Unwarranted Delays Research Articles

Investigating Challenges of Mobile Money usage in the Central Business District of the Kumasi Metropolitan Assembly, Adum- Ghana

A descriptive cross-sectional design approach was deployed using a structured questionnaire underpinning the research objective to collect data from mobile money users and non-users within the Business District Centre of the Kumasi Metropolitan Assembly, Adum. The purposive random selection technique was used to choose a sample size of 59. This study seeks to investigate the challenges encountered by patrons of mobile money and examine their behaviour and attitudes towards the usage of mobile money transactions. The study identified seven (7) challenges, namely, financial, security, privacy, performance, time, convenience, and psychological, with performance, security, and privacy challenges being the most prevalent. The low transaction limits due to inadequate constant liquidity flow (cash and e-float) by agents affect consumers who wish to transact more than being offered; unwarranted delays experienced by customers and merchants due to incomplete payment process are some of the causative challenges of mobile money transaction; and invasion of privacy and defamation are among major. Fraudsters use the fear and anxiety of customers’ personal details in the hands of a third party, especially when the mobile money accounts are linked to clients’ bank accounts. The effect of inconvenience and delays in transactions are pointers to a duplicated transaction. It is recommended that service charges be lowered to their minimum rates, ensure a reliable mobile money system for consumers through system upgrades, and service providers ensure that personal details remain private to avoid consumer-driven fraud by inadvertently making pin codes known to third parties. Keywords: Global System for Mobile Communications Association (GSMA), Mobile Money, Theory of Reasoned Action (TRA), Technology Acceptance Model (TAM), Theory of Planned Behavior (TPB) and the Diffusion of Innovation Theory.

Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia

BackgroundTimely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care. MethodsThis included children admitted between July 2015 and September 2016, <16 years with an injury severity (ISS) ≥9; or requiring intensive care admission; or deceased following injury. Children were identified through the three PTCs, NSW Trauma Registry and NSW Medical Retrieval Registry. ResultsThere were 593 children admitted following injury and 46% required transfer to a PTC. There was no significant difference in age, ISS, ICU admission or head injury (AIS >2) between transferred and directly transported cohorts. There were significant differences in mechanism of injury between the two groups (χ2(9) = 45.9, p < 0.001). The median (IQR) time to book a transfer from arrival at the referring facility, was 146.5 (86–238) minutes. Time from injury to arrival at the PTC more than doubled for children transferred, with significant and unwarranted variability between transporting agencies resulting in unwarranted delays to surgical intervention. For example, time spent at the referring facility by Aeromedical Retrieval Service was less than half that of the Newborn & paediatric Emergency Transport Service [53 (IQR:47–61) vs 115 (84–155) minutes (p <0.001)]. ConclusionClinicians caring for paediatric trauma patients in facilities outside trauma centres require the capability and opportunity to identify and notify early those requiring transfer for ongoing management. The provision of a streamlined referral and transfer process for all paediatric trauma patients requiring treatment in NSW PTCs would reduce the burden on the referring facility, reduce variation amongst transport providers and improve time to definitive care.

Role of Carotid Artery Ultrasound Duplex Prior to Cardiac Surgery in Adults in Predicting Neurocognitive Complications.

