Current Practice In Europe Research Articles

Continuous infusion in haemophilia: current practice in Europe

Summary. Continuous infusion (CI) of factor VIII (FVIII) is an effective method for replacement therapy in haemophilia. Recently, concerns have been raised regarding association of CI with the development of inhibitors. The aim of this study was to gain information on the current practices in Europe regarding CI and the true inhibitor incidence after this mode of therapy. In a cross sectional study performed in 22 Comprehensive Care Centres (CCCs), we evaluated CI techniques, treatment protocols, efficacy, safety and complications of CI including inhibitors. Thirteen (59%) CCCs reported a total of 1079 CI treatments, given peri-operatively or for major bleeds, in 742 patients. Most centres used 'adjusted dose' CI aimed at median target FVIII level of 0.8 IU mL(-1). CI was haemostatically very effective with a low incidence of complications: median incidence of postoperative bleeding was 1.8%, six centres observed phlebitis in 2-11% of CI treatments. Only nine (1.2%) patients developed inhibitors (0.45% of 659 severe and 7.2% of 83 mild haemophilia patients). Additional analysis of inhibitor patients revealed several confounding factors (low number of prior FVIII exposure days, high steady-state factor levels during CI, high-risk genotype). In this unprecedentedly large cohort, CI treatment appears to be an effective and safe treatment that does not increase the risk of inhibitor development in patients with severe haemophilia. Thus, previous small case series reports suggesting that CI may increase inhibitors cannot be confirmed. Inhibitor risk in mild haemophilia could not be evaluated as the influence of other, potentially confounding, risk factors could not be excluded.

What is the current practice in Europe when difficult shoulder injuries are treated?

In this issue of the journal, a group of Italian researchers discusses the European orthopedic surgeon’s management of choice for several difficult clinical scenarios of shoulder pathologies [1]. They divided their survey into four scenarios; i.e., anterior shoulder dislocation, shoulder arthritis combined with rotator cuff tear, large rotator cuff tendon tears combined with major fatty infiltration of the infraspinatus muscle and instability of the long head of the biceps and finally adhesive capsulitis. It might be claimed that at least three out of four are difficult cases. Therefore, the answers are of great interest. The authors used an online Web-based questionnaire and it is obvious that a questionnaire of this kind has the potential to improve our knowledge about the current trends in modern technology and ultimately might be helpful in creating clinical guidelines on a large scale. The first scenario was related to anterior dislocation of the shoulder. Interestingly, more than 70 % of the orthopedic surgeons recommended arthroscopic Bankart reconstruction, approximately half as an acute procedure and the rest as a planned procedure. This is the case description: ‘‘21-year-old male, recreational soccer player, first-time shoulder dislocation, with a minimal Hill-Sachs lesion, and a Bankart lesion’’… Less than 30 % of the surgeons recommended non-surgical treatment, which is of interest. The question is whether we really know that an acute/ semi-acute surgical procedure is the correct way to approach this particular—and in fact very common— problem. There might be arguments for instance for a more conservative approach. Also interesting is the recommendation for a brace in internal or external rotation in almost 75 %. The second scenario is a 55-year-old female with painful shoulder arthritis, total supraspinatus tear and infraspinatus fatty infiltration. In this case, the majority of surgeons (more than 60 %) recommended surgical treatment, while less than 40 % would favor a conservative regimen. Supraspinatus tendon repair/reconstruction was recommended by 85 % of all surgeons, with or without biceps tenodesis/tenotomy. The question is whether we really know if biceps tenodesis/tenotomy is needed in a case like this? Again, the dominance of surgical approach is of great interest. Only few surgeons recommended either debridement or shoulder replacement (15 %) in this patient. The third scenario is a 65-year-old male manual worker,

PHP67 Tendering for Outpatient Prescription Pharmaceuticals: What Can Be Learned from Current Practices in Europe?

PHP67 Tendering for Outpatient Prescription Pharmaceuticals: What Can Be Learned from Current Practices in Europe?

Tendering for outpatient prescription pharmaceuticals: What can be learned from current practices in Europe?

