Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

The lauraceae collected in brazil by ludwig riedel - I

The species of Lauraceae collected by Ludwig Riedel, excluding Ocotea, are commented and contex-tualized according to the different itineraries he travelled in Brazil, from 1821 to 1836, indicating the localities and dates of collections, whenever possible. To complete this work, two diaries of Riedel have been consulted and the information from them cross-checked with the annotations found on specimen labels. An annotated list of 48 entries provides information on the status of species names and their types, currently accepted names, and collections found in different herbaria. Lectotypes for five names, Aydendron verrucosum var. attenuata, Aydendron parviflorum, Mespilodaphne parviflora, Nectandra spicata, and Oreodaphne fasciculata, are designated. The species of Ocotea collected by Riedel will be treated in part II of this series. © President and Fellows of Harvard College, 2012.

The lauraceae collected in brazil by ludwig riedel - II. Ocotea

The species of Ocotea (Lauraceae) collected by Ludwig Riedel are commented and contextualized according to the different itineraries he travelled in Brazil, from 1821 to 1836, indicating the localities and dates of collections, whenever possible. To complete this work, two diaries of Riedel have been consulted and the information from them crossed-checked with the annotations found on specimen labels. An annotated list of 44 entries provides information on the status of species names and their types, currently accepted names, and collections found in different herbaria. Lectotypes for 19 names are designated, two new synonyms are proposed, as well as the new combination Ocotea estrellensis (Meisn.) P.L.R. Moraes, based on Oreodaphne estrellensis Meisn. © President and Fellows of Harvard College, 2012.

A repatriação de refugiados afegãos: do Paquistão ao leste do Afeganistão

Pós-graduação em Relações Internacionais (UNESP - UNICAMP - PUC-SP) - FFC

Diagnóstico da pesquisa em biodiversidade no Brasil

Biodiversity is a result of millions of years of biological evolution, and is the component of the system which supports life on our planet. Besides the intrinsic value of each species, all of them as a whole, as well as of the interactions among the species, and their interaction with the physical and chemical environment, result in ecosystem services vital for supporting life on Earth. Because of that, the science of biodiversity is largely recognized as a priority area of scientific investigation both in developed and developing countries. In Brazil, the research on biodiversity can be divided in three parts: 1) discovery and characterization of biodiversity – including marine and human-altered landscapes – systematics and taxonomy; 2) understanding the functioning of ecosystems and environmental services, including in marine and human-altered landscapes; 3) bioprospecting of the chemical diversity of the Brazilian biota.

Book Review of Archaeological Theory and the Politics of Cultural Heritage by Laurajane Smith

The passage of the Native American Graves Protection and Repatriation Act (NAGPRA) in 1991 significantly changed the way archaeology would be done in the United States. This act was presaged by growing complaints and resentment directed at the scientific community by Native Americans over the treatment of their ancestral remains. Many of the underlying issues came to a head with the discovery and subsequent court battles over the 9,200-year-old individual commonly known as Kennewick Man. This had a galvanizing effect on the discipline, not only perpetuating the sometimes adversarial relationship between archaeologists and Native Americans, but also creating a rift between those archaeologists who understood Native American concerns and those who saw their ancestral skeletal remains representing the legacy of humankind and thus belonging to everyone. Similar scenarios have emerged in Australia.

Italia: La chiusura della Casa dell’Emigrante come spunto riflessione sui rientri degli emigrati italiani