BackgroundNeurocognitive complications (NCCs) after cardiac surgery are one of the most devastating complications. Significant internal carotid artery stenosis is assumed to be a predictor of NCCs. Carotid duplex ultrasound (DUS) is a non-invasive imaging study that remains the modality of choice and is routinely used in many centers for screening adult cardiac surgery patients prior to surgery. This study aims to assess the utility of preoperative carotid DUS in the prediction of NCCs in adult patients undergoing cardiac surgery in our center.MethodsWe retrospectively reviewed the medical records of patients who underwent coronary artery bypass graft (CABG), valvular or combined surgery, at King Faisal Cardiac Center in Jeddah between January 2017 and December 2018 (n = 229). The preoperative carotid DUS findings were evaluated. Risk factors associated with NCC were analyzed.ResultsOver the study period, a total of 229 patients underwent 233 procedures. Median age was 60 years (interquartile range [IQR] = 51-67 years), of whom 71% were males. Out of the diabetic patients, 67% had an HbA1C level above 7% pre-operatively. Carotid DUS was performed on 63% of patients, but only 6.9% developed a post-operative NCC. Patients who were actively smoking were more likely to develop NCC compared to nonsmokers or ex-smokers (14.7% vs 4.6%; p = 0.02), with an odds ratio of 3.6 (95% CI = 1.2-10.5). Patients who developed NCC had a significantly higher median intensive care length of stay (7 vs. 5 days; p = 0.05).ConclusionsAlthough international guidelines clearly define which patient should get preoperative carotid DUS screening, the level of evidence is low. Based on our findings, preoperative routine use of carotid DUS prior to cardiac surgery has low utility in predicting NCC. We recommend a more tailored approach based on signs, symptoms, and high-risk features to optimize the utilization of resources, avoid unwarranted delays, and personalize patient care.

The next frontier for recovering endangered huemul (Hippocamelus bisulcus): how to avoid recurrent misdiagnoses of health status and risks

Abstract Context The currently remaining 350–500 huemuls in Argentina are not recovering. We evaluated live huemuls, along with animals that died soon after confinement, or those that had died recently. Although information on the health status is highly valuable, repeated misdiagnoses of the health status indicate a need for other strategies. Aims . Discrepancies between clinical and postmortem diagnoses are critical for improving subsequent management decisions. Methods Initial clinical interpretations and risk assessments were reinterpreted on the basis of necropsies and other data. Results Two debilitated huemul individuals examined by veterinarians died soon afterwards, supposedly one being intoxicated and one being without lesions. Necropsies showed osteopathology and fluorosis (fluorine concentrations of 2209 and 2979 mg/kg). Another male was tied up, with authorities and veterinarians arriving the next day. After being sedated, and judged healthy, the animal was translocated. Because there was no reversal, this animal died 22 h post-capture. Exhumation showed severe osteopathology. Elsewhere, huemuls were considered adequate in selenium because values below the detection limit were excluded. However, when all values were included, 75% of the animals were selenium-deficient; this population had numerous cases of osteopathology. Recently, specialists went to Torres del Paine Park suspecting caseous lymphadenitis, reporting of which has been obligatory since 1937. However, many cases documented in 1999–2007 have not elicited responses since that time by health professionals. Selenium deficiency negatively affects antibody responses against caseous lymphadenitis. One province had denied huemul capture (2012 and 2013) on recommendation of scientific advisors. Because of the right for transparency, it was found out in 2016 that authorities had requested advice from only one veterinarian who assessed that darting was too risky. Another 2016 project proposed to dart the first huemul in Argentina. Two weeks earlier, that same team was called to rescue a tied-up huemul; the team opted not to involve a laboratory with drugs and radios that was only 1 h away. This huemul died and was left in the woods. Finally, the first huemul enclosure in Argentina was proposed (1995), but the permission was denied. Again, in 2000, the first huemul centre with private funding secured for 30 years was proposed. However, the Regional Delegation for Patagonian National Parks prevented aerial surveys, and advised not to provide a permit for the centre. Conclusions Future assessments should consider osteopathology. Risk assessments should be transparent and based on assessment by multiple qualified professionals. Implications Clinical misdiagnoses may reduce life expectancy, in contrast to taking individuals to enclosures, which would also allow valuable reintroductions. Not permitting captures, censusses and enclosures has resulted in unwarranted delays in conservation progress.

