5 research outputs found
OECD principles on water governance in practice:an assessment of existing frameworks in Europe, Asia-Pacific, Africa and South America
Through the lens of the 12 OECD Principles on Water Governance, this article examines six water resources and water services frameworks in Europe, Asia-Pacific, Africa and South America to understand enhancing and constraining contextual factors. Qualitative and quantitative methods are used to analyze each framework against four criteria: alignment; implementation; on-ground results; and policy impact. Four main target areas are identified for improving water governance: policy coherence; financing; managing trade-offs; and ensuring integrity and transparency by all decision makers and stakeholders. Suggestions are presented to support practical implementation of the principles through better government action and stakeholder involvement.No Full Tex
Acesso a Tratamento Endovascular para Acidente Vascular Cerebral Isquémico em Portugal
Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke
healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential
access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding
endovascular treatment in mainland Portugal and its administrative districts.
Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated
with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed
to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular
treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized
ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between
stroke onset, first-door, and puncture.
Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000
inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in
districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged
from 212 to 432 minutes, reflecting regional heterogeneity.
Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and
in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in
high-volume tertiary hospitals.Introdução: A aprovação do tratamento endovascular para o acidente vascular cerebral isquémico obrigou à reorganização dos
cuidados de saĂșde em Portugal. Os nove centros que realizam tratamento endovascular nĂŁo estĂŁo distribuĂdos equitativamente pelo
territĂłrio, o que poderĂĄ causar acesso diferencial a tratamento. O principal objetivo deste estudo Ă© realizar uma anĂĄlise descritiva da
frequĂȘncia e mĂ©tricas temporais do tratamento endovascular em Portugal continental e seus distritos.
Material e MĂ©todos: Estudo de coorte nacional multicĂȘntrico, incluindo todos os doentes com acidente vascular cerebral isquĂ©mico
submetidos a tratamento endovascular em Portugal continental durante um perĂodo de dois anos (julho 2015 a junho 2017). Foram
colhidos dados demogrĂĄficos, relacionados com o acidente vascular cerebral e variĂĄveis do procedimento. Taxas de tratamento endovascular
brutas e ajustadas (ajuste indireto a idade e sexo) foram calculadas por 100 000 habitantes/ano para Portugal continental e
cada distrito. Métricas de procedimento como tempo entre instalação, primeira porta e punção foram também analisadas.
Resultados: Foram registados 1625 tratamentos endovasculares, indicando uma taxa bruta nacional de tratamento endovascular
de 8,27/100 000 habitantes/ano. As taxas de tratamento endovascular entre distritos variaram entre 1,58 e 16,53/100 000/ano, com
taxas mais elevadas nos distritos próximos a hospitais com tratamento endovascular. O tempo entre sintomas e punção femural entre
distritos variou entre 212 e 432 minutos.
ConclusĂŁo: Portugal continental apresenta uma taxa nacional de tratamento endovascular elevada, apresentando, contudo, assimetrias
regionais no acesso. As mĂ©tricas temporais foram comparĂĄveis com as observadas nos ensaios clĂnicos piloto
O modelo de regulação das ĂĄguas e resĂduos em Portugal
Traduz as principais linhas estratĂ©gicas de atuação do Instituto Regulador de Ăgua e dos ResĂduos ( IRAR ) no atual contexto de desenvolvimento desses setores (ĂĄgua e resĂduos) em Portugal
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)