Objectives To explore the current status (2010) of tendering programs for outpatient pharmaceuticals in the European countries and how these programs operate. Methods A survey was designed to assess the features of tendering programs in European countries. All 27 countries of the European Union plus Norway were included in the study. The survey was sent to national representatives of authorities and organizations and to academic researchers with expertise in the domain. Results Nineteen of the 28 countries have responded to the questionnaire (68%). Seven countries have adopted tendering programs for pharmaceuticals in ambulatory care. Tendering was more popular in countries with a mature generic medicines market (54%) than in countries with a developing generic medicines market (12.5%). A legal basis, criteria to grant the tender, the number of winners and the duration of the tender were amongst the features for the program to work. Conclusions Tendering programs can achieve savings in the short term. There are however some problems allied with the policy and the effects in the long term are still unclear. It can be concluded that the policy can work, but the features of the programs have to be well-thought-out.

Juvenile psoriasis and its clinical management: a European expert group consensus

Psoriasis, an inflammatory disorder of the skin, can significantly impact on a patient's quality of life, affecting their daily activities and families. The onset of psoriasis in childhood is quite common; however, the treatment of moderate-to-severe disease in this population is challenging, with a paucity of data reported and few licensed agents available. A Delphi survey was conducted among a panel of European expert dermatologists and physicians with a particular interest in pediatric inflammatory disorders. The survey covered the aspects of psoriasis types, psoriatic arthritis, diagnosis and treatment options in childhood. A series of consensus opinions were reached, detailing the current practice in Europe for the diagnosis and treatment of psoriasis in childhood. These opinions are presented in the context of evidence from the literature and the current licensure status and indications of therapies for psoriasis in childhood. These data provide detailed information on the current practices in Europe for treating psoriasis in childhood.

A general perspective on breast disease and training system for breast cancer specialists in Europe

Breast is a female reproductve organ and breast disease is closely related to female reproductive function. In recent years, becoming the most frequent cancer in female, breast cancer has emerged as a major health concern for Korean women. Obtaining basic knowledge about breast disease is crucial for the specialists dealing with female reproductive organs. In this article a brief overview over the management of breast cancer as well as benign breast disease will be presented. In addition, the current stauts of training system for breast cancer in Europe will be discussed. Examinations of the current practices in Europe will be able to guide the effort in Korea to incorporate breast diseae into the field of gynecology.

The planning, management and communication of research to inform environmental policy making and regulation: an empirical study of current practices in Europe

Despite a range of initiatives over the last 10 years to enhance the use of science in policy-making by the European Commission and by governments in individual European Union member states, concerns remain that the substantial investments made in research on environmental issues are not as effective as they could be in supporting an evidence-informed approach to environmental policy-making and regulation. The empirical study summarised in this article set out to establish whether shortcomings in the planning, management and communication of research commissioned by governmental ministries and agencies are contributing to this ineffectiveness, and to identify how problem areas can be addressed. Specific issues addressed are the planning and management of research, communication of research results to end-users, the roles of interpreters and intermediaries, engagement with stakeholders, and the evaluation of research uptake and impact. Copyright , Beech Tree Publishing.

Consequences of the Chicago consensus on disorders of sex development (DSD): current practices in Europe

ObjectiveTo assess clinical management of disorders of sex development (DSD) subsequent to recommendations issued in the 2006 Consensus Statement.DesignOnline questionnaire and audit of DSD literature.SettingInvitation to complete a 28-item online...

Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe 2009

The European Group for Blood and Marrow Transplantation regularly publishes special reports on the current practice of haematopoietic SCT for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred since the first report was published. HSCT today includes grafting with allogeneic and autologous stem cells derived from BM, peripheral blood and cord blood. With reduced-intensity conditioning regimens in allogeneic transplantation, the age limit has increased, permitting the inclusion of older patients. New indications have emerged, such as autoimmune disorders and AL amyloidosis for autologous HSCT and solid tumours, myeloproliferative syndromes and specific subgroups of lymphomas for allogeneic transplants. The introduction of alternative therapies, such as imatinib for CML, has challenged well-established indications. An updated report with revised tables and operating definitions is presented.

The need for public participation in the governance of science centers

Science centers and museums are developing new strategies to increase inclusiveness, to engage the public more actively and to respond to the need to present contemporary science and research as part of their public programs. In order to do so, they need to increase the level of public participation not only to inform the development of specific exhibitions and programs, but also to share authority in their interpretive and decision-making process. However, existing models of governance do not allow for a formal role of the public in the decision making process. We review current practices in Europe and argue that a new model of governance for science centers is needed where public participation and consultation activities are integral components alongside the board, director and staff.

Replacement therapy for invasive procedures in patients with haemophilia: literature review, European survey and recommendations

Although most surgical and invasive procedures can be performed safely in patients with haemophilia, the optimal level and duration of replacement therapy required to prevent bleeding complications have not been established conclusively. For providing more insight into optimal therapy during invasive procedures, a literature review of surgical procedures in patients with haemophilia was conducted. Concomitantly, current practice was surveyed in 26 European Haemophilia Comprehensive Care Centres, representing 15 different countries. The review identified 110 original papers published between 1965 and 2007. Of these, only two studies were randomized controlled trials. Target levels and the duration of replacement therapy in the published studies were as follows. For major orthopaedic surgery: preoperative targets were 80-90%; postoperative targets showed a high degree of variation, with trough levels ranging from 20% to 80%, duration 10-14 days; for liver biopsy, 70-100%, 1-7 days; tonsillectomy: 90-100%, 5-11 days; indwelling venous access device insertion: 100%, 3-10 days; circumcision: 50-60%, 2-4 days; dental surgery: 30-50%, single treatment. With the exception of dental surgery, current practice in Europe, as assessed by the survey, was largely in agreement with published data. In conclusion, this study provides both a comprehensive review and a large survey of replacement therapy in patients with haemophilia undergoing invasive procedures; these data have informed the consensus practical treatment recommendations made in this paper. This study highlights the need for better-designed studies in order to better define minimal haemostatic levels of replacement therapy and optimal treatment duration.

Understanding patient and physician perceptions of benign prostatic hyperplasia in Europe: The Prostate Research on Behaviour and Education (PROBE) Survey

AimsBenign prostatic hyperplasia (BPH) is a bothersome disease that can progress if left untreated. However, patient and urologist perspectives on BPH management are not fully understood. The aim of the Prostate Research on Behaviour and Education (PROBE) Survey was to assess healthcare-seeking behaviour and attitudes to BPH treatment in 502 BPH patients, and the beliefs and management practices of 100 urologists, from France, Germany, Italy, Spain and the UK.ResultsThe principal concerns of patients seeking medical advice were fear of cancer, sleep disruption, discomfort or embarrassment. The majority of BPH patients recalled receiving a digital rectal examination (61%), routine prostate-specific antigen (PSA) tests (67%) and prescription medication (72%). Eighty per cent of 5α-reductase inhibitor (5ARI) users vs. 68% of α-blocker users were satisfied with their treatment. More than half of the patients were concerned about requiring surgery or developing acute urinary retention, and > 75% would prefer a drug that provides reduction in the risk of surgery than one that provides rapid symptom relief. Most urologists performed digital rectal examinations (96%) and PSA tests (71%) on > 90% of patients presenting with BPH symptoms. Eighty-seven per cent of urologists believe that BPH progresses, and 78% believe that 5ARIs prevent BPH progression. However, most urologists prescribe α-blockers while few prescribe 5ARIs.ConclusionsThis study highlights discrepancies between views and beliefs of patients and physicians regarding BPH and current practice in Europe.What's known There is increasing recognition of the importance of the role of the patient in clinical decision-making and the importance of consideration of patient perceptions and preferences in ensuring selection of the appropriate management strategy and treatment success.A recently reported US national survey indicated that currently there are significant differences in the beliefs and attitudes of patients and physicians towards benign prostatic hyperplasia (BPH) (also known as enlarged prostate) and its management.What's new This article provides information on the views and beliefs of both patients and urologists towards BPH and its management, and on current practice, across five European countries.This study confirms and extends the findings of the US survey and further highlights the need for improved communication between physicians and patients and greater involvement of the patient during clinical decision-making.

Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: definitions and current practice in Europe

The Accreditation Subcommittee of the EBMT regularly publishes special reports on current practice of haemopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred since the first report was published in 1996. Haemopoietic stem cell transplantation today includes grafting with allogeneic and autologous stem cells derived from bone marrow, peripheral blood and cord blood. With reduced intensity conditioning regimens in allogeneic transplantation, the age limit has increased, permitting the inclusion of older patients. New indications have emerged such as autoimmune disorders and AL amyloidosis for autologous, and solid tumours for allogeneic transplants. The introduction of alternative therapies has challenged well-established indications such as imatinib for chronic myeloid leukaemia. An updated report with revised tables and operating definitions is presented here.

Alimentation et soins nutritionnels dans les hôpitaux : une vision européenne

Disease-related undernutrition is significant in European hospitals but is seldom treated. In 1999 the council of Europe decided to collect information regarding Nutrition programmes in hospitals and for this purpose a network consisting of national experts from 12 of the Partial Agreement member states was established. The aim was to review the current practice in Europe regarding hospital food provision, to highlight deficiencies and guidelines to improve the nutritional care and support of hospitalised patients. Five major problems seemed to be common in this context: (1) lack of clearly defined responsibilities; (2) lack of sufficient education; (3) lack of influence of the patients; (4) lack of co-operation among all staff groups; (5) lack of involvement from the hospital management. To solve the problems highlighted, a combined “team-effort” is needed from national authorities and all staff involved in the nutritional care and support, including support managers.

The European View of Hospital Undernutrition

Disease-related undernutrition is significant in European hospitals but is seldom treated or prevented. In 1999, the Council of Europe decided to collect information regarding nutrition programs in hospitals, and for this purpose, a network consisting of national experts from 12 of the Partial Agreement member states was established. The aim was to review the current practices in Europe regarding hospital food provision, to highlight deficiencies, and to issue recommendations to improve the nutritional care and support of hospitalized patients. Five major common problems were identified: 1) lack of clearly defined responsibilities, 2) lack of sufficient education, 3) lack of influence and knowledge of the patients, 4) lack of cooperation between different staff groups, and 5) lack of involvement from the hospital management. To solve the problems highlighted, a combined timely and concerted effort is required from national authorities and hospital staff, including managers, to ensure appropriate nutritional care and support.

WHAT CAN FOODSERVICE OPERATORS DO TO REMEDY UNDER NUTRITION IN HOSPITALS?.

Undernutrition is a serious problem in hospitals. Therefore the Council of Europe in 1999 decided to establish an ad hoc group consisting of national experts to look further into the problem. Since then the group has studied the current practices in Europe regarding hospital foodservice and has issued guidelines to improve the nutritional care and foodservice practices. The result of the study points at a number of major problems related to the different staff groups, the patients and the management. Among the staff groups involved in foodservice and nutritional care there seems to be a lack of clearly defined responsibilities, and a lack of educational possibilities, as well as a lack of cooperation between those groups. Foodservice and nutritional care does not pay sufficient attention to the rights of the patients and their needs for information, and, finally, hospital management seems unaware of the key role of both foodservice and nutritional care. Different staff groups must combine efforts in order to make foodservice become successful nutrition. Among these groups, the foodservice staff is a key player, though ward staff, physicians, dietitians, nurses and hospital orderlies also are relevant. It is the responsibility of the hospital management to make these groups work together, however, without the support of skilled experts and professionals in the hospital environment very little will be done. This paper takes a closer look at foodservice and nutritional care from the foodservice operator's point of view, as well as the of the recommendations from the ad hoc group and the implications for foodservice operators

Isaac Max Rubinow: advocate for social insurance.

