scholarly journals Regulation of Triage in Times of a Pandemic: Experiences from Slovenia (and Beyond)

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Luka Mišič ◽  
Grega Strban
Keyword(s):  
Medical Treatment ◽  
Healthcare Providers ◽  
Professional Organizations ◽  
Medical Services ◽  
Professional Conduct ◽  
Medical Practitioners ◽  
Legal Rules ◽  
Medical Standards ◽  
Private Autonomy ◽  
The One

The article offers an overview of legal regulations governing (medical) triage in Slovenia and their importance in times of the Covid-19 epidemic. Focusing on the Patients’ Rights, Health Care and Health Insurance, Medical Services, and Health Services Act, it looks at ways in which legal rules and medical standards intertwine when it comes to deciding who should receive particular limited medical treatment first or in what order. It also deals with ways in which professional rules of conduct or medical standards may, on the one hand, exclude the unlawfulness of particular conduct, and how, on the other hand, law may limit the autonomy of medical practitioners. Both the autonomy in their professional conduct as well as healthcare providers’, but especially professional organizations’ law-making autonomy. Even if grounded in the Slovenian legal order, the present article by nature surpasses its domestic boundaries, since the Covid-19 epidemic created similar issues in several if not in all European jurisdictions. Even more so, since the article addresses several general challenges concerning triage in times or moments of crisis, such as state’s positive obligations, recognition of patients’ private autonomy, medical treatment abroad, ethical deliberations concerning a just distribution of scarce medical services, etc.

Prescribing and medication-initiation roles based on the perspectives of rural healthcare providers in a study community in Queensland

2013 ◽  
Vol 37 (2) ◽  
pp. 172 ◽  
Author(s):  
Amy C. W. Tan ◽  
Lynne M. Emmerton ◽  
H. Laetitia Hattingh
Keyword(s):  
Rural Communities ◽  
Health Service ◽  
Medical Treatment ◽  
Nurse Practitioners ◽  
Health Professionals ◽  
Rural Areas ◽  
Healthcare Providers ◽  
Rural Healthcare ◽  
Medical Practitioners ◽  
Rural Settings

Objective. There are recognised health service inequities in rural communities, including the timely provision of medications, often due to shortages of qualified prescribers. The present paper explores the insights of rural healthcare providers into the prescribing and medication-initiation roles of health professionals for their rural community. Methods. Forty-nine healthcare providers (medical practitioners, pharmacists, nurses, occupational therapists, a dentist and an optometrist) from four neighbouring towns in a rural health service district in Queensland participated in face-to-face semistructured interviews. The interviews explored medication supply and management issues in the community, including the roles of health professionals to address these issues. The interviews, averaging 45 min in duration, were recorded, transcribed and qualitatively analysed for general trends and unique responses. Results. Participants recognised the potential for dentists, optometrists and nurse practitioners to reduce the prescribing workload of rural medical practitioners, and there was some support for a ‘continued dispensing’ model for pharmacists. Medication-initiation orders by endorsed registered nurses were also valued in providing timely medical treatment in rural hospitals. Conclusions. Rural communities have unique needs that require consideration of multidisciplinary support to assist medical practitioners in coping with prescription demands for timely medical treatment. What is known about the topic? Extension of prescribing rights to non-medical prescribers has been a topic of considerable debate in Australia for some decades. Several extended-prescribing or medication-initiation roles were established to supplement and support the medical workforce, particularly in rural areas, where health service inequalities and inefficiencies in prescribing and provision of medications are recognised. To date, workforce dynamics and legislative boundaries have restricted the eventual number of rurally located non-medical prescribers. What does this paper add? Little research has been conducted to investigate or evaluate the application of prescribing or medication-initiation roles in rural settings from a multidisciplinary approach. This paper provides the perspectives of rural healthcare providers on the prescribing and medication-initiation roles across health professions. Key findings from this rural-engagement exercise are considered valuable for policymakers and health service planners in optimisation of the prescribing or medication-initiation models. The qualitative methods also added richness and depth to the discussion about these roles. What are the implications for practitioners? According to the literature review and other media, extended prescribing roles are not universally accepted. However, some of the roles are being developed and implemented. Hence, it is important for health practitioners to embrace the roles and optimise their application. Specifically in rural settings, it is also important to recognise the value of multidisciplinary support and collaboration within the limited health workforce.