In the literature on migration, as well as in social policies regarding this phenomenon, the situation of returning emigrants receives scant attention. This essay establishes an intricate connection between attitudes and policies that prevail in a country regarding emigration and those concerning immigration. The case of Italy provides a prime example for this as it once was a classical country of emigration, only to turn, in recent decades, into a country that appears highly attractive (and relatively accessible) to immigrants. The essay traces the pervasive ambiguity that characterizes this country’s attitudes towards emigration from the beginning of mass emigration shortly after the unification of Italy in 1868 to the emigration policies of the fascist regime of Mussolini and the post-World War II waves of emigration right through to the corresponding ambiguity concerning the status of immigrants in contemporary society, including the indifferent treatment of returning Italian emigrants who constitute a considerable numerical phenomenon. These reflections take their origin from the impending closure of a reception centre in Lazio, the Casa dell’Emigrante near Sant’Elia Fiumerapido, Province of Frosinone, ostensibly for financial reasons. This centre had been the only one of its kind in the whole of Italy dealing officially with the needs of repatriated Italians. It had assisted returning emigrants both with practical matters, such as negotiating the labyrinth of Italian bureaucracy , and with psychological implications of a return, which are often considerable given the time lag of experiences with current social realities and the frequently unrealistic expectations associated with the return. Questions of identity become highly acute in those circumstances. The threatened closure of the centre illustrates the unwillingness of the state to face up to the factual prevalence of migratory experiences in the country as a whole and as a core element of national history, experiences of migration in both directions. The statistics speak for themselves: of the 4.660.427 persons who left Italy between 1880 and 1950, 2.322.451 have returned, almost exactly 50%. To those have to be added 3.628.430 returnees of the 5.109.860 emigrants who left Italy between the end of World War II and 1976 for Europe alone. Attitudes towards people leaving changed ostensibly over time. In the first two decades after Unification parliament on the one hand wanted to show some concern over the fate of its citizens, not wanting to abandon those newly created citizens entirely to their own destiny, while on the other portraying their decisions to emigrate as expressions of individual liberty and responsibility and not necessitated by want and poverty. Emigrants had to prove, paradoxically that they had the requisite means to emigrate when in fact poverty was largely driving them to emigrate. To admit that publicly would have amounted to admission of economic and political failure made evident through emigration. In contrast to that Mussolini’s emigration policies not only enforced large population movements within the territory of Italy to balance unemployment between regions and particularly between North and South, but also declared it citizen’s duty to be ready to move also to the colonies, thereby ‘turning emigration as a sign of social crisis into a sign of national strength and the success of the country’s political agenda’ (Gaspari 2001, p. 34). The duplicity continued even after World War II when secret deals were done with the USA to allow a continuous flow of Italian immigrants and EU membership obviously further facilitated the departure of unemployed, impoverished Italians. With the growing prosperity of Italy the reversal of the direction of migration became more obvious. On the basis of empirical research conducted by one of the author on returning emigrants four types of motives for returning can be distinguished: 1. Return as a result of failure – particularly the emigrants who left during the 1950-1970 period usually had no linguistic preparation, and in any case the gap between the spoken and the written language is enormous with the latter often being insurmountable. This gives rise to nostalgic sentiments which motivates a return into an environment where language is familiar 2. Return as a means of preserving an identity – the life of emigrants often takes place within ghetto-like conditions where familiarity is being reproduced but under restricted conditions and hence not entirely authentic. The necessity for saving money permits only a partial entry into the host society and at the same time any accumulating savings add to the desire to return home where life can be lived fully again – or so it seems. 3. Return of investment – the impossibility to become fully part of another society often motivates migrants to accumulate not so much material wealth but new experiences and competences which they then aim to reinvest in their home country. 4. Return to retire – for many emigrants returning home becomes acute once they leave a productive occupation and feelings of estrangement build up, in conjunction with the efforts of having invested in building a house back home. All those motives are associated with a variety of difficulties on the actual return home because, above all, time in relation to the country of origin has been suspended for the emigrant and the encounter with the reality of that country reveals constant discrepancies and requires constant readjustment. This is where the need for assistance to returning emigrants arises. The fact that such an important centre of assistance has been closed is further confirmation of the still prevailing politics of ambiguity which nominally demand integration from nationals and non-nationals alike but deny the means of achieving this. Citizenship is not a natural result of nationality but requires the means for active participation in society. Furthermore, the experiences of returning immigrants provide important cues for the double ambivalence in which immigrants to Italy live between the demands made on them to integrate, the simultaneous threats of repatriation and the alienation from the immigrants’ home country which grows inexorably during the absence. The state can only regain its credibility by putting an end to this ambiguity and provide to returning emigrants, and immigrants alike, the means of reconstructing strong communal identities.

Repatriations and 28-day mortality of ill and injured travellers: 12 years of experience in a Swiss emergency department

QUESTIONS UNDER STUDY Many persons are travelling all over the world; the elderly with pre-existing diseases also travel to places with less developed health systems. Reportedly, fewer than 0.5% of all travellers need repatriation. We aimed to analyse and examine people who are injured or ill while abroad, where they travelled to and by what means they were repatriated. METHODS Retrospective cross-sectional study with adult patients repatriated to a single level 1 trauma centre in Switzerland (2000-2011). RESULTS A total of 372 patients were repatriated, with an increasing trend per year. Of these, 67% were male; the median age was 56 years. Forty-nine percent sustained an injury, and 13% had surgical and 38% medical pathologies. Patients with medical conditions were older than those with injuries or surgical emergencies (p <0.001). Seventy-three percent were repatriated from Europe. For repatriation from Africa trauma was slightly more frequent (53%, n = 17) than illnesses, whereas for most other countries illnesses and trauma were equally distributed. Injured patients had a median Injury Severity Score of 8. The majority of illnesses involved the nervous system (38%), mainly stroke. Forty-five percent were repatriated by Swiss Air Ambulance, 26% by ground ambulance, 18% by scheduled flights with or without medical assistance and two patients injured near the Swiss boarder by helicopter. The 28-day mortality was 4%. CONCLUSIONS The numbers of travellers repatriated increased from 2000 to 2011. About half were due to illnesses and half due to injuries. The largest group were elderly Swiss nationals repatriated from European countries. As mortality is relatively high, special consideration to this group of patients is warranted.

Comparative analysis of bilateral memoranda on anti-human trafficking cooperation between Thailand and three neighboring countries : what do the origin and the destination states agree upon?

