en Suisse, c’était un pédiatre dans 82% des cas, ce qui favorisait un accès plus direct au centre de RP. Enfin nous avons voulu explorer l'expérience des familles et des enfants avant l’établissement du diagnostic. Les résultats montraient que les parents jouaient un rôle clé dans le parcours diagnostic et qu’ils avaient eu besoin de solliciter leur entourage pour accéder plus facilement au centre de RP. Les premiers symptômes, souvent banalisés, pouvaient retarder l’accès au centre de RP. Les familles se heurtaient généralement à des médecins de premiers recours peu formés à l’AJI, ce qui entraînait des tensions et un sentiment d’incompréhension. L'annonce du diagnostic était un soulagement, mais les retards de prise en charge avaient des conséquences psychosociales, notamment chez les adolescents. La dernière partie de la thèse est une discussion des résultats obtenus et une mise en perspective avec des propositions concrètes. Renforcer la formation des médecins de premiers recours est une voie classique mais difficilement envisageable pour toutes les pathologies chroniques. L’amélioration de l’accès aux spécialistes repose également sur des décisions au niveau national qui mérite d’être mis en perspective avec toute l’organisation du parcours de santé des enfants. L’accent est mis également sur la nécessité d’une meilleure collaboration entre les acteurs du système de santé, et surtout sur l’importance d’intégrer les expériences et points de vue des enfants et de leurs parents dans les programmes de formation des médecins et de développer des supports adaptés pour faciliter le diagnostic et l'accès à l’informationJuvenile Idiopathic Arthritis (JIA) is the most common chronic pediatric rheumatologic disease. The importance of early management and timely referral to a pediatric rheumatology (PR) center has been widely demonstrated to reduce the risk of joint and/or eye damage and improve children's quality of life. Globally, the median time to access (TA) a PR center ranges from 3 to 10 months, but there is significant variability, with extreme delays of several years for some patients. Previous research has focused on identifying factors associated with delayed access to PR centers, mainly clinical and biological characteristics. However, these factors alone cannot fully explain the observed disparities in pathways and delays. It seemed important to us to study all the parameters that might complicate these journeys. A first study was conducted among patients followed in France and Switzerland, based on an international cohort, the JIR-cohort. This study aimed to identify individual and environmental determinants impacting TA. Among the 250 children in the cohort diagnosed with JIA, the median TA was relatively short compared to the literature (2.4 months). However, disparities existed: children with enthesitis-related arthritis or those who had consulted an orthopedic surgeon experienced longer delays. Distance from the PR center and place of residence (urban or rural) did not influence TA. Although the study did not find a direct link between socioeconomic status and TA, there was a trend suggesting that maternal education level could play a role in faster referral to the PR center (favoring a faster consultation with a primary care physician). The second study, also based on the JIR-cohort, examined the differences in care between France and Switzerland and their potential link to TA. Patients had similar median TA in both France and Switzerland, although Switzerland had a less complex pathway with fewer medical intermediaries before reaching the PR center. In France, children often saw a general practitioner as the first point of care (60%), while in Switzerland, it was a pediatrician in 82% of cases, which facilitated more direct access to the PR center. Finally, we wanted to explore the experiences of families and children before the diagnosis was established. The results showed that parents played a key role in the diagnostic journey and had to rely on their social network to access PR centers more easily. The initial symptoms, often trivialized, could delay access to the PR center. Families generally encountered primary care physicians who were not well-trained in JIA, which led to tension and a sense of misunderstanding. Receiving the diagnosis was a relief, but delays in care had psychosocial consequences, particularly for adolescents. The final part of the thesis is a discussion of the results and a reflection on concrete proposals for action. Strengthening the training of primary care physicians is a traditional approach but difficult to implement for all chronic diseases. Improving access to specialists also depends on national-level decisions, which should be considered in the context of the entire healthcare pathway for children. The emphasis is also placed on the need for better collaboration among healthcare providers and, most importantly, on integrating the experiences and perspectives of children and their parents into medical training programs and developing appropriate resources to facilitate diagnosis and access to information
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Johnson, Jessica Fry. « An Evaluation of the Early Steps Referral Process in Hillsborough County to Detect Delays in Access to Early Intervention Services ». Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3171.
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Early intervention services are important in obtaining better outcomes for infants with a developmental delay or a condition that may result in a delay. In Florida, a primary resource for providing these services is the Early Steps Program. This study analyzed the Early Steps referral process to identify barriers to prompt access. The guiding hypothesis was if differences exist in key outcomes of the referral process, then these differences may reveal where improvements can be made. Improving access to early intervention should produce better outcomes and reduce the costs of services required later by addressing developmental concerns earlier.
The dataset included records for 10,688 infants referred to the Hillsborough County Early Steps Program between 2006 and 2009. Two measures (age at referral and time to IFSP) represented points within the referral process where delays could be quantified. Age at referral is a measure of how long it takes for a delay to be identified and the infant referred for evaluation. The time from the referral to the date an IFSP is created provides a measure of the delay in beginning services.
Delays in obtaining a referral were associated with being referred by a family member, the referral code Developmental Delay At Risk and barrier codes Child/Family Issues and No Show/Unsuccessful Contact. Delays in completing the IFSP were related to being younger at referral, being referred by one of the sources that made less frequent referrals to Early Steps, an eligibility determination related to behavior concerns, maternal education that stopped at grade 8 or below and being Black.
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Whitehead, Nathan Robert. « Design and Measurement of StrongARM Comparators ». BYU ScholarsArchive, 2019. https://scholarsarchive.byu.edu/etd/8715.
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The StrongARM comparator is utilized in many analog-to-digital converters (ADCs) because of its high power efficiency and rail-to-rail outputs. The performance of the comparator directly affects the speed, power, and accuracy of an ADC. However, the StrongARM comparator performance parameters such as delay, noise, and offset measured directly from silicon prototypes are rare in literature and often consist of small sample sets. In addition, existing techniques to measure the comparator require large chip areas, making it impractical to characterize a large number of comparators to obtain stochastic parameters such as offset and noise. This work presents novel circuit techniques to measure a large number of comparators (4,000) in a compact chip area to directly obtain silicon data including delay, noise, offset, and power. The proposed techniques also relax the requirement on the test instruments to measure the small time values. Four comparators with different transistor size ratios have been designed and measured to study the performance tradeoffs. In addition, this work presents a method utilizing supercomputing resources to simulate the large design space of the StrongARM comparator to observe the performance trends. Measurements are compared to simulations showing their accuracy and, for the first time, detailed study on the performance trends with different transistor size ratios.
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Nilsson, Gunnar. « Ischaemic heart disease - risk assessment, diagnosis, and secondary preventive treatment in primary care : with special reference to the relevance of exercise ECG ». Doctoral thesis, Umeå universitet, Allmänmedicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-117149.
