Аналіз правового регулювання міжбюджетних трансфертів

Астіон С. І. Аналіз правового регулювання міжбюджетних трансфертів / С. І. Астіон // Актуальні проблеми держави і права : зб. наук. пр. / редкол.: С. В. Ківалов (голов. ред.), В. М. Дрьомін (заст. голов. ред.) Ю. П. Аленін [та ін.] ; МОН України; НУ ОЮА. – Одеса : Юрид. л-ра, 2014. – Вип. 74. – С. 165-171.The article deals with the characterization of institutional regulation of interbudgetary relations, the analysis of the regulation of interbudgetary transfers, and certain problems of legal regulation to enhance the financial autonomy of local governments

Treatment of Femoral Shaft Fracture with an Interlocking Humeral Nail in Older Children and Adolescents

∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2012 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens

Artificial Neural Networks Versus Multiple Logistic Regression to Predict 30-Day Mortality After Operations For Type A Ascending Aortic Dissection§

There are few comparative reports on the overall accuracy of neural networks (NN), assessed only versus multiple logistic regression (LR), to predict events in cardiovascular surgery studies and none has been performed among acute aortic dissection (AAD) Type A patients. OBJECTIVES: We aimed at investigating the predictive potential of 30-day mortality by a large series of risk factors in AAD Type A patients comparing the overall performance of NN versus LR. METHODS: We investigated 121 plus 87 AAD Type A patients consecutively operated during 7 years in two Centres. Forced and stepwise NN and LR solutions were obtained and compared, using receiver operating characteristic area under the curve (AUC) and their 95% confidence intervals (CI) and Gini's coefficients. Both NN and LR models were re-applied to data from the second Centre to adhere to a methodological imperative with NN. RESULTS: Forced LR solutions provided AUC 87.9+/-4.1% (CI: 80.7 to 93.2%) and 85.7+/-5.2% (CI: 78.5 to 91.1%) in the first and second Centre, respectively. Stepwise NN solution of the first Centre had AUC 90.5+/-3.7% (CI: 83.8 to 95.1%). The Gini's coefficients for LR and NN stepwise solutions of the first Centre were 0.712 and 0.816, respectively. When the LR and NN stepwise solutions were re-applied to the second Centre data, Gini's coefficients were, respectively, 0.761 and 0.850. Few predictors were selected in common by LR and NN models: the presence of pre-operative shock, intubation and neurological symptoms, immediate post-operative presence of dialysis in continuous and the quantity of post-operative bleeding in the first 24 h. The length of extracorporeal circulation, post-operative chronic renal failure and the year of surgery were specifically detected by NN. CONCLUSIONS: Different from the International Registry of AAD, operative and immediate post-operative factors were seen as potential predictors of short-term mortality. We report a higher overall predictive accuracy with NN than with LR. However, the list of potential risk factors to predict 30-day mortality after AAD Type A by NN model is not enlarged significantly

Managing the Pre- and Post-analytical Phases of the Total Testing Process

For many years, the clinical laboratory's focus on analytical quality has resulted in an error rate of 4-5 sigma, which surpasses most other areas in healthcare. However, greater appreciation of the prevalence of errors in the pre- and post-analytical phases and their potential for patient harm has led to increasing requirements for laboratories to take greater responsibility for activities outside their immediate control. Accreditation bodies such as the Joint Commission International (JCI) and the College of American Pathologists (CAP) now require clear and effective procedures for patient/sample identification and communication of critical results. There are a variety of free on-line resources available to aid in managing the extra-analytical phase and the recent publication of quality indicators and proposed performance levels by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) working group on laboratory errors and patient safety provides particularly useful benchmarking data. Managing the extra-laboratory phase of the total testing cycle is the next challenge for laboratory medicine. By building on its existing quality management expertise, quantitative scientific background and familiarity with information technology, the clinical laboratory is well suited to play a greater role in reducing errors and improving patient safety outside the confines of the laboratory

Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice

Background There is an emerging interest in the inadvertent harm caused to patients by the provision of primary health-care services. To date (up to 2015), there has been limited research interest and few policy directives focused on patient safety in primary care. In 2003, a major investment was made in the National Reporting and Learning System to better understand patient safety incidents occurring in England and Wales. This is now the largest repository of patient safety incidents in the world. Over 40,000 safety incident reports have arisen from general practice. These have never been systematically analysed, and a key challenge to exploiting these data has been the largely unstructured, free-text data. Aims To characterise the nature and range of incidents reported from general practice in England and Wales (2005–13) in order to identify the most frequent and most harmful patient safety incidents, and relevant contributory issues, to inform recommendations for improving the safety of primary care provision in key strategic areas. Methods We undertook a cross-sectional mixed-methods evaluation of general practice patient safety incident reports. We developed our own classification (coding) system using an iterative approach to describe the incident, contributory factors and incident outcomes. Exploratory data analysis methods with subsequent thematic analysis was undertaken to identify the most harmful and most frequent incident types, and the underlying contributory themes. The study team discussed quantitative and qualitative analyses, and vignette examples, to propose recommendations for practice. Main findings We have identified considerable variation in reporting culture across England and Wales between organisations. Two-thirds of all reports did not describe explicit reasons about why an incident occurred. Diagnosis- and assessment-related incidents described the highest proportion of harm to patients; over three-quarters of these reports (79%) described a harmful outcome, and half of the total reports described serious harm or death (n = 366, 50%). Nine hundred and ninety-six reports described serious harm or death of a patient. Four main contributory themes underpinned serious harm- and death-related incidents: (1) communication errors in the referral and discharge of patients; (2) physician decision-making; (3) unfamiliar symptom presentation and inadequate administration delaying cancer diagnoses; and (4) delayed management or mismanagement following failures to recognise signs of clinical (medical, surgical and mental health) deterioration. Conclusions Although there are recognised limitations of safety-reporting system data, this study has generated hypotheses, through an inductive process, that now require development and testing through future research and improvement efforts in clinical practice. Cross-cutting priority recommendations include maximising opportunities to learn from patient safety incidents; building information technology infrastructure to enable details of all health-care encounters to be recorded in one system; developing and testing methods to identify and manage vulnerable patients at risk of deterioration, unscheduled hospital admission or readmission following discharge from hospital; and identifying ways patients, parents and carers can help prevent safety incidents. Further work must now involve a wider characterisation of reports contributed by the rest of the primary care disciplines (pharmacy, midwifery, health visiting, nursing and dentistry), include scoping reviews to identify interventions and improvement initiatives that address priority recommendations, and continue to advance the methods used to generate learning from safety reports

A cross-sectional mixed methods study protocol to generate learning from patient safety incidents reported from general practice

Introduction Incident reports contain descriptions of errors and harms that occurred during clinical care delivery. Few observational studies have characterised incidents from general practice, and none of these have been from the England and Wales National Reporting and Learning System. This study aims to describe incidents reported from a general practice care setting. Methods and analysis A general practice patient safety incident classification will be developed to characterise patient safety incidents. A weighted-random sample of 12 500 incidents describing no harm, low harm and moderate harm of patients, and all incidents describing severe harm and death of patients will be classified. Insights from exploratory descriptive statistics and thematic analysis will be combined to identify priority areas for future interventions. Ethics and dissemination The need for ethical approval was waivered by the Aneurin Bevan University Health Board research risk review committee given the anonymised nature of data (ABHB R&D Ref number: SA/410/13). The authors will submit the results of the study to relevant journals and undertake national and international oral presentations to researchers, clinicians and policymakers

Impact of laboratory test use strategies in a Turkish hospital

Objectives: Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs. Methods: A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months. Results: Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars. Conclusion: Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory test