Time from breast cancer diagnosis to therapeutic surgery and breast cancer prognosis: A population‐based cohort study

Theoretically, time from breast cancer diagnosis to therapeutic surgery should affect survival. However, it is unclear whether this holds true in a modern healthcare setting in which breast cancer surgery is carried out within weeks to months of diagnosis. This is a population- and register-based study of all women diagnosed with invasive breast cancer in the Stockholm-Gotland healthcare region in Sweden, 2001-2008, and who were initially operated. Follow-up of vital status ended 2014. 7,017 women were included in analysis. Our main outcome was overall survival. Main analyses were carried out using Cox proportional hazards models. We adjusted for likely confounders and stratified on mode of detection, tumor size and lymph node metastasis. We found that a longer interval between date of morphological diagnosis and therapeutic surgery was associated with a poorer prognosis. Assuming a linear association, the hazard rate of death from all causes increased by 1.011 (95% CI 1.006-1.017) per day. Comparing, for example, surgery 6 weeks after diagnosis to surgery 3 weeks after diagnosis, thereby confers a 1.26-fold increased hazard rate. The increase in hazard rate associated with surgical delay was strongest in women with largest tumors. Whilst there was a clear association between delays and survival in women without lymph node metastasis, the association may be attenuated in subgroups with increasing number of lymph node metastases. We found no evidence of an interaction between time to surgery and mode of detection. In conclusion, unwarranted delays to primary treatment of breast cancer should be avoided.

Vaccination timeliness in preterm infants: An integrative review of the literature.

To take a systematic approach to reviewing the scientific literature examining the timeliness of vaccination in preterm infants and to identify any factors associated with timeliness. Preterm infants are vulnerable to infection and guidance advocates they are vaccinated in accordance with their full-term peers. Vaccination is well tolerated and protective immune responses are observed, yet some early enquiries suggest that preterm infants experience unwarranted delays. The recent surge in pertussis cases and the increase in vaccinations administered make this a topic requiring further exploration. An integrative review of the empirical literature. Studies were identified following a search of Medline, Academic Search Premier, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature. The review methods used were influenced by a narrative synthesis approach. The retrieval of papers adhered to recognised reporting standards. Fourteen studies were identified, which indicated that infants with the lowest gestational ages and birthweights experience the greatest delays. Vaccination timeliness is influenced by hospitalisation and increased postdischarge follow-up. There was a lack of consensus to indicate that parental socio-economic status and level of education were indicators for a delay. The studies propose that many delays are unjustified and not according to genuine contraindications. This review indicates that preterm infants are not vaccinated in a timely manner. Those involved in vaccinating preterm infants must be informed of the genuine contraindications to avoid unnecessary delays putting preterm infants at an increased risk of infection. Care providers should acknowledge the risk of a delay in preterm infants and actively promote vaccination in this population. Regular training should help to negate the occurrence of inappropriate delays, and careful discharge planning is needed to ensure that preterm infants are vaccinated on time.

P2.06-046 Shaping and Optimization of the Non-Small Cell Lung Cancer (NSCLC) Diagnostic Landscape in Australia and New Zealand (ANZ): Topic: LAB, Other

Discovery of oncogenic genetic alterations in certain NSCLC subgroups, and their use as biomarkers and molecular targets for cancer therapy has been paradigm shifting. This has made early identification of these genetic (EGFR, KRAS, ALK, c-MET, ROS1,PI3K, HER2) mutations pivotal for achieving better clinical outcomes. Various testing guidelines which are reviewed periodically have been unable to keep pace with the rapid technological and scientific advances in the diagnostic field. Lack of awareness and in-depth understanding of the testing guidelines may result in patients potentially missing out on the eligible targeted therapies. A literature search was conducted for molecular testing guidelines in NSCLC, that may have been published in major peer reviewed journal, presented at a major conference or recommended by a local regulatory body. Comparisons were made to identify key commonalities and differences in terms of patient flow, tests recommended, timing of tests and type of tests. A local algorithm was derived to be pressure tested at key testing centres. Digital platforms such as ALK-Testing website (www.alktesting.asia) and virtual reality (VR) simulations were created and utilized to educate and increase awareness on molecular testing amongst all the stakeholders. Review of the major NSCLC molecular testing guidelines and algorithms revealed several potential gaps. Consequently, an updated, a simpler and a potentially cost-efficient molecular testing algorithm for NSCLC patients has been formulated. The algorithm recommends single stage upfront reflex testing for major genetic aberrations (IHC or targeted sequencing) concurrent to histological diagnosis to facilitate tissue preservation and decrease turn-around-time (TAT). Further, to improve the efficiency and TATs for testing, and broaden awareness beyond centres of excellence, an ALK-testing website with information on the various testing facilities, current guidelines and testing protocols was created. Currently, use of liquid biopsies is advocated mainly in NSCLC patients who maybe too fragile, unable to provide a tumor specimen or an apt case for delineating resistant mechanisms. To quantify the impact of the new algorithm, an expansion study involving 4-5 key health centres is planned. Furthermore using VR platform, simulations on tumor heterogeneity and various ALK-testing scenarios have been created for educating the respective stakeholders and driving testing protocols. The modified diagnostic algorithm and education through digital and virtual media has the potential to bring consistency and uniformity in diagnosing patients with NSCLC, who are likely to benefit from targeted therapies. Finally, improvements in efficiency and TAT will inform physicians on management decisions without any unwarranted delays.

Reversal of warfarin anticoagulation using prothrombin complex concentrate at 25 IU kg-1 : results of the RAPID study.

Real-world studies of the emergency reversal of warfarin using 4-factor prothrombin complex concentrate (PCC) report unwarranted delays. The delay to receiving PCC was ≥ 8 h in 46·7% of patients with warfarin-associated bleeding (PWAB) treated with a variable PCC dosing protocol in our retrospective audit. To report the impact of a simplified PCC dosing protocol on the interval to reversal of anticoagulation. We developed a PCC dosing protocol standardising the initial PCC dose and simplifying dosing calculations. Study end points were the proportion of PWAB achieving international normalised ratio (INR) ≤1·5 and treated within 8 h of presentation, respectively. Of 17, 15 (88·2%) PWABs achieved a post-treatment INR ≤ 1·5; 14 of 17 (82·4%) PWABs were reversed within 8 h. Median intervals between triage and PCC request and PCC request and start of infusion (administration interval) were 126 min (range 39-520) and 30 min (range 5-100), respectively. Compared with the retrospective cohort, RAPID is associated with an improved administration interval (mean 37·7 vs 76 min, P = 0·031) and the proportion of PWABs treated within 30 min (58·8 vs 6·7%, P = 0·009). The RAPID protocol reduces unwarranted delays without compromising efficacy.

Multilingual and Native English‐speaking Student Writers in Medical Laboratory Sciences (MLS): A Comparative Pilot Study.

Medical laboratory scientists are health care practitioners who perform testing on blood and other body fluids providing vital information to physicians for the diagnosis, treatment, and management of patients in health and disease. Miscommunications between laboratory personnel and other health care practitioners can result in unwarranted delays in patient care or errors in treatment selection, which ultimately could cause patient harm, including the possible loss of life. In spite of prerequisite writing course requirements, students in our laboratory science baccalaureate degree program struggled to reach the program’s writing competencies. The situation in our program was complicated by the high percentage of multilingual students with varying abilities in English. This pilot study was initiated to describe the nature of writing in our field of practice and to analyze the current status of student writing abilities. A survey of writing activities among current laboratory science practitioners confirmed the essential nature of writing in our field and the types of writing activities performed on a regular basis. Analysis of current student writing samples showed that both native-English speaking and multilingual student writers made essentially the same types of errors although the multilingual students made significantly more errors in some categories.

Implementation of proteomic biomarkers: making it work

While large numbers of proteomic biomarkers have been described, they are generally not implemented in medical practice. We have investigated the reasons for this shortcoming, focusing on hurdles downstream of biomarker verification, and describe major obstacles and possible solutions to ease valid biomarker implementation. Some of the problems lie in suboptimal biomarker discovery and validation, especially lack of validated platforms with well-described performance characteristics to support biomarker qualification. These issues have been acknowledged and are being addressed, raising the hope that valid biomarkers may start accumulating in the foreseeable future. However, successful biomarker discovery and qualification alone does not suffice for successful implementation. Additional challenges include, among others, limited access to appropriate specimens and insufficient funding, the need to validate new biomarker utility in interventional trials, and large communication gaps between the parties involved in implementation. To address this problem, we propose an implementation roadmap. The implementation effort needs to involve a wide variety of stakeholders (clinicians, statisticians, health economists, and representatives of patient groups, health insurance, pharmaceutical companies, biobanks, and regulatory agencies). Knowledgeable panels with adequate representation of all these stakeholders may facilitate biomarker evaluation and guide implementation for the specific context of use. This approach may avoid unwarranted delays or failure to implement potentially useful biomarkers, and may expedite meaningful contributions of the biomarker community to healthcare.

PAY FOR DELAY

AS PART OF ITS EFFORT to slash health care costs, the Obama Administration is urging Congress to stop brand-name pharmaceutical companies from paying their generics rivals to keep lower priced equivalent medicines off the market. The antitrust arm of the Federal Trade Commission (FTC) has been battling these agreements, saying they enable drugmakers to preserve their monopolies on certain products and cost consumers hundreds of millions of dollars in higher prescription prices. “The enormous costs that result from unwarranted delays in generic entry burden consumers, employers, state and local governments, and federal programs already struggling to contain spiraling costs,” FTC Commissioner J. Thomas Rosch told the House Energy & Commerce Subcommittee on Commerce, Trade & Consumer Protection at a recent hearing. Congressional action to prohibit these “pay for delay” agreements between brand manufacturers and their generics competitors is “both appropriate and timely,” Rosch said. “Agreements to eliminate ...

Criminal Prosecution for HMO Treatment Denial

When people deliberately do things that are almost certain to cause death, and someone then dies, prosecutions for homicide are normally appropriate. However, the administrative conduct of HMOs seems to be an exception. Unwarranted delays and denials of medical treatment are not prosecuted even in cases where the HMO's responsible personnel must have foreseen that their actions would probably lead to death or grievous harm. This article considers the basis for this exception, analyzing the existing criminal law of omissions and surrounding policy considerations. HMOs are subject to powerful market incentives. In the eyes of a rational HMO executive, the company's clientele can be divided into two groups, the net-positive and the subscribers. The net-positives are the people who will probably pay more in future premiums than they will cost the HMO in future medical services. The net-negative group contains those who will probably cost the HMO more in future medical services than they will ever pay in future premiums (e.g., the seriously and chronically ill). From the HMO's economic perspective, any money spent to extend the lives of net-negative patients is merely prolonging an already losing proposition. Most large HMOs are traded on national stock exchanges and their financial results are closely scrutinized by securities analysts and others. This public market activity means HMO executives are under steady pressure to keep medical costs down and profits up. At the same time, individual medical decisions are necessarily discretionary and never exact. Therefore, a quiet and low-key bias against treatment authorizations to net-negative subscribers might be relatively hard to detect but potentially very lucrative. Given the normal economic incentives, it is no surprise that older and chronically ill people (the net-negatives) do much worse under HMOs than under traditional insurance plans. One study found, for example, that elderly, chronically ill patients in HMOs were nearly twice as likely to decline in physical health over time as those with traditional medical insurance. To state the problem bluntly, there is a potentially lethal economic flaw in the HMO concept. The market does not reward HMO executives for saving lives at stockholder expense. Criminal sanctions may work better than civil damages to motivate HMOs to authorize the medical treatments their subscribers are contractually entitled to. Whereas the burden of civil damage awards can be shifted, in the form of higher premiums and reduced medical expenditures, the criminal sanction of imprisonment cannot. The only way to prevent HMOs from shifting the penalties of wrongful denials back to subscribers and patients may be to impose a cost that the HMO's personnel cannot shift. This is, of course, the classic function of the criminal law--to impose costs on bad behavior that harm-doers cannot shift. Unlike civil damage actions, moreover, criminal prosecutions are already permitted by ERISA. Under the prevailing categories and definitions of the criminal law, prosecutions for wrongful HMO treatment denials would seem a straightforward application of the principle that, when death is foreseeable, lethal behavior is a crime.

