Brussels In December Research Articles

Rhinology future trends: 2017 EUFOREA debate on allergic rhinitis.

The 2nd Rhinology Future Debate, organized by EUFOREA (European Forum for Research and Education in Allergy and Airways diseases) was held in Brussels in December 2017. One of these debates addressed the position of MP-AzeFlu in allergic rhinitis (AR) treatment. The current article summarizes this debate; reviewing recent data, and exploring how this has been interpreted by experts and incorporated into AR management guidelines and a clinical decision support system (CDSS). The Allergic Rhinitis & its Impact on Asthma (ARIA) guideline position MP-AzeFlu firstline for the treatment of AR, and in preference to intranasal corticosteroids (INSs) during the first 2 weeks of treatment. The AR CDSS recommends MP-AzeFlu as one of the firstline treatments for patients with a visual analogue scale (VAS) score lower than 5/10 cm, and in preference (along with INS) for those with a VAS score equal or higher than5/10 cm. Panellists agreed that AR management should be kept as simple as possible, with some preferring a one treatment fits all approach, while others preferred a step-up approach. The need to change the AR management mentality was acknowledged, accepting that most patients use their medication as needed and use multiple treatments; AR medications are needed which have a very fast onset of action and which target breakthrough symptoms. Panellists agreed that MP-AzeFlu has a role to play here, since it has a 5 minute onset-of-action, provides clinically-relevant symptom relief in 15 mins and AR control in less than 3 days, targets nasal hyper-reactivity (NHR) which likely contributes to uncontrolled AR and breakthrough symptoms, and provides more effective AR symptom relief than INS monotherapy or INS + oral antihistamine. Finally, experts considered it likely that MP-AzeFlu should have a greater impact on asthma control than INS in co-morbid patients, but clinical data is required to back up existing pharmacoeconomic evidence. The next Rhinology Future Debate will be in held in Brussels in Dec 2019.

Rhinology Future Debates, an EUFOREA Report.

The first Rhinology Future Debates was held in Brussels in December 2016, organized by EUFOREA (European Forum for Research and Education in Allergy and Airways diseases). The purpose of these debates is to bring novel developments in the field of Rhinology to the attention of the medical, paramedical and patient community, in a highly credible and balanced context. For the first time in Rhinology, a peer to peer scientific exchange with key experts in the field of rhinology and key medical colleagues from leading industries let to a brainstorming and discussion event on a number of hot issues in Rhinology. Novel developments are presented by key experts from industry and/or key thought leaders in Rhinology, and then followed by a lively debate on the potential positioning of new developments in care pathways, the strengths and weaknesses of the novel development(s), and comparisons with existing and/or competing products, devices, and/or molecules. As all debates are recorded and distributed on-line with limited editing (www.rhinology-future.com), EUFOREA aims at maximizing the education of the target groups on novel developments, allowing a critical appraisal of the future and a more rapid implementation of promising novel tools, techniques and/or molecules in clinical practise in Europe. The next Rhinology Future debate will be held in Brussels in December 2017.

Europe and Maritime Security in the South China Sea: Beyond Principled Statements?

Europe and Maritime Security in the South China Sea:Beyond Principled Statements? Mathieu Duchâtel (bio) The European Union, France, Germany, Italy, and the United Kingdom all signed the G-7 Foreign Ministers’ Declaration on Maritime Security in Lübeck in April 2015. The declaration reiterates their commitment to “freedoms of navigation and overfight” and to an “international maritime order based upon the principles of international law, in particular as reflected in UNCLOS [the United Nations Convention on the Law of the Sea].” The declaration also makes clear that Europe shares the concerns of the United States and Japan regarding “unilateral actions” in the East and South China Seas.1 However, despite this diplomatic support, Europe has been by far a marginal player in the South China Sea and appears disconnected from the Asian security debate that takes place in Washington—for example, only a very tiny minority of individuals in European capitals has discussed the possibility of freedom of navigation operations in the South China Sea. This essay examines European interests in the South China Sea and argues that Europe faces a gap between intentions and capabilities regarding Asian security. This gap is widening as a result of the deteriorating security environment in Europe’s immediate neighborhood—the wars in eastern Ukraine and Syria, the refugee crisis, and the necessity of protecting European populations from terrorist actions. For the United States, Europe should be taken for what it is—a partner in values that can only make limited contributions to improving the security environment in the South China Sea. As long as tensions in the South China Sea remain below the threshold of armed confrontation, the policy debate in Europe will remain focused on how to best formulate statements. [End Page 54] Europe’s Declaratory Diplomacy Europe has been generally restrained in commenting on recent developments in the South China Sea. At the EU level, the response to deteriorating security trends has come in the form of reactive statements reaffirming the principles of peaceful settlement, international law, and the importance of confidence building. This approach is summarized in the 2012 “Guidelines on the EU’s Foreign and Security Policy in East Asia.” The document defines the European interests in the South China Sea in terms of the promotion of a “rules-based international system [and] the principle of freedom of navigation” and mentions “the risk of tensions impacting on the consistent increase in trade and investment, with negative consequences for a ll.” 2 The document also encourages the claimants to resolve their “disputes through peaceful and cooperative solutions and in accordance with international law (in particular UNCLOS), while encouraging all parties to clarify the basis for their claims.”3 The EU reiterates these general principles whenever a major development occurs in the South China Sea. In May 2014, it issued a statement when China deployed an oil rig in waters disputed with Vietnam, leading to a tense standoff that lasted two months. The statement mentions the international law of the sea and the importance of a “peaceful and cooperative solution.” The main adjustment in the May 2014 statement concerns the greater insistence on freedom of navigation and the need to refrain from unilateral actions. Further statements became slightly more specific, including one released on the occasion of Vietnamese prime minister Nguyen Tan Dung’s visit to Brussels in December 2015 that emphasized Europe’s “serious concerns” regarding “massive land reclamation.” 4 A final notable feature of the European approach is the constant reaffirmation of the importance of all processes led by the Association of Southeast Asian Nations (ASEAN) to guarantee peace and stability in the South China Sea. Repeated in all meetings where the EU has a voice—such as the ASEAN Regional Forum and the Asia-Europe Meeting—this diplomatic language suggests that the essence of the European approach is to remain [End Page 55] at the general level of principles and avoid taking clear sides.5 Similar to other external stakeholders, the EU does not have a stance on territorial sovereignty in the South China Sea. At the same time, the European choice has been to emphasize international law without stating clearly which elements of UNCLOS or...