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Background: Ischaemic heart disease is a diagnostic and therapeutic challenge to most general practitioners. We sought to identify diagnostic characteristics and prognoses of patients in primary care that received exercise electrocardiography (ECG). We compared the ECG test results with respect to probability of subsequent cardiologist referrals. We also aimed to identify determinants for pre-hospital delays and lack of statin treatment before a first-time myocardial infarction (MI). Methods: Setting: Region of Jämtland Härjedalen, Sweden (adult population, approximately 99 000); study period 2010-2014. Patients and study designs: studies I and II: 865 patients referred to exercise ECG. Primary outcome: Incidence of cardiovascular events (I) and cardiologist referrals within six months after exercise ECG (II). Observed outcomes were compared to predictions from multivariable logistic models. Study III: 265 patients with first-time MI. Characteristics were analysed for determinants of pre-hospital delay ≥ 2 hours. Study IV: Survey of 931 patients with first-time MI. Analyses of characteristics associated with rates of statin treatment in patients with previously diagnosed cardiovascular diseases (CVD). Results: Study I: Exercise test results were associated with exertional chest pain, a pathologic ST-T segment on resting ECG, angina diagnosis according to the patient's opinion, and medication for dyslipidaemia. Cardiovascular events occurred in 52.7%, 18.3%, and 2.0% of patients with positive (ST-segment depression >1mm and chest pain indicative of angina), inconclusive (ST depression or chest pain), or negative tests, respectively. Study II: Positive or inconclusive exercise tests were associated with cardiologist referrals. Among patients with positive exercise tests, referral rates decreased with age, after adjusting for co-morbidity. Self-employed women were referred to cardiologic evaluations more often than other employed women. Study III: The first medical contact was a primary care facility for 52.3% of patients. The pre-hospital delay time was ≥ 2 h for 67.0% of patients in primary care and 44.7% of patients that called emergency medical services or were self-referred to hospital. Study IV: Among patients with prior CVD, 34.5% received current statin treatment before for the first MI. Statin treatment rates decreased with age, after adjusting for CVD and diabetes; women ≥70 years old were treated half as often as men of the same age. Conclusions: Clinical characteristics can be used to identify patients at low risk of cardiac events. The prognosis in patients with a negative exercise ECG was benign for six months after the exercise ECG. Exercise tests are important for selecting patients that require cardiologic evaluations. Age, gender, and employment status interacted with rates of referrals for cardiac evaluation. The pre-hospital delay time was considerably prolonged, particularly when primary care was the first medical contact. Only one third of patients with a prior CVD received statin treatment. Pre-MI statin treatment decreased with age, particularly among women ≥70 years old. In making medical decisions, it is necessary to be aware of biases regarding age, gender, and socioeconomic status. Methodologies for case finding and follow-up need to be improved and implemented in clinical practice. Keywords: Exercise ECG, Ischaemic heart disease, Myocardial infarction, Pre-hospital delay, Primary care, Prognosis, Referral, Statins, Secondary preventionSammanfattning på svenska: Bakgrund och syfte: Patienter med ischemisk hjärtsjukdom (IHD) utgör en diagnostisk och terapeutisk utmaning för läkare inom primärvården. Arbets-EKG är en vanlig metod vid utredning av patienter som söker till primärvården för besvär som kan vara förorsakade av IHD. Vi undersökte primärvårdspatienter remitterade till arbets-EKG, med avseende på de kliniska karakteristika (egenskaper och symtom) som kunde associeras med resultatet av arbets-EKG och med prognosen inom sex månader efter undersökningen. Vi jämförde arbets-EKG-svaren med avseende på efterföljande remittering för utredning vid hjärtklinik. Vi kartlade även faktorer av betydelse för tidsfördröjningen före sjukhusvård och för sekundärpreventiv behandling med kolesterolsänkande läkemedel (statiner), före insjuknande i hjärtinfarkt. Metod: De studier som ingår i avhandlingsarbetet (studier I-IV) genomfördes i Region Jämtland och Härjedalen, befolkningsunderlag cirka 99 000 personer i åldrar från 20 år och äldre, under åren 2010-2014. Undersökta patienter och studiedesign: Studier I och II: Prospektiv studie av 865 patienter undersökta med arbets-EKG, klassificerade som: positivt arbets-EKG (dynamisk ST-sänkning >1mm under arbetsprov och bröstsmärta typisk för kärlkramp), inkonklusivt (ST-sänkning eller bröstsmärta) eller negativt arbets-EKG. Utfallsvariabler: hjärt-kärlhändelser (instabil kärlkrampssjukdom, hjärtinfarkt, öppen kranskärlsoperation, ballongvidgning av kranskärl och kardiovaskulära dödsfall) (I) och remittering för utredning vid hjärtklinik inom sex månader efter arbets-EKG (II). Observerade hjärt-kärlhändelser jämfördes med förväntat utfall, enligt multivariabla statistiska modeller. Studie III: Retrospektiv studie av 265 patienter med förstagångs hjärtinfarkt, analyserade med avseende på faktorer av betydelse för tid från symtomdebut och till sjukhusvård, med brytpunkten två timmar eller längre tid för vård på sjukhus. Studie IV: Tvärsnittsstudie av 931 patienter med förstagångs hjärtinfarkt. Patienter med tidigare hjärt-kärlsjukdom analyserades med avseende på statinbehandling före hjärtinfarkten. Resultat: Studie I: Faktorer associerade med arbets-EKG-resultatet (positivt eller inkonklusivt svar mot negativt svar) var: ansträngningskorrelerad bröstsmärta före arbetsprovet, ST-T-segmentsförändringar på vilo-EKG, kärlkrampsdiagnos enligt patientens egen bedömning, samt medicinering för förhöjda kolesterolvärden i blodet. Hjärt-kärlhändelser inträffade i 52.7%, 18.3%, och 2.0% bland patienter med positivt, inkonklusivt respektive negativt arbets-EKG. Studie II: Resultatet från arbets-EKG styrde remitteringen av patienter till hjärtklinik, med högre sannolikhet för remiss efter positivt test. Bland patienter med positivt arbets-EKG remitterades färre patienter vid stigande ålder, justerat för tidigare känd hjärt-kärlsjukdom. Egenföretagande kvinnor blev oftare remitterade än andra kvinnor, justerat för ålder, bröstsmärtesymtom och arbets-EKG-svar. Studie III: I 52.3% av samtliga fall var primärvården (personligt besök eller via telefonrådgivning) den första vårdkontakten för patienter med förstagångs hjärtinfarkt. Tidsfördröjningen före sjukhusvård var 2 timmar eller mer bland 67.0% av alla patienter från primärvården och 44.7% bland de patienter som först ringde larmcentralen (112) eller sökte direkt till sjukhusets akutmottagning. Studie IV: Patienter med tidigare konstaterad hjärt-kärlsjukdom hade en pågående statinbehandling i 34.5% av fallen, före insjuknandet i förstagångs hjärtinfarkt. Andelen patienter med pågående statinbehandling avtog med stigande ålder, justerat för diabetes och tidigare hjärt-kärlsjukdom. Kvinnor från 70 år och äldre erhöll statinbehandling hälften så ofta som jämförbara män. Slutsats: Patienter med låg risk för hjärt-kärlhändelser kan identifieras före remittering till arbets-EKG, med hjälp av kliniska karakteristika. Patienter med negativt svar på arbets-EKG har en god prognos, med få hjärt-kärlhändelser inom sex månader efter arbetsprovet. Urvalet av patienter som remitteras för fortsatt hjärtutredning styrs av resultatet från arbets-EKG, men interaktioner mellan ålder, kön och anställningsförhållanden påverkar sannolikheten för remittering. Tiden från symtomdebut och till sjukhusvård var avsevärt fördröjd, särskilt för de patienter som primärt kontaktade primärvården. Endast en tredjedel av alla patienter med tidigare konstaterad hjärt-kärlsjukdom hade en pågående statinbehandling vid hjärtinfarktinsjuknandet. Andelen patienter med pågående statinbehandling avtog med högre ålder, särskilt bland kvinnor från 70 års ålder och äldre. En ökad medvetenhet om hur ålder, kön och social ställning påverkar den medicinska beslutsprocessen är angelägen. Metoder för bättre identifiering och uppföljning av riskpersoner behöver utvecklas och införas i den medicinska verksamheten. Nyckelord och förklaringar: Arbets-EKG (kliniskt arbetsprov på ergometercykel med samtidig EKG-registrering), positivt arbets-EKG (talar för kärlkrampssjukdom), negativt arbets-EKG (talar för frånvaro av sjukdom). EKG (elektrokardiografi), hjärtinfarkt, ischemisk hjärtsjukdom (sjukdomstillstånd med otillräcklig blodtillförsel till hjärtat), sekundärprevention (förhindra återinsjuknande i tidigare genomliden sjukdom).
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Lagerstedt, Marianne. « Komplexa operationer i en komplex vårdform : om ledning, ledningsbehov och möjligheter till ledning för säkrare vård i hemmet ». Licentiate thesis, KTH, Patientsäkerhet, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-95388.
