Bałkanskie państwa kandydujące na drodze do konsolidacji fiskalnej: uwarunkowania prawne a wyniki ekonomiczne

The subject of this paper is four Balkan countries (Albania, Serbia, Macedonia, and Montenegro) that are determined to join the European Union. More particularly, it looks at their work towards accomplishing the political, legal and economic requirements for the EU. Thus, the legislation with the EU Fiscal Compact is the prime focus. Methodologically, the research is based on an assessment of fiscal and monetary legal documents, evaluating the stages of accomplishing the harmonization with the EU’s conditions. Further, cross‑section analyses are made by in putting selected indicators; additionally, the authors compare the four countries’ achievements. The EU’s rigorous fiscal rules are being quietly bypassed, but more frequently by existing member states than the candidate states; this statement is founded on legal and economic arguments, with mathematical estimations. Consequently, the authors question the political courage and financial capacity of the examined countries to cope with the fiscal compact of the superior EU 28 members. The answers are supported with numerous analyses of EU Reports for each country, as well as tables and figures that compare the states’ results and economic achievements vs. EU fiscal consolidation rules. The EU 28 average is givenin addition as a comparison. The conclusion gives across analysis between the four countries and the EU 28 member states, with accompanying argumentation to the main statement about the legal and economic developments of the examined Balkan countries as well as a future prognosis.W artykule poddano analizie cztery państwa bałkańskie (Albanię, Serbię, Macedonię i Czarnogórę), zdeterminowane by przystąpić do Unii Europejskiej. W szczególności jest on poświęcony analizie ich wysiłów służących spełnieniu politycznych, prawnych i gospodarczych warunków wejścia do UE. W związku z tym głównym punktem zainteresowania autorów było prawodawstwo dotyczące unijnego paktu fiskalnego. Od strony metodologicznej badania opierały się na ocenie dokumentów prawnych, regulujących kwestie podatkowe i monetarne. Dokonano oceny kolejnych etapów ich harmonizacji z regulacjami UE. Ponadto wykonano analizy przekrojowe przy wykorzystaniu określonych wskaźników. Dodatkowo autorzy porównali osiągnięcia tych czterech państw. Rygorystyczne reguły fiskalne UE były po cichu omijane, ale częściej przez państwa członkowskie niż państwa kandydujące. Stwierdzenie to opierało się na argumentach prawnych i ekonomicznych oraz oszacowaniach matematycznych. W związku z tym autorzy postawili pytania o polityczną odwagę i zdolność finansową badanych państw do radzenia sobie z paktem fiskalnym, jaki obowiązuje 28 państw członkowskich UE. Odpowiedzi na te pytania zostały poparte licznymi analizami, zawartymi w raportach UE dla poszczególnych państw, a także tabelami i danymi liczbowymi, które umożliwiają porównanie wyników państw i ich osiągnięć gospodarczych z wymogami UE dotyczącymi konsolidacji fiskalnej. Dodatkowo, jako punkt odniesienia, wykorzystano średnią dla UE–28. W konkluzji przedstawiono wyniki analizy krzyżowej między tymi czterema państwami a 28 państwami członkowskimi UE, wraz z towarzyszącą im argumentacją dotyczącą głównego stwierdzenia o postępach badanych państw bałkańskich w obszarze prawa i gospodarki, a także prognozą na przyszłość

Secondary intervention due to symptomatic ureteral stones is not necessary in the majority of patients after previous stenting