In order to prevent, suppress and punish human trafficking, bilateral agreements between origin of victim countries and destination countries are crucial, because their cooperation involves cross-border activities such as repatriation of victims, extradition of criminals and information-sharing. This article analyzes three bilateral legal instruments between The Government of The Kingdom of Thailand and her three neighboring countries, namely The Royal Government of Cambodia, The Government of Lao People's Democratic Republic and The Government of The Union of Myanmar. The analysis will examine the legal status of the victim, the victim as witness in criminal proceedings, the victim protection programs, the recovery and restitution of damages, the process of repatriating the victim, and the prosecution of the criminal.

A note on ethnic return migration policy in Kazakhstan : changing priorities and a growing dilemma

This paper offers a brief analysis of the legal aspects of the ethnic return migration policy of Kazakhstan, a post-Soviet Central Asian state that has been active in seeking ties with its diaspora since independence. This paper examines the definition of oralman (repatriates) and the establishment of a quota on the number of Kazakh immigrants who are eligible for government funds to show how the rationale and preferences in repatriation policy have changed over the years. By focusing on changes in migration-related legislation in the late 2000s and early 2010s, the paper notes that two key goals of Kazakhstan’s migration policy are not necessarily consistent with each other: the promotion of an ethnically based nation-building project by encouraging the "return" of co-ethnics living abroad, and building a workforce that is best suited for the development of the state’s economy.

The Dutch wish-list for a lighter regulatory touch from the EU. CEPS Commentary, 1 July 2013

The Dutch government set out the results of its review of EU competences on June 21st, under the slogan “European where necessary, national where possible”, claiming that the EU does not adequately respect the principles of subsidiarity and proportionality. It published a list of 54 points for corrective action, which Michael Emerson assesses in this new CEPS Commentary. The political significance of this initiative is heightened because it comes alongside the UK's ongoing review of EU competences, although unlike the British, the Dutch make no mention of secession, treaty changes or repatriation of competences.

British Balance of Competence Reviews, Part II: Again, a huge contradiction between the evidence and Eurosceptic populism. EPIN Paper No. 40, June 2014

This paper is the second in a series for a CEPS project entitled “The British Question and the Search for a Fresh European Narrative”. It is pegged on an ambitious exercise by the British government to review all the competences of the European Union on the basis of evidence submitted by independent stakeholders. In all, 32 sectoral policy reviews are being produced over the period 2013-2015, as input into public information and debate leading up to a referendum on whether the UK should remain in, or secede from, the EU, planned for 2017. This second set of reviews covers a broad range of EU policies (for the single market for goods, external trade, transport policy, environment, climate change, research, asylum, non-EU immigration, civil judicial cooperation, tourism, culture and sport). The findings confirm what emerged from the first set of reviews, namely that there is little or no case for repatriation of EU competences at the level they are defined in the treaties. This does not exclude that at a more detailed level there can be individual actions or laws that might be done better or not at all. However, that is the task of all the institutions to work at on a regular basis, and hardly a rationale for secession. For the UK in particular the EU has shown considerable flexibility in agreeing to special arrangements, such as in the case of the policies here reviewed of asylum, non-EU immigration and civil judicial cooperation. In other areas reviewed here, such as the single market for goods, external trade, transport, environment, climate change and research, there is a good fit between the EU’s policies and UK priorities, with the EU perceived by stakeholders as an ‘amplifier’ of British interests.

Repatriación ; anexo, la explotación de los montes fiscales /

Includes Ley de 6 de Agosto de 1906.

Migranten Und Internierte:Deutsche in Glasgow, 1864-1918

Für deutsche Migranten des 19. Jahrhunderts war Großbritannien eines der wichtigsten Zielländer innerhalb Europas. Zum ersten Mal wird eine der zahlreichen deutsch-ethnischen Kolonien einer mikrohistorischen Untersuchung unterzogen. Die Perspektive erlaubt quellengestützt genauere Aussagen zu Themenkomplexen wie Wanderungsverhalten, Berufsstruktur oder ethnischer Selbstorganisation. In Glasgow bildete sich ein dichtes Netz an ethnischen Vereinigungen, das sich nach Kriegsausbruch unter dem germanophoben Druck der britischen Öffentlichkeit sowie staatlichen Maßnahmen wie Internierung, Repatriierung oder Enteignung fast vollständig auflöste. Die Glasgower Fallstudie wird durch zahlreiche Querverweise auf andere Regionen und Länder in einen größeren migrationsgeschichtlichen Rahmen eingeordnet. German migrants of the 19th century. Century Britain was one of the main destination countries within Europe. One of the many German ethnic colonies of a micro historical investigation is subjected for the first time. The perspective allows more detailed statements on topics such as migratory behavior, occupational structure or ethnic self-organization source based. A dense network of ethnic associations that almost completely disbanded after war germanophoben pressure from the British public and Government measures such as detention, repatriation or expropriation was formed in Glasgow. The Glasgow case study are classified by numerous cross-references to other regions and countries within a larger migration history.