Texte intégralRésumé :
Advanced home care (ASIH) enables the patient to stay at home rather than to stay hospitalized in connection with severe medical conditions, while simultaneously this Thesis demonstrates that this is in fact not completely unproblematic and without risk. This partly because ASIH proves to be a complex form of care with many different kind of collaterally ongoing care contacts and efforts of care and concern, partly since ASIH concurrently can assume an overview over the treatment process and collaboration or cooperation between several treatment agents from different kinds of organizations and/or operations during all hours. This composes a relatively new heterogenetic and multifaceted context of care which to the professional practice means both new and less known problems within patient safety, which substantially can obstruct and rule out both the completion and the implementation of a safe home care. The Thesis is based upon an exploratory case study of problems within patient safety in correlation with an advanced home care, and where the research study has had its starting position in the professional practice with an interactive and qualitative research approach. The case study houses two part studies which show that the patient safety problems can be related to an intermediary and multi-organizational form of care, rather than an single operation. A command and control view upon the problems of patient safety, which the professional practice faces, show that missions within the frame of the care form ASIH can be regarded as either a complicated and not rarely a complex operation consistent with Alberts & Hayes (2007) and Brehmers (2008a; 2009c) terminology and where the assignments includes dynamic decision tasks. The case study reveals that the patient safety problems which concretely can obstruct and rule out the completion or implementation of the assignments in a safe way, can be considered related to the layout of the description of the assignments and also a lack of operative and tactical command and control level (of the handling and care of patients) in correlation with the different sorts of assignments that prevails – coincidentally as there is no suitable organization (forums of cooperation) and no appropriate IT-resources for the liaisons which effectively manages to promote and support the forms of cooperation that the character of the assignments also needs. The implicit system of conduct which comes forth through the analysis indicates that there is a need of improvement in order to enable effective command and control for a safer care, since the form of the system of conduct according to Brehmer´s (2006a,b; 2007a,b; 2008a,b; 2009c, 2010, 2011) model fails to satisfy the needs set by the function of command and control. The conclusion of the case study is that advanced home care should be regarded as an intermediary and multi-organizational care form which includes dynamic decision tasks and character wise complex operations contemplated per patient, thus demanding substantial command and control resources, a new point of view upon management and new auxiliary means of management in order to maintain a safe care during the implementation. The hypothesis which has been crystallized during the conclusions of the case study is that a more effective control and command and appropriate auxiliary means of command and control in real time, concerning primarily the handling of patients at the time of a change in care form, can improve the conditions of work in the professional practice and also result in more patient time, which consequently can be expected to contribute to concept of “Good care” i.g. cost effective, patient safe and dignified care.QC 20120525
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Chawdhary, Ayesha Bartholomew L. Kay Sharma Shreela. « Delays in diagnosis and referral and treatment for hematologic malignancies ». 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1467396.
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Chiang, Yu-hsuan, et 江雨璇. « A Study of Public-private Partnership—The Case of Children with Developmental Delay Reporting Referral System in Yunlin Country ». Thesis, 2006. http://ndltd.ncl.edu.tw/handle/42836321065319735075.
Texte intégralRésumé :
碩士南華大學
公共行政與政策研究所
94
Since 1980''s, "Privatization" is gradually valued by countries. Western countries realize that the power of big government is still deficient in some sectors. Public sectors have big power but not use in right place, and also lack efficiency, lack competition, and monopolize public service. This makes government losing its sensitive but would stimulate privatization coming up. Government start to push monopolize public sector, and then apply policy of privatize to entrust folk to conduct or transfer to privative organization. The process should take all responsibility of public sectors, and pass on to operate by private sectors or markets. The privatization establishment is showing the relation that between public sectors and private sectors, and develops partnership of the two sectors.With tendency of privatization and more coordinated between public sectors and private sectors, the Public-Private Partnership is developed. In 2003, Children with Developmental Delay Reporting Referral System had established in Yunlin County, and this system commissioned to center of Taiwan Fund Children and Family in Yunlin. Public-Private Partnership is still in developing, and how to establish a good interaction process will be urgency in the moment. Therefore, the thesis will introduce outlook of public-private partnership for public and private sectors and group of policy target, and further confer partnership in between public sectors and private sectors.
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Chang, Ching-yi, et 張靜儀. « On the Public Accountability and Autonomy of Public-private Partnership : The Case of Children with Developmental Delay Reporting Referral Center in Chaiyi ». Thesis, 2010. http://ndltd.ncl.edu.tw/handle/47177502881795265376.
Texte intégralRésumé :
碩士南華大學
公共行政與政策研究所
98
The transform of whole political and economic structures has led to a new model for countries to execute public policies, i.e. partnerships between governments and nonprofit organizations. Besides, internal and external factors have caused partnerships to be realized in the public policy such as rise of private participation, trends toward civilization of state-owned enterprises and a change of public management type recently. This study aims to understand what is the relationship between accountability and autonomy in nonprofit organizations with focus on how the public-private partnership is developed and goes when they interact with governments. In addition, finding a balance between accountability and autonomy is another main idea in this thesis. This research is qualitative, which will be done through the literature analysis and semi-unstructured interview. The outline for interviews is organized by referring to the literatures on the system and partnerships theories and therefore, three main concepts can be derived from them including administrative coordination (forcible means,) resource dependency (incentives and motives,) and degree of trust (normativity.) The study concludes that administrative coordination does help public sector and third sector seek a consensus and establish some rules of game governing mutual responsibilities and obligations, and resource dependency helps reach organizational goals by making resources exchanged and interactions closer. Additionally, a higher degree of trust can intensify the partnerships in a long term and increase the willingness of cooperation. In the conclusion, several suggestions presented are the ideas that may direct researchers who will study the same issues in the future to think of in different ways. “Contracting-out” is the latest trend in the new public management movement and when mentioning accountability and autonomy, considered a kind of important and classic discussions in the literatures on the partnerships between governments and nonprofit organizations. This research finds that institutionalized accountability from public sector is not necessary to impact the autonomy of third sector. However, a better way to help development of nonprofit organizations is to adopt self-regulation as a primary strategy and regulation as a second one.
Livres sur le sujet "Delayed referral"
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Mawhood, Lynn. The referral of language-delayed children for speech therapy : An investigation of the factors affecting age at referral. London : Central School of Speech and Drama, 1985.
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Delayed Entry Referral Program. [Washington, D.C.?] : The Army, 1990.
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Sierakowski, Adam, David Warwick et Roderick Dunn. Vascular. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198757689.003.0018.
Texte intégralRésumé :
Vascular pathology in the hand may present to many different specialties, and delayed referral to hand specialists is not unusual. We provide an overview of vascular hand anatomy and pathophysiology to enable early diagnosis and treatment. We discuss general assessment of vascular hand pathology, including vascular anomalies, vascular injury, and Raynaud’s disease. It is important to understand the diagnosis and emergency surgical treatment of compartment syndrome of the upper limb which if unrecognized can lead to permanent loss of function from post-ischaemic fibrosis (and may be less anticipated than lower limb compartment syndrome).
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Nick, Gallus. 4 Temporal Jurisdiction over Acts before the Period of Limitation. Oxford University Press, 2017. http://dx.doi.org/10.1093/law/9780198791676.003.0004.
Texte intégralRésumé :
Regardless of the date of entry into force of the obligation allegedly breached, or of the acceptance of its jurisdiction, a tribunal might not hear a claim if it was brought too long after the challenged act, commonly referred to as a ‘time limit’ or ‘time bar’ on a claim, or an application of a ‘statute of limitations’. This chapter addresses the effect of treaty provisions that prevent a tribunal from hearing delayed claims. It addresses the effect of all such provisions, even though some affect the admissibility of a claim rather than the tribunal’s jurisdiction. The chapter then examines whether, in the absence of a treaty provision that limits a tribunal’s ability to hear a delayed claim, general principles of law impose a similar restriction.
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Mathiesen, Amber, et Kali Roy. Common Indications. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190681098.003.0005.
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This chapter describes common reasons for referral to a perinatal genetic counselor including age-related risks, personal and family history, ultrasound anomalies, teratogen exposure, recurrent pregnancy loss, and preconception counseling. Maternal and paternal age-related pregnancy risks are described, such as aneuploidy, single-gene conditions, and autism. A referral for a personal and/or family history of various conditions including single-gene conditions, aneuploidy, multifactorial conditions, birth defects, intellectual disability, developmental delay, autism, and consanguinity is described. The chapter reviews ultrasound anomalies and describes common ultrasound findings associated with aneuploidy, and hallmark ultrasound findings associated with particular genetic conditions, as well as identification of open neural tube defects. Teratogen exposure during pregnancy is discussed, including timing, dose, and duration and a description of typical features and symptoms associated with common teratogens. The chapter reviews the evaluation of pregnancy loss and stillbirth, male and female infertility, and referral for preconception counseling.
