280 research outputs found
Regulating the health workforce in Europe: implications of the COVID-19 pandemic
No full textPanteli D, Maier CB. Regulating the health workforce in Europe: implications of the COVID-19 pandemic. Human Resources for Health. 2021;19(1): 80.In the European free movement zone, various mechanisms aim to harmonize how the competence of physicians and nurses is developed and maintained to facilitate the cross-country movement of professionals. This commentary addresses these mechanisms and discusses their implications during the COVID-19 pandemic, drawing lessons for future policy. It argues that EU-wide regulatory mechanisms should be reviewed to ensure that they provide an adequate foundation for determining competence and enabling health workforce flexibility during health system shocks. Currently, EU regulation focuses on the automatic recognition of the primary education of physicians and nurses. New, flexible mechanisms should be developed for specializations, such as intensive or emergency care. Documenting new skills, such as the ones acquired during rapid training in the pandemic, in a manner that is comparable across countries should be explored, both for usual practice and in light of outbreak preparedness. Initiatives to strengthen continuing education and professional development should be supported further. Funding under the EU4Health programme should be dedicated to this endeavour, along with revisiting the scope of necessary skills following the experience of COVID-19. Mechanisms for cross-country sharing of information on violations of good practice standards should be maintained and strengthened to enable agile reactions when the need for professional mobility becomes urgent
Structural and dynamic properties of translocase motor SecA:
No full textSecA is a large, 204 kDa, homodimeric, helicase-like protein that is a key component of the bacteria protein secretion machinery. SecA, being a motor protein, couples the translocation of polypeptide segments across or into biological membranes with the expenditure of metabolic energy extracted from ATP hydrolysis. SecA adopts a compact conformation in the cytoplasm but switches to a relaxed one when is engaged to translocation at the membrane. Specific interaction of SecA with SecYEG induces large conformational changes to both partners that result in the stimulation of SecA’s ATPase activity and trigger the opening of the channel.
We use a combination of NMR spectroscopy, Isothermal Titration Calorimetry (ITC) and biochemical techniques to characterize E. coli SecA along the protein secretion pathway. Recent advances in isotope labeling and NMR methodology (methyl-TROSY) enabled the NMR study of SecA.
We found that the nucleotide binding cleft of SecA exists in a metastable state that undergoes a disorder-order transition upon nucleotide binding. Our data show that SecA uses a novel mechanism wherein conserved regions lining the cleft undergo cycles of disorder-order transitions while switching among functional catalytic states. The structural relation of SecA to helicases suggests that these proteins may utilize similar mechanisms to convert the ATP binding/hydrolysis energy to mechanical work.
Our data reveal that C domain undergoes cycles of detachment and rebinding to the motor that are linked with the ATPase activation of SecA. When the contacts with the C domain are loosened, SecA becomes activated and this process is probably facilitated by the membrane. Moreover, allosteric communication between the preprotein binding and the motor domain of SecA is regulated by nucleotide and signal peptide binding. Finally, we found that the extreme C terminus of SecY (C6 loop) contacts both the motor and the C domain of SecA and we identified important residues from the loop C6 that mediate this interaction.
In summary, our studies revealed the intimate relation between flexibility and catalytic efficiency in SecA as well the allosteric communication among the domains.Ph.D.Includes bibliographical references (p. 131-144)by Dimitra Keramisano
Remission as an Emerging Therapeutic Target in Type 2 Diabetes in the Era of New Glucose-Lowering Agents: Benefits, Challenges, and Treatment Approaches
No full textType 2 diabetes mellitus (T2DM) is a progressive disease with a growing prevalence, associated with an increased risk of complications. The introduction of new classes of antidiabetic drugs into clinical practice has dramatically changed the landscape of diabetes therapy. However, despite the progress made in the pharmacotherapy of T2DM, mitigating the burden of the disease on individuals, societies and health care systems remains a challenge. Remission has recently emerged as a therapeutic target in T2DM, achievable through a wide range of interventions. Recent studies have shown that extensive lifestyle changes, such as weight reduction, bariatric surgery, and intensive glucose lowering therapy, can prompt the remission of diabetes, but some unanswered questions remain regarding its long-term effects on diabetic complications. Metabolic surgery and novel classes of glucose-lowering medications are currently the most effective interventions to induce weight loss and by extension remission in patients with diabetes; however, the ideal strategy to achieve the long-term maintenance of remission remains doubtful. In this narrative review, we discuss the available therapeutic approaches to target the remission of diabetes through personalized multimodal care, based on the latest evidence
Geolinguistic spaces and the geopolitics of organization studies: movements across centers and peripheries: European group for organisational studies colloquium
No full textAcademic knowledge production and evaluation has been studied as a phenomenon situated across global and (semi)peripheral contexts (Lillis and Curry, 2010; Bennett, 2014). The metaphor of scales draws attention to the study of academic discourses as practices that develop across vertical, hierarchically organized layers (Blommaert, 2010). In this paper, we draw on 3 sub-corpora of organization studies journal articles, with each journal occupying a different position in the impact factor continuum. Building on the work of Lillis and Curry (2010), we study networked activities as social capital in the global academic economy. In our analysis we first examine the epistemological profile of organisation studies, as reflected in differentially ranked journals located in European contexts. We then explore the complex configuration of spaces/localities within and around which the production of knowledge takes place, by examining networks of author affiliations in relation to the identified sites in the empirical papers included in the corpus. Finally, we examine how constructions of the ‘local’ and the ‘global’ relate to the themes foregrounded in the aims and scope of each journal and we explore how discourses of the ‘local’ and the ‘global’ relate to key concepts in the field of organization studies, including institutions, alternatives and resistance, as well as power and gender
How can the EU support sustainable innovation and access to effective antibiotics?: Policy options for existing and new medicines
No full textDo health systems cover the mouth? Comparing dental care coverage for older adults in eight jurisdictions
No full textThe Articles reports the results of an International project about coverage of dental care
A systematic analysis of 27 new diagnostic and treatment methods between 2005 and 2017: Diffusion, evidence, and research activities
No full textDie Anwendung von neuen Untersuchungs- und Behandlungsmethoden (NUB) im stationären Sektor bleibt auch nach der Einführung einer frühen Nutzenbewertung für bestimmte Medizinprodukte hoher Risikoklassen ein kontroverses Thema der gesundheitspolitischen Debatte. Es gilt eine Balance zu finden zwischen dem Zugang zu innovativen Methoden, der Sicherstellung des Nutzens sowie der Finanzierbarkeit durch die gesetzliche Krankenversicherung. Schwächer ausgestaltete Zulassungskriterien für Medizinprodukte im Vergleich zu Arzneimitteln erfordern ein Nachsteuern, wenn es darum geht Medizinprodukte in der Regelversorgung anzuwenden.
Das übergreifende Ziel der Studie ist, die Bedeutung wissenschaftlicher Evidenz bei der Einführung und Verbreitung von NUB in deutschen Krankenhäusern zu untersuchen. Aufbauend auf einer systematischen Vorgehensweise werden kriterienbasiert 27 versorgungsrelevante NUB identifiziert. Für diese werden die Entwicklungen der Evidenz hinsichtlich Wirksamkeit und Sicherheit sowie die Entwicklung der Fallzahlen in anwendenden Krankenhäusern longitudinal (2005–2017) analysiert. Wissenschaftliche Publikationen werden systematisch identifiziert, selektiert und ausgewertet, um eine Übersicht zu schaffen, welche Evidenz zu welchem Zeitpunkt des Anwendungsgeschehens vorlag. Weitere Faktoren wie Finanzierungsänderungen und Sicherheitswarnungen werden in der Analyse berücksichtigt. Zudem werden die Versorgungs- und Forschungsaktivitäten deutscher Krankenhäuser erfasst und deskriptiv ausgewertet.
Ein Zusammenhang zwischen Diffusion und Evidenzentwicklung kann für ca. die Hälfte der untersuchten Methoden vermutet werden. Für die restlichen Methoden ist entweder nicht genügend Evidenz vorhanden, sind die Fallzahlen zu gering, um einen Zusammenhang abzuleiten, oder die Fallzahl- und die Evidenzentwicklung weisen eine entgegengesetzte Richtung auf. In der Stichprobe dauert es von der Marktzulassung bis zur ersten Veröffentlichung der ersten Ergebnisse einer randomisiert klinischen Studie bis zu zehn Jahre. Ein robuster Evidenzkörper liegt für die Mehrheit der Methoden erst nach mehreren Jahren der Anwendung vor oder entsteht überhaupt nicht im betrachteten Zeitraum. Hin-sichtlich der Finanzierung bestätigt die Studie die Kenntnis, dass NUB mehrere Jahre in der Systematik zeitlich befristeter Entgelte verweilen, ohne dass ein Nutzen nachgewiesen ist. Die Notwendigkeit, jährlich NUB-Anträge für eine Finanzierung zu stellen, scheint kein Hindernis für eine zügige Diffusion einer Technologie zu sein.