Acid/base transport in glial cells of Necturus optic nerve

Membrane properties of glial cells of Necturus maculosus optic nerve were studied using conventional microelectrodes and double-barreled, pH-sensitive microelectrodes. The effects of Ba\sp{++}, a known K\sp+-channel blocker, were studied with conventional microelectrodes. The addition of Ba\sp{++} (2-5 mM) reversibly depolarized glial cells by 20 to 50 mV and reduced the sensitivity of the membrane to changes in bath (K\sp+). These effects were accompanied by an increase in the input resistance of the membrane, strongly suggesting that Ba\sp{++} decreases the K\sp+ conductance of the glial cells. With the K\sp+ conductance decreased by Ba\sp{++}, the membrane response to HCO\sb3\sp- was investigated. Addition of HCO\sb3\sp- at constant pH caused a hyperpolarization which was Na\sp+-dependent, SITS (4-acetamido-4\sp\prime-isothiocyanato-stilbene-2,2\sp\prime-disulfonic acid)-sensitive, Cl\sp--independent, and strophanthidin-insensitive. These results strongly suggest the presence in the glial membrane of an electrogenic Na\sp+/HCO\sb3\sp- cotransporter that transports Na\sp+, HCO\sb3\sp-, and net negative charge in the same direction across the cell membrane. To determine the relation between intracellular pH (pH\sb{\rm i}) and acid/base transport mechanisms like electrogenic Na\sp{+}/HCO\sb3\sp{-} cotransport, glial cells were studied with double-barreled, pH-sensitive microelectrodes. At a bath pH of 7.5, the mean initial pH\sb{\rm i} was 7.32 (S.D. 0.03, n = 6) in HEPES-buffered Ringer\u27s solution and 7.39 (S.D. 0.1, n = 6) in HCO\sb3\sp{-}/CO\sb2-buffered solution. These values for pH\sb{\rm i} are more than 1 pH unit alkaline to the pH\sb{\rm i} predicted from a passive distribution of protons; thus, glial cells actively extrude acid. Acid extrusion mechanisms were determined by inducing acidifications from the steady-state pH\sb{\rm i} and analyzing the ionic dependence and pharmacology of the pH\sb{\rm i} recovery. Superfusion followed by withdrawal of 15 mM NH\sb4\sp{+} induced an acidification of 0.1 to 0.3 pH unit after which the pH\sb{\rm i} recovered toward the original steady-state over the next 7 to 16 min. In the absence of HCO\sb3\sp{-}/CO\sb2, the recovery from acidification was Na\sp{+}-dependent, and amiloride-sensitive. Recovery from acidification was stimulated by adding HCO\sb3\sp{-}/CO\sb2 at constant pH. In HCO\sb3\sp{-}/CO\sb2-buffered solution, the recovery was Na\sp{+}-dependent, SITS-sensitive, and associated with a membrane hyperpolarization. The data strongly suggest that the relatively alkaline pH\sb{\rm i} of glial cells is due to the activity of at least two mechanisms, Na\sp{+}/H\sp{+} exchange and electrogenic Na\sp{+}/HCO\sb3\sp{-} cotransport

Acid/base transport in glial cells of Necturus optic nerve

Membrane properties of glial cells of Necturus maculosus optic nerve were studied using conventional microelectrodes and double-barreled, pH-sensitive microelectrodes. The effects of Ba\sp{++}, a known K\sp+-channel blocker, were studied with conventional microelectrodes. The addition of Ba\sp{++} (2-5 mM) reversibly depolarized glial cells by 20 to 50 mV and reduced the sensitivity of the membrane to changes in bath (K\sp+). These effects were accompanied by an increase in the input resistance of the membrane, strongly suggesting that Ba\sp{++} decreases the K\sp+ conductance of the glial cells. With the K\sp+ conductance decreased by Ba\sp{++}, the membrane response to HCO\sb3\sp- was investigated. Addition of HCO\sb3\sp- at constant pH caused a hyperpolarization which was Na\sp+-dependent, SITS (4-acetamido-4\sp\prime-isothiocyanato-stilbene-2,2\sp\prime-disulfonic acid)-sensitive, Cl\sp--independent, and strophanthidin-insensitive. These results strongly suggest the presence in the glial membrane of an electrogenic Na\sp+/HCO\sb3\sp- cotransporter that transports Na\sp+, HCO\sb3\sp-, and net negative charge in the same direction across the cell membrane. To determine the relation between intracellular pH (pH\sb{\rm i}) and acid/base transport mechanisms like electrogenic Na\sp{+}/HCO\sb3\sp{-} cotransport, glial cells were studied with double-barreled, pH-sensitive microelectrodes. At a bath pH of 7.5, the mean initial pH\sb{\rm i} was 7.32 (S.D. 0.03, n = 6) in HEPES-buffered Ringer\u27s solution and 7.39 (S.D. 0.1, n = 6) in HCO\sb3\sp{-}/CO\sb2-buffered solution. These values for pH\sb{\rm i} are more than 1 pH unit alkaline to the pH\sb{\rm i} predicted from a passive distribution of protons; thus, glial cells actively extrude acid. Acid extrusion mechanisms were determined by inducing acidifications from the steady-state pH\sb{\rm i} and analyzing the ionic dependence and pharmacology of the pH\sb{\rm i} recovery. Superfusion followed by withdrawal of 15 mM NH\sb4\sp{+} induced an acidification of 0.1 to 0.3 pH unit after which the pH\sb{\rm i} recovered toward the original steady-state over the next 7 to 16 min. In the absence of HCO\sb3\sp{-}/CO\sb2, the recovery from acidification was Na\sp{+}-dependent, and amiloride-sensitive. Recovery from acidification was stimulated by adding HCO\sb3\sp{-}/CO\sb2 at constant pH. In HCO\sb3\sp{-}/CO\sb2-buffered solution, the recovery was Na\sp{+}-dependent, SITS-sensitive, and associated with a membrane hyperpolarization. The data strongly suggest that the relatively alkaline pH\sb{\rm i} of glial cells is due to the activity of at least two mechanisms, Na\sp{+}/H\sp{+} exchange and electrogenic Na\sp{+}/HCO\sb3\sp{-} cotransport