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Emond, Alan, et James Law. Supporting children with developmental disorders and disabilities. Sous la direction de Alan Emond. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198788850.003.0024.
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At least 10% of children have a development disorder which could be disabling. Many children with developmental conditions can be identified in pregnancy or shortly after birth, or will be referred from a child health programme with atypical or delayed development. Early identification of developmental disorders helps children to achieve their potential and facilitates support to their families. Assessment by a multidisciplinary child development team should lead to the provision of family-friendly services coordinated by a lead professional. Children require packages of care, provided through Education, Health, and Care plans/child plans to optimize learning. To meet families’ needs for information, family support, and respite, coordinated packages need to be commissioned from health and social care, education, and the voluntary sector.
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Stephens, Paul, et Roderick Dunn. Soft tissue injuries of the hand. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198757689.003.0006.
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Soft tissue injuries of the hand are common and may present variously to therapists, general practice, emergency departments, or surgeons. Simple injuries can be treated without specialist input, but the majority of hand trauma should be referred to dedicated hand surgery centres. Diagnostic error and delayed specialist treatment may lead to poor outcomes and long-term disability. This chapter provides a detailed overview for non-specialists, as well as an aide memoire for hand surgeons and hand therapists. It includes the principles of general wound care, the management of nail injuries, the treatment of extravasation and high-pressure injection injuries, and gunshot wounds. We describe different levels of upper limb amputation, as well as microvascular reconstruction (both replantation and revascularization). We also cover thermal injuries (burns and frostbite), trauma-induced cold sensitivity, and factitious injury.
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Kohn, Robert, Jessica Warner, Wendy Verhoek-Oftedahl et Emily Murphy. Elder Abuse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199374656.003.0021.
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There are five principal domains of elder abuse: physical abuse, psychological abuse, sexual abuse, neglect, and financial abuse. This chapter discusses the prevalence, prediction, and assessment of elder abuse as well as other factors related to abuse. The incidence of elder abuse is 24 times greater than the number of cases referred to social service, law enforcement, or other legal authorities. Caregiver factors, rather than risk factors associated with the abused elder, may be more important in predicting abuse. Lack of compliance with medical regimens, delay in seeking medical care, disparity in explanations given for injuries, unexplained injuries, and implausible or vague explanations may be warning signs. Elder financial victimization can be classified as door-to-door scams, professional swindles, and caregiver abuse. Elder abuse increases mortality, emergency room visits, hospitalizations, and skilled nursing home placement. The psychiatric assessment may raise red flags of suspected elder abuse and may necessitate reporting to adult protective services. Interventions should be tailored to the circumstances and the resources available.
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Holloway, Cheryl D. The Black Woman’s Breast Cancer Survival Guide. ABC-CLIO, LLC, 2017. http://dx.doi.org/10.5040/9798400619861.
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Breast cancer is reaching epidemic levels, especially among black women. This survival guide provides tools that women–black women in particular–can use to identify and combat this all-too-common threat. This "what you need to know" guide is unique in its common sense, "laywoman's" approach and particular relevance to women of color. Its premise is simple: ignorance and lack of education about breast cancer signs and symptoms are still all too prevalent among black women. Many women are not informed about resources available for early detection screening and are not referred for mammography screening. They may also receive significantly delayed treatment–especially black women. For those reasons and more, black women with or at risk for breast cancer need an advocate who speaks for them and tells them the truth. They have that advocate in Cheryl Holloway, PhD–and in this book. A breast cancer survivor and cancer researcher, Dr. Holloway draws on her personal experience and research to offer something far different than the usual medical/oncological works. Her book provides support, current information, and practical advice for confronting and beating the disease. The book is divided into four parts. "Dealing with the Basics" explains how breast cancer hits black women harder and discusses the types of breast cancer they may develop, with an emphasis on the most dangerous. The second section offers practical information, such as how screenings work and the meaning of various breast cancer tests. Part three describes treatments, including surgery, radiation therapy, chemotherapy, hormone therapy, combined therapy, and other options. The final section describes how to stay vigilant after the cancer is gone and also discusses other forms of cancer for which black women are at risk, such as lung cancer, colon cancer, and cervical cancer.
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Huber, Kurt, et Tom Quinn. Systems of care for patients with acute ST elevation myocardial infarction (STEMI networks). Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0042.
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Although primary percutaneous coronary intervention is the preferred strategy for patients with ST elevation myocardial infarction, offering a fast access to this procedure often remains difficult, because of local resources and capabilities and a lack of cooperation and organization. Accordingly, for most countries worldwide, primary percutaneous coronary intervention can be provided for only part of the population. Moreover, not all patients referred for primary percutaneous coronary intervention receive an optimal mechanical reperfusion within the recommended time intervals with the procedure performed in an experienced centre by an experienced team. Intravenous thrombolytic therapy, preferably administered pre-hospital and as part of a pharmacoinvasive strategy, offers a reasonable therapeutic option in selected cases. Network organization is central to offering fast and optimal reperfusion treatment in the individual case. It has been shown repeatedly that an early recognition of ST elevation myocardial infarction, as well as minimizing time delays, is important for the achievement of optimal clinical results. These findings should encourage the building up of regional networks, according to specific local constraints, and the monitoring of their effectiveness by ongoing registries. Financial, regulatory, and political barriers can be resolved, and a prompt guideline-recommended care becomes feasible and affordable if stakeholders and participants agree and cooperate.
Chapitres de livres sur le sujet "Delayed referral"
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Cui, Shiliang, Zhongbin Wang et Luyi Yang. « Referral Priority Programs ». Dans Innovative Priority Mechanisms in Service Operations, 75–98. Cham : Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-30841-3_5.
Texte intégralRésumé :
AbstractThis chapter presents a model of the referral priority program, an emerging business practice adopted by a growing number of technology companies that manage a wait list of customers. It enables existing customers on the wait list to gain priority access if they successfully refer new customers to the wait list. Unlike more commonly used referral reward programs, this novel mechanism does not offer monetary compensation to referring customers but leverages customers’ own disutility of delays to create referral incentives. Despite this appealing feature, our queueing-game-theoretic analysis finds the effectiveness of such a scheme as a marketing tool for customer acquisition, and an operational approach for wait-list management depends crucially on the underlying market conditions, particularly the base market size of organic customers. The referral priority program does not generate referrals when the base market size is either too large or too small. When customers do refer, the program could actually backfire, namely, by reducing the system throughput and customer welfare, if the base market size is intermediately large. This phenomenon occurs because the presence of referred customers severely cannibalizes the demand of organic customers. We also compare the referral priority program with the referral reward program and find that the referral priority program is more profitable when the base market size is intermediately small. We further solve for the optimal scheduling rule of the referral priority program and find that in addition to full priority and FIFO, partial priority and strategic delay can also emerge in the optimal mechanism. This chapter is primarily based on Yang and Debo (Manag Sci 65(5):2231–2248, 2019) and Yang (Manuf Serv Oper Manag 23(5):1139–1156, 2021) where interested readers can find proofs of the results shown in this chapter.
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Setiawan, Budi. « Implementation of SISTRO (Truck Scheduling System) to Enhance Supply Chain Efficiency and Performance to Support Industrial Revolution 4.0 in Petrokimia Gresik ». Dans Proceedings of the 19th International Symposium on Management (INSYMA 2022), 1078–85. Dordrecht : Atlantis Press International BV, 2022. http://dx.doi.org/10.2991/978-94-6463-008-4_133.
