Consumer Representatives Research Articles

Efforts to Improve Perinatal Outcomes for Women Enrolled in Medicaid.

Improving women's health and perinatal health outcomes is a high priority for Medicaid, the jointly financed federal-state health coverage program. The authorities provided by the Affordable Care Act give Medicaid new resources and opportunities to improve coverage and perinatal care. Given that the Medicaid program currently covers almost half of all births in the United States, the Centers for Medicare and Medicaid Services, working in partnership with states and other stakeholders, is using new and existing authorities to improve birth outcomes. Quality measurement, quality-improvement projects, and expanded models of care underscore the major quality approach of the center. As an outgrowth of an expert panel that included membership of several state Medicaid medical directors, Medicaid providers, and consumer representatives, the Centers for Medicare and Medicaid Services' Center for Medicaid and CHIP Services launched the Maternal and Infant Health Initiative, which aims to increase postpartum visit rates and the use of effective contraception among women covered by Medicaid. This Initiative provides focus on key opportunities and strategies to improve the rate, measurement, timing, and content of postpartum visits. Additionally, a focus on contraception will serve to improve pregnancy planning and spacing and prevent unintended pregnancy. As the Initiative evolves, the Center for Medicaid and CHIP Services plans to identify policy, service delivery, and reimbursement policies to advance the Initiative's goals and improve outcomes for women covered by Medicaid.

Stable isotope ratios of hydrogen separate mammals of aquatic and terrestrial food webs

Summary In food web studies, hydrogen stable isotope ratios (δ2H) are increasingly used as endogenous markers to quantify the relative importance of allochthonous input of organic material into aquatic ecosystems. Yet, it is unclear if differences in δ2H values between aquatic and terrestrial food webs translate into corresponding differences of δ2H values of vertebrate consumers. Using a triple‐isotope approach, we asked if fur keratin of 12 sympatric, non‐migratory bat species differ in stable isotope ratios (δ2HK, δ13CK, δ15NK) according to the ecosystem (aquatic or terrestrial) in which they predominantly forage. We conducted a study with two captive species beforehand that suggested species‐specific differences in trophic discrimination for C and N, but not for H. In wild bats, stable isotope ratios of two Myotis species that trawl insects in aquatic habitats differed from those of four congeneric species that glean terrestrial insects by about 40‰ for H and by about 5‰ for N, indicating that both δ2HK and δ15NK values are useful for identifying membership of aquatic and terrestrial food webs. Further, we assessed the relative association of aerial‐hawking bat species to the terrestrial food web using trawling and gleaning bats as representatives of consumers in aquatic and terrestrial ecosystems, respectively. We found that the relative association of bats to terrestrial food webs varied largely among species, ranging from about 90% in Rhinolophus hipposideros to 43% in Eptesicus serotinus. Isotopic niche dimensions, as estimated by standardized ellipse areas using δ2HK and δ15NK values, varied largely among the 12 study species, with largest overlaps of isotopic niches among members of the aerial‐hawking bat ensemble. We conclude that δ2HK and δ15NK values are suitable parameters for evaluating the relative membership of mammals to aquatic and terrestrial food webs and also to evaluate isotopic niche dimensions and thus niche packing of species within consumer ensembles.

Collaborative Governance in the Reform of Western Australia's Alcohol and Other Drug Sector

Collaborative governance involves processes and structures for policy development and decision making with particular relevance for health and social services. We examined collaborative governance in the reform of Western Australia's alcohol and other drug sector, applying Emerson et al.'s (2012) integrative framework. A documentary review and group interviews with government, sector, and consumer representatives were involved. Contextual factors included increased service funding, and the development of a partnership approach. Drivers for collaboration involved leadership and financial incentives for policy implementation. Key stakeholders across government and the sector reported a mutually supportive and constructive relationship and increased capacity, and they shared an agenda for change. The integrative framework was a useful structure for the explication of collaborative governance, although financial arrangements were not addressed.

Ethics and equity in research priority-setting: stakeholder engagement and the needs of disadvantaged groups.

A transparent and evidence-based priority-setting process promotes the optimal use of resources to improve health outcomes. Decision-makers and funders have begun to increasingly engage representatives of patients and healthcare consumers to ensure that research becomes more relevant. However, disadvantaged groups and their needs may not be integrated into the priority-setting process since they do not have a "political voice" or are unable to organise into interest groups. Equitable priority-setting methods need to balance patient needs, values, experiences with population-level issues and issues related to the health system.

