Notification Procedures Research Articles

Improving Critical Value Read-Back Failure Rate by Modifying the Notification Procedure.

The aim of the study was to determine whether a system process change improved successful read-back of critical values by the appropriate provider. The study implemented a system process change of switching the "first call" physician from the admitting physician to the most recent document writer. Data were compared before (N = 301) and after the intervention (N = 201). Predictor variables included patient factors, physician factors, and environmental factors. The outcome variables measured were successful read-back within 5 and 30 minutes. Read-back failure within 5 minutes was significantly reduced (P < 0.001) from preintervention (49.5%) to postintervention (31.3%). Multivariate logistic regression showed reduced odds for read-back failure postintervention (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.31-0.67, P < 0.001) and increased odds for read-back failure for patients of Hispanic race/ethnicity (OR 1.77, 95% CI 1.09-2.89, P < 0.05). Read-back failure within 30 minutes did not significantly change. Multivariate logistic regression showed that an increased number of telephone calls were associated with an increased odds for read-back failure (OR 3.12, 95% CI 2.13-4.57, P < 0.001). We recommend the use of the physician who has most recently engaged with the patient as documented in the medical record for the daily note as the primary source of contact for reporting critical values.

A Study on the Revision of the Notification Form and Procedures of Marine Incident

A Study on the Revision of the Notification Form and Procedures of Marine Incident

Challenges in Infection Epidemiology: On the Underreporting of Norovirus Gastroenteritis Cases in Germany.

It is commonly accepted that the number of officially reported incidences of norovirus (NoV) according to the German Protection against Infection Act (Infektionsschutzgesetz) does not reflect the ‘true’ incidence of NoV in Germany. This study aims to reveal the reasons for the underreporting of NoV cases by comparing secondary data. Methods: NoV incidence (cases per 100,000 reference persons) in the age group 18–65 was derived from register data of four different sources in the German public health system (2011–2015): Statutory health insurance in the federal state of Lower Saxony (AOK; in- and outpatient cases), the Research Institute of Ambulatory Health Care in Germany (ZI; outpatient cases), the German Federal Statistical Office (inpatient cases; DESTATIS), and the Robert Koch Institute (RKI SurvStat; health reporting data). Results: the incidence derived from the AOK in Lower Saxony varied between 49 and 66 NoV cases per 100,000 persons and was thus lower than at the federal level. Incidences of all inpatient and outpatient data were lower than the incidence according to the RKI in the last 2–3 years of the observation period. Conclusions: the disagreement between NoV incidences calculated from secondary inpatient and outpatient data and the respective numbers published by the RKI can be regarded as an indication that not all NoV cases were reported to public health authorities. This might be due to missed cases during the notification procedure or misclassification of gastroenteritis cases by general practitioners. Considering the limitations associated with analyzing secondary data, the appropriateness of these assumptions should be verified in future studies.

Was sind grenzüberschreitende Pensionskassengeschäfte?

This article deals with the crossborder business of pension funds, resp Institutions for Occupational Retirement Provision (IORPs) according to the IORP-II Directive. In case of a cross-border business of IORPs, the IOPR-II Directive provides for a special supervisory regime. However, from a legal point of view it is unclear what circumstances trigger a cross-border case and the respective legal consequences (notification procedure etc). This question will be analysed on the basis of an occupational pension scheme where the IORP and the employee reside resp work in Austria, but the employer resides in another Member State. In this scenario, the question arises whether this constitutes a cross-border business according to the IORP-II Directive resp the Austrian Pension Fund Act which implements the directive. It is argued that the decisive test for this problem is the applicable “social and labour law” - within the meaning of the directive - for the pension scheme. A cross-border case is triggered only if - according to international labour law - the “social and labour law” of another country than the home state of the IORP is applicable. Since in the case analysed in this article, where employees work in Austria for a foreign employer that contracts with an Austrian IORP, the Austrian “social and labour law” is applicable, the Austrian IORP does not operate cross-border.