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AbstractSISTRO, a truck scheduling and management system, was developed to optimize stock fulfillment following the government regulation (Peraturan Menteri Perdagangan/Permendag) and the distribution process of subsidized fertilizer from Gresik Warehouse of PT Petrokimia Gresik (PG) to Buffer Warehouse located in almost every province in Java Island. The volume that must be distributed is around 5.4 million tons of fertilizer/year. During the implementation, a critical problem is the lack of integration and single information about the supply chain and truck loading process. The information includes (1) truck arrival delay, (2) the difference between planning and reality, and (3) the availability of workers. These three pieces of information are out of sync, so they have direct and indirect impacts. The direct impact is the potential for unscheduled open storage (OPS) in Gresik warehouse. At the same time, the indirect impact is the high logistics costs in the form of land transportation cost increases every year and the potential to lose the opportunity/moment to sell goods due to delays in fertilizer distribution. Therefore, a solution is needed by creating an integrated system to accommodate related parties in truck schedule arrivals, stock availability, and labor availability in the loading line warehouse, hereinafter referred to as SISTRO. The SISTRO’s scope of work starts from the distribution of quota allocations for heavy loading that has been adjusted to stock conditions and loading capacity in each warehouse so that the truck vendors can book the loading plan according to the schedule they want, based on the POSTO that has been uploaded on the SISTRO application and partners will get a booking code. The booking code will later be printed as a security pass. The security pass will later be scanned at all SISTRO checkpoints, which is proven can reduce the number of late arrivals for trucks to load appropriately from an average of 1.361 events/month to just 553 events/month. This project impacts several sectors, including reducing the risk of losing chances to sell goods that previously averaged 24,034 tons/month equivalent to Rp. 110 billion/month, a decrease in the OPS quantity (which is currently happening due to oversupply that does not match with quantum distribution). There has been no increase in inland transportation costs for 3 years and monitoring all license numbers and transportation partners so that there is no combined number of registration numbers. In fact, SISTRO can be used by all logistics companies.
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Wilson, G. R., P. A. Nee, J. S. Watson et R. K. Harrison. « Septic arthritis ». Dans Emergency Management of Hand Injuries, 137–38. Oxford University PressNew York, NY, 1997. http://dx.doi.org/10.1093/oso/9780192628244.003.0043.
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Chandra Sahoo, Krushna. « Traditional Treatment for Rheumatoid Arthritis ». Dans Rheumatoid Arthritis [Working Title]. IntechOpen, 2021. http://dx.doi.org/10.5772/intechopen.99258.
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The most prevalent musculoskeletal disorder is rheumatoid arthritis (RA). The main concern with RA is extreme fatigue, pain, and weakness. Patients having severe pain are compelled to take medications containing a variety of indigenous substances. These indigenous substances, on the other hand, exacerbated illnesses and delay in seeking appropriate healthcare. Treatment is delayed due to a number of reasons, including patients’ lack of access to trained healthcare professionals, delays in referral to a rheumatologist, and patients’ belief on traditional healing practices. The choice of inappropriate healthcare providers often causes a delay in referral to a rheumatologist. Self-medication and seeking treatment from traditional healers are often compelled the patient to engage in a variety of traditional practices. Cultural values have a significant influence on care-seeking behavior. Since healthcare promotion is dictated by community demands, the healthcare system should understand the contextual phenomena behind common practices for better health education. This chapter will address the beliefs and values that underpin traditional treatment, the sources of traditional learning pathways and ethical aspects of traditional practice.
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Davidson, Mayer. « Case 72 : Delayed Response to NPH Insulin By Mayer B. Davidson, MD ». Dans Diabetes Case Studies : Real Problems, Practical Solutions, 267–70. American Diabetes Association, 2015. http://dx.doi.org/10.2337/9781580405713.72.
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A 58-year-old lean woman with type 2 diabetes was referred to the diabetes clinic for control of her diabetes. Diabetes was diagnosed 12 years ago and she had been taking insulin for 1 year after failing oral medication. Her insulin regimen at the time of referral was 20 units of NPH insulin before breakfast and 12 units before supper. Her BMI was 25.1 kg/m2 and her HbA1c level was 9.5%. She was motivated to improve her control. Table 72.1 summarizes our initial experience with her. Glucose values (mg/dL) are the range (median). The interval between visits was 3 weeks unless otherwise noted.
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Fulginiti, Adriana, Frank Borao, Martin Michalewski et Robert A. Graebe. « From Open to Minimally Invasive : The Sacrocolpopexy ». Dans Hysterectomy - Past, Present and Future [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.101308.
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With an increased demand for pelvic organ prolapse surgeries as the population ages, mesh-related osteomyelitis will become more prevalent. This case series enriches the paucity of data on management options for delayed osteomyelitis related to pelvic organ prolapse mesh. A literature review revealed no case reports of delayed onset osteomyelitis presenting up to a decade after colpopexy mesh placement. We present three cases of delayed osteomyelitis, their presentation, diagnosis and management at a tertiary academic referral center. Patients presented between 1 and 10 years after mesh colpopexy. Three different mesh materials were utilized during the initial procedures: Restorelle Y, Gynamesh and Gore-Tex mesh. The first case demonstrates failed expectant management with eventual surgical intervention on a medically compromised patient. The two subsequent cases describe elective complete mesh resection after several prior failed mesh revision attempts. This short case series and literature review illustrates that mesh-related osteomyelitis after a remote sacrocolpopexy carries significant morbidity. Mesh removal by means of minimally invasive surgery in the hands of an experienced surgical team utilizing DaVinci Robotic System is a good option and may lead to best patient outcomes.
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Stein, Michael D., et Sandro Galea. « Healthy Homes ». Dans Pained, 227–30. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780197510384.003.0065.
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This chapter looks at how 16 million American children live in poverty, putting them at risk for delayed development, disease, and poor educational outcomes. The Earned Income Tax Credit (EITC) is a pro-work, federal tool that has reduced or eliminated poverty for 13.2 million children. However, 20% of eligible households do not claim this tax credit. To lower the US poverty rate, which has plateaued, how might health systems help families maximize this economic credit? A 2018 program suggests it is possible to connect EITC-eligible families to free tax preparation through physician referral, fliers included with visit reminders, in-clinic advertising, and calls to families with upcoming appointments in the pediatric clinic, offering tax services 15 to 25 hours weekly, including evenings and weekends. The program was associated with increased filing rates, receipt of EITC, and use of free tax preparation, all of which increase money for low-income families. Finding such clever, convenient ways to make better use of federal policies to reduce poverty one family at a time creates a novel community resource.
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Swindall, Rebecca, William Sorensen et Andria Horton. « Developmental Screening in Young Children : Subsequent Impacts in Academic Performance, Self-Management, and Parental Knowledge ». Dans Physical and Mental Health and School Adjustment - Contextual, Psychological Variables and Performance in School Settings [Working Title]. IntechOpen, 2024. https://doi.org/10.5772/intechopen.1008322.
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Developmental delays in children occur in communication, motor skills, problem-solving, and personal-social domains. Clinicians often overlook developmental delays. Studies show 1 in 6 of all children have a developmental delay, with increased prevalence if a child lives in an economically disadvantaged home. These delays are burdensome to individuals, families, education systems and society. Our aim was to launch an intervention by increasing developmental screenings through community collaboration. A non-profit collaborated with childcare centers to conduct center wide screenings, referrals for identified delays, and 4-month follow-up screenings with continued referral support. From November 2023 to February 2024, 617 Ages and Stages Questionnaires (3rd edition) were distributed. Of the caregivers who responded, 29.9% were at high or moderate risk of a developmental delay or had a caregiver concern (N = 80). We connected and provided referrals to 48% of those respondents. At the 4-month follow up, 84.6% of caregivers reported they followed through with referrals received and 83% reported developmental improvements; working with their child was the most cited factor for the progress (31%). The aim of this study was met; the authors subsequently speculate on short- and long-term consequences of this intervention not only for the child, but also for the caregiver and future school performance.
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Michael Anyaeze, Chineme. « Common Genitourinary Fistulas in Rural Practice : Treatment and Management ». Dans Rural Health [Working Title]. IntechOpen, 2021. http://dx.doi.org/10.5772/intechopen.99116.