EMF monitoring-concepts, activities, gaps and options.

Exposure to electromagnetic fields (EMF) is a cause of concern for many people. The topic will likely remain for the foreseeable future on the scientific and political agenda, since emissions continue to change in characteristics and levels due to new infrastructure deployments, smart environments and novel wireless devices. Until now, systematic and coordinated efforts to monitor EMF exposure are rare. Furthermore, virtually nothing is known about personal exposure levels. This lack of knowledge is detrimental for any evidence-based risk, exposure and health policy, management and communication. The main objective of the paper is to review the current state of EMF exposure monitoring activities in Europe, to comment on the scientific challenges and deficiencies, and to describe appropriate strategies and tools for EMF exposure assessment and monitoring to be used to support epidemiological health research and to help policy makers, administrators, industry and consumer representatives to base their decisions and communication activities on facts and data.

Development and content validation of the information assessment method for patients and consumers.

BackgroundOnline consumer health information addresses health problems, self-care, disease prevention, and health care services and is intended for the general public. Using this information, people can improve their knowledge, participation in health decision-making, and health. However, there are no comprehensive instruments to evaluate the value of health information from a consumer perspective.ObjectiveWe collaborated with information providers to develop and validate the Information Assessment Method for all (IAM4all) that can be used to collect feedback from information consumers (including patients), and to enable a two-way knowledge translation between information providers and consumers.MethodsContent validation steps were followed to develop the IAM4all questionnaire. The first version was based on a theoretical framework from information science, a critical literature review and prior work. Then, 16 laypersons were interviewed on their experience with online health information and specifically their impression of the IAM4all questionnaire. Based on the summaries and interpretations of interviews, questionnaire items were revised, added, and excluded, thus creating the second version of the questionnaire. Subsequently, a panel of 12 information specialists and 8 health researchers participated in an online survey to rate each questionnaire item for relevance, clarity, representativeness, and specificity. The result of this expert panel contributed to the third, current, version of the questionnaire.ResultsThe current version of the IAM4all questionnaire is structured by four levels of outcomes of information seeking/receiving: situational relevance, cognitive impact, information use, and health benefits. Following the interviews and the expert panel survey, 9 questionnaire items were confirmed as relevant, clear, representative, and specific. To improve readability and accessibility for users with a lower level of literacy, 19 items were reworded and all inconsistencies in using a passive or active voice have been solved. One item was removed due to redundancy. The current version of the IAM4all questionnaire contains 28 items.ConclusionsWe developed and content validated the IAM4all in partnership with information providers, information specialists, researchers and representatives of information consumers. This questionnaire can be integrated within electronic knowledge resources to stimulate users’ reflection (eg, their intention to use information). We claim that any organization (eg, publishers, community organizations, or patient associations), can evaluate and improve their online consumer health information from a consumers’ perspective using this method.

A Through-chain Analysis of Food Safety Hazards and Control Measures Associated with the Production and Supply of Seed Sprouts for Human Consumption

Background: Seed sprouts contaminated with pathogenic microorganisms, such as Salmonella spp. and Shiga toxin-producing Escherichia coli (STEC) present an unacceptable health risk to consumers. An outbreak that occurred in Australia during 2005 and 2006 due to the consumption of alfalfa sprouts contaminated with Salmonella Oranienburg resulted in 141 infected cases, and cost an estimated $1.19 million to the Australian community. In Japan in 1996, consumption of radish sprouts contaminated with STEC O157:H7 affected more than 10,000 individuals. The outbreak of E. coli O104:H4 linked to the consumption of fenugreek sprouts that occurred in Europe in 2011 was an unprecedented foodborne outbreak. More than 4,000 individuals were infected by STEC O104:H4. Among them, 908 developed haemorrhagic uraemic syndrome (HUS), and 50 died of STEC infection. This demonstrates the potential food safety risk arising from seed sprouts and that the consequences can be devastating. Food Standards Australia New Zealand (FSANZ) initiated the development of a primary production and processing standard for seed sprouts in 2009 to enhance the safety of seed sprouts produced and sold in Australia. After extensive consultations with the State and Territory food safety regulators, and a thorough investigation of the Australian Grey Literature European Journal of Nutrition & Food Safety, 4(4): 424-428, 2014 425 industry practices in producing seed sprouts for human consumption, a technical paper was prepared to inform the design of potential risk mitigation measures for a national food safety standard on seed sprout production. This technical paper described the Australian seed sprout industry, depicted the steps involved in the production of seed sprouts for human consumption, and provided an analysis of potential food safety hazards that could occur during seed sprout production and processing. A food safety standard for the production and sale of seed sprouts in Australia was finalised in November 2011. This extended abstract describes the key aspects of the technical paper. Aims: To provide technical and scientific information to support risk management decisions aimed at maximizing the safety of seed sprouts produced for human consumption in Australia. Study Design: A through-chain qualitative food safety risk analysis. Place and Duration of Study: FSANZ, Canberra, Australia, between July 2009 and January 2010. Methodology: This through-chain risk analysis was prepared upon a comprehensive review of literature available at the time on: investigations of foodborne outbreaks associated with consumption of seed sprouts; surveys of microbial contamination of seed sprouts; specific publications on crop production, seed harvest, post-harvest processing and storage of seeds; production of seed sprouts; risk assessments on seed sprouts; and regulatory guidelines published by Australian and international food safety regulatory authorities on seed sprouts. Members of the FSANZ project team conducted field studies of sprout production, lucerne crop production, lucerne seed processing, wholesale and retail sale of seed sprouts. A survey was conducted on the variety, volume and value of sprouts produced, source and quantity of seeds used to produce sprouts for human consumption, trend of consumption of seed sprouts in Australia, as well as the size and the location of sprout producers in Australia. Stakeholders were consulted through a FSANZ standard development committee with participants from State and Territory food safety regulators, peak sprout producer industry bodies, seed producers and seed processors, major food retailers, and consumer representatives. The through-chain analysis of food safety hazards associated with the production and processing of seed sprouts was prepared in line with the principles of hazard analysis critical control points (HACCP).

A Delphi Study to Elicit Policies for Nurse Workforce based on Patient Safety

Purpose: This study was done to suggest policies for nurse workforce based on patient safety. Methods: The two steps in developing the items were items related to what would be desirable policies and items on how the policies should be developed for patient safety regarding nurse workforce. A literature review was done and suggestions from experts through two rounds using the Delphi technique were outlined. The fifteen experts who participated in this study were six representatives of service consumers and nine representatives of service providers (four medical doctors and fives nurses). Results: To guarantee patient safety, accreditation of nursing practice and nursing education were found to be necessary, and to prevent medical and nursing accidents in clinical practice, the professional judgement of the nurses was found to be pivotal to the provision of safe nursing services. Conclusion: Polices on nursing for the nurse workforce based on patient safety in clinical settings should be established to ensure that nursing care is provided according to the nurses' clinical judgements based on their professional knowledge and assessment

Best Practices: Level-of-Care Criteria for Peer Support Services: A Best-Practice Guide

Peer support services (PSS) are an expanding part of the continuum of care provided for behavioral health conditions. These services have been deemed an evidence-based reimbursable model of care by the Centers for Medicare and Medicaid Services. States, counties, employers, and health plans are increasingly covering PSS in benefit plans. Controlled and experimental studies are building the evidence base for these services. Medicaid and the states have not developed level-of-care or medical necessity criteria for PSS, even though these criteria are standards for determining coverage and reimbursement. This review of emerging level-of-care criteria for PSS provides a framework for the further development of these resources.

Development of a satisfaction scale for young people attending youth mental health services

This study aimed to develop a comprehensive measurement tool for assessing client satisfaction at a youth mental health service. We developed a scale based on existing scale items and by generating new items, before undertaking revisions and item reduction in consultation with an expert panel composed of researchers, clinicians and consumer representatives. This draft scale was then pilot tested in seven enhanced primary care youth mental health services across Australia. A total of 215 respondents completed the scale. Cronbach's alpha (α = 0.953) demonstrated excellent internal consistency, and exploratory factor analysis suggested that the scale measures a global construct of satisfaction. Through a rigorous and participatory process involving key experts, service providers and service users, this study has resulted in the development of a scale that can appropriately measure the level of user satisfaction with youth-friendly early intervention services.

Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia

BackgroundFetal alcohol spectrum disorders (FASD) are underdiagnosed in Australia, and health professionals have endorsed the need for national guidelines for diagnosis. The aim of this study was to develop consensus recommendations for the diagnosis of FASD in Australia.MethodsA panel of 13 health professionals, researchers, and consumer and community representatives with relevant expertise attended a 2-day consensus development workshop to review evidence on the screening and diagnosis of FASD obtained from a systematic literature review, a national survey of health professionals and community group discussions. The nominal group technique and facilitated discussion were used to review the evidence on screening and diagnosis, and to develop consensus recommendations for the diagnosis of FASD in Australia.ResultsThe use of population-based screening for FASD was not recommended. However, there was consensus support for the development of standard criteria for referral for specialist diagnostic assessment. Participants developed consensus recommendations for diagnostic categories, criteria and assessment methods, based on the adaption of elements from both the University of Washington 4-Digit Diagnostic Code and the Canadian guidelines for FASD diagnosis. Panel members also recommended the development of resources to: facilitate consistency in referral and diagnostic practices, including comprehensive clinical guidelines and assessment instruments; and to support individuals undergoing assessment and their parents or carers.ConclusionsThese consensus recommendations provide a foundation for the development of guidelines and other resources to promote consistency in the diagnosis of FASD in Australia. Guidelines for diagnosis will require review and evaluation in the Australian context prior to national implementation as well as periodic review to incorporate new knowledge.

Consumer's perceptions of Recovery‐oriented mental health services: An Australian case‐study analysis

Recovery approaches to health care now feature in the mental health policies of many Western countries. There are, however, continuing challenges to the operationalization of these approaches. This study aimed to identify the nature of these challenges for a public mental health service organization located in a major urban center in southeastern Australia, where Recovery-oriented services have been implemented; and to develop recommendations to address these challenges. These aims were achieved by asking mental health consumers about their experiences of the implementation of Recovery-oriented services. Research participants described an uncertainty in health professionals and consumers alike about how to practice within a Recovery model, with many health professionals taking a "hands off" approach in the name of Recovery, rather than working in partnership with consumers and other stakeholders, including the community managed organizations. Solutions to these challenges included more targeted, practice-focused education for consumers and health professionals, with this education provided by consumer representatives. Insights derived from this research add to the growing body of evidence related to the implementation of Recovery-oriented services in Western countries.

Involving consumers and the community in the development of a diagnostic instrument for fetal alcohol spectrum disorders in Australia

BackgroundAustralia’s commitment to consumer and community participation in health and medical research has grown over the past decade. Participatory research models of engagement are the most empowering for consumers.MethodsAs part of a project to develop a diagnostic instrument for fetal alcohol spectrum disorders (FASD) in Australia (FASD Project), the Australian FASD Collaboration (Collaboration), including a consumer advocate and two consumer representatives, was established. On completion of the FASD Project an on-line survey of Collaboration members was conducted to assess their views on consumer involvement. Women in the community were also invited to participate in Community Conversations to discuss real life situations regarding communications with health professionals about alcohol and pregnancy. Community Conversation feedback was analysed qualitatively and attendees were surveyed about their views of the Community Conversation process.ResultsThe on-line survey was completed by 12 members of the Collaboration (71%). Consumer and community participation was considered important and essential, worked well, and was integral to the success of the project. The 32 women attending the Community Conversations generated 500 statements that made reference to prevention, how information and messages are delivered, and appropriate support for women. Nearly all the attendees at the Community Conversations (93%) believed that they had an opportunity to put forward their ideas and 96% viewed the Community Conversations as a positive experience.ConclusionsThe successful involvement of consumers and the community in the FASD Project can be attributed to active consumer and community participation, which included continued involvement throughout the project, funding of participation activities, and an understanding of the various contributions by the Collaboration members.

Evidence base in guideline generation in diabetes

During recent years much emphasis has been on the validity, reliability, reproducibility, clinical applicability, clarity, multidisciplinary process, scheduled review and documentation of clinical practice guidelines (CPGs). Still, CPGs show substantial variance in methodological quality. The present paper mainly focuses on two aspects that are particularly critical and contemporary from the perspective of evidence-based medicine: patient centredness and shared decision making, and conflict of interest. Sophisticated patient and consumer involvement at all stages of CPG development could be judged as being the gold standard. However, co-opting patients or consumer representatives and using other techniques of active patient involvement does not replace individual patient preferences in clinical decision-making processes. Current CPGs do not meet patient needs, since they do not provide concise, easy-to-read summaries of the benefits and risks of medicines together with more comprehensive scientific data as a prerequisite for informed or shared decision making. The vast majority of CPG panels have a financial conflict of interest (COI) and under-reporting is common. Not all organisations producing CPGs have set up COI policies, and existing policies vary widely. To solve the problem, CPG experts have recommended that methodologists without any important COI should lead the development process and have primary responsibility. There is a lot of room for other improvements through network transnational activities in the field of CPG development. Waste of time and resources should be avoided through sharing published and unpublished data identified, appraised and extracted for guideline development. The EASD could provide such a clearing house.