Small bowel capsule endoscopy for management of Crohn's disease: Where do we stand?

During the pioneering phase of the use of video capsule endoscopy (VCE), the diagnosis and even the suspicion of Crohn’s disease was considered as an absolute contraindication to the performance of the procedure, because of the risk of capsule retention proximal to a stenosis. In subsequent years, the view has changed, and known or suspected Crohn’s disease is now the second most common indication for VCE, accounting for about 10–15% of the capsule procedures performed. However, Crohn’s disease is diagnosed on the basis of the combination of endoscopic, histological, radiological and biochemical investigations, and therefore, the value of VCE in this setting must be evaluated in the context of the different available techniques. To help establishing the role of VCE and other diagnostic techniques in the management of inflammatory bowel disease, the European Crohn’s and Colitis Organisation (ECCO) and the Organisation Mondiale d’Endoscopie Digestive (OMED) jointly organized a consensus meeting in Brussels in December 2008, which led to the publication of clinical practice guidelines [1]. The reasons why VCE is attractive for the management of Crohn’s disease are that in up to 30% of cases the disease is limited to the small bowel [2], that the technique has limited invasiveness and has the unique possibility of exploring the entire small bowel mucosa. However, VCE also has some drawbacks, such as the inability to take tissue samples, the risk of retention and the lack of a widely accepted classification of small bowel lesions in inflammatory bowel disease. The potential applications of capsule endoscopy in inflammatory bowel disease include the following clinical scenarios: patients with a clinical suspicion of Crohn’s disease, where VCE could help establishing a new diagnosis; patients with known Crohn’s disease, where VCE could help assessing the extent and severity of the disease, and thus assist in making treatment decisions; in previously operated patients, VCE could be used to evaluate the appearance of recurrences; patients with inflammatory bowel disease, unclassified (IBDU), where VCE could help distinguishing ulcerative colitis

Alliance for biomedical research in Europe

Europe is facing one of the most challenging times in its history, with austerity measures being applied across member states that are leaving research programmes in uncertain territory. Funding for European research and development (R&D) programmes remains stagnant at 1.8% of European Union GDP, well short of the 3.0% that was committed to in the Lisbon summit of 2002. This stagnation occurs while all of Europe's major competitors – namely the USA (2.7%), Japan (3.4%) and most recently China – continue to invest in their biomedical research programmes. UNESCO data from 2007 shows that China's total R&D investment was one third of that of the entire EU. But continued investment and rising GDP means that China's investment is likely to quadruple by 2020, meaning its total R&D spending will overtake Europe in a few years. European biomedical research could be left behind unless major steps are taken to address this gulf in funding. Yet it is not only how much money we receive, but how we spend that money, that has inspired the creation of the Alliance for Biomedical Research in Europe (Biomed Alliance) (see Box 1 for formation of the Alliance). For too long the voices of researchers in Europe have not had sufficient impact on proposed research programmes by the European Union. Such contact has, until now, been sporadic and not produced the desired results on research topics and priorities. Our new Alliance aims to give a single, powerful voice to the European biomedical research community, that aims to increase funding and ensure the correct research priorities are given funding across all biomedical disciplines. BOX 1: Formation of the alliance The Biomed Alliance officially formed at a meeting in Brussels in December 2010, consisting of the four founding societies: the European …