Medicare Privacy Ruling Angers Insurer, Distresses Psychiatrists

Medicare Privacy Ruling Angers Insurer, Distresses Psychiatrists

Prediction of the need for mechanical ventilation in acute severe asthma.

Unwarranted long delays in treating asthmatic patients requiring assisted mechanical ventilation (AMV) could be associated with higher death rates. The objective of the study was to identify which were the best predictive characteristics of patients with acute severe asthma (ASA) who required AMV. For this purpose, we reviewed retrospectively the hospital record of every patient with ASA admitted to the intensive care unit (ICU) from 1981 to 1991 (38 with AMV and 38 without AMV). Twenty-seven variables were obtained from the history, physical examination, laboratory tests, blood gases and treatment. Using a multivariate discriminant analysis, the most powerful predictor of patients needing AMV was a function that consisted of eight variables: arterial pH, number of previous admissions to ICU, asthma severity, time elapsed since last visiting a physician, respiratory rate, age, systolic pressure and heart rate. With this function, 33 of 38 mechanically ventilated patients were well classified (sensitivity: 0.89) and the overall accuracy of the test was 92% (70 out of 76 cases). The positive and negative predictive values of the function for mechanical ventilation were 0.96 and 0.90, respectively. We conclude that the application of the calculated final discriminant function could be appropriate to decide which patients with ASA require AMV.

Cable Yarding in Southern Africa: An Analysis of its Productivity and Possible Procedure for its Improvement

ABSTRACT The demand for timber in southern Africa is increasing and this is resulting in the afforestation of areas which require cable yarding when harvested. The demand for cable yarders, essentially fixed skylines, is therefore increasing rapidly. Stress is being placed on the productivity of skylines since about half the timber has a piece size of under 0,2 m3. Work study analyses showed that much productivity was lost from slow carriage turn-about times caused mainly by inefficient choking techniques, slow carriage speeds, small load masses caused again by inefficient choking and by unwarranted delays. The productivity of the skyline was nearly tripled by fitting an automatic transmission gearbox to the drive to increase carriage speed, by using a single locking carriage that could also accommodate tag lines, and by the development and use of suitable tag lines. Timber piece size had little effect on timber productivity.

Streamlining the Building Permit Process

As a result of the growing complexity of construction projects, the processes of administration and enforcement of building codes and regulations have become very cumbersome. This leads to unwarranted delays, increased project costs, and needless frustration and aggravation. The methodology and findings of a study conducted in Israel, with analysis of the causes of delays in permit issuance and exploration of ways for making the regulatory system more result‐oriented, are presented. Time data on the process and outlines recommendations for improvement which should be of interest in many countries are included.

Neonatal and Infantile Hypoglycemia Due to Insulin Excess

Persistent hypoglycemia in the neonate and young infant usually results from inappropriate, excessive secretion of insulin, or a deficiency of one of the hepatic gluco-regulatory enzymes. Hypoglycemia due to hyperinsulinism, whether associated with nesidioblastosis, islet cell hyperplasia, adenoma or normal islets, may have devastating consequences in this age group and demands recognition and effective treatment. Medical management consisting primarily of frequent feeding, the intravenous infusion of glucose and the administration of glucagon, glucocorticoids, epinephrine, and diazoxide is often ineffective and may be punctuated by repeated episodes of hypoglycemia, convulsions, and central nervous system damage. Although subtotal-total pancreatectomy is effective in restoring blood sugar to normal, almost half of the reported patients are mentally retarded. This may be due in part to unwarranted delays in performing pancreatectomy. Experience with 6 patients undergoing subtotal--total pancreatectomy for intractable hypoglycemia supports the contention that this procedure is effective. A euglycemic state was restored in all 6 patients and there was no evidence of residual central nervous system damage. The spleen should be preserved in view of its importance in maintaining normal immunodefense mechanisms.

