Current Practice In Europe Research Articles

Rostering of air traffic controllers – current practices in Europe, key performance trade-offs and future opportunities

The process of staff planning and rostering is one of the key factors affecting the performance of an Air Navigation Service Provider in terms of capacity and cost-efficiency delivered to airspace users. This paper gives a summary of previous works and current rostering practices applied at Area Control Centres (ACCs) in Europe. Furthermore, it identifies key trade-offs between rostering flexibility, capacity and productivity by establishing a relationship between ACC demand, rostering flexibility in place and the number of Air Traffic Control Officers (ATCOs) needed, as well as by exploring how varying rostering practices applied in ACCs affect spare capacity in the system. To that end, an initial mathematical model for optimizing ATCO staffing requirements has been proposed and tested on a case study involving three representative ACCs, reflecting different hourly variability in demand. The results suggest that - for different combinations of shift patterns and capacity profiles - substantial variation exists in both the minimum number of ATCOs and the associated spare ACC capacity. It has also been shown that a certain amount of spare capacity is inevitably present in the system due to inability to perfectly match ATCO hours with demand. Different options and enablers for exploiting such capacity are also discussed in the paper.

Current practice in proton therapy delivery in adult cancer patients across Europe

Background and purposeMajor differences exist among proton therapy (PT) centres regarding PT delivery in adult cancer patient. To obtain insight into current practice in Europe, we performed a survey among European PT centres. Materials and methodsWe designed electronic questionnaires for eight tumour sites, focusing on four main topics: 1) indications and patient selection methods; 2) reimbursement; 3) on-going or planned studies, 4) annual number of patients treated with PT. ResultsOf 22 centres, 19 (86%) responded. In total, 4233 adult patients are currently treated across Europe annually, of which 46% consists of patients with central nervous system tumours (CNS), 15% head and neck cancer (HNC), 15% prostate, 9% breast, 5% lung, 5% gastrointestinal, 4% lymphoma, 0.3% gynaecological cancers. CNS are treated in all participating centres (n = 19) using PT, HNC in 16 centres, lymphoma in 10 centres, gastrointestinal in 10 centres, breast in 7 centres, prostate in 6 centres, lung in 6 centres, and gynaecological cancers in 3 centres. Reimbursement is provided by national health care systems for the majority of commonly treated tumour sites. Approximately 74% of centres enrol patients for prospective data registration programs. Phase II-III trials are less frequent, due to reimbursement and funding problems. Reasons for not treating certain tumour types with PT are lack of evidence (30%), reimbursement issues (29%) and/or technical limitations (20%). ConclusionAcross European PT centres, CNS tumours and HNC are the most frequently treated tumour types. Most centres use indication protocols. Lack of evidence for PT and reimbursement issues are the most reported reasons for not treating specific tumour types with PT.

Electricity Tariff Design in the Context of an Ambitious Green Transition

Current tariff designs do not incentivize efficient or equitable responses by active customers adopting renewable self-generation or providing flexibility in a future fully decarbonized electricity system. This chapter revises current practices in Europe and, based on the revisited principles of efficiency and equity, proposes a first benchmark for tariff design. Forward-looking peak-coincident network charges that reflect network incremental costs and fixed charges that collect residual network costs and policy costs are recommended. No one-size-fits-all model exists, in practice. These are guidelines for regulators when dealing with the trade-offs between the tariff legacy and the new requirements imposed by this energy transition.

Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019.

This is the seventh special EBMT report on the indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders. Our aim is to provide general guidance on transplant indications according to prevailing clinical practice in EBMT countries and centres. In order to inform patient decisions, these recommendations must be considered together with the risk of the disease, the risk of the transplant procedure and the results of non-transplant strategies. In over two decades since the first report, the EBMT indications manuscripts have incorporated changes in transplant practice coming from scientific and technical developments in the field. In this same period, the establishment of JACIE accreditation has promoted high quality and led to improved outcomes of patient and donor care and laboratory performance in transplantation and cellular therapy. An updated report with operating definitions, revised indications and an additional set of data with overall survival at 1 year and non-relapse mortality at day 100 after transplant in the commonest standard-of-care indications is presented. Additional efforts are currently underway to enable EBMT member centres to benchmark their risk-adapted outcomes as part of the Registry upgrade Project 2020 against national and/or international outcome data.

