Pharmaceutical regulation in 15 European countries: review

In the context of pharmaceutical care, policy-makers repeatedly face the challenge of balancing patient access to effective medicines with affordability and rising costs. With the aim of guiding the health policy discourse towards questions that are important to actual and potential patients, this study investigates a broad range of regulatory measures, spanning marketing authorization to generic substitution and resulting price levels in a sample of 16 European health systems (Austria, Belgium, Denmark, England, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Poland, Portugal, Scotland, Spain and Sweden). All countries employ a mix of regulatory mechanisms to contain pharmaceutical expenditure and ensure quality and efficiency in pharmaceutical care, albeit with varying configurations and rigour. This variation also influences the extent of publicly financed pharmaceutical costs. Overall, observed differences in pharmaceutical expenditure should be interpreted in conjunction with the differing volume and composition of consumption and price levels, as well as dispensation practices and their impact on measurement of pharmaceutical costs. No definitive evidence has yet been produced on the effects of different cost-containment measures on patient outcomes. Depending on the foremost policