Europe-wide Survey Research Articles

Treatment of children with hyperbaric oxygenation (HBOT): a Europe-wide survey.

Hyperbaric oxygenation therapy (HBOT) is used as emergency treatment for decompression sickness, gas embolism, carbon monoxide intoxication, and necrotizing fasciitis. There is low evidence and little clinical knowledge about the treatment of children with HBOT. We sent an internet-based questionnaire to HBO centers in Europe to gain information about their experience with children and HBOT. Out of all HBO-centers who participated in the questionnaire 90% treat children analogue to adults about indication and HBOT protocol. Most treated children had life-threatening indications or the risk of organ loss. The reported rate of side effects was: 6.8% anxiety, 2.4% barotrauma, 0.9% seizure, 0.2% retinopathy and no case of pulmonary barotrauma or oxygen toxicity. HBO therapy for children is present in European HBO centers. The rate of severe side effects is as low to the rates in adults; apart from this, oxygen-related seizures and anxiety are more frequent. A special focus seems necessary on the psychological management of the children, because anxiety is common depending on the age of the children. Especially for smaller children, an adequate psychological support seems essential. Prospective observational or controlled studies in children seem necessary to create relevant clinical evidence for HBOT and to observe the rate of side-effects.

A European cross-sectional survey to investigate how involved doctors training in clinical pharmacology are in drug concentration monitoring

PurposeTherapeutic drug monitoring (TDM) is widely recognised as a key attribute of clinical pharmacologists; yet, the extent to which physicians undertaking postgraduate training in clinical pharmacology (hereafter trainees) are involved in TDM is poorly characterised. Our own experience suggests wide variation in trainee exposure to TDM.MethodWe performed a Europe-wide cross-sectional internet-based survey of trainees to determine the nature and extent of trainee involvement in TDM.ResultsThere were 43 responses from eight countries analysed. Of the 21 respondents from the UK, all were also training in general internal medicine (GIM), while all of the respondents who were solely training in clinical pharmacology were from outside the UK. Overall, 86.0% of respondents reported access to drug monitoring for clinical care at their affiliated institution, of which 81.0% were personally involved in TDM in some capacity. On average, trainees reported that drug monitoring was available for 16 of the 33 (48%) of the drug/drug classes surveyed. UK-based respondents were involved in requesting drug-level investigations and interpreting the results for patients under their care in 76.2% and 85.7% of cases, respectively, while non-UK respondents supported other healthcare professionals to interpret results in 45.4% of cases. Trainees felt TDM training was generally either insufficient or very inadequate.ConclusionWhile access to TDM is relatively available at institutions where trainees are based, the role of trainees is variable and affected by a variety of factors including country and training programme. Universally, trainees feel they need more education in TDM.

Opera History, the Travel Edition

This book has been in my bag for a long time and, on reflection, I am glad that I have read it gradually. When the central premise is so simple – Grand Opera Outside Paris is, indeed, about Grand Opera outside Paris – the payback comes in the detail of individual chapters and the slow emergence of a Europe-wide survey of encounter and exchange. The volume's editor, Jens Hesselager, provides an erudite and generous introduction, beginning with the familiar difficulty of defining grand opera and the importance of attending to specific performance contexts. In the first instances, of course, this meant the Paris Opéra, and Hesselager draws our attention to Sarah Hibberd's observation that the coherence of the genre was initially established ‘more through the licensing requirements of [this] institution than by [any] specific dramatic content’ (1). From here, the introduction gently encourages us to look outward.

The use of Faecal Microbiota Transplantation (FMT) in Europe: A Europe-wide survey.

BackgroundFaecal microbiota transplantation (FMT) is an emerging treatment modality, but its current clinical use and organisation are unknown. We aimed to describe the clinical use, conduct, and potential for FMT in Europe.MethodsWe invited all hospital-based FMT centres within the European Council member states to answer a web-based questionnaire covering their clinical activities, organisation, and regulation of FMT in 2019. Responders were identified from trials registered at clinicaltrials.gov and from the United European Gastroenterology (UEG) working group for stool banking and FMT.FindingsIn 2019, 31 FMT centres from 17 countries reported a total of 1,874 (median 25, quartile 10–64) FMT procedures; 1,077 (57%) with Clostridioides difficile infection (CDI) as indication, 791 (42%) with experimental indications, and 6 (0•3%) unaccounted for. Adjusted to population size, 0•257 per 100,000 population received FMT for CDI and 0•189 per 100,000 population for experimental indications. With estimated 12,400 (6,100–28,500) annual cases of multiple, recurrent CDI and indication for FMT in Europe, the current European FMT activity covers approximately 10% of the patients with indication. The participating centres demonstrated high safety standards and adherence to international consensus guidelines. Formal or informal regulation from health authorities was present at 21 (68%) centres.InterpretationFMT is a widespread routine treatment for multiple, recurrent CDI and an experimental treatment. Embedded within hospital settings, FMT centres operate with high standards across Europe to provide safe FMT. A significant gap in FMT coverage suggests the need to raise clinical awareness and increase the FMT activity in Europe by at least 10-fold to meet the true, indicated need.FundingNordForsk under the Nordic Council and Innovation Fund Denmark (j.no. 8056–00006B).

Clowning during COVID-19 – A survey of European Healthcare Clowning Organisations highlights the role of humour and art in the healthcare system

ObjectivesThis paper presents the findings of a Europe-wide survey that investigates the impact of COVID-19 on Healthcare Clowning Organisations and encourages the healthcare community to reflect on the role of medical clowning within the healthcare system. Study designOnline survey. MethodsThe survey was conducted in June 2020. Forty organisations from 21 countries across Europe responded through a mix of closed and open-ended answers. ResultsDuring the pandemic, 36 out of 39 of the surveyed organisations (with one non-response) had to postpone or cancel their artistic activities. As the crisis continued, 34 out of 40 of them managed to adapt their in-person activities, but the impact of virtual and distanced interactions with the beneficiaries was generally perceived as lower than that of in-person activities. In open responses, many Healthcare Clowning Organisations criticised the exclusion of medical clowns from healthcare institutions in times when the need for psychosocial support was particularly acute. ConclusionsThe healthcare sector should reconsider the important role the medical clowns play within healthcare settings, and allow for more inclusive and flexible safety regulations that take into consideration the holistic well-being of vulnerable groups, especially children, the elderly, and medical staff.

Professional learning and development needs of Chinese university-based physical education teacher educators

ABSTRACT This study examines the professional learning and development (PLD) needs of Chinese university-based physical education teacher educators (PETEds) and their views about effective ways to address them. This is significant given the limited research exploring this group. A European-wide survey was translated and distributed in China, receiving 251 responses of PETEds from 28 provinces. We found that the majority of PETEds had a strong desire to undertake further PLD in three areas: subject knowledge and didactics with particular emphasis on professional training in specific types of sports, research related academic activities and institutional activities. They preferred formal learning programmes as well as international learning activities to address these needs. The cost of the activities was the most significant factor influencing their engagement. We recommend paying closer attention to the PLD needs of specific subject area groups of teacher educators.

Evidence for antifouling biocides as one of the limiting factors for the recovery of macrophyte communities in lakes of Schleswig-Holstein

BackgroundThe European Water Framework Directive (WFD) has been implemented to achieve a good ecological status in European water bodies requiring macrophyte community assessment as one of the biological quality elements (BQEs). While in several lakes in Schleswig-Holstein (Germany) different BQEs improved within recent years, no recovery of macrophyte communities in some lakes could be achieved, despite the reduction of nutrient input and eutrophication. Due to the fact that no impairment of phytoplankton could be observed, toxic stress due to sediment contamination was hypothesized as a possible limiting factor of macrophyte community recovery.ResultsSediment toxicity was investigated by performing an extensive chemical screening of sediment contamination and a risk assessment based on toxic unit (TU) summation, using equilibrium water concentrations and algal toxicity as surrogates for lacking data on macrophyte toxicity. Possible indirect risks via toxic pressure on grazer were assessed via TUs based on crustaceans. The study revealed algal TUs of more than one order of magnitude below chronic toxicity thresholds in lakes with high and good status of the macrophyte community and increasing concentrations and frequency of exceedance of toxicity thresholds for lakes with moderate-to-bad status. The antifouling biocides irgarol and diuron were identified as major risk drivers. In addition, PAHs and glyphosate could not be ruled out to contribute to toxic pressure on macrophytes. Despite exceedance of toxicity thresholds for crustaceans, no connection of the ecological status of the macrophyte communities with toxic risks to grazers could be observed.ConclusionsOur study suggests that in a multiple pressure situation the toxic pressure created due to the contamination of sediments with antifouling biocides is one of the limiting factors for the recovery of macrophyte communities in impaired lakes of Schleswig-Holstein. This finding is in agreement with a Europe-wide survey on almost 47,000 sites suggesting that no good ecological status can be observed at sites with contamination exceeding toxicity thresholds. Similar to the survey, our study indicates additional stressors preventing the achievement of a good quality status of the lake ecosystems.

A generic curriculum development model for the biomedical physics component of the educational and training programmes of the non-physics healthcare professions.

The objective of the study was the construction of a generic curriculum development model for the use of biomedical physics (BMP) educators teaching the non-physics healthcare professions (HCP) in Europe. A comprehensive, qualitative cross-sectional Europe-wide survey of the curricula delivered by BMP in Faculties of Medicine and Health Sciences (FMHS) was carried out. Curricular content was collected from faculty web-sites, curricular documents and textbooks. The survey data was supplemented with semi-structured interviews and direct observation during onsite visits. The number of faculties studied was 118 from 67 universities spread all over Europe, whilst the number of onsite visits/interviews was 15 (geographically distributed as follows: Eastern Europe 6, North Western Europe 5, and South Western Europe 4). EU legislation, recommendations by European national medical councils, educational benchmark statements by higher education quality assurance agencies, research journals concerning HCP education and other documents relevant to standards in clinical practice and undergraduate education were also analyzed. Best practices and BMP learning outcomes were elicited from the curricular materials, interviews and documentation and these were subsequently used to construct the curriculum development model. A structured, comprehensive BMP learning outcomes inventory was designed in the format required by the European Qualifications Framework (EQF). The structures of the inventory and curriculum development model make them ideally suited for use by BMP involved in European curriculum development initiatives for the HCP.

LIBER Digital Humanities and Digital Cultural Heritage Working Group: a case study of international collaboration and network building

How can European library staff working in digital humanities connect with peers in the library sector, determine where to find relevant information about digital scholarship, provide their collections as data and to be an equal partner in digital humanities research? The LIBER Digital Humanities Working Group was created as a participatory knowledge network in 2017 to address these questions. Through a series of workshops, knowledge sharing activities, and a Europe-wide survey and resulting report, the Working Group engaged with the international LIBER DH community. Useful reflections are provided on organising an open, voluntary DH community and planning for inclusive activities that benefit digital scholarship in European research libraries.

A Tricky Subject – archaeology in opinion polls on cultural heritage. Recent examples from Poland

Understanding the public by analysing the wants, interests and expectations regarding their involvement in archaeology is one of the strategic aims of Europae Archaeologiae Consilium (EAC). Cultural heritage has been the topic of several public opinion polls in Poland over the past few years. In 2011 and 2015, the Narodowy Instytut Dziedzictwa (National Institute of Cultural Heritage) carried out two representative surveys. Subsequent polls focusing on more specific issues or groups of respondents were undertaken in 2015, 2017 and 2018. Other data from Poland come from the 2017 Special Eurobarometer survey on cultural heritage. They can be contrasted with archaeology-orientated opinion polls: a Europe-wide survey carried out within the NEARCH project led by Inrap (French National Institute for Preventive Archaeological Research) and several smaller-scale projects, which might be treated as starting points for more representative research. The scope of these surveys includes: public perception of cultural heritage and archaeology, subjective value of cultural heritage, attitudes towards archaeology, relevance of archaeology for the present (also in terms of the socio-economic potential of archaeological heritage), people's interaction with archaeology and archaeological heritage, sources of information about archaeological heritage etc. Comparison of these data will serve to establish the relevance of surveys for archaeological heritage management. The author will also examine if the specific nature of archaeological heritage is reflected in the surveys and how the public feels about its most hidden heritage. Based on the results of her analysis, the author will look at the desired scope of a survey aimed at filling the identified gaps and shaped to fit the needs of evidence-based archaeological heritage management.

Understanding European patient expectations towards current therapeutic development in spinal muscular atrophy

Following the 2017 approval of a first spinal muscular atrophy (SMA) treatment by the European Medicines Agency, SMA Europe launched a Europe-wide survey with the goal of understanding patients’ treatment expectations, realities of daily living and access to clinical trials and therapy, and how this varied according to parameters such as age and disease severity. A response rate of 31% yielded 1474 completed surveys from 26 European countries. In line with findings from a 2015 SMA Europe-led survey, participants considered stabilization of their condition to be progress. Notably, responses indicated that the current classification of SMA at diagnosis by ‘type’ often does not reflect current mobility level. Large gaps in treatment access were identified that varied in particular between age and disease severity groups, yet there was high interest in clinical trial participation. In addition, alternative treatment options, including combination therapies, are now expectations. These perspectives should be central considerations through the research and development processes of new SMA therapies, through data generation and discussions on access to therapies. Results from this survey indicate that collaboration between stakeholders is essential to the foundation upon which innovative approaches for SMA treatments and access can be explored.

The Impact of the SARS-CoV-2 (COVID-19) Pandemic on Gastroenterology Training

Introduction: The SARS-CoV-2 (COVID-19) pandemic has brought about a radical change in our working patterns. These changes can affect the training that gastroenterology trainees undergo, especially endoscopy since these are aerosol-generating procedures. The aim of this survey was to assess the effect of the COVID-19 pandemic on gastroenterology training across the European countries. Methodology: A questionnaire was set up whereby the different elements of training were analysed. The questionnaire (online) was distributed among trainees through the National Representatives of the European Board of Gastroenterology and Hepatology. Results: In total, 86 trainees (females: 55%; mean age: 32.5 years [SD ±4.57 years]; mean training duration of 2.68 years [SD ±1.63]) from 22 different countries were recruited. From the cohort, 10.5% were considered as vulnerable for acquiring COVID-19. During their job, 4.7% acquired the infection and 26.7% were placed in quarantine. Most trainees noted that their various aspects of gastroenterology training were moderately or severely affected during the initial height of the pandemic: clinical gastroenterology training (67.4%), outpatients (75.5%), didactic teaching (88.3%), multidisciplinary team meetings (65.2%) and endoscopy training (75.6%). Later, when the number of COVID-19-related infections decreased across Europe, the above modalities returned to normal for <50% of the trainees. Conclusion: This European-wide survey has demonstrated that gastroenterology training has been severely impacted during both the initial height of the pandemic and afterwards. Furthermore, the psychological impact on trainees, in terms of training quality, duration and exposure to COVID-19, is unknown. A re-assessment of each centre training programme should be done as to ensure that a high standard of training is still being delivered.

Challenges and satisfaction in Cardiothoracic Surgery Residency Programmes: insights from a Europe-wide survey.

The increasing complexity of surgical patients and working time constraints represent challenges for training. In this study, the European Association for Cardio-Thoracic Surgery Residents' Committee aimed to evaluate satisfaction with current training programmes across Europe. We conducted an online survey between October 2018 and April 2019, completed by a total of 219 participants from 24 countries. The average respondent was in the fourth or fifth year of training, mostly on a cardiac surgery pathway. Most trainees follow a 5-6-year programme, with a compulsory final certification exam, but no regular skills evaluation. Only a minority are expected to take the examination by the European Board of Cardiothoracic Surgery. Participants work on average 61.0 ± 13.1 h per week, including 27.1 ± 20.2 on-call. In total, only 19.7% confirmed the implementation of the European Working Time Directive, with 42.0% being unaware that European regulations existed. Having designated time for research was reported by 13.0%, despite 47.0% having a postgraduate degree. On average, respondents rated their satisfaction 7.9 out of 10, although 56.2% of participants were not satisfied with their training opportunities. We found an association between trainee satisfaction and regular skills evaluation, first operator experience and protected research time. On average, residents are satisfied with their training, despite significant disparities in the quality and structure of cardiothoracic surgery training across Europe. Areas for potential improvement include increasing structured feedback, research time integration and better working hours compliance. The development of European guidelines on training standards may support this.