A pioneer of the American social security movement, Isaac Max Rubinow (1875–1936) emigrated from Russia to the United States in 1893. A member of a relatively comfortable Jewish family, he was able to attend and graduate from Columbia University and New York University Medical School. He then practiced medicine for 5 years among poor immigrants in New York City’s Lower East Side, an experience that taught him about the effects of poverty on health and turned his attention to the field of social insurance. In 1900, while still in medical practice, Rubinow began part-time graduate study at Columbia University in economics, statistics, and sociology. In 1903 he left medicine for full-time employment in Washington, DC, in a succession of federal bureaus and agencies. Rubinow soon emerged as America’s leading authority on social insurance and the expert author of comprehensive studies on current practices in Europe. A 1904 article in the Journal of Political Economy1 was “the first publication by an American to call unequivocally for social insurance.”2 A few years later, Rubinow contributed to a major study undertaken by the US Department of Commerce and Labor on “Workmen’s Insurance and Compensation Systems in Europe.” This well-over-2000-page study was published in 2 large volumes as the Twenty-Fourth Annual Report of the Commissioner of Labor 1909.3 In 1913, Rubinow published Social Insurance, With Special Reference to American Conditions, the first and definitive American textbook on the subject.4 Figure Courtesy of the Isaac M. Rubinow Papers, Kheel Center, Cornell University, Ithaca, NY. Also active in various political and reform movements during America’s Progressive Era, Rubinow was a member of the American Association of Labor Legislation (AALL) from its formation in 1906. In the early 1910s, he was one of the most effective advocates for workmen’s compensation legislation. Inspired by the success of that movement, in 1913 he turned with other AALL leaders to what Dr Rupert Blue, president of the American Medical Association (AMA), called “health insurance—the next great step in social legislation.”5 The AMA joined the campaign and appointed Rubinow executive secretary of its newly created Committee on Social Insurance. Rubinow worked tirelessly in this position until, in early 1917, the AMA, in a sharp reversal, cut off funds to the committee. After several short-term positions and a 4-year stint as head of the American Zionist Medical Unit in Palestine, Rubinow returned to the United States in 1923 and made a new career in the world of Jewish philanthropy and social service.6 Between 1925 and 1929, he also edited the Jewish Social Service Quarterly and in 1927 became vice president of the American Association for Old-Age Security.7 In this position and others, he led efforts in the late 1920s and early 1930s to create unemployment and old age insurance. In 1931, Rubinow chaired an important conference in Chicago whose purpose was to draw up a unified program of legislation for old age. Early in the New Deal, President Franklin D. Roosevelt wrote to Rubinow to express “great interest” in his suggestions. When the president appointed the Committee on Economic Security in the summer of 1934 to advise on drafting the Social Security Act, Rubinow served as a consultant.8

Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: definitions and current practice in Europe

The Accreditation Sub-Committee of the EBMT regularly publishes special reports on current practice of haemopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders. Major changes have occurred since the last report in 1998. Haemopoietic stem cell transplantation today includes allogeneic and autologous stem cells derived from bone marrow, peripheral blood and cord blood. With reduced intensity conditioning regimens in allogeneic transplantation, the age limit has increased, permitting the inclusion of older patients. New indications have emerged, such as autoimmune disorders and AL amyloidosis for autologous, and solid tumours for allogeneic transplants. Other indications, such as autologous transplantation for breast cancer have been challenged. An updated report with revised tables and operating definitions is presented here.

Food and nutritional care in hospitals: how to prevent undernutrition–report and guidelines from the Council of Europe

In 1999 the Council of Europe decided to collect information regarding Nutrition programmes in hospitals and for this purpose a network consisting of national experts from eight of the Partial Agreement member states was established. The aim was to review the current practice in Europe regarding hospital food provision, to highlight deficiencies and to issue guidelines to improve the nutritional care and support of hospitalized patients. Five major problems seemed to be common in this context: 1) lack of clearly defined responsibilities; 2) lack of sufficient education; 3) lack of influence of the patients; 4) lack of co-operation among all staff groups; and 5) lack of involvement from the hospital management. To solve the problems highlighted, a combined ‘team-effort’ is needed from national authorities and all staff involved in the nutritional care and support, including hospital managers.

The derivation of scientific guidelines for best environmental practice for the monitoring and regulation of marine aquaculture in Europe

The MARAQUA concerted action (Monitoring and Regulation of Marine Aquaculture) aimed to establish scientific guidelines for best environmental practice for the regulation and monitoring of marine aquaculture throughout the European Union. This paper focuses on the specific objectives of the MARAQUA concerted action and describes the processes adopted by the partnership when reviewing current practice in Europe in relation to licensing, regulatory and monitoring procedures. The paper also summarizes the findings of five topic groups established to analyse the scientific and socio-economic basis of current environmental practice in marine aquaculture and identifies the key recommendations for best environmental practice in relation to marine aquaculture.