Current Practices and Challenges of Medical Services on Health Care System of Mandalay General Hospital

2019 ◽  
Vol 31 (2) ◽  
pp. 131
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Health Care Providers ◽  
Quality Care ◽  
Healthcare Providers ◽  
Medical Services ◽  
Tertiary Level ◽  
Care Providers ◽  
Level Hospital ◽  
Care System

In Myanmar, the main challenge to provide quality healthcare by Universal Health Care approach is documented as low health services coverage with substantial wealth-based inequality. To achieve the effective health care system, strong medical care system is essential. Understanding on challenges and needs in provision of medical services among patients and health care providers is critical to provide quality care with desirable outcomes. The aim of the study was to explore the patients’ and health care providers’ perceptions on the challenges in provision of medical services at the Mandalay General Hospital. This was a qualitative study conducted at the tertiary level hospital (Mandalay General Hospital). The data was collected by using focus group discussions and in-depth interviews with hospitalized patients or attendants, healthcare providers such as medical doctors, nurses, laboratory scientists and hospital administrators in March 2017. The qualitative data was analyzed using themes by themes matrix analysis. Most patients were satisfied with the care provided by the doctors because they believed that they received quality care. However, some patients complained about long waiting time for elective operation, congested conditions in the ward, burden for investigations outside the hospital for urgent needs and impolite manners of general workers. Healthcare providers reported that they had heavy workload due to limited human and financial resources in the hospital, poor compliances with hospital rules and regulation among patients and attendants, and inefficient referral practices from other health facilities. Other challenges experienced by healthcare providers were lack of ongoing training to improve knowledge and skills, limited health infrastructure and inadequate medicinal supplies. The findings highlighted the areas needed to be improved to provide quality health care at the tertiary level hospital. The challenges and problems encountered in this hospital can be improved by allocating adequate financial and human resources. The systematic referral system and hospital management guidelines are needed to reduce workload of health staff.

scholarly journals SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1076.1-1077
Author(s):  
L. Moroni ◽  
L. Giudice ◽  
G. A. Ramirez ◽  
S. Sartorelli ◽  
A. Cariddi ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Clinical Characteristics ◽  
Granulomatosis With Polyangiitis ◽  
Balloon Catheter ◽  
Subglottic Stenosis ◽  
Damage Accrual ◽  
The Mean ◽  
The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

When Mathematics Teacher Educators Come Under Attack

2018 ◽  
Vol 6 (2) ◽  
pp. 68-74
Author(s):  
Rochelle Gutiérrez
Keyword(s):  
Teacher Education ◽  
Mathematics Education ◽  
Mathematics Teacher ◽  
Teacher Educators ◽  
Mathematics Teacher Education ◽  
Professional Organizations ◽  
Mathematics Teacher Educators ◽  
And Mathematics ◽  
The One ◽  
Historical Moment

We are in an interesting historical moment in mathematics teacher education. On the one and, there is greater realization within our field of the connections between systems of power and mathematics (O'Neil, 2016). We are starting to acknowledge how mathematics education can be viewed as dehumanizing for both students and teachers as well as what might constitute rehumanizing practices (Gutiérrez, in press). Our professional organizations are calling for teachers to move beyond simplistic notions of equity to understand these power dimensions and challenge the system on behalf of (and in community with) Black,1 Indigenous,2 and Latinx3 students in particular

scholarly journals RELEVANSI HUKUM DAN HAK ASASI MANUSIA DENGAN AGENDA REFORMASI: DIMENSI NASIONAL DAN INTERNASIONAL

2020 ◽  
Vol 5 (2) ◽  
pp. 350
Author(s):  
Ismail Marzuki ◽  
Faridy Faridy
Keyword(s):  
Human Rights ◽  
Social Interactions ◽  
Social Order ◽  
Reform Agenda ◽  
Legal Rules ◽  
Recognition Respect ◽  
Protection Of Human Rights ◽  
The Law ◽  
The Difference ◽  
The One

In life, humans certainly cannot be separated from their social interactions with others. Friction between individuals or between nations is something that is inevitable. That is because the understanding of the legal system and culture of a different society. The difference in opinion certainly needs to be harmonized by not locking up the meeting room of everyone's expression. From here, the existence of legal rules/norms on the one hand becomes important in people's lives. On the other hand, the recognition, respect and protection of human rights are also important to be accommodated. Therefore, this article examines the law as a means of maintaining social order, and human rights as a set of rights that describe the existence of human freedom in expressing their actions, and how relevant they are to the reform agenda, namely enforcing the law against violators of human rights seriously, both in national and international.

scholarly journals Comparative International Law

2018 ◽  
Keyword(s):  
International Law ◽  
International Norms ◽  
Domestic Institutions ◽  
Legal Norms ◽  
Legal Rules ◽  
Diverse Backgrounds ◽  
Geographic Differences ◽  
Similarities And Differences ◽  
Cross Country ◽  
The One