Variability in breast cancer surgery training across Europe: An ESSO-EUSOMA international survey

BackgroundAt present there is a lack of standardization of training in breast cancer surgery across Europe. The aim of this survey was to assess current practice in Europe regarding training in breast cancer (BC) surgery. Material and methodsGeneral surgeons, surgical oncologists, gynecologist, and plastic surgeons in Europe were invited to participate in this bespoke survey including 19 questions. ResultsThe survey was sent to 3.000 surgical oncologists across Europe. A total of 671 physicians (387 general surgeons, 152 gynecologists, 126 surgical oncologist, 31 plastic surgeons) answered the survey (23% response rate). Four hundred and sixty-eight physicians devoted between 50% −100% of their job to treating breast cancer. 45% worked in a community/University hospital within a dedicated Breast Unit.Specific additional breast surgery training was not universal: 20% had undertaken an accredited breast fellowship, 30% in a Breast Unit as a trainee, 21% had done additional courses, masters or diploma and 8% had not done any additional training. The majority (61%) of respondents worked in Units treating >150 BC cases per year, while 26% of the responders treat >120 new primary cases per year, and 23% less than 50 new cases a year. Multivariate analysis showed that breast surgeons working in a Breast Unit and treating more than 50 cases/year significantly performed oncoplastic procedures. ConclusionThere is a great variability in breast cancer surgery training in Europe. It is imperative to develop quality standards for breast cancer surgery training to ensure that patients get standardized and certified surgical management regardless of the country in which they are treated.

Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients: a survey of current practice in Europe.

Asymptomatic bacteriuria is frequent in kidney transplant recipients (KTRs). However, there is no consensus on diagnosis or management. We conducted a European survey to explore current practice related to the diagnosis and management of asymptomatic bacteriuria in adult KTRs. A panel of experts from the European Renal Association-European Dialysis Transplant Association/Developing Education Science and Care for Renal Transplantation in European States working group and the European Study Group for Infections in Compromised Hosts of the European Society of Clinical Microbiology and Infectious Diseases designed this cross-sectional, questionnaire-based, self-administered survey. Invitations to participate were e-mailed to European physicians involved in the care of KTRs. Two hundred and forty-four participants from 138 institutions in 25 countries answered the survey (response rate 30%). Most participants [72% (176/244)] said they always screen for asymptomatic bacteriuria in KTRs. Six per cent (15/240) reported never treating asymptomatic bacteriuria with antibiotics. When antimicrobial treatment was used, 24% of the participants (53/224) said they would start with empirical antibiotics. For an episode of asymptomatic bacteriuria caused by a fully susceptible microorganism and despite no contraindications, a majority of participants (121/223) said they would use a fluoroquinolone (n = 56), amoxicillin/clavulanic acid (n = 38) or oral cephalosporins (n = 27). Screening for and treating asymptomatic bacteriuria are common in KTRs despite uncertainties around the benefits and harms. In an era of antimicrobial resistance, further studies are needed to address the diagnosis and management of asymptomatic bacteriuria in these patients.

Cryoablation for treatment of cardiac arrhythmias: results of the European Heart Rhythm Association survey.

The purpose of this survey was to assess the current practice in Europe regarding cryoablation for treatment of different cardiac arrhythmias. The data are based on an electronic questionnaire sent to members of the European Heart Rhythm Association Research Network. Responses were received from 49 centres in 18 countries. The results show that cryoablation for supraventricular tachycardia in European centres is an alternative to radiofrequency ablation, which is in accordance with guidelines. There is reasonable consensus regarding clinical results and complications of cryoablation procedure. Some inter-centre variability with respect to patient selection and ablation strategy in cryoablation of atrial fibrillation was demonstrated, underscoring the need for further research.

Uso tópico versus intracameral de antibiótico na profilaxia de endoftalmite pós-cirurgia de catarata

The intracameral use of antibiotics following cataract surgery significantly reduces the risk of postoperative endophthalmitis when compared to the pre- or postoperative use of topical antibiotics. The prophylactic use of this therapeutic regimen is a current practice in Europe and in a large number of countries around the world. It is not routinely followed in the US because no commercial antibiotic for intracameral use has been approved by the Food and Drug Administration. With this update on the topic, the Brazilian Society for Cataract and Refractive Surgery intends to show the positive impact of the intracameral use of antibiotics on reducing the rates of endophthalmitis following cataract surgery and highlights evidence of good outcomes that reinforce the safety and efficacy of this prophylactic therapeutic regimen.

The scientific evidence of arterial line filtration in cardiopulmonary bypass.

The indication for arterial line filtration (ALF) is to inhibit embolisation during cardiopulmonary bypass. Filtration methods have developed from depth filters to screen filters and from a stand-alone component to an integral part of the oxygenator. For many years, ALF has been a standard adopted by a majority of cardiac centres worldwide. The following review aims to summarize the available evidence in support for ALF and report on its current practice in Europe. The principles and application of ALF in Europe was investigated using a survey conducted in 2014. The scientific evidence for ALF was examined by performing a systematic literature search in six different databases, using the following search terms: "Cardiopulmonary bypass AND filters AND arterial". The primary endpoint was protection against cerebral injury verified by the degree of cerebral embolisation or cognitive tests. The secondary endpoint was improvement of the clinical outcome verified elsewise. Only randomised clinical trials were considered. The response rate was 31% (n=112). The great majority (88.5%) of respondents were using ALF, following more than 10 years of experience. Integrated arterial filtration was used by 55%. Of respondents not using ALF, fifty-four percent considered starting using integrated arterial filtration. The systematic literature database search returned 180 unique publications where 82 were specifically addressing ALF in cardiopulmonary bypass. Only four out of the 82 identified publications fulfilled our inclusion criteria. Of these, three were more than 20 years old and based on the use of bubble oxygenation. ALF is a standard implemented in a majority of cardiopulmonary bypass procedures in Europe. The level of scientific evidence available in support of current arterial line filtration methods in cardiopulmonary bypass is, however, poor. Large, well-designed, randomised trials are warranted.

Linking databases on perinatal health: a review of the literature and current practices in Europe.

Background: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. Methods: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. Results: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. Conclusion: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance.

A systematic framework of location value taxes reveals dismal policy design in most European countries

Location values have long been recognized as an attractive instrument to raise municipal revenues. First, they increase fiscal efficiency and equability compared to traditional property taxes. Second, they can be used to enhance sustainable urban planning. The question of how to design a location value tax has long been discussed in various strands of literature, but there are few efforts to create multidisciplinary approaches. This lack of reconciliation hampers the discussion on optimal designs that includes all economic, social and environmental considerations. Here we combine literature on public finances, urban economics and value capture with that of sustainable urban planning to narrow this gap. We develop a framework to assess the design characteristics of location value taxes from a sustainability perspective, and apply this framework to assess current practices in Europe. The analysis reveals severe shortcoming in policy design in most European countries, although Denmark provides a more promising example. Nonetheless, location value taxes have a high potential for improving sustainable urban planning.

Intermittent inotrope therapy: evidence or belief?