ГРАЖДАНСКО-ПРАВОВОЙ РЕЖИМ ТОВАРОВ ДВОЙНОГО НАЗНАЧЕНИЯ С ПОЗИЦИИ ОБЕСПЕЧЕНИЯ БАЛАНСА ЧАСТНОГО И ПУБЛИЧНОГО ИНТЕРЕСОВ: СРАВНИТЕЛЬНО-ПРАВОВОЙ АСПЕКТ

The article examines the dialectical relationship between the balance of private and public interests and the effectiveness of legal regulation of the dual-use goods. The concepts of dual-use goods and the legal regime of dual-use goods are examined and the conclusion is made that there is an interdependence between the categories «fair balance of private and public interests» and «the form and content of the dual-use goods regime». The structure of the legal regime system, consisting of interconnected subsystems that are in functional unity with each other, is analyzed. The dynamic property of the legal regime of dual-use goods to change the status of the goods and the status of the subject, depending on the state of the balance of private and public interests, is revealed. A special mechanism has been identified for regulating the system of the legal regime for dual-use goods, arising from the process of unification of legal norms, both at the international and national levels. The author proposed measures to improve the mechanism for regulating the legal regime of dual-use goods, based on the achievements of scientific and technological progress. Thus, increasing inter-industry relations through the unification of legal norms, as well as the use of modern technologies in the export control process, will ensure a fair balance between private and public interests. Meanwhile, state intervention in the property relations of individuals should be of an exceptional nature, providing for the existence of a mechanism for judicial protection of the weak side, for example, in the form of an institution for consumer protection. It is a focused approach based on the additional role of the state that will improve the effectiveness of the dual-use goods regime, as well as eliminate archaic methods of legal regulation of the turnover of dual-use goods based on the permissive type of regulation. In that way, the system measures that allow integrating advanced technologies into the mechanism of dual-use goods regime include: - introduction of a risk-based approach in the export control system; - transition to the notification procedure for export control; - transition to automatic identification of dual-use goods; - creation of a unified technological platform for controlling the turnover of dual-use goods; - creating a virtual image of dual-use goods with the function of saving the history of their use; - chipping of dual-use goods; - use of distribution registers in transactions with dual-use goods.

Meldung von Studien ausländischer Bildungseinrichtungen nach § 27 HS-QSG: Die Rechtslage und erste Erfahrungen nach der Novellierung 2018

The legal regulations concerning notification procedures for degree programmes of foreign educational institutions conducted in Austria were revised in December 2018. The following paper provides an overview of the amendment and the previous experience of AQ Austria as the statutory notification office.

Evaluation of the national surveillance of Legionnaires' disease in Norway, 2008-2017

BackgroundIn Norway, Legionnaires’ disease is reportable upon clinical suspicion to public health authorities and mandatorily notifiable through the Norwegian surveillance system for communicable diseases (MSIS) for both clinicians and laboratories. In the summer of 2017, several European countries reported high notification rates for Legionnaires’ disease, which was not observed in Norway. We evaluated MSIS to assess if it meets its objectives of detecting cases and trends in incidence of Legionnaires’ disease.MethodsWe retrieved MSIS data from 2008 to 2017 and calculated timeliness as days from sampling to notification, and internal completeness for key variables as the proportion of observations with a value. Where possible, we assessed internal validity on the presence of a plausible value. To estimate external completeness and validity we linked MSIS with hospital reimbursement claims in the Norwegian Patient Registry. To assess acceptability and representativeness, we surveyed doctors in 39 hospitals on their units’ diagnostic and notification procedures, and their use of MSIS.ResultsThere were 438 notified cases. Internal completeness and internal validity were high for key variables (≥95%). The median delay from sampling to notification was 4 days.There were 73 patients in MSIS only, 70 in the Norwegian Patient Registry only, and 351 in both registers. The external completeness of MSIS was 83% (95% CI 80–86%). For external validity, the positive predictive value of MSIS was 83% (95% CI 79–86%).Forty-seven respondents from 28 hospitals described testing procedures. These were inconsistent: 29 (62%) reported no systematic application of criteria for requesting legionella testing. Eighteen (38%) reported testing all patients with suspected pneumonia and a travel history. Thirty-one (66%) found the notification criteria clear.ConclusionsOur results suggest that the surveillance in MSIS can detect incidence changes for Legionnaires’ disease over time, by place and person, but likely does not detect every case diagnosed in Norway.We recommend wider investigation of diagnostic procedures in order to improve representativeness and awareness of MSIS notification criteria among clinicians in order to improve acceptability of the surveillance. We also recommend a more comprehensive assessment of whether patients only registered in the Norwegian Patient Registry were true Legionnaires’ disease cases.