European wide survey on allogeneic haematopoietic cell transplantation practice for myelofibrosis on behalf of the EBMT chronic malignancies working party

Heterogeneous practices exist across transplant centres regarding assessment prior to allogeneic haematopoietic cell transplantation (allo-HCT) for myelofibrosis, post-transplant monitoring and management of relapse. The ‘Practice Harmonisation and Guidelines’ and Myeloproliferative Neoplasms subcommittees of the Chronic Malignancies Working Party (CMWP) of the EBMT generated an electronic survey proposal to investigate approaches to the above aspects of myelofibrosis allo-HCT practice. This survey was sent to a total of 65 centres experienced in allo-HCT for myelofibrosis across Europe in February 2020. By time of survey closure, a total of 36 centres (55 %) had completed the survey. Responses were aggregated and reported in a comparative fashion. Marked variations in assessment prior to allo-HCT, JAK inhibitor management peri-transplant, molecular, histopathological and cytogenetic monitoring and approaches to the definition and management of relapse were apparent across surveyed centres. On the basis of these findings, future CMWP efforts will focus on defining guidelines for relapse definition in MF allo-HCT and also suggested optimal monitoring practices for the transplant community.

Patterns in informal and non-formal science learning activities for children–A Europe-wide survey study

Abstract There is a growing number of informal and non-formal learning activities worldwide related to STEM (Science, Technology, Engineering, Mathematics) curricular subject areas—particularly those involving coding and making. To better understand the general aim and content of such activities, we conducted a survey addressing highly experienced instructional designers and instructors of informal and non-formal science learning activities in nine European countries (N = 128). The goal of this paper is to investigate the relation between the gender of the activity leader experts, the target audience, the covered curricular subjects, the main goal, and the place of the activity. The results show that the gender and age of the participants are related to the covered curricular subjects and to the goal of the activity, and that the place of the activity is associated with all of the investigated dimensions. We introduce the patterns we identified that describe typical goals and the covered curricular subjects in relation to the participants’ gender and age along with patterns between the activity leader experts’ gender, the covered curricular subjects, and the main goal of the activity, as well as relationships between the studied dimensions and the place of the activity. Furthermore, we discuss the best practices and the bottlenecks of the activities, as well as detailed study findings regarding the revealed patterns, in addition to their implications and value for the informal and non-formal learning communities.

“Urban interventionism” in welfare and planning: National typologies and “local cultures” in Europe

ABSTRACT Comparative research on welfare and planning has traditionally been based on broadly defined typologies of national welfare state and planning systems, thereby neglecting the role of local “cultures” that help sustain and redevelop underlying institutions and practices. Drawing on a European-wide survey of city mayors, we explore how well the established typologies are reproduced in local welfare and planning cultures, as reflected in mayoral attitudes, and whether there are systematic variations of welfare and planning cultures even within the same country. The findings suggest that nationally based categories of welfare regimes and planning systems do not necessarily correspond with mayors’ preferences for “urban intervention” in service delivery, housing provision, or planning. Local specificities, including permeability to the influence of European institutions and policies, may in fact have a significant impact on mayors’ attitudes in these fields, possibly creating new local understandings as well as pressures for reforming national welfare and planning systems. These conclusions strengthen the argument that “local cultures” are presenting a challenge to national typologies of planning and welfare, and are important elements to take into account when exploring the evolution of urban policies at the local level.

Ecological Sanitation and Sustainable Nutrient Recovery Education: Considering the Three Fixes for Environmental Problem-Solving

In the context of phosphorus as a finite resource and the unsustainable character of current sanitation in Europe, this paper examined social factors in a technological transition towards sustainable sanitation. The evaluation is based on the idea of cognitive, structural, and technological fixes to achieve environmental protection. The cognitive fix has been evaluated through literature and a European-wide survey with universities that offer civil and environmental engineering programs. Contrary to an initial hypothesis, ecological sanitation and nutrient recycling are taught by the majority (66%) of responding programs. There are, however, local differences in terms of context and detail of the education. The main impediments for teaching were identified as academic resources (especially in Belgium, Germany and Denmark) and the technological status quo (Ireland, Italy, Spain and some programs of the United Kingdom). Instructors’ personal commitment and experience was evaluated to be a key factor for an extensive coverage of sustainable sanitation in higher education programs. The role of higher education has a critical role to play in changing sanitation practices, given the unique professional developmental stage of students and the potential for a cognitive fix to contribute to meaningful change.

Treatment of children with Hyperbaric Oxygenation (HBOT): an Europe-wide survey

Hyperbaric oxygenation therapy (HBOT) is used as emergency treatment for decompression sickness, gas embolism, carbon monoxide intoxication, and necrotizing fasciitis. There is low evidence and little clinical knowledge about the treatment of children with HBOT. We sent an internet-based questionnaire to HBO centers in Europe to gain information about their experience with children and HBOT. Out of all HBO-centers who participated in the questionnaire 90% treat children analogue to adults about indication and HBOT protocol. Most treated children had life-threatening indications or the risk of organ loss. The reported rate of side effects was: 6.8% anxiety, 2.4% barotrauma, 0.9% seizure, 0.2% retinopathy and no case of pulmonary barotrauma or oxygen toxicity. HBO therapy for children is present in European HBO centers. The rate of severe side effects is as low to the rates in adults; apart from this, oxygen-related seizures and anxiety are more frequent. A special focus seems necessary on the psychological management of the children, because anxiety is common depending on the age of the children. Especially for smaller children, an adequate psychological support seems essential. Prospective observational or controlled studies in children seem necessary to create relevant clinical evidence for HBOT and to observe the rate of side-effects.

Genetic evidence further elucidates the history and extent of badger introductions from Great Britain into Ireland.

The colonization of Ireland by mammals has been the subject of extensive study using genetic methods and forms a central problem in understanding the phylogeography of European mammals after the Last Glacial Maximum. Ireland exhibits a depauperate mammal fauna relative to Great Britain and continental Europe, and a range of natural and anthropogenic processes have given rise to its modern fauna. Previous Europe-wide surveys of the European badger (Meles meles) have found conflicting microsatellite and mitochondrial DNA evidence in Irish populations, suggesting Irish badgers have arisen from admixture between human imported British and Scandinavian animals. The extent and history of contact between British and Irish badger populations remains unclear. We use comprehensive genetic data from Great Britain and Ireland to demonstrate that badgers in Ireland's northeastern and southeastern counties are genetically similar to contemporary British populations. Simulation analyses suggest this admixed population arose in Ireland 600–700 (CI 100–2600) years before present most likely through introduction of British badgers by people. These findings add to our knowledge of the complex colonization history of Ireland by mammals and the central role of humans in facilitating it.

Influences of rurality on action to diagnose cancer by primary care practitioners – Results from a Europe-wide survey in 20 countries

BackgroundRural-dwellers have poorer cancer outcomes than urban counterparts, for reasons which are unclear. At healthcare institution level, poorer access to investigations and different clinical decision-making by rural primary healthcare practitioners (PCPs) could be important. AimTo compare access to investigations, attitudes to cancer diagnosis and clinical decision-making between rural and urban PCPs. SettingA vignette-based cross-sectional survey of rural and urban PCPs in 20 European countries. MethodsData on PCPs’ decision-making and attitudes to cancer diagnosis were based on clinical scenarios. Comparisons were made using tests of proportion, univariable and multivariable binary logistic regression. ResultsOf the 1779 PCPs completing the survey 541 30.4 %) practiced rurally. Rural PCPs had significantly less direct access to all investigative modalities: ultrasound; endoscopy; x-ray and advanced screening (all p < 0.001). Rural PCPs were as likely as urban PCPs to take diagnostic action (investigation and/or referral) at the index consultation in all four clinical vignettes ((OR, 95 % CI) for lung: 0.90, 0.72–1.12; ovarian: 0.95, 0.75–1.19; breast: 0.87, 0.69–1.09; colorectal: 0.98, 0.75–1.30). Rural PCPs were less likely to refer to a specialist at the index consultation for ovarian cancer (OR 0.71 95 % CI 0.51-0.99). Rural PCPs were significantly more likely to report that their patients faced barriers to accessing specialist care, but practitioners did not report greater difficulties making specialist referral than their urban counterparts ConclusionsEuropean rural PCPs report poorer access to investigations but are at least as likely as urban PCPs to investigate or refer patients that might have cancer at the index consultation.