Trotz diverser Unterschiede zwischen den Methoden sind die Fallzahlen der Anwendungen von NUB in an Studien beteiligten Krankenhäusern (in der Regel große Häuser oder Universitätskliniken) im Allgemeinen höher im Vergleich zu den übrigen anwendenden Krankenhäusern, im Besonderen in den ersten Jahren der Anwendung. Gleichzeitig fallen jedoch Krankenhäuser auf, die neue Methoden basierend auf Hochrisikomedizinprodukten sehr selten anwenden, was wiederum Fragen hinsichtlich der Patientensicherheit und Behandlungsqualität in diesen Krankenhäusern hinsichtlich dieser NUB aufwirft.
Insgesamt bleibt die Abwägung zwischen Innovationsförderung und evidenzbasierter Versorgung eine grundsätzliche Herausforderung. Unter Berücksichtigung aller methodischen Limitationen untermauern die Ergebnisse den Anstoß, das existierende Regelwerk des Verbotsvorbehalts im stationären Sektor zu hinterfragen und eine systematische Evidenzgenerierung in den Vordergrund zu rücken. Wesentlich ist hierbei eine Lösung, die die Wirksamkeit und Sicherheit der Methoden für PatientInnen in den Vordergrund rückt, aber auch einen Rahmen bietet, um eine systematische Evidenzgenerierung voranzutreiben.The use of new examination and treatment methods (NUB) in the inpatient sector remains a contro-versial topic of health policy discussions even after the introduction of an early benefit assessment for certain medical devices of high-risk class. Policy makers must balance access to innovative technologies, risks and benefits of the technologies, and the ability and resilience of the statutory health insur-ance systems to finance those. Weaker approval criteria for medical devices compared to pharmaceu-ticals require consequent evaluation of (clinical) effectiveness and safety when it comes to the diffu-sion of medical devices in standard care.
The overall aim of the study is to investigate the importance of scientific evidence for the adoption and diffusion of NUB in German hospitals. Using a new systematic, criteria-based approach, 27 health care relevant NUB have been identified for further analyses. For these, the development of evidence regarding efficacy and safety as well as the development of the case numbers in hospitals was ana-lyzed longitudinally (2005–2017). Publications were systematically identified, selected, and evaluated to create an overview of evidence available at different point of times. Other factors such as changes in financing schemes and safety alerts have been considered in the analysis. In addition, the utilization and research activities of German hospitals have been identified and analyzed descriptively.
A relationship between diffusion and evidence development can be assumed for about half of the included methods. For the remaining methods, either the body of evidence is too sparse, the case numbers are too small to infer a relationship, or the case number and evidence development show opposite directions. In the sample, it takes up to ten years after marketing authorization until the first results of a randomized clinical trial are published. A robust body of evidence is only available for the majority of technologies after several years of use or does not emerge at all during the observation period. With regard to financing schemes, the study confirms that temporary payments for NUB have been paid for several years without evidence of benefit of the corresponding technologies. The need to submit annual NUB applications for funding does not appear to be a barrier to rapid diffusion.
Despite various differences between technologies, case numbers in hospitals participating in studies (usually large hospitals or university hospitals) were generally higher compared to the remaining hos-pitals; in particular in the first years of NUB utilization. At the same time, however, some hospitals use new methods based on high-risk medicines infrequently, which in turn raise questions about patient safety and quality of care in these hospitals.
Overall, the trade-off between promoting innovation and ensuring evidence-based care remains a fundamental challenge. Considering all methodological limitations, the results support the impetus to question the existing regulatory framework for NUB and to focus on systematic evidence generation. It is essential to find a common solution that focuses on the efficacy/effectiveness and safety of the technologies for patients, but also provides a framework for systematic evidence generation
The right to childhoods : critical perspectives on rights, difference and knowledge in a transient world
No full textThis book offers an engaging study that analyses contemporary childhood by examining new lines of argument about diversity, disability and difference. The author critiques the key issues that affect both adults' and children's quality of life, including market-driven values, poverty and civic disengagement.In this fascinating study, Dimitra Hartas analyses contemporary childhood. She discusses the plurality inherent in childhood and the cultural, ideological, social and biological forces that shape children's experience of growing up in the 21st century. She engages with new lines of argument about diversity, disability and difference, and critiques the big issues that affect both adults' and children's quality of life such as market-driven values, poverty and civic disengagement.Hartas uncovers evidence of how the right to childhood is being violated in both the developed and developing world and how our consumerist culture is shaping children's lives in ways that are not always understood, and advocates the right to childhoods. She concludes by discussing the implications of her findings for both policy and practice in early childhood education, and examines pedagogies that are responsive to ethics, diversity and difference
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