Adoption practices: An operational and evaluative study in an outpatient department

Association/or Ambulatory Atlantic City, May 9, 1962 Pediatric Services, Adoption practices: An operational and evaluative stu@ in an outpatient department Morris Green, M.D., and Carolyn Godfrey, M.A. T I-I E last decade has witnessed a greatly increased interest in adoptions. Recent experiences in the Outpatient Department of the Riley Hospital have repeatedly demonstrated both the opportunities and the need for pediatric research in this area. The present study was designed to evaluate certain problems in adoption practice in the community and to determine the possible contributions that a diagnostic center could make to their solution. The study was conducted in the period From the Department o] Pediatrics, Indiana University School of Medicine, and the James Whiteomb Riley Hospital for Children, Indianapolis, Ind. eAddress, Dr. Richard W. Olmsted, ehalrman, Department o[ Pediatrics, University of Oregon Medical School, 3181 S.W. Sam Jackson Park Road, Portland I, Ore. 276 from September, 1960, through December, 1961, and involved the collection of data on 40 children referred to the pediatric diagnostic clinic for evaluation in relation to adoption. In 12 of the 40 cases the authors judged that previous utilization of professional services by the responsible agency had been inadequate. Previous professional advice was judged to have been inadequate or incorrect in 20 per Cent of the cases. Five such instances were the result of undue reliance on infant developmental tests. An attempt was also made to assess the previous total planning for each child by the agency concerned. A rating of good, fair, or adequate was assigned to 35 per cent of the cases and a rating of poor or very poor was given in 65 per cent of the cases. Volume 62 Number 2 Abstracts--A. Ambulatory Pedlar. Services 2 7 7 The data document the presence Of serious deficiencies in adoptive practices and help define a new role for an outpatient department in relation to (1) diagnostic services, (2) preventive services, (3) professional education, (4) research, and (5) social action. In regard to diagnostic services, the outpatient department appears to be in the most advantageous position to provide consultative services to agencies in the case of children with multiple handicaps where a variety of medical consultations, infant developmental tests, genetic counseling, or psychiatric appraisal are indicated. These special examinations are not readily available in many communities. The preventive services supplied by the clinic chiefly involve counseling with agencies to help eliminate unwarranted delays in permanent planning and placement. The provision of services to adoption agencies also provides an uncontrived opportunity for medical students and pediatric residents to gain realistic experience in the important area of adoptions as well as some knowledge of the functioning of community social agencies. This investigation also represents a type of operational and evaluative research in the field of child welfare services, a type of research that may have a wider application in communityoriented outpatient departments. Finally, the paper demonstrates how the staff of a children's hospital can join with others to help gain the increased support necessary for the provision of adequate services to children through investigation and publication of the facts in relation to deficiencies in child welfare practices. This activity would appear consonant with the role of the university in research and social action.

Home care scheme for sick children in London

The data document the presence Of serious deficiencies in adoptive practices and help define a new role for an outpatient department in relation to (1) diagnostic services, (2) preventive services, (3) professional education, (4) research, and (5) social action. In regard to diagnostic services, the outpatient department appears to be in the most advantageous position to provide consultative services to agencies in the case of children with multiple handicaps where a variety of medical consultations, infant developmental tests, genetic counseling, or psychiatric appraisal are indicated. These special examinations are not readily available in many communities. The preventive services supplied by the clinic chiefly involve counseling with agencies to help eliminate unwarranted delays in permanent planning and placement. The provision of services to adoption agencies also provides an uncontrived opportunity for medical students and pediatric residents to gain realistic experience in the important area of adoptions as well as some knowledge of the functioning of community social agencies. This investigation also represents a type of operational and evaluative research in the field of child welfare services, a type of research that may have a wider application in communityoriented outpatient departments. Finally, the paper demonstrates how the staff of a children's hospital can join with others to help gain the increased support necessary for the provision of adequate services to children through investigation and publication of the facts in relation to deficiencies in child welfare practices. This activity would appear consonant with the role of the university in research and social action.