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Acquired genitourinary fistulas are common in rural practice. They are pathological communications between the urinary and genital tracts, or between either of the tracts and gastrointestinal tract or skin. Vesicovaginal fistula is the commonest and most devastating. They may result from prolonged and obstructed labor, injuries during obstetric, gynecologic, pelvic and urologic procedures, circumcision, fall from heights, road traffic accidents and female genital mutilation. They present as urinary leakage with characteristic odor. Diagnoses are mainly clinical and confirmed by dye tests, contrast radiography and endoscopy. Treatment is individualized according anatomic sites and etiology. Timing of repair is of essence; delayed repair for obstetric and early for focal injuries. Multidisciplinary team approach and cooperation is encouraged in the management of some of these cases. The sustenance of the 2 – way referral system is emphasized in cases beyond the scope of rural practice. Repairs when undertaken by skilled compassionate fistula surgeons with attention to principles of fistula management and surgical treatment, success rate can approach 90%. Interposition of vascularized grafts have improved success rate. The burden of this condition will be reduced through integration of rural practitioners in the preventive strategies of health education of the public and girlchild; improvement of healthcare, education and transportation infrastructures.
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Luiza Bejenaru, Paula, Raluca Grigore, Bogdan Popescu, Alexandru Nicolaescu, Mihnea Cojocărița-Condeescu, Catrinel Simion-Antonie, Gloria Berteșteanu et al. « Pharynx Reconstruction and Quality of Life ». Dans Pharynx – the Incredible Rendezvous Sites of Gas, Liquid and Solid [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.104411.
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Patients who are diagnosed with squamous cell carcinoma of the pharynx have a first delayed presentation, with advanced stages of the disease. Therefore, they frequently require a multimodal approach—by surgery, radio, and chemotherapy. Due to anatomic spatial limits and particularities, therapy can imply large organ resection with difficulties in reconstruction. Nowadays, there is a paradigm shift in the management of this pathology, with significant first referral to oncology departments and initiation as the first line of treatment of radio/radio-chemotherapy. As a consequence, salvage surgery may be mandatory in some selected cases. The proposed chapter will address the oncological particularities of the pharynx, with a focus on the oro- and hypopharynx, ways of reconstruction after oncological ablative surgery of these segments, and impact on quality of life (QoL) index. Speech, respiratory, and deglutition rehabilitation of these patients is essential and will be a distinct topic. This paper will have the structure of a literature review with clinical examples of reconstruction from ENT and Head and Neck Surgery Department of Coltea Clinical Hospital, Bucharest. Reconstruction methods used in our clinic are regional flaps and biocompatible prostheses in advanced stages. QoL index in our clinic is assessed with questionnaires developed by the European Organization for Research and Treatment of Cancer – EORTC QLQ C30.
Actes de conférences sur le sujet "Delayed referral"
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Nissen, Jeffrey, et Cody Torno. « On-Machine Inspection for Rotorcraft Manufacturing ». Dans Vertical Flight Society 72nd Annual Forum & Technology Display, 1–5. The Vertical Flight Society, 2016. http://dx.doi.org/10.4050/f-0072-2016-11487.
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The inspection step of rotorcraft component fabrication is critical to the manufacturing process. Inspection is essential for demonstrating that component quality meets engineering requirements and tolerances. Engineering specifications often require components to undergo coordinate measuring machine (CMM) inspections more than once during manufacturing. Off-line CMM inspection can introduce lengthy delays due to CMM backlogs and/or operator availability. The ability to perform inspections while the manufactured component remains in-position (on the machining platform) presents an opportunity to eliminate set-up time, reduce manufacturing span and lower inspection costs. The capability, referred to as On-Machine Inspection (OMI), has been implemented at Bell Helicopter on a large machining system to inspect several military and commercial composite components. An innovative calibration artifact and validation method is described. The approach ensures high inspection integrity and allows for rapid manufacturing resolution when data anomalies occur. The use of OMI on a main rotor yoke has resulted in a dramatic reduction in manufacturing span and inspection duration.
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Leyakathali Khan, Shahul, Fawad Zaman et Elizabeth Schofield. « Patient's Delay And Referral Delay, Do They Still Contribute To Delayed Diagnosis Of Lung Cancer ». Dans American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California. American Thoracic Society, 2012. http://dx.doi.org/10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a4411.
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Lamas, Daniela J., Steven M. Kawut, Nisha Philip, Selim M. Arcasoy et David J. Lederer. « Delayed Referral To A Tertiary Care Center Is Associated With Higher Mortality In Idiopathic Pulmonary Fibrosis ». Dans American Thoracic Society 2011 International Conference, May 13-18, 2011 • Denver Colorado. American Thoracic Society, 2011. http://dx.doi.org/10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a5298.
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Wu, Hon Lin, Salma Mahmoud et Timothy Gatheral. « Effect of delayed secondary care referral on morbidity and mortality in idiopathic pulmonary fibrosis patients treated with antifibrotics ». Dans ERS International Congress 2019 abstracts. European Respiratory Society, 2019. http://dx.doi.org/10.1183/13993003.congress-2019.pa1329.
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Dell'Anna, G., F. V. Mandarino, E. Fasulo, A. Barchi, F. Azzolini, L. Fanti, E. Viale et al. « Endoscopic Management of Delayed-Gastric-Emptying after Esophagectomy in a Tertiary Referral Center : comparison between different endoscopic procedures ». Dans ESGE Days 2024. Georg Thieme Verlag KG, 2024. http://dx.doi.org/10.1055/s-0044-1783236.
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Ostovar, R., T. Claus, M. Hartrumpf, M. Erb, M. Zytowski, F. Schröter, M. Laux et M. Albes. « MitraClip Implantation : A Word of Caution Regarding an All Too Liberal Indication and Delayed Referral to Surgery in Case of Failure ». Dans 48th Annual Meeting German Society for Thoracic, Cardiac, and Vascular Surgery. Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0039-1678769.
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Ferreira Filho, Darley de Lima, Nancy Cristina Ferraz de Lucena Ferreira et Thais Ferreira. « ANALYSIS OF WOMEN WITH BREAST CANCER SUBMITTED TO IMMEDIATE OR DELAYED BREAST RECONSTRUCTION ». Dans Brazilian Breast Cancer Symposium 2022. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s2071.
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Objective: Breast reconstruction is a right guaranteed by the public health system to patients undergoing mastectomy. However, there are factors that delay the performance of this procedure, mainly in the single health system. This study aims to analyze the characteristics of immediate or delayed reconstructions in women with breast cancer in a referral hospital in the state of Pernambuco (Barao Lucena Hospital). Methods: This is an observational, retrospective, analytical research with a descriptive approach of 400 cases of breast reconstruction from 2010 to 2020. Data were collected through a clinical-surgical questionnaire from patients with breast carcinoma who underwent reconstruction mammary, being later analyzed by the SPSS software version 18 with the percentages of the categories evaluated by the chi-square test, considering the level of significance of 5%. The comparison of analyses was significant (p <0.005), demonstrating that the profile described is the most frequent in the group of patients evaluated. CAAE: 42457420.1.0000.5193. Results: Most patients were with a mean age between 46 and 59 years (45.3%), mixed race (61.1%), married (79.1%), with schooling up to high school (60.7%), housewives (45 %), non-smokers (84.9%), and do not consume alcohol (94.9%). Using the TNM system, 84% of the patients were in the initial stages, underwent immediate reconstruction after mastectomy or sectorectomy (70.3%), and the reconstruction surgeries with regional flaps such as inferior, superior, or mediolateral and implants were performed in 70% of the patients. According to the molecular subtype, luminal A represented 60% of the patients, followed by luminal B with 16%, triple-negative with 15%, and HER2 with 9%. Conclusion: The findings support the fact that patients with high educational levels are able to immediately undergo breast reconstruction. We conclude that the number of immediate breast reconstructions in patients with breast cancer has a significant increase.
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Pasquier, E., P. Lissouba, AM Moore, OO Owolabi, H. Chen, TN Williams, C. Schulte-Hillen et al. « High severity of abortion complications in fragile and conflict-affected settings : AMoCo, a mixed-methods cross-sectional study in two referral hospitals in sub-Saharan Africa ». Dans MSF Scientific Day International 2023. NYC : MSF-USA, 2023. http://dx.doi.org/10.57740/pq3n-my95.