Introduction and Objective Over the past 20 years, ureteroscopy (URS) has become one of the most popular treatment options for patients with ureterolithiasis. While prestenting is usually not necessary if the ureteral stones is <1 cm, some clinical situations (e.g. obstructive pyelonephritis) require stent placement for a short period. While the stent dilates the ureter, thus facilitating spontaneous stone passage, the question arises whether secondary intervention is necessary at all. We thus evaluated whether our institutional approach of removing the ureteral stent the day before secondary intervention in local anesthesia can spare the patient this intervention. Methods: Retrospective analysis of 216 patients who had previously been stented due to a symptomatic ureteral stone and who were scheduled for secondary intervention from 01/2013 to 01/2018 at our institution. The stent was removed under local anaesthesia. Patients were told to filter their urine overnight. Spontaneous stone passage or persistence of the stone was documented either by presenting the filtered stone and/or radiologically. To evaluate potential predictors for spontaneous stone passage (stone size, location, composition, stent dwell time, patient age and sex), a multivariable logistic regression was performed. Results: Median stone size was 5 mm (IQR:4-6). 26% of stones were located in the proximal, 25% in the mid-, and 49% in the distal ureter. 129/216 (60%) patients had spontaneous stone passage after a median stent dwell time of 4 weeks (IQR:3-5): 72/129 (56%) before and 57/129 (44%) within 24 hours after stent removal. In only 87/216 (40%) pre-stented patients a secondary intervention was necessary. Multivariable logistic regression analysis showed a significant association between spontaneous stone passage and stone size (OR:0.67, 95%CI: 0.55-0.83; p<0.001), distal stone location (OR:2.17, 95%CI: 1.01-4.67; p=0.049) and stent dwell time (OR:1.20; 95%CI: 1.03-1.40; p=0.02). Conclusions: The majority (60%) of ureteral stones passed spontaneously after senting, especially if they were small and located in the distal ureter; 44% of these stones passed within 24 hours after stent removal. Thus, a stent should be removed at least one day before secondary intervention in order to avoid unnecessary surgery. Characters (not including spaces): 2091 Topic: Stone disease – surgical therapy Key words: ureteral calculi, stents, ureteroscopy Source of funding: Non

Detection and quantification of overactive bladder activity in patients: Can we make it better and automatic?

AIMS: To explore the use of time-frequency analysis as an analytical tool to automatically detect pattern changes in bladder pressure recordings of patients with overactive bladder (OAB). To provide quantitative data on the bladder's non-voiding activity which could improve the current diagnosis and potentially the treatment of OAB. METHODS: We developed an algorithm, based on time-frequency analysis, to analyze bladder pressure during the filling phase of urodynamic studies. The algorithm was used to generate a bladder overactivity index (BOI) for a quantitative estimation of the average bladder non-voiding-activity. We tested the algorithm with one control group and two groups of patients with OAB symptoms: one group with detrusor overactivity (DO), assessed by an experienced urologist (OAB-with-DO group), and another group for which detrusor overactivity was not diagnosed (OAB-without-DO group). RESULTS: The algorithm identified diagnostically significant data on the bladder non-voiding activity in a specified frequency range. BOI was significantly higher for both OAB groups compared to the control group: the median value of BOI was twice as big in OAB-without-DO and more than four times higher in OAB-with-DO compared to control group. Moreover the algorithm was successfully tested to detect episodes of detrusor overactivity. CONCLUSIONS: We have shown that a simple algorithm, based on time-frequency analysis of bladder pressure, may be a promising tool in the clinical setting. The algorithm can provide quantitative data on non-voiding bladder activity in patients and quantify the changes according to phenotype. Moreover the algorithm can detect DO, showing potential for triggering conditional bladder stimulation

A treatment strategy to help select patients who may not need secondary intervention to remove symptomatic ureteral stones after previous stenting.

PURPOSE This study aimed at evaluating whether removal of the ureteral stent the day before scheduled secondary intervention facilitates spontaneous ureteral stone passage and thus can spare the pre-stented patient this surgery. METHODS Retrospective analysis of a single-centre consecutive series of 216 patients after previous stenting due to a symptomatic ureteral stone from 01/2013 to 01/2018. Indwelling stents were removed under local anaesthesia. Patients were told to filter their urine overnight. Multivariate analysis was performed to assess predictive factors for spontaneous stone passage. RESULTS 34% (74/216) of patients had spontaneous stone passage while the stent was indwelling. Of the remaining 142 patients, 41% (58/142) had spontaneous stone passage within 24 h after stent removal. Only 84/216 (39%) patients needed secondary intervention. Multivariate logistic regression analysis of all 216 patients showed a significant association between spontaneous stone passage and smaller stone size (p < 0.001), distal stone location (p = 0.046) and stent dwell time (p = 0.02). Predictive factors for spontaneous stone passage after stent removal were smaller size (p < 0.001), distal location (p = 0.001), and stone movement while the stent was indwelling (p = 0.016). A treatment strategy was established that helps select patients suitable for conservative management. CONCLUSIONS The majority (61%) of ureteral stones passed spontaneously after pre-stenting; 34% while the stent was indwelling, 27% within 24 h after stent removal. Besides distal stone location, stone size (< 6 mm) and stone movement (≥ 5 cm) while the stent is indwelling indicate patients who are likely to pass their ureteral stone spontaneously after stent removal. The treatment strategy (decision tree) presented here helps identify those patients. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN12112914