Revisiting “on meetings that matter”

Our May issue was dedicated to the subject of Fertility Preservation and highlighted recent advances in this field that were presented at the First World Congress of Fertility Preservation held in Brussels in December, 2009. With swift editorial prerogative, sensing both the timeliness and relevance of this topic, JARG obtained and ran with this opportunity and in the process overlooked the tiring efforts and inspiring dedication made by so many that were involved with the meeting in Brussels and the May issue of JARG. As my commentary intended to show, meetings that do matter are few and far between. Those meetings that leave a deep impression are usually those that have received support and encouragement from an organization that cares. In this sense, that the First World Congress on Fertility Preservation was a resounding success was most certainly due to the central role played by the Serono Symposia International Foundation(SSIF). The importance of the SSIF in making this meeting meet and exceed its expectations was articulated by the meeting organizers and conveners, Professors Jacques Donnez and S. Sam Kim. In summarizing the conclusions reached after two and one half days of intense discussion and debate, the organizers cited the confluence of venue, participation, and the climate staged by SSIF as the driving force behind this meeting, an event that will be viewed as stage setting for the field of fertility preservation for years to come. SSIF involvement did not stop at meeting’s end. Staff member Francesca Caputo, who oversaw the meeting from its inception to conclusion, was asked yet again by myself to assist in making the May issue of JARG one that would materially evidence the importance of this field and the issues that were raised at the meeting. My requests for abstracts and other media were pleasantly addressed by Francesca and with a timeliness that frequents the world of journal production and publication. To Francesca, I am deeply indebted. In summary, a sincere note of gratitude is extended to the SSIF for their support of the First World Congress of Fertility Preservation on behalf of the participants, members of the International Society for Fertility Preservation, and the organizers. The birthright of this important field has been imprinted by SSIF!

On meetings that matter

On meetings that matter

Europe's constitutional momentum and the search for polity legitimacy

To suggest that the European Union (EU) in 2004 possesses constitutional momentum may not seem a particularly audacious claim. It might appear self-evident, in fact, that an entity going through a high-profile, self-styled constitutional experiment is imbued with constitutional momentum—witness the busy sequence of events leading from the Treaty of Nice,1 to the Laeken declaration,2 to the Convention on the Future of Europe and its draft Treaty Establishing a Constitution for Europe,3 and, finally, following the failure in Brussels in December 2003,4 to the agreement on a text by the intergovernmental conference (IGC) in June 20045 to be put to the member states for ratification according to their domestic constitutional requirements. But first impressions would be deceptive. The delivery of an agreed-upon text demonstrates that there is, indeed, a thin if tautological truth implicit in the proposition that the EU has constitutional momentum. But there are harder and more important questions to ask about constitutional momentum that distinguish between the short-term, event-framed horizon and its specific product,

Training logbook for radiotherapy

Aim: To develop a structured logbook for trainees in the medical speciality of radiotherapy with Europe that records the increasing experience throughout their training period.Material and methods: A working party appointed by the European Board of Radiotherapy developed a draft version of a European logbook for trainees in radiotherapy. For development, the update European Core Curriculum for Radiotherapists (Radiation Oncologists) was taken into consideration. The logbook is composed of six sections: (1) biodata of the trainee, (2) scientific training documentation, (3) clinical training documentation, (4) record of formal presentations by the trainee, (5) publications, (6) training courses. Decisions were made to suggest that the clinical section of the logbook should: (a) only collect data that was essential for the purposes of appraisal, assessment and regulation, (b) be as user friendly as possible, (c) concentrate on quality of the data and not volume. The logbook was tested by trainees in several European training departments and adapted according to their suggestions. A final draft of the logbook was circulated among the national and professional societies for radiotherapy in Europe for review before a European consensus conference took place in Brussels in December 2002.Results: The European training logbook for radiotherapy was endorsed by representatives of 35 European nations during the Brussels consensus conference on December 14, 2002.Conclusion: Keeping a training logbook is an essential feature of the record of training for all EU trainees who wish to retain an opportunity to spend part of their training time in another country of the Union, important for someone who seeks an appointment as a specialist in another country within a few years of achieving specialist accreditation, and good professional practice for all other trainees. The European training logbook for radiotherapy is a robust instrument that allows the systematic collection of the information that needs to be recorded to monitor the professional development of European trainees in Radiation Oncology.