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INTRODUCTION Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. We aimed to describe the severity of abortion-related complications and contributing factors in two MSF-supported referral hospitals; one in a rural setting, northern Nigeria, and one in the capital city, Bangui, in the Central African Republic (CAR). METHODS This cross-sectional mixed-methods study included four components: 1) a clinical study using prospective review of medical records for women presenting with abortion-related complications between November 2019 and July 2021; 2) a quantitative survey among hospitalized women, to identify contributing factors for severe complications; 3) a qualitative study to understand the care pathways of women with severe complications; and 4) a knowledge, attitude, and practice (KAP) survey among health professionals providing post-abortion care in the two hospitals. The clinical study and the quantitative survey used the methodology of the WHO multi-country study on abortion led in 11 sub-Saharan African countries in stable contexts. ETHICS This study was approved by the MSF Ethics Review Board, the Central African Republic’s Comité Scientifique Chargé de la Validation des Protocoles d’Etude et des Résultats de Recherche en Santé, and by the Guttmacher Institute International Review Board. RESULTS 520 and 548 women comprised the clinical study enrollees for the Nigerian and CAR settings, respectively; of these, 360 and 362, respectively, participated in the quantitative survey. Of these women, 66 in Nigeria and 18 in CAR were interviewed for the qualitative study. Lasty, 140 and 84 health providers in Nigeria and CAR, respectively, participated in the KAP survey. The severity of abortion complications was high: 348 (67%) and 278 (50,7%) of women had a severe complication (potentially life-threatening, near-miss, or death) respectively in Nigerian and CAR hospitals. The KAP survey showed that almost 60% and 91% of health providers in Nigerian and CAR hospitals respectively, personally knew a woman who had died from abortion complications. Among women who did not have severe bleeding (146 in Nigeria and 231 in CAR), anemia was nonetheless frequent, affecting 66.7% of women in Nigeria and 37.6% in CAR. Among women participating in the quantitative survey, 23% in Nigeria and 45% in CAR reported having induced their abortion. Among them, 97% in Nigeria and almost 80% in CAR used unsafe methods. In CAR, qualitative data indicated that these included unsafe instrumental evacuations performed by unskilled individuals, and self-administered decoctions of traditional ingredients such as herbs, roots, or vegetables, ingested either alone or in combination with pharmaceutical drugs. In Nigeria, 50% did not want to be pregnant but fewer than 3% reported using contraception at the start of the index pregnancy. In CAR, 56% did not want the pregnancy, but 37% of women reported using contraception at its start. Women faced long delays accessing care, with 50% of hospitalized women in both settings taking two or more days to reach adequate post-abortion care after the onset of symptoms. Nevertheless, delays were worse in Nigeria where 27% took six days or more to access those care, versus 16% in CAR. Qualitative data indicated that factors implicated in longer delays included delayed recognition of danger signs necessitating medical care, unsuccessful attempts to self-manage symptoms, internalized stigma causing fear of disclosure among women reporting induced abortion, and in Nigeria, requiring permission to seek care. In both settings, structural barriers associated with lack of capacity and low quality of care in local health care structures, and transport difficulties to access adequate care also increased delays. Lastly, despite restrictive legal environments in both contexts, the KAP survey revealed that most health providers (74% in Nigeria and 67% in CAR) considered that access to safe abortion care was the right of every woman. CONCLUSION Our data suggests a higher severity of abortion-related complications, as compared to WHO data from African hospitals in more stable settings. Factors that could contribute to such high severity include greater delays in accessing post-abortion care, decreased access to contraception and safe abortion care, resulting in unsafe abortions; and food insecurity leading to iron deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high-quality post-abortion care, to prevent and manage complications of abortions in fragile and conflict-affected settings. CONFLICTS OF INTEREST None declared
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TA, Haj-Hassan, Amer M, Al-Jubori K, Salim H, Hameed A, Thanon K et Dewez JE. « The implementation of continuous positive airway pressure in a humanitarian content : The experience of Médecins sans Frontières in Mosul, Iraq ». Dans MSF Paediatric Days 2024. NYC : MSF-USA, 2024. http://dx.doi.org/10.57740/f0fo0r.
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BACKGROUND AND OBJECTIVES Continuous Positive Airway Pressure (CPAP) is recommended for neonates with respiratory distress. CPAP is widely used in high-income countries, but less so in low- and middle-income settings. Here we assess key aspects of implementing CPAP in a humanitarian setting and describe the initial cohort of neonates treated, along with their clinical outcomes. METHODS MSF implemented CPAP in a basic neonatal unit in Mosul following the request of the local medical team. Implementation of two bubble CPAP machines included initial training and refresher training one year later. Clinical data was recorded over 16 months (13 April 2021- 21 July 2022). Descriptive statistics were used to assess the feasibility and outcomes of using CPAP in this setting. RESULTS CPAP was well accepted by most healthcare workers and parents. 93 neonates were placed on CPAP. 98% of patients had a birthweight >1.5Kg. The main indications were respiratory distress syndrome, pneumonia, transient tachypnoea, and meconium aspiration (46%, 22%, 16%, and 14% respectively). Average duration on CPAP was 53 hours. 63% of patients recovered, 8% were discharged against medical advice, 9% were referred, and 15% died. Among the 15 patients who died at our facility or at the referral facility, 7 had a contraindication to CPAP, and the initiation of CPAP was delayed in 9 patients. Complications included minor nasal lesions (17%), irritability (8%), and pneumothoraces (5%). DISCUSSION Most patients improved with CPAP and were discharged home. 5% of patients developed pneumothoraces, which is in keeping with other reports. However, among patients who did not improve, a significant proportion had contraindications to CPAP initiation and/or were placed on CPAP in extremis, highlighting the importance of clear indication criteria and training. Using CPAP in a humanitarian setting may be feasible but is associated with high human resource needs for both training and practice.
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Otsuka, Kenju, et Jyh-Long Chern. « Coexistence of Two Attractors in Lasers with Incoherent Delayed Feedback ». Dans Nonlinear Dynamics in Optical Systems. Washington, D.C. : Optica Publishing Group, 1992. http://dx.doi.org/10.1364/nldos.1992.mc5.
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Delay-induced complex dynamics in lasers have been investigated in various schemes, such as rich phenomena, in semiconductor lasers with external feedback,1 and quasiperiodicity in CO2 lasers with electro-optic feedback.2 Recently, we proposed high-speed picosecond pulse generation in semiconductor lasers with incoherent delayed feedback.3 The basic idea was derived from successive carrier modulation by delayed feedback light whose polarization direction is rotated to be orthogonal to the lasing light. Such a feedback scheme is referred to as incoherent feedback.4 We showed theoretically that periodic spiking oscillations can be excited in a short-delay regime, i. e., delay time ≪ carrier lifetime. In this paper, we extend this scheme to general class-B lasers and investigate dynamics in wide parameter regions.
Rapports d'organisations sur le sujet "Delayed referral"
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Atkins, Kristi. Early Intervention Referral Outcomes for Children at Increased Risk of Experiencing Developmental Delays. Portland State University Library, janvier 2000. http://dx.doi.org/10.15760/etd.6976.
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Wallace, Ina F. Universal Screening of Young Children for Developmental Disorders : Unpacking the Controversies. RTI Press, février 2018. http://dx.doi.org/10.3768/rtipress.2018.op.0048.1802.
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In the past decade, American and Canadian pediatric societies have recommended that pediatric care clinicians follow a schedule of routine surveillance and screening for young children to detect conditions such as developmental delay, speech and language delays and disorders, and autism spectrum disorder. The goal of these recommendations is to ensure that children with these developmental issues receive appropriate referrals for evaluation and intervention. However, in 2015 and 2016, the US Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care issued recommendations that did not support universal screening for these conditions. This occasional paper is designed to help make sense of the discrepancy between Task Force recommendations and those of the pediatric community in light of research and practice. To clarify the issues, this paper reviews the distinction between screening and surveillance; the benefits of screening and early identification; how the USPSTF makes its recommendations; and what the implications of not supporting screening are for research, clinical practice, and families.
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Leis, Brian, et Tom McGaughy. PR-185-163731-R01 Time-delayed Failure in X65 Moderate-toughness Line-pipes. Chantilly, Virginia : Pipeline Research Council International, Inc. (PRCI), mai 2018. http://dx.doi.org/10.55274/r0011483.