With interest, we read the article by Hubner et al. [1] reporting a single German center experience with intermittent inotropes for patients on the high-urgent heart transplant waiting list as defined by Eurotransplant criteria, in particular as this study has been utilized as a scientific basis for the current treatment strategy for these patients at the authors’ institution. The authors describe their results as a retrospective collection of clinical data in a cohort of over 100 patients whom various doses of inotropes including dobutamine, milrinone, adrenaline, noradrenaline and levosimendan were administered. These inotropes were given ‘based on the patient’s specific characteristics’. Unfortunately, no related information is included in the manuscript and the authors fail to define these ‘patient’s specific characteristics’ which is an essential factor to understand the study design. Thereafter, the authors state, that intermittent inotropes for 3–4 days were given predefined on a weekly regimen until the year 2011 and later on an 8-week interval. Again, there is no explanation, scientific base or rationale within the manuscript that would explain this change of strategy and intervals of inotropic therapy. The authors also decided to exclude 29 patients for ‘different reasons’ which are not specified. On an undefined basis they stratified patients into more than 5 treatment arms (dobutamine, milrinone, adrenaline, noradrenaline, levosimendan and combinations of different inotropes). However, the percentage of patients in each treatment arm is not reported in the manuscript and interventions such as thoracentesis and paracentesis had to be frequently performed in all patient cohorts due to repetitive cardiac decompensations. The authors state further that due to severe side effects of their weekly administered inotropes the regimen was changed to an 8-week interval, but fail to quantify or specify these side effects. The authors decided on the use of a large variety of inotropes for this study with in part very different pharmacokinetics. All of these drugs have been investigated in randomized controlled trials in the past [2, 3]. For some substances such as levosimendan, it is current practice in Europe and it seems reasonable to apply this drug in an intermittent fashion as a consequence of its pharmacokinetics [4], in case of dobutamine this treatment pattern seems rather questionable due to the extremely short halflife (2 min) [5]. As a rationale for their choice of intermittent inotropic therapy the authors quote a meta-analysis by Thackray et al. [6] who looked at effectiveness of intravenous inotropic drugs in patients with heart failure. However, in this meta-analysis the majority of sixteen trials contributed data from acute invasive hemodynamic studies of severe heart failure and only five trials were based on intermittent inotropic therapy in an outpatient context, not comparable to patients on the high-urgent heart transplant waiting list. Intermittent inotropic intravenous therapy is by no means an accepted standard treatment for patients with terminal heart failure on the high-urgent heart transplant & Stephan Ensminger sensminger@hdz-nrw.de

Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015.

This is the sixth special report that the European Society for Blood and Marrow Transplantation regularly publishes on the current practice and indications for haematopoietic SCT for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred in the field of haematopoietic SCT over the last years. Cord blood units as well as haploidentical donors have been increasingly used as stem cell sources for allo-SCT, thus, augmenting the possibility of finding a suitable donor for a patient. Continuous refinement of conditioning strategies has also expanded not only the number of potential indications but also has permitted consideration of older patients or those with co-morbidity for a transplant. There is accumulating evidence of the role of haematopoietic SCT in non-haematological disorders such as autoimmune diseases. On the other hand, the advent of new drugs and very effective targeted therapy has challenged the role of SCT in some instances or at least, modified its position in the treatment armamentarium of a given patient. An updated report with revised tables and operating definitions is presented.

Linking databases on perinatal health: a review of the literature and current practices in Europe

Linking databases on perinatal health: a review of the literature and current practices in Europe

Stroke and bleeding risk evaluation in atrial fibrillation: results of the European heart rhythm association survey.

The aim of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to stroke and bleeding risk evaluation in atrial fibrillation, particularly regarding the use of risk evaluation schemes, among members of the EHRA electrophysiology (EP) research network. In this EP Wire survey, we have provided some insights into current practice in Europe for the use of these risk assessment schemes. There were some obvious practice differences. However, reassuring information on current practice in Europe was evident, but more focus on renal function is warranted, especially facing the fact that novel oral anticoagulants are used for antithrombotic therapy.