Guidelines for the infrastructure of training institutes and teaching departments for radiotherapy in Europe

AimTo develop guidelines for the infrastructure of training institutes and teaching departments for medical specialist training in radiotherapy within Europe. Material and methodsGuidelines for teaching departments were developed under consideration of the updated European Core Curriculum for Radiotherapists (Radiation Oncologists) by an expert panel jointly appointed by the European Union of Medical Specialists and the European Society of Therapeutic Radiology and Oncology. The group approached national professional and scientific societies for information on national requirements for teaching departments. Based on this information, a draft document was circulated among the national and professional societies for radiotherapy in Europe for review before a European consensus conference took place in Brussels in December 2002. ResultsThe guidelines for the infrastructure of training institutes and teaching departments for medical specialist training in radiotherapy within Europe were endorsed by representatives of 35 European nations during the Brussels consensus conference on December 14, 2002. ConclusionThe infrastructure guidelines represent an important instrument that can be used by teaching departments for comparison of their situation with that of other departments in Europe as a basis for negotiations with authorities on resources provided for training.

Updated European core curriculum for radiotherapists (radiation oncologists). Recommended curriculum for the specialist training of medical practitioners in radiotherapy (radiation oncology) within Europe

AimTo produce updated state-of-the-art recommendations for harmonised medical specialist training in radiotherapy within Europe. Material and methodsThe Minimum Curriculum for the Theoretical Education in Radiation Oncology in Europe from 1991 was updated under consideration of new developments in medicine in general, and in radiotherapy and its basic sciences in particular. Recent medical developments, national guidelines and training programmes from European countries, as well as equivalent documents from the USA and Australia were reviewed by an expert panel jointly appointed by the European Society of Therapeutic Radiology and Oncology and the European Board of Radiotherapy. A draft document prepared by this group was circulated among the national and professional societies for radiotherapy in Europe for review before a European consensus conference took place in Brussels in December 2002. ResultsThe updated European Core Curriculum for Radiotherapists (Radiation Oncologists) was endorsed by representatives of 35 European nations during the Brussels consensus conference on December 14, 2002. Compared to the earlier version the updated document contains specific recommendations not only for the 5 year training curriculum but also for organisatoric and infrastructural aspects of teaching departments, and for supplementation of the training by formal teaching courses. ConclusionThe updated European core curriculum is an important step on the way to fully harmonise medical specialist training in Europe and to guarantee equal access for all European citizens to highest quality medical care. The responsibility for the implementation of the standards and guidelines set in the updated Core Curriculum for radiotherapy (radiation oncology) will lie with the local and/or national training bodies and authorities.

A Constitutional Court for Europe?

The purpose of this article is to consider the effect of the draft Treaty establishing a Constitution for Europe on the European Court of Justice (ECJ). At the time of writing, the future of the draft Constitution is somewhat uncertain. Having been finalised by the Convention on the Future of Europe in the summer of 2003 and submitted to the then President of the European Council, it formed the basis for discussion at an intergovernmental conference (IGC) which opened in October 2003. Hopes that the text might be finalised by the end of the year were dashed when a meeting of the IGC in Brussels in December 2003 ended prematurely amid disagreement over the weighting of votes in the Council. However, it seems likely that a treaty equipping the European Union with a Constitution based on the Convention’s draft will in due course be adopted and that the provisions of the draft dealing with the ECJ will not be changed significantly. Even if either assumption proves misplaced, those provisions will remain of interest as reflecting one view of the position the ECJ might occupy in a constitutional order of the Union.

A Constitutional Court for Europe?

The purpose of this article is to consider the effect of the draft Treaty establishing a Constitution for Europe on the European Court of Justice (ECJ). At the time of writing, the future of the draft Constitution is somewhat uncertain. Having been finalised by the Convention on the Future of Europe in the summer of 2003 and submitted to the then President of the European Council, it formed the basis for discussion at an intergovernmental conference (IGC) which opened in October 2003. Hopes that the text might be finalised by the end of the year were dashed when a meeting of the IGC in Brussels in December 2003 ended prematurely amid disagreement over the weighting of votes in the Council. However, it seems likely that a treaty equipping the European Union with a Constitution based on the Convention’s draft will in due course be adopted and that the provisions of the draft dealing with the ECJ will not be changed significantly. Even if either assumption proves misplaced, those provisions will remain of interest as reflecting one view of the position the ECJ might occupy in a constitutional order of the Union.

The ripening of Integrated Product Policy

This article aims at highlighting the development and present status quo of the debate over IPP. In the first part it summarizes how this topic was taken up by research and by policy makers. In the second part it provides a synopsis of the main findings of a European workshop on IPP held in Brussels in December 1998. Copyright © 1999 John Wiley & Sons, Ltd and ERP Environment.

Electronic Records: the European Dimension

This article is based on two sets of sources: the work of the International Congress on Archives (ICA) Electronic Records Committee, and a series of European initiatives, most recently the DLM Forum on electronic records held in Brussels in December 1996. The article concentrates largely on national archives, because governments are the largest record creators and it is in the public sector that the problems of electronic records are seen most clearly.