Daphnia magna Straus, 1820 response to sediment samples from a contaminated river ( Rio Grande do Sul, Brazil)

AIM: The Sinos River, a tributary of Guaíba Lake, is 200 km long from the headwaters to the mouth and is influenced by several sources of pollution. A study to learn more about conditions in this river was performed in the middle and lower reaches. The study evaluated the effects of sediment contamination by xenobiotics on the survival and reproduction of Daphnia magna. METHODS: Eight sediment samples were collected per site from Dec/2007 to Aug/2009, as a substrate for 480 young cladocera (2-26 h old at the beginning of the trials) in chronic toxicity tests (21 days). For this purpose, D. magna individuals were exposed to sediment and M4 culture medium, at a proportion of 1:4 (v:v) using 50 mL beakers, kept at 20 ºC ± 2 ºC in 16h light:8h dark cycles. The test organisms came from lots with LC50-24h = 1.04 mgK2Cr2O7 ± 0.11 mg. Percentage survival and reproduction were considered to define acute and/or chronic responses. Duncan (p < 0.05) and T (p < 0.05) Tests, ANOVA and Spearman correlation of the biological data were used as statistical complementation. The Spearman correlation was also applied looking for dependencies between the rainfall measured at the sites and the biological parameters but there was no evidence of correlation. The presence of acute toxicity was diagnosed for the sample in which survival was less than 80%, and for chronic toxicity when the mean number of neonates was less than 20 daphniids. RESULTS: Reproductive delays were found coinciding with physical and chemical parameters, as well as the presence of metals at values that were not in accordance with the law. Statistical analysis suggested the predominance of point sources of contamination. An effect on survival was observed in 17% of the samples, and on reproduction in 87%. CONCLUSIONS: This study found that pollutants discharged into the Sinos River remain and can interfere in the equilibrium of the trophic network, since they increase mortality and diminish the production of offspring among the cladocera, representatives of the primary consumers in the food chain.

A community education initiative to improve using online health information: Participation and impact

The Internet has become a major source of health information for the general public and has the potential to influence health behaviours; however, most people lack the knowledge and skills to use it insightfully. This paper reports on the evaluation of a community education program, in which a team of clinicians and consumer representatives from a large metropolitan hospital partnered with a major public library to provide free interactive workshops for the general public. The aim of the workshops was to improve participants' ability to find and use evidence-based health information on the Internet. The aim of the evaluation reported here was to study participation in and impact of these workshops. Researchers administered pre- and post-workshop surveys to 89 members of the general public who participated in a workshop. This study found not only similarities in participants' pre-workshop use of online health information compared with population-level studies but also some interesting differences. The workshop was found to have an overall positive impact on changing the way participants intended to look for and use health information in the future, and on improving their knowledge about evidence-based health information, with 63.5% of respondents stating that they would use health information in the future to ask a doctor new questions. These findings offer important evidence of the need to plan nuanced health literacy education and information strategies for the general public.

Competence training in evidence-based medicine for patients, patient counsellors, consumer representatives and health care professionals in Austria: a feasibility study