By definition, international law, once agreed upon and consented to, applies to all parties equally. It is perhaps the one area of law where cross-country comparison seems inappropriate, because all parties are governed by the same rules. However, as this book explains, states sometimes adhere to similar, and other times adopt different, interpretations of the same international norms and standards. International legal rules are not a monolithic whole, but are the basis for ongoing contestation, in which states set forth competing interpretations. International norms are interpreted and redefined by national executives, legislatures, and judiciaries. These varying and evolving interpretations can, in turn, change and impact the international rules themselves. These similarities and differences make for an important, but thus far largely unexamined, object of comparison. This is the premise for this book, and for what the editors call “comparative international law.” This book achieves three goals. The first is to show that international law is not a monolith. The second is to map the cross-country similarities and differences in international legal norms in different fields of international law, as well as their application and interpretation with regards to geographic differences. The third is to make a first and preliminary attempt to explain these differences. The book’s contributors include leading international law and comparative law scholars with diverse backgrounds, experience, and perspectives. It is organized into three broad thematic sections, exploring: conceptual matters, domestic institutions and comparative international law, and comparing approaches across issue-areas.

scholarly journals Developing a professionalism and harassment policy for organized neurosurgery

2021 ◽  
pp. 1-2
Author(s):  
Ellen L. Air ◽  
Katie O. Orrico ◽  
Deborah L. Benzil ◽  
Alan M. Scarrow ◽  
James R. Bean ◽  
...  
Keyword(s):  
Professional Growth ◽  
Professional Organizations ◽  
Scientific Debate ◽  
Home Institution ◽  
Diverse Community ◽  
The One ◽  
Harassment Policy ◽  
Prompt Response

Annual conferences, educational courses, and other meetings draw a diverse community of individuals, yet also create a unique environment without the traditional guard rails. Unlike events held at one's home institution, clear rules and jurisdiction have not been universally established. To promote the open exchange of ideas, as well as an environment conducive to professional growth of all participants, the leading neurosurgical professional organizations joined to delineate the expectations for anyone who participates in sponsored events. The One Neurosurgery Summit Taskforce on Professionalism and Harassment developed a foundational policy that establishes common expectations for behavior and a unified roadmap for the prompt response to untoward events. We hope that publishing this policy will inspire other medical organizations to establish their own meeting and conference policies. More importantly, we wish to bring greater attention to everyone's responsibility for ensuring a safe and respectful space for education, scientific debate, and networking during organized events.

Shaping Comprehensive Emergency Response Networks

2014 ◽  
pp. 26-48 ◽  
Author(s):  
W. Treurniet
Keyword(s):  
Emergency Response ◽  
Large Scale ◽  
Critical Infrastructure ◽  
Focal Point ◽  
Professional Organizations ◽  
Internal Resources ◽  
Response Planning ◽  
Response Network ◽  
Response Organization ◽  
The One

Given its nature, a crisis has a significant community impact. This applies in particular to emergencies: crises that arise quickly. Because of the complex and multifaceted nature of large-scale incidents, the response requires coordinated effort by multiple organizations. This networked collaboration is not solely restricted to professional organizations. In responding to an incident, the affected community can itself be an important source of information and capabilities. This chapter discusses how one can shape a trustworthy and decisive response organization in which relevant and useful capacities available in the community are incorporated. This discussion has two focal points. The first focal point is the role of the affected community in the case of an emergency. On the one hand, an emergency affects the fabric of the community, such as the critical infrastructure. On the other, a community has inherent internal resources that give it resilience and capacity to respond in a crisis. This needs to be reflected in the choice of emergency response planning model. The second focal point is the structure of the emergency response network. An emergency response network is a mixed-sector network. This means that coordination is needed among organizations and collectives with differing strategic orientations.

A general framework for assessing fitness for work

2013 ◽  
pp. 1-20 ◽  
Author(s):  
Keith T. Palmer ◽  
Ian Brown
Keyword(s):  
General Framework ◽  
Medical Information ◽  
Health And Safety ◽  
Pension Scheme ◽  
Medical Assessment ◽  
Medical Practitioners ◽  
Fitness For Work ◽  
Medical Standards ◽  
Medical Fitness

This introductory chapter deals mainly with the principles underlying medical assessment of fitness for work, contacts between medical practitioners and the workplace, and confidentiality of medical information. Medical fitness is relevant where illnesses or injuries reduce performance, or affect health and safety in the workplace. It may also be specifically relevant to certain onerous or hazardous tasks for which medical standards exist. Medical fitness should always be judged in relation to the work, and not simply the pension scheme. It has limited relevance in most employment situations: many medical conditions, and virtually all minor health problems, have minimal implications for work and should not debar from employment. Medical fitness for employment is not an end in itself. It must be maintained.

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