Description:
Timor Leste which emerged as a sovereign nation in 2002, is one of the most oil dependent countries in the world but with limited oil reserves. In 2005 it set up a Petroleum Fund to provide a stable source of revenues for the budget over the long term and to preserve intergenerational equity. Ten years later, the petroleum fund balance fell for the first time due to falling output, lower oil prices and lower returns on investment. With its oil production expected to cease in 2023 and withdrawals from the fund far exceeding the estimated sustainable income level it is imperative that revenues are spent wisely. This study focuses on examining the pattern of oil revenue expenditures and concludes that expenditures on veterans' payments and large scale infrastructure projects have thwarted the stated aims of the fund particularly that of preserving intergenerational equity. The paper concludes by examining the policy implications of the findings. •Timor is highly dependent on oil but has limited reserves.•Withdrawals from its Petroleum Fund far exceeds its estimated sustainable income.•Veterans' payments and infrastucture projects thwarted intergenerational equity.•Changes in expenditure are needed to foster intergenerational equity.
Description:
Aim: The aim of this review was to identify and synthesise published accounts of recognising and responding to patient deterioration in the presence of deterioration antecedents. Design: The systematic review canvassed four electronic databases/ search engines for studies of adult ward patients who had altered physiological parameters before developing major adverse events. Synthesis Methods: The findings were synthesised using a narrative approach. Results: Clinical deterioration can be missed by nurses, even with adequate charting. Delays in recognising and responding to patient deterioration remains an international patient safety concern, and strategies to enhance recognition of patient deterioration have not achieved consistent improvements. The lack of significant and sustained improvement through targeted training suggests the problem may be rooted in human behaviour and local ward culture. Nurses play a pivotal role in recognising and responding to patient deterioration; however, patient records do not facilitate tracking of all nurse decisions and actions, and any undocumented care cannot be easily captured by auditing processes. Conclusion: Failure to recognise clinical deterioration was evident even with adequate charting. It is not clear if nurses do not recognise clinical deterioration because they failed to interpret the signs of deterioration or they made a conscious decision not to escalate based on their clinical judgement or they lacked attention at the time of the event. Whatever the reason, focus is warranted for nurses' decisionmaking after the recording of clinical deterioration signs and the role of human factors in delayed recognition, before maximum benefit of any strategy can be achieved.