Management of acute coronary syndrome in patients with non-valvular atrial fibrillation: results of the European Heart Rhythm Association Survey

Management of patients with non-valvular atrial fibrillation (AF) presenting with an acute coronary syndrome (ACS) may be particularly challenging. Given the lack of sound evidence-based recommendations for the management of such patients, the aim of this European Heart Rhythm Association survey was to provide an insight into current practice in Europe regarding management of these patients. Overall, 41 centres submitted a valid response. The majority of respondents were university hospitals (85%). The survey has shown that the principal aspects of the European Society of Cardiology guidelines on the management of AF, and those on ACS, have been adopted. The survey highlights two important areas of uncertainty regarding the optimal composition and duration of antithrombotic therapy with multiple drugs and the optimal regimen(s) of novel oral anticoagulants in patients with AF and ACS.

Novel oral anticoagulants for stroke prevention in atrial fibrillation: results of the European Heart Rhythm Association survey

The purpose of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to stroke prevention in atrial fibrillation (AF), particularly into the use of novel oral anticoagulants (NOACs) for stroke prevention, among members of the EHRA electrophysiology (EP) research network. In this EP Wire survey, we have provided some insights into current practice in Europe for the use of NOACs for stroke prevention in AF. There were clear practice differences evident, and also the need for greater adherence to the guidelines, especially since guideline adherent management results in better outcomes in AF.

Current practice in Europe: how do we manage patients with ventricular tachycardia? European Heart Rhythm Association survey

The purpose of the EP wire is to examine the clinical practice in the management of sustained ventricular tachycardia (VT), with special focus on diagnostic and therapeutic strategies. Forty-five European centres, all members of the EHRA-EP Research network completed the questions of the survey. There was an equal distribution of centres with high, medium, and low volume of activity. The most common aetiologies were: post-myocardial infarction ischaemic heart disease (55%), followed by idiopathic dilated cardiomyopathy (18%), and idiopathic VT (11%) and others (12%). Cardiac magnetic resonance imaging was performed in more than 50% of patients in 24 centres (62.2%). Invasive electrophysiological study was performed in more than 70% of patients in 16 centres (35.6%), between 51 and 70% in 9 (20%), below 50% in 20 (44.5%). In 39 centres (86.7%), implantable cardioverter defibrillator implantation was considered in all patients with structural heart disease and left ventricular ejection fraction <35%. In the setting of secondary prevention, early radiofrequency ablation of the VT was performed in more than 50% of the patients in only five centres (11.4%). Sequential endo-epicardial approach was reported in 52.2% of centres.

Transatlantic perspectives on TAVI: from essential infrastructure and integration to expansion, research and development

Transcatheter aortic valve implantation (TAVI) is arguably the greatest advance in interventional cardiology since the introduction of drug eluting stents in the 1990s. Results from multicentre randomised controlled trials clearly...

The Role of CEUS in the Characterization of Hepatocellular Nodules Detected During the US Surveillance Program – Current Practices in Europe

The basic pathological feature for the differential diagnosis between hepatocellular carcinoma (HCC) and non-malignant hepatocellular nodules in cirrhotic patients detected during ultrasound (US) is the vascular supply to the nodule. Computed tomography (CT) and magnetic resonance imaging (MRI) are considered reference imaging techniques for depicting hepatocellular nodule vascularity in the noninvasive diagnosis of HCC. Contrast-enhanced US (CEUS) improves the diagnostic performance of unenhanced US in the diagnosis of HCC, giving an overall diagnostic accuracy that is similar to that of CT, even for nodules smaller than 2 cm. An additional diagnostic feature of CEUS relative to CT is the possibility to visualize contrast wash-in to hepatic nodules during the arterial phase and contrast washout during the portal venous and late phases. Sensitivity for the diagnosis of HCC with combined assessment of CEUS and CT is higher than for separate assessments of CEUS and CT due to the reduction of false-negative findings. CEUS represents a competitive imaging method from an economic point of view, and is an effective imaging tool for assessing the therapeutic outcome after surgery, ablation therapy, and transarterial chemoembolization (TACE).