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Chronic kidney disease is an urgent public health problem in the U.S., affecting 15% of all adults, and more than 740,000 have progressed to end-stage renal disease (ESRD), requiring life-sustaining renal replacement therapy (RRT). ESRD has devastating health, quality-of-life, and economic consequences, rendering most patients unable to maintain employment and costing Medicare $36 billion in 2017. Arguably, the most disadvantaged subgroup is the subset of patients that received no or minimal pre-ESRD nephrology care, which currently accounts for one third of the total ESRD population. This subgroup suffers increased morbidity and mortality, and has limited access to kidney transplantation, the optimal RRT. Despite this subgroup representing a large minority of the ESRD patient population, there has been no U.S.-based examination of their ESRD diagnosis experiences, coping styles and strategies, and RRT decision-making preferences. Therefore, we conducted a study that compared the ESRD diagnosis experiences, coping styles and strategies, and RRT decision-making preferences among patients with varying amounts of pre-ESRD nephrology care. We also assessed nephrologists’ current practices and perspectives on the manner and timing of RRT education for patients with varying amounts of pre-ESRD care. This mixed methods study provides a comprehensive understanding of the diagnosis experiences, coping styles and strategies, and RRT decision-making preferences of patients facing sudden and unexpected ESRD diagnosis. The study contributes important knowledge about this subgroup of patients that can influence and improve health care delivery. The results of this research will inform future intervention-based investigations to improve care for patients with minimal or no pre-ESRD nephrology care. / Public Health

The emergency department (ED) has often been considered the safety net of the American healthcare system. It earned this distinction because every person in the United States has access to a medical screening exam and stabilization at an ED regardless of their ability to pay. Unfortunately, over the past several decades, decreasing numbers of EDs and inpatient beds, coupled with increasing rates of ED usage, has led to crowding of EDs across the country. Crowding leads to unsafe conditions that may increase morbidity and mortality for patients, or cause patients to leave the ED without being evaluated by a physician. Essentially, crowding causes a barrier for patients to access their right to emergency evaluation. The problem of crowding is most pronounced in large urban communities, and these already frequently underserved patients suffer the most from the crowding burden. The main cause of crowding seems to be the boarding of admitted patients in the ED, however many often cite high rates of non-urgent patients presenting to the ED as a cause of crowding. Some have even suggested diverting non-urgent patients to help solve the problem of crowding. I became interested in this topic due to crowding concerns and initiatives to decrease the number of patients who left without being seen at my own institution. As I reviewed relevant research, I became aware of my own misconceptions and noted a trend of literature suggesting non-urgent patients are not the cause of crowding. Drawing on research from many different sources, paired with evaluation based on principles in bioethics, I have come to several conclusions. I believe the systematic diversion of non-urgent patients is unsafe, and that the unequal burden of ED crowding on urban communities represents an unjust barrier in access to care. We must continue to carefully research the demographics of patients frequently presenting to EDs to avoid perpetuating stereotypes about which types of patients are responsible for crowding. We should also look for ways to ease the crowding burden in urban communities. Additionally, we should take a qualitative assessment of our individual communities to determine if there are any particular reasons in our community that people choose to use the ED rather than other healthcare options. I believe these suggestions can be an important addition to the efforts already in motion to help reduce ED crowding and provide equitable access to emergency medical evaluation. / Urban Bioethics