EDUCATIONAL TRAINING INTERVENTION ON WORKPLACE VIOLENCE AMONG HEALTHCARE WORKERS

Background: Workplace violence is defined as incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health. In healthcare setting, it can bring serious consequences to the workers, organization and quality of patient care. Educational training is one of the methods to reduce the incident and prepare the workers in order to face this challenge. This manuscript aims to analytically analyse educational intervention on workplace violence among health workers. Materials and Methods: Systematic review was conducted via Pubmed and ScienceDirect, using keywords of (aggression OR violence) AND healthcare workers) AND (education OR training). A total of 1914 articles from search engines and other sources were obtained. After screening, 12 articles were included in this manuscript. Result: There are 12 studies in this review including two randomised controlled trials (RCTs), five quasi-experimental design and five before-after experimental design. Studies were conducted across various healthcare organizations and most of these were hospitals. Most of the studies include multiple modules including de-escalating techniques, assessing risk of violence, communication skills, workers responsibility, notification and post incident procedure, and legal aspect of workplace violence. Studies showed improvement in knowledges, attitude, confidence and coping. Conclusion: Majority of this evidence were weak and more high-quality research is needed in this area of study. Sound methodology and controlled study design to avoid biases should be done to prove the effectiveness of educational learning in workplace violence. Keywords: workplace violence, educational, intervention, review

2006. Evaluation of Rapid Blood Culture Identification with Antimicrobial Stewardship Treatment Recommendations at a Community Health System in Patients with Gram-negative Bacteremia: Adequacy, Adherence, and Outcomes

BackgroundSepsis mortality is greatly affected by the timely receipt of appropriate antibiotics. FilmArray Blood Culture Identification (BCID) is used at Cone Health to identify organisms in blood cultures within one to 2 hours after growth detected. The Cone Health antimicrobial stewardship (AMS) team has created treatment recommendations for each organism and resistance mechanism identifiable by BCID. Results and antibiotic recommendations are communicated in real time to providers by clinical pharmacists. The purpose of this evaluation was to validate the adequacy of antibiotics recommended by the BCID treatment algorithm for Gram-negative rods (GNR); assess proper implementation of the BCID notification procedure; and evaluate its effect on AMS.MethodsPatients with GNR BCID results in January and April 2018 were retrospectively identified. Information collected for each patient included: demographics, location, organism, admission antibiotics, pharmacist compliance with BCID procedure, recommendation acceptance rate, organism susceptibility, changes to antibiotics post-BCID and final cultures, extended-spectrum β-lactamase (ESBL) incidence, length of antibiotic therapy, and patient outcome.ResultsA total of 101 patients were evaluated. The BCID treatment algorithm recommendations covered 97% of identified organisms (Figures 1–4). Resistant isolates were ESBL producers. Pharmacist antibiotic recommendations matched the treatment algorithm 66% of the time. Providers accepted 90% of pharmacist recommendations. Twenty-two percent of antibiotics were not de-escalated after BCID results without identifiable reason.ConclusionThe BCID treatment algorithm provided adequate coverage for nearly all identified organisms, except ESBLs. However, patients with ESBL organisms all survived to hospital discharge. Pharmacists are following the BCID protocol in a majority of cases. One-third of recommendations deviated from the algorithm but only 17% did not have documented reasoning. Providers are very receptive to pharmacist input, with only 8% of recommendations rejected without documented reasoning. Finally, nearly a quarter of empiric antibiotics were not de-escalated despite organism identification, which represents opportunity for improvement. Disclosures All authors: No reported disclosures.

Protecting Privacy in Divorce Actions: Article 8 and the Need for Law Reform

This article makes the case for reform of divorce law by demonstrating that the current provisions in the Divorce (Scotland) Act 1976 are not compliant with Article 8 ECHR. Scots law's mix of fault and no fault provisions requires the mandatory disclosure of often highly personal and intimate details in order to establish adultery, behaviour, or non-cohabitation. This statutory requirement to disclose private and personal information to the state, to fulfil the test for irretrievable breakdown of the marriage, constitutes an invasion of the spouses’ privacy. The article then goes on to show that such invasion cannot be justified as necessary in a democratic society, in terms of Article 8 jurisprudence. Consequently, reform is required to ensure that Scots divorce law is ECHR compliant. The final section sets out a proposal to transform divorce law in Scotland into a no-fault notification procedure, removing the damaging and invasive process currently in force.

Health professionals are the cornerstone of public health security

An efficient health security system—based on early detection of risks to the population's health and establishment of operational public health measures—is crucial to population health. In France, the health security system is deemed efficient, as exemplified in 2017 when despite mild symptoms and few cases, the surveillance laboratory system identified contaminated powder milk as the source of a Salmonella enterica serovar Agona epidemic, which infected 38 infants,1Santé publique FranceÉpidémie de Salmonellose à Salmonella enterica sérotype Agona chez des nourrissons en France.https://www.santepubliquefrance.fr/Actualites/Epidemie-de-Salmonellose-a-Salmonella-enterica-serotype-Agona-chez-des-nourrissons-en-France-Point-au-1er-fevrier-2018Date: Feb 1, 2018Date accessed: May 2, 2019Google Scholar and led to the recall of all identified products from the market. The world is evolving at an exponential pace, especially with intensive globalisation, climate change, and technical progress. Thus, the risks of tomorrow are new. Accordingly, our system must constantly adapt and innovate to guarantee the public's health. Although some of these issues might seem distant from their daily practice, health professionals are the cornerstone of the health security system. Distributed over territories, they have genuine experience of on-the-ground realities, they are in direct and regular contact with people in hospitals, medical practice, schools, and workspaces; hence, they are the forefront of detection, alert, and first response when adverse public health events occur. To ensure we respond to tomorrow's public health threats, we need to identify current challenges and adapt the health security system to health professionals. Surveillance data and notifications are the raw materials for assessing public health risks and implementing appropriate measures. Yet, this fundamental contribution might be compromised if it is perceived as a burden and an obstacle to the clinical activity of health-care professionals. For this reason, the reality of the daily practice of health-care professionals needs to be accounted for when designing notification tools and procedures. The French Ministry of Health held a conference on Jan 23, 2019, about the essential participation of health-care professionals in the health security system.2Le professionnel de santé au cœur de la sécurité sanitaire : colloque du 23 janvier 2019. Ministère des Solidarités et de la Santé, Jan 2, 2019https://solidarites-sante.gouv.fr/actualites/evenements/article/le-professionnel-de-sante-au-coeur-de-la-securite-sanitaire-colloque-du-23Date accessed: May 10, 2019Google Scholar The conference was also an opportunity to review the use of an online portal, launched in March, 2017, that intended to open up the notification process to individuals and facilitate notifications for professionals.3Portail de signalement des événements sanitaires indésirablesMinistère Chargé De La Santé.https://signalement.social-sante.gouv.fr/psig_ihm_utilisateurs/index.html#/accueilDate accessed: May 2, 2019Google Scholar In addition to the 34 mandatory notifiable infectious diseases, a wide panel of fields for declaration have been added, ranging from adverse health events caused by medical products or practices, to other products such as food supplements, pesticides, or cosmetics. Some areas for improvement have been identified. Because entering information multiple times can be time consuming, there is a need to simplify the process as much as possible by retaining only data relevant to public health emergency management and surveillance. Additionally, professionals would like to receive feedback once notifications have been processed to better understand the usefulness of their contribution. Finally, because the amount of information to analyse is huge, an advanced algorithm would be a valuable addition to detect weak and relevant signals (ie, any information on a health phenomenon or exposure to a hazard, which requires an investigation to validate and whether or not to consider it as an alert) and avoid missing threats to public health. Beyond notifications, health-care professionals can engage with health security in other ways. They can volunteer to perform their primary function of caregivers during acute moments—eg, the French emergency medical team, established in 2007, can intervene during exceptional sanitary situations—such as the Zika epidemic in 2016. In addition to the operational response network, they can also engage in surveillance networks. For example, the French Sentinelles network4Réseau SentinellesPrésentation. Le réseau Sentinelles.https://www.sentiweb.fr/france/fr/?page=presentationDate accessed: May 2, 2019Google Scholar is composed of general practitioners and paediatricians and collects and operates clinical surveillance on ten health indicators, of which nine are infectious diseases. Thanks to their epidemic forecasts, the network allows health authorities to prepare early responses. Another important way to promote health security is active prevention, which includes educating people about hygiene measures, healthy behaviours, and immunisation to foster individual-level health and contribute to collective health. Overall, the technical improvements and the awareness raised here through the French example could foster a shared health security culture among health professionals for them to acknowledge and endorse their keystone role within the health security system. We declare no competing interests.

Jurisdictional Etiquette Workgroup: An offshoot of a Syndromic Surveillance Consortium

Objective● To demonstrate the importance of a cross-jurisdictional etiquette workgroup in the Texas Southeast region that leverages on the Syndromic Surveillance Consortium● To promote data sharing and communicate the findings of disease to assist rapid investigation and data sharingKey words:ESSENCE (Electronic Surveillance System for Early notification of Community-based Epidemics)IntroductionSyndromic data is shifting the way surveillance has been done traditionally. Most recently, surveillance has gone beyond city limits and county boundary lines. In southeast Texas, a regional consortium of public health agencies and stakeholders in the 13-County area governs the local ESSENCE system. The Houston Health Department, (HHD) is responsible for deploying ESSENCE to the entire region.To effectively monitor the health of the region’s population, a need arose to establish clear guidelines for disease investigation and data sharing triggered by syndromic surveillance across the area. Since Houston’s instance of ESSENCE serves all 13 counties, the consortium instituted a cross- jurisdictional etiquette group. The purpose of the group is to determine the standard protocol for responding to ESSENCE alerts and best practices for data sharing and use among consortium members.MethodsTo achieve these goals, it was determined that a smaller group of stakeholders besides governing officials is needed to provide guidance for regional data sharing and use. The etiquette group was established in the first quarter of 2018 and it included four consortium representatives from the 6/5 south region of Texas. Their first meeting tackled issues relating to data sharing.ResultsThe following products emerged from the activities of the etiquette group within 3 months of its existence:● Publication/presentation guidance/policy to avoid duplication of efforts and misrepresentation of jurisdiction.● Procedure for alert responses●. Instructions for within-systems management of alerts;●. Instructions for events/times of interest (e.g., political convention, Olympics);● Instructions of syndromes of interest/syndrome-specific policies;● Instructions for changing the syndrome definition;● Notification procedures for identification of a single case of reportable disease/important free text element within data.ConclusionsCross jurisdictional workgroups can influence rapid investigations of disease, protect patient health information and promote privacy and data security and confidentiality by establishing set rules/guidelines for data exchange. All 13-counties in the region rely on these guidelines as a standard for responsibly accessing, using and sharing data in the Texas Southeast ESSENCE system.Lessons Learned:● As the etiquette group continues to evolve, there is need for more resources to help foster data use and sharing among jurisdictional partners.● Partner engagement is limited due to ongoing process of configuring the new system ESSENCE.● Since disease has no boundaries, allocation of jurisdictional responsibilities for responding to alerts should be operationalized● Continuous training is essential to ensure all system users adhere to the protocols in place for meaningful data use and data sharing

Ochrona danych osobowych – od czego zacząć?

The present article focuses on the main General Data Protection Regulation requirements for private medical practices. It starts with description of 2 basic capacities in which an entity processing personal data can act, i.e. the controller or processor. Then, aforementioned roles are allocated to the physicians depending on the nature of their work (hospital or private medical practice), together with the description of legal basis for personal data processing in healthcare sector. The last part contains the most important elements of data protection that any physician should start with. These are: implementation of adequate technical and organisational security measures, provision of accurate privacy notice to patients as well as introduction of basic personal data documentation, i.e. the records of processing activities and personal data breach notification procedure

Notification and Transparency Issues in the WTO and the US’ November 2018 Communication

Various WTO Members submitted a Communication to the WTO in November 2018 which, if accepted, would affect the implementation of Members’ transparency and notification obligations at the WTO. It would strengthen the already burdensome notification obligations and introduce new punitive administrative measures should obligations not be complied with. This paper provides information about WTO Members’ current notification obligations and their level of compliance; looks at the history of discussions on notifications, particularly in the Working Group on Notification Obligations and Procedures which took place in 1995 – 1996; and provides an analysis of the Communication. The analysis focuses on the extent to which the elements are consistent with or go beyond the current WTO disciplines. It concludes that non-compliance with notification obligations is real. However, rather than expanding obligations and introducing punitive measures, constructive and effective solutions should be based on nuancing of obligations in the context of a Special and Differential Treatment approach and through the use of incentives. It also acknowledges that countries with a chronic lack of capacities will continue to struggle with the WTO’s complex notification obligations and requirements until they attain higher levels of development and, thus, improved institutional capacities.

Normative Criteria and Their Inclusion in a Regulatory Framework for New Plant Varieties Derived From Genome Editing.

Any legal regulation has to take into account fundamental interests and concerns, whether of private or public nature. This applies in particular to the politically and socially sensitive question of regulating plant biotechnology. With the advent of new breeding techniques, such as genome editing, new challenges are arising for legislators around the world. However, in coping with them not only the technical particularities of the new breeding techniques must be taken into account but also the diverse and sometimes conflicting interests of the various stakeholders. In order to be able to draft a suitable regulatory regime for these new techniques, the different interests and concerns at play are identified. Subsequently, a determination is made on how these interests relate to each other, before regulatory concepts to reconcile the conflicting demands are presented. The examined normative criteria, which can have an impact on regulatory decisions regarding genome edited plants and products derived from them, include: industry interests, farmer interests, public opinion, consumer rights and interests, human health and food safety, food security, environmental protection, consistency, and coherence of the regulatory framework and ethical or religious convictions. Since those interests differ from country to country depending on the respective political, economic, and social circumstances, the respective legislator has the task of identifying these normative criteria and must find a suitable balance between them. To this end, a concept is developed on how the different interests can be related to each other and how to deal with conflicting and irreconcilable demands. Additionally, a legislator may have recourse to a number of further analyzed regulatory measures. An approval or notification procedure can be used for a risk assessment or a socio-economic evaluation. Coexistence measures and labeling provisions are able to reconcile interests that are at odds with each other and the precautionary principle can justify certain safeguard measures. As a result, the individual country-specific regulatory outcomes regarding genome edited plants are likely to be as manifold as the interests and regulatory measures at hand.

Health care providers' compliance with the notifiable diseases surveillance system in South Africa.

BackgroundThe optimal performance of a notifiable disease surveillance system (NDSS) is dependent on health care provider (HCP) compliance with communicable disease notification. HCP compliance ensures appropriate investigation and control measures by relevant health care authorities. This study examines the compliance of HCPs with the NDSS in South Africa and factors associated with their compliance.MethodsA cross-sectional survey was carried out in three randomly selected provinces. We stratified by type of facility, and recruited clusters of HCPs on survey day to participate. All consenting HCPs in the randomly selected health care facilities on the day of the survey, completed a questionnaire that elicited information on socio-demographic characteristics and notification practices. The data were analysed using STATA® 14, using the identifiers for stratum and cluster as well as the calculated sampling weights.ResultsThe study found that 58% of 919 HCPs diagnosed a notifiable disease in the year preceding the survey. The majority of these professionals (92%) indicated that they had reported the disease, but only 51% of those notified the disease/s correctly to the Department of Health. Paediatricians were less likely to notify correctly (OR 0.01, 95% CI 0.00–0.12, p = 0.001). The factors that influenced notification were HCPs perceptions of workload (OR 0.84, 95% CI 0.70–0.99, p = 0.043) and that notification data are not useful (OR 0.84, 95% CI 0.71–0.99, p = 0.040). The study found no association between correct notification and HCPs’ willingness to notify, experience or training on the NDSS, understanding of the purpose of the NDSS, knowledge of what to notify, or perception of feedback given.ConclusionsThe compliance of HCPs in South Africa with the NDSS is suboptimal. In light of the important role of HCPs in the effective functioning of the NDSS, information on NDSS usefulness and guidelines on correct notification procedures are needed to increase their compliance.

院前预通知流程改善急性缺血性卒中患者血管内治疗的预后 Prehospital Notification Procedure Improves Endovascular Treatment Outcome in Patients with Acute Ischemic Stroke

院前预通知流程改善急性缺血性卒中患者血管内治疗的预后 Prehospital Notification Procedure Improves Endovascular Treatment Outcome in Patients with Acute Ischemic Stroke

Considerations Regarding the Attributions of the Prefect in the Field of State Aid

In recent years the prefect (in his capacity as representative of the Government at the local level) gained tasks relating to domestic proceedings in the field of state aids granted by local government authorities to various beneficiaries. The article aims at establishing to what extend this procedure (which is part of the domestic proceedings concerning the appropriateness analysis that is carried, prior to notification procedure to the European Commission by the national authority, by the Competition Council), is liable to affect the way the prefect carries out the legality review for acts issued by local administrative authorities.

Prehospital Notification Procedure Improves Stroke Outcome by Shortening Onset to Needle Time in Chinese Urban Area.

Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) can improve clinical outcome in eligible patients with acute ischemic stroke (AIS). However, its efficacy is strongly time-dependent. This study was aimed to examine whether prehospital notification by emergency medical service (EMS) providers could reduce onset to needle time (ONT) and improve neurological outcome in AIS patients who received IVT. We prospectively collected the consecutive clinical and time data of AIS patients who received IVT during one year after the initiation of prehospital notification procedure (PNP). Patients were divided into three groups, including patients that transferred by EMS with and without PNP and other means of transportation (non-EMS). We then compared the effect of EMS with PNP and EMS use only on ONT, and the subsequent neurological outcome. Good outcome was defined as modified Rankin Scale score of 0-2 at 3-months. In 182 patients included in this study, 77 (42.3%) patients were transferred by EMS, of whom 41 (53.2%) patients entered PNP. Compared with non-EMS group, EMS without PNP group greatly shortened the onset to door time (ODT), but EMS with PNP group showed both a significantly shorter DNT (41.3 ± 10.7 min vs 51.9±23.8 min, t=2.583, p=0.012) and ODT (133.2 ± 90.2 min vs 174.8 ± 105.1 min, t=2.228, p=0.027) than non-EMS group. Multivariate analysis showed that the use of EMS with PNP (OR=2.613, p=0.036), but not EMS (OR=1.865, p=0.103), was independently associated with good outcome after adjusting for age and baseline NIHSS score. When adding ONT into the regression model, ONT (OR=0.994, p=0.001), but not EMS with PNP (OR=1.785, p=0.236), was independently associated with good outcome. EMS with PNP, rather than EMS only, improved stroke outcome by shortening ONT. PNP could be a feasible strategy for better stroke care in Chinese urban area.

Knowledge and attitude of mandatory infectious disease notification among final year medical students.

Background:Disease surveillance is one of the major components to combat against infectious diseases. As health-care professionals are indispensable to mandatory notifiable disease surveillance, their knowledge and attitudes toward infectious disease notification played an important role for timely and effective reporting to the surveillance system. Therefore, we aimed to determine the knowledge of mandatory notifiable infectious diseases in Malaysia and attitude towards infectious disease reporting among final year medical students.Methods:A cross-sectional study was conducted from May to June 2017 in the private medical college in Malaysia.Materials and Methods:We purposively selected the final year (semester 10) medical students and a total of 124 students participated in this study. We collected data using a self-administered, structured questionnaire. Data were analyzed using descriptive statistics, independent t-test, and one-way analysis of variance.Results:Among the final year medical students, 47.5% had moderate knowledge but 4.2% had good knowledge of mandatory infectious disease notification. Only 3.2% of the students correctly answered all the notifiable diseases listed in the questionnaire. Most of the students had positive attitude toward communicable diseases reporting, rewards, and penalty for notification. There was no significant relationship between sociodemographic characteristics and knowledge and attitude of infectious disease notification.Conclusions:The majority of the final year medical students had moderate level of knowledge and positive attitude of infectious disease notification; however, there were some deficiencies. Better instruction and training on infectious disease notification procedures of Malaysia should be provided to the final year medical students which could not only reduce underreporting but also improve timely and effective reporting in future.