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A gouge, or a dent and gouge in pipelines can fail at a constant pressure after some period of time has elapsed, and is commonly referred to as a time-delayed failure. Such behavior has been observed both in the laboratory and in the field. Older pipelines are more likely to fail during or immediately after damage due to limited toughness. Tougher modern pipelines can survive significant damage and can be susceptible to stable tearing upon re-rounding of the damaged pipe. Under certain circumstances, this combination of factors has the potential to promote delayed failure over a period of time. Incident experience indicates that for modern line pipe steels this combination of factors can lead to failures with significant consequences. This combination, coupled with the expanding use of inline inspection (ILI) by which previously undetected damage might be identified, points to the need to better understand the response of such features as the basis to develop guidelines for integrity management and for first responders dealing with more immediate concerns. Results are presented for a total of eight axial part through-wall defects in X65 pipes subjected to step-increasing sustained pressures, until a leak or instability occurred at one of the features. The associated test pressure histories were designed to simulate field conditions that are relevant to service at 72% of specified minimum yield stress (SMYS), as well as at 100% of specified minimum yield stress, as might occur in a hydrotest.
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Pantig, Ida Marie, Lovely Ann Tolin, Xylee Javier et Valerie Gilbert Ulep. Analysis of the National Health Expenditure Survey Round 1 and Design of Survey Protocol for NHES Round 2 (Phase 1). Philippine Institute for Development Studies, février 2023. http://dx.doi.org/10.62986/dp2023.01.
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From 2018 to 2021, the Department of Health (DOH), with assistance from United States Agency for International Development-Health Policy Plus (USAID-HP+) and European Union-Philippine Health Sector Reform Contract, implemented a National Health Expenditure Survey (NHES). The NHES consists of two components: a household survey (NHES-HC) and a medical provider survey (NHES-MPC). Healthcare use and financing information provided by select NHES-HC respondents are cross-referenced during the NHES-MPC with their health facility records. Intended as a regular tool to inform decisionmaking on health sector reforms, DOH plans to implement a second round of NHES by 2022 to 2023. DOH commissioned the Philippine Institute for Development Studies to redesign the NHES questionnaires to address the challenges encountered during its first round of implementation, capture critical facets of the Universal Health Care agenda, and revise the sampling design to consider panel surveys and be representative at the regional level. NHES Round 1 related reports, datasets, and documentation obtained from DOH were reviewed to identify the recommendations. The first round of NHES yielded rich information on health-seeking behavior and utilization, healthcare billing, healthcare expenditure, financial protection, and quality of care. The recommendations of USAID-HP+ on NHES tools are valid and sufficient as enhancements for the next round of NHES. The health utilization, expenditure, and financial information that can be collected through NHES are adequate. In NHES-HC, questions on referral; primary health care; components of out-of-pocket spending; and delay in health-seeking behavior are proposed to be added. Health facilities visited by respondents for primary care, as well as referring and/or referral facilities identified in NHES-HC with health care events in the last 6 months, are recommended to be subject to the conduct of the proposed NHES-MPC Supplemental questionnaire. Deleted questions for the next round do not necessarily mean discontinued questions but could be collected intermittently for certain rounds, particularly if NHES will be implemented as a panel survey. If so, the frequency and interval between rounds shall determine if there are sections, subsections, or questions that can be omitted in some rounds. In the meantime, some questions are proposed to be removed due to space constraints and consideration for respondent fatigue in general in lieu of other proposed questions to be explored. The abovementioned recommendations, however, are subject to change pending discussions with DOH for priority specifications and indicators. In terms of NHES sampling methodology, due to data limitations, it is proposed to use the same Round 1 sampling design with a 12,500 sample size or up to 15,625 if interested in conducting NHES as a panel design. The additional 25 percent accounts for possible attrition in the next round.
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Cvijić, Srdjan, Nikola Dimitrov, Leposava Ognjanoska Stavrovska et Ivana Ranković. Bilateral Disputes and EU enlargement : A Consensual Divorce. Belgrade Centre for Security Policy, mai 2024. http://dx.doi.org/10.55042/xubk6023.
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Bilateral disputes between European Union member states and candidate countries are one of the key obstacles to EU enlargement. They have been plaguing the EU accession process ever since the breakup of Yugoslavia and the subsequent border dispute between EU member Slovenia and candidate country Croatia which then ensued. More recently we have the case of North Macedonia. It became a candidate country in 2005 but ever since, its accession negotiations have been bogged down by endless bilateral disputes. While the case of North Macedonia and its decades long conflicts with Greece and Bulgaria are the most well-known of such cases, they are not the only ones. In a seminal 2018 publication the Balkans in Europe Policy Advisory Group (BIEPAG) outlined the most prominent “open” or “latent” disputes between EU member states and candidate countries in the Western Balkans. Ranging from border to territorial disputes, or ones concerning the status of national minorities, four out of five candidate countries in the region – Albania, Bosnia and Herzegovina, North Macedonia or Serbia, has a bilateral dispute with one or more EU member states. If you look at new candidates Ukraine and Moldova and potential candidate Georgia however, the list of active or potential bilateral disputes is even longer. Even when a candidate country meets the criteria to progress in EU accession talks, bilateral disputes can delay it for years or even decades as in the case of North Macedonia. In this way such disputes present a serious challenge to the credibility of the EU enlargement process. In the context of the war in Ukraine, as we have seen with regard to the policies of Viktor Orbán’s Hungary towards Ukraine, invoking bilateral disputes can seriously challenge the geopolitical orientation and the security of the entire Union. On the legal side, since most of these issues fall outside the scope of the EU law and are not covered by the accession criteria, there is a need to think of an institutional mechanism to deal with bilateral disputes. Enlargement policy does not offer an appropriate platform for settlement of bilateral disputes, especially for those that fall outside the EU law. Hence, these issues should be addressed via the international legal dispute resolution toolbox and thus be subjects of separate processes. The EU’s role however cannot be passive. It should invest efforts in these processes in order for them to be mutually reinforcing and so that the accession process has a mollifying rather than tension amplifying effect on the issue. In its policy brief, published at the end of 2023, the European Council on Foreign Relations (ECFR) proposed updating the Copenhagen criteria such that they should include a stipulation to resolve bilateral issues between member states and candidate countries through external dispute resolution mechanisms: Territorial disputes should be referred to arbitration or the International Court of Justice, while those on minority rights should be dealt with by the European Court of Human Rights and other appropriate dispute settlement mechanisms. In this policy brief we suggest ways how to operationalise this proposal. First, we describe different types of vertical bilateral disputes (the ones that include asymmetrical relations) between EU members and Western Balkan candidate countries, then we outline international mechanisms to resolve them, and finally we propose an institutional architecture to remove bilateral disputes that fall outside of the scope of the Copenhagen criteria and the EU acquis from the purview of EU accession talks.
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UK-wide study reveals a pattern of delay in referrals to specialist end-of-life care. National Institute for Health Research, août 2018. http://dx.doi.org/10.3310/signal-000635.
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Traditional birth attendants in maternal health programmes. Population Council, 2003. http://dx.doi.org/10.31899/rh2003.1017.
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Despite the tremendous resources invested in training Traditional Birth Attendants (TBAs) over the past two decades, scientific evidence from around the world has shown that training TBAs has not reduced maternal mortality. Any improvement observed when TBA training programs have been introduced was because of the associated supervision and referral systems, and the quality of essential obstetric services available at first referral level. Conversely, evidence has shown reduced maternal and perinatal morbidity and mortality when women have a “Skilled Attendant” (a qualified health care provider who has midwifery or obstetric skills) present at every birth. Thus, national safe motherhood programs, including in Kenya, are now focusing on increasing the number of Skilled Attendants, whether a woman delivers in a facility or at home. Since TBAs are highly regarded by their communities, it is critical that they still be enabled to play a role in improving maternal health. As noted in this brief, the continued preference for TBAs in Western Province can be attributed to their proximity to the woman’s home, respectful attitude toward women, and flexible modes of payment. Problems can arise, however, when TBAs delay seeking skilled care for women in difficult labor.