Informed and shared decision-making require competences for both partners - healthcare professionals and patients. There is a lack of training courses in evidence-based medicine for patients and counsellors. We investigated feasibility, acceptability and the potential effects of a 2x2.5 days training course on critical health competences in patients, patient counsellors, consumer representatives and healthcare professionals in Austria. We adapted a previously developed curriculum for patient and consumer representatives. The adaptation comprised the specific needs of our target group in Austria and was founded on Carl Rogers' theory of person-centred education. For the formative evaluation a questionnaire was applied to address the domains: 1) organisational conditions (time and duration of the course, location, and information given in advance, registration); 2) assistance outside the courses; 3) teaching methods (performance of lecturers, teaching materials, structure of modules and blocks) and 4) satisfaction; 5) subjective assessment of competences. Participants evaluated the course, using a 5-point Likert scale. Long-term implementation was assessed using semi-structured interviews three to six months after the course. To estimate the increase in critical health competences we used the validated Critical Health Competence Test (CHC test). Eleven training courses were conducted including 142 participants: patients (n=21); self-help group representatives (n=17); professional counsellors (n=29); healthcare professionals (n=10); psychologists (n=8); teachers (n=10) and others (n=29). 97 out of 142 (68%) participants returned the questionnaire. On average, participants strongly agreed or agreed to 1) organisational conditions: 71% / 23%; 2) assistance outside the courses: 96% / 10%; 3) teaching methods: 60% / 28%; and 4) satisfaction: 78% / 20%, respectively. Interviews showed that the training course raised awareness, activated and empowered participants. Participants passed the CHC test with mean person parameters of 463±111 (pre-test, n=120) and 547±135 (post-test, n=91). For participants who returned both tests (n=71) person parameters were comparable: pre-test 466±121 versus post-test 574±100, p<0,001. Training in evidence-based medicine for patients, patient counsellors, consumer representatives and healthcare professionals is feasible. For a broad implementation, train-the trainer courses and further research are needed.

887 - Peri-Operative Chemotherapy or Surveillance in Upper Tract Urothelial Cancer (POUT - CRUK/11/027) - A New Randomised Controlled Trial to Define Standard Post-Operative Management

ABSTRACT Background The POUT trial aims to establish whether platinum-based combination chemotherapy is superior to surveillance following nephro-ureterectomy with curative intent for upper tract transitional cell carcinoma (utTCC). Methods We aim to randomise 345 participants world-wide, over a 5-year period. Previous trials of adjuvant chemotherapy for urothelial cancers suggest that potential challenges to recruitment include randomisation between “no treatment” vs chemotherapy with its potential toxicity, and early identification of eligible patients. To support trial design and the development of patient information, we therefore conducted a survey of participating UK centres' current standard treatment and also held a dedicated consumer focus group. During the trial set up period, additional sites expressed interest in participating and the survey was recirculated; results are presented here. Results 26 of 44 UK centres questioned routinely place utTCC patients on surveillance following surgery; 18 give chemotherapy if the patient is considered fit enough. The 9 respondents who specified chemotherapy regimens give gemcitabine and cisplatin or carboplatin, dependent on renal function. All centres discuss patients pre-operatively in a multi-disciplinary team meeting, but 6 centres do not routinely discuss patients post-operatively. The consumer group welcomed the opportunity for utTCC patients to participate in research. They approved of the proposed randomisation between surveillance and chemotherapy and supported the use of a two stage pre- and post-operative information giving process. Conclusions There is no consensus among UK clinicians regarding optimum post-operative treatment of muscle invasive utTCC. The POUT trial offers the opportunity to standardise post-operative management of utTCC internationally and is supported by urologists, oncologists and consumer representatives from the target patient population. The trial design incorporates an initial two-year recruitment optimisation phase which includes qualitative research to inform recruitment practices. Disclosure All authors have declared no conflicts of interest.

The Roundup

The Roundup

Food safety issues: From Enlightened Elitism towards Deliberative Democracy? An overview of EFSA’s “Public Consultation” instrument

Following the BSE crisis, the importance of reassuring European consumers and involving them in debate about food safety management issues is generally recognised. Indeed, consulting stakeholders is one of the European Food Safety Authority’s (EFSA) main duties, as stated in its founding regulation (art. 42, whereas 56), where EFSA must have “effective contacts with consumer representatives, producer representatives, processors and any other interested parties”. Even if not clearly obliged to, EFSA has also opted to consider lay citizens’ opinion (under an interpretation of art. 42, wh. 40 of the 178 Reg.) in order to enhance “trust” in food safety. Beyond having formally established meetings with restricted access for participants – like the Stakeholders’ Consultative Platform and the Annual Colloquium, – EFSA engages in its “Public Consultation” web-based Window (PCW). It allows listening to anybody who wishes to submit comments on technical issues.An intriguing question is whether this constitutes a step towards “direct democracy” on food safety issues; under which assumptions EFSA adopted this tool; and under which (internal and external) pressures it updated its functioning in 2008.Using evaluation criteria from the academic literature, we assess the qualities of this mechanism. We conclude that the mechanism does have some merits, even though – as stated by Douglas (1982) “… creating practical participatory mechanisms for the public is increasingly difficult in a decision-making environment heavily dominated by technical expertise”.