Background: There is an increasing flow of patients seeking care at various facilites, such as Healt Centers, Family Doctor Emergency services, and emergency departments, where the pressure is already high. Through triage and urgent assessments, patients can be prioritized to the appropriate level of care so that those requiring immediate medical attention receive it promtly.  Aim: The aim of this study was to describe district nurses´experiences and perceptions of triage and urgent assessments.  Method: This study employs a descriptive design with a qualitative approach. Data collection was conducted through semi-structured interviews guided by an interview guide developed by the authors. The collected data were analyzed using qualitative content analysis. A total of nine district nurses participated.  Main results: Several participants reported that work experience, clinical acumen, education, and various triage systems facilitate the process of triage and assessments. However, some participants encountered various difficulties and challenges during assessment. With the right skills, experience, and knowledge, the duration of care and wait time can be reduced, thereby minimizing the risk of incorrect assessments. Conclusion: Several participants felt that the high patient flow and lack of time were challenges and could sometimes be experienced as stressful when performing accurate triage. The study described that district nurses with extensive experience, broad knowledge, and a clinical perspective felt confident in making assessments independently. However, the majority of participants stated that ongoing education is necessary to maintain good competence. / Bakgrund: Det förekommer ett ökat flöde av patienter som söker sig till olika delar av vården, såsom Hälsocentral, Familjeläkarjour och akutmottagning där trycket redan är högt. Genom akuta bedömningar och triage, kan patienterna prioriteras till rätt vårdnivå för att den patient som behöver snabbast vård ska få det.  Syfte: Syftet var att beskriva distriktssköterskors upplevelser och erfarenheter av triage och akuta bedömningar.  Metod: Denna studie har en deskriptiv design med en kvalitativ ansats. Datainsamlingen har skett genom semistrukturerade intervjuer med en intervjuguide sammanställd av författarna. Insamlade data har analyserats genom kvalitativ innehållsanalys. Totalt deltog nio distriktssköterskor.  Resultat: Flera av deltagarna berättade att med arbetslivserfarenhet, klinisk blick, utbildning och olika triagesystem kan triageringen och bedömningarna underlätta för den distriktsköterska som utför det. Dock upplevde några av deltagarna olika svårigheter och utmaningar vid bedömningarna. Med rätt kompetens, erfarenhet och kunskap kan vårdtider och vårdköerna kortas ner, och minska risken för felbedömningar.  Slutsats: Flera av deltagarna ansåg att det höga patientflödet samt tidsbrist var en utmaning och ibland kunde upplevas som stressigt för att utföra en korrekt triagering av patienten. Studien beskrev att distriktssköterskor med lång erfarenhet, bred kunskap samt en klinisk blick kände sig trygga i att göra bedömningar på egen hand. Flertalet av deltagarna uppgav dock att utbildning är nödvändigt för att bibehålla god kompetens.

Yes / Purpose: Although urgent primary eye care schemes exist in some areas of England, their current safety is unknown. Accordingly, the aim of the present study was to quantify the clinical safety and effectiveness of a COVID-19 Urgent Eyecare Service (CUES) across Luton, Bedford, Hull, East Riding of Yorkshire and Harrogate. Methods: Consenting patients with acute onset eye problems who had accessed the service were contacted to ascertain what the optometrist’s recommendation was, whether this worked, if they had to present elsewhere and how satisfied they were with the CUES. Results: 27% (170/629) and 6.3% (28/445) of patients managed virtually and in person, respectively, did not have their acute eye problem resolved. Regression analysis revealed that patients who attended a face-to-face consultation were 4.66 times more likely to be correctly managed (Exp (β) = 5.66), relative to those managed solely virtually. Optometrists phone consultations failed to detect conditions such as stroke, intracranial hypertension, suspected space occupying lesions, orbital cellulitis, scleritis, corneal ulcer, wet macular degeneration, uveitis with macular oedema and retinal detachment. Of referrals to hospital ophthalmology departments, in total, 19% were false-positives. Patients, however, were typically very satisfied with the service. Uptake was associated with socio-economic status. Conclusion: The present study found that a virtual assessment service providing optometrist teleconsultations was not effective at resolving patient’s acute-onset eye problems. The range and number of pathologies missed by teleconsultations suggests that the service model in the present study was detrimental to patient safety. To improve this, optometrists should follow evidence based guidance when attempting to manage patients virtually, or in person. For example, patients presenting with acute-onset symptoms of flashing lights and/or floaters require an urgent dilated fundus examination. Robust data collection on service safety is required on an ongoing basis. / The full-text of this article will be released for public view at the end of the publisher embargo on 10 Nov 2022.

Submitted by Marlene Aparecida de Souza Cardozo (mcardozo@pucsp.br) on 2016-12-19T14:57:47Z No. of bitstreams: 1 Natália Cançado Scarpelli.pdf: 1486317 bytes, checksum: 8b671bfdce3cb774d993981268ed7fe9 (MD5) / Made available in DSpace on 2016-12-19T14:57:47Z (GMT). No. of bitstreams: 1 Natália Cançado Scarpelli.pdf: 1486317 bytes, checksum: 8b671bfdce3cb774d993981268ed7fe9 (MD5) Previous issue date: 2016-11-30 / The scope of this dissertation is to analyze, through a vast bibliographic research, the interlocutory advance injunction (also called interlocutory relief) stabilization technique recently incorporated in our legal system with the edition of the 2015 Civil Litigation Code. In regards to its structure, this work is divided in five chapters. The first chapter discusses the historical evolution of the interlocutory injunction focusing in the characterization of said institute by Italian doctrine, as well as its development in the Brazilian environment analyzing the precautionary injunction introduced in our legal system with the 1939 Civil Litigation Code and the preliminary injunction introduced with the 1973 Civil Litigation Code. The second chapter presents the treatment dispensed to the interlocutory injunction by foreign legal systems, specifically Italian, German, French and Portuguese Law. The third chapter assesses Brazilian current rules related with the interlocutory injunction through examination of the applicable provisions in the 2015 Civil Litigation Code. The fourth chapter specifically analyzes the procedures involved in filing motions for interlocutory injunctions of urgent and advance natures. At last, the fifth chapter is dedicated to a thorough exam of all specifics and potential issues related with the interlocutory advance injunction stabilization technique. The objective of this work is, supported in solid doctrine, to bring solutions to questions and doubts derived from the interpretation of Article 304 of the 2015 Civil Litigation Code in its concise terms. The ultimate goal is to achieve the dynamic construction of the entire procedure required to stabilize the interlocutory advance injunction and allow the practical application of such technique to ensure that Brazilian Litigation systems may take advantage of this application / A presente dissertação possui como objeto o estudo, a partir de ampla pesquisa bibliográfica, da técnica de estabilização da tutela antecipada antecedente, inserida recentemente em nosso sistema por ocasião da entrada em vigor do Código de Processo Civil de 2015. No tocante à estrutura, o trabalho se divide em cinco capítulos. O primeiro capítulo aborda a evolução histórica da tutela provisória, com destaque no estudo e caracterização do instituto pela doutrina italiana, bem como o seu desenvolvimento dentro da realidade brasileira, mediante a análise da tutela cautelar, prevista em nosso sistema desde o Código de Processo Civil de 1939, e da tutela antecipada, introduzida na vigência do Código de Processo Civil de 1973. O segundo capítulo apresenta o tratamento da tutela provisória pelo direito estrangeiro, especificamente nos sistemas da Itália, Alemanha, França e Portugal. O terceiro capítulo explora a atual disciplina da tutela provisória através do exame dos respectivos dispositivos legais previstos no Código de Processo Civil de 2015. O quarto capítulo, por sua vez, trata especificamente sobre o procedimento da tutela de urgência antecipada requerida em caráter antecedente. Por fim, o quinto capítulo se dedica ao minucioso estudo de todas as questões que envolvem a técnica da estabilização da tutela antecipada antecedente. O objetivo deste trabalho é, com o apoio na doutrina, trazer soluções para as dúvidas interpretativas que decorrem da concisa redação do artigo 304 do Código Processual de 2015. Busca-se, assim, a construção da dinâmica de todo o procedimento necessário para se estabilizar a tutela antecipada requerida em caráter antecedente e permitir, sem qualquer receio das partes, que a técnica seja efetivamente aplicada na prática, de modo a possibilitar que o sistema processual brasileiro usufrua dos benefícios decorrentes desta aplicação.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-04-06T12:48:16Z No. of bitstreams: 1 Leticia Arenal e Silva.pdf: 1245549 bytes, checksum: 4bcecd11e9ee303899ce1687fe0aca7a (MD5) / Made available in DSpace on 2017-04-06T12:48:16Z (GMT). No. of bitstreams: 1 Leticia Arenal e Silva.pdf: 1245549 bytes, checksum: 4bcecd11e9ee303899ce1687fe0aca7a (MD5) Previous issue date: 2017-03-27 / This very study has as its main objective the investigation of the stabilization of summary judgement. Before dully exploring the main object herein, foreign law is asserted in order to base the study on the institute inserted in the Brazilian legal system with the arrival of the New Civil Procedure Code. After having dealt with the stabilization of the phenomenon that falls on interim protection, an introductory study is performed to its sorts, procedures and requirements that shall be present for us to pass on to the analysis of the object of stabilization. Later, we move on to the study of the stabilization itself. We have chosen to develop the current paper considering the innovation from the 2015 legislator that established discussions and debates in the legal system, without having up to now proof of its practical application. Thus, stabilization on interim protection does not bear resemblance with the institutes from existing procedural law in the Brazilian legal system that translates the challenge experienced in the empirical and academic area. We have attempted to approach more emblematic issues already arising from the doctrine, always in light of the Federal Constitution and the new Brazilian Civil Procedure Code / O estudo em apreço tem por objetivo a investigação da estabilização da tutela antecipada. Antes de adentrar propriamente ao objeto principal desse breve ensaio, é perquirido o direito estrangeiro, a fim de balizar o estudo do instituto inserido no sistema positivo brasileiro com a chegada do novo Código de Processo Civil. Tratando-se a estabilização de fenômeno que recai sobre a tutela provisória, é realizado um estudo introdutório às suas espécies, procedimento e requisitos que devem estar presentes para que se passe à análise do objeto da estabilização. Posteriormente, passa-se ao estudo do instituto da estabilização propriamente dito. Optamos por desenvolver o presente trabalho considerando a inovação do legislador de 2015, que ensejou discussões e debates na seara jurídica, não havendo, até esse momento, indícios de sua aplicação prática. Com efeito, a estabilização da tutela provisória não guarda similitude com institutos do direito processual até então existentes no ordenamento jurídico brasileiro, o que traduz o desafio vivenciado na área empírica e acadêmica. Procuramos abordar as questões mais emblemáticas já suscitadas pela doutrina, sempre à luz da Constituição Federal e do novo Código de Processo Civil brasileiro

Made available in DSpace on 2016-04-26T20:23:14Z (GMT). No. of bitstreams: 1 Marcello Soares Castro.pdf: 1149944 bytes, checksum: acda411a643ccdf39ba512aa2b793c77 (MD5) Previous issue date: 2014-09-15 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This study Jurisdictional Urgent Relief of Protection of the Trade Mark Rights, conducted by Marcello Castro Soares, has as its object the protection of trademark rights from the perspective of effective judicial protection, conveyed by satisfativa tutelage of urgency. Thus it is justified to analyze the technical and procedural apparatus of guardianship satisfativa urgency and instrumental ensemble of effectively protective of trademark rights, detecting the characteristics and requirement of substantive law, to identify and provide appropriate forms of applicability of these techniques if the prompt granting to judicial review. With doctrinal and jurisprudential research, the aim is to examine the effective and sensitive to the legal reality of trademark rights, in order to present an effective judicial remedy procedural strategies. We adopted this approach to design a constructive new perspective in which configures the Civil Procedure Law, the use of procedural techniques as suitable for the protection of rights instruments. The methodological procedures of this research leave from literature and legislative review on the subject, later the jurisprudential analysis. After performing these procedures, sistematizaremos the use of procedural technique to institute substantive law, simultaneously highlighting the construction of the Civil Procedure Law as an instrument of efficiency of trademark rights. The basic research techniques used are the jurisprudential literature and documentary. The literature will be developed from prominent works on the subject, and specialty papers, both directed to specific public jurists. The desk research will involve the study of relevant documents held as normative acts related to the topic and current jurisprudence of the main courts dealing with these problems. In short, like the findings, initially highlights aspects such as overcoming paradigm in civil procedural law, the collaboration of doctrinal, jurisprudential and legislative debates on this aspect, as well as show how the judicial protection of urgency was a standard of effectiveness. In another room, we present the specific interpretation of the relevant rules to that legal protection, with the goal of leading the reader to a different compression on the applicability, effectiveness and imperative nature of technical procedural points. Finally, these elements listed for debate, he strove to analyze the application's tutelage satisfativa urgency in protecting trademark rights, when they require immediate judicial protection / O presente trabalho Tutela de Urgência Satisfativa na Proteção dos Direitos de Marca, desenvolvido por Marcello Soares Castro, tem como objeto a proteção dos direitos de marca sob a ótica da tutela jurisdicional efetiva, veiculada pela tutela de urgência satisfativa. Assim se justifica analisar o aparato técnico-processual da tutela de urgência satisfativa como conjunto instrumental efetivamente de protetivo dos direitos de marca, detectando as características e exigência do direito material, para identificar e apresentar formas adequadas de aplicabilidade dessas técnicas caso seja fundamental a concessão imediata de tutela jurisdicional. Com investigações doutrinárias e jurisprudenciais, almeja-se examinar as estratégias processuais efetivas e sensíveis à realidade jurídica dos direitos de marca, com a finalidade de apresentar uma tutela jurisdicional efetiva. Adotou-se neste projeto uma abordagem construtiva da nova perspectiva em que se configura o Direito Processual Civil, a da utilização das técnicas processuais como instrumentos idôneos para a tutela dos direitos. Os procedimentos metodológicos desta pesquisa partem da revisão bibliográfica e legislativa acerca do tema, posteriormente a análise jurisprudencial. Após realizados estes procedimentos, sistematizaremos o uso da técnica processual ao instituto de direito material, destacando concomitantemente a construção do Direito Processual Civil como instrumento de eficácia dos direitos de marca. As técnicas básicas de pesquisa adotadas são a bibliográfica e documental jurisprudencial. A pesquisa bibliográfica será desenvolvida a partir de obras de destaque quanto ao tema, e artigos científicos especializados, ambos dirigidos a público específicos, os operadores do direito. A pesquisa documental consistirá no estudo detidos de documentos relevantes, como diplomas normativos referentes ao tema e jurisprudências atualizadas dos principais tribunais que se ocupam com estes problemas. Em síntese, como resultados obtidos, inicialmente se destaca aspectos como a superação de paradigma no direito processual civil, a colaboração da doutrinária, jurisprudencial e debates legislativos sobre esse aspecto, assim como apontar como a tutela jurisdicional de urgência se constituiu um standard da efetividade. Noutro espaço, apresentam-se pontos específicos da interpretação das normas atinentes à referida tutela jurisdicional, com o objetivo de conduzir o leitor a uma compressão diferenciada quanto à aplicabilidade, eficácia e imperatividade da técnica processual. Por fim, elencados esses elementos para debate, ocupou-se em analisar a aplicação da tutela de urgência satisfativa na proteção dos direitos de marca, quando os mesmos exigem imediata proteção jurisdicional

This thesis deals with the urgent and follow-up measures in case of chlorine leak and a retrospective analysis of past cases. Chlorine is a widely used toxic gas. It is known from history as the first practically used warfare agent. Today, it is an important chemical raw material that is used widely in industry. It is also commonly transported by road and rail. It is one of the substances whose leakages occur very often. The objective of this paper is to assess the impacts of chlorine leakage on the lives and health of people and to provide an overview of urgent and follow-up measures in case of chlorine leakage in the perspective of the integrated rescue system and the general public. In addition, to locate, describe and analyze past cases. The theoretical part contains information about chlorine, the principles of behaviour of the population in case of an accident with chlorine leakage and an overview of measures undertaken at the site of chlorine leakage. Through studying available literature and resources on the Internet, overview of major chlorine leakages in the Czech Republic as well as abroad has been created. Selected events are described in detail. The practical part simulates, using computer programme called TerEx, a chlorine leakage from a water treatment plant in Písek, South Bohemia. To compare the results, several model situations were created with varying amounts of chlorine leaked at different times of accident and atmospheric conditions. A specific example is used to assess the risks to people living near the plant and to outline the urgent and follow-up measures.

The goal of this diploma thesis is to introduce urgent and follow-up precautions in case of leakage of chlorine - simulated accident of vehicle transporting chlorine. The major objective of this study is to analyse the risk of chlorine-transport for people with the aid of available simulation programme and to specify urgent and follow-up precautions. The next part of this study is to investigate the knowledgeability of people. The theoretical part of this study is systematical structured into a number of chapters and worked out on the basis of available legislative regulations, literature and internet sources. At first basic legislation of transport of dangerous substances is described, from the european, as well as national perspective. The next chapter deals with transport of dangerous substances, danger classes of these substances, their labeling in transport, as well as labeling of transport units. The following chapter is devoted to aspects of an accident in case of transporting of dangerous substances. This chapter demonstrates an accident with leakage of dangerous substance, its impact, escape of this substance and its spread. Further the sources and risks of transportation of dangerous substances and accident rate in this transport are described. The next chapter deals with the specific dangerous substance - chlorine. It is aimed at physico-chemical characters of chlorine, its history and its current utilisation, its effect on human health, on environment and first aid in case of contact. At the end urgent and follow-up precautions in case of an accident inkl. leakage of chlorine. The empirical part of this study is devoted to two basic research questions. Qualitative, as well as quantitative methods of research were used to answers these questions. The empirical part is devided into two major chapters. The primary purpose of this study is to simulate an accident of vehicle transporting chlorine with the aid of the programme TerEx and to determine its impact on people and surrounding. The first question was to analyse the potential dangerous for people and surroundings in case of an accident with chlorine. For this purpose the town České Budějovice was used. First the transport of liquid chlorine in small containers in the Czech Republic was analysed focusing on the southbohemian region and especially the regional city. Thereafter input data were entered. On the basis of obtained outputs were determined threats, that arise from the transport of dangerous chlorine and on the basis of simulation were characterized activities carried out by Integrated Rescue System using appropriate urgent and follow-up precautions. Part of this work was also the second research question - the level of knowledge of people located close to the simulated accident about this problem. This survey was aimed at the risk of chlorine, its transport and characteristics and impact on human health as well as protection against its adverse effects. For this purpose a group of second-year students of the local gymnasium located close to the place of simulated accident was chosen. The data were collected through a questionnaire, which contained a group of questions relating to this problem. The obtained data were evaluated using basic methods of elemental statistical analysis and graphic processing. Findings resulting from the analysis of transporting of chlorine and from the simulation using the programme TerEx show, that the danger to the population of České Budějovice in case of an accident with chlorine is significant. The issue of chlorine-transport and its risks is additionally complicated by insufficient regulation. Another negative factor of transporting of these substances is the complicated traffic situation in the country town. Based on the results of the questionary can be stated, that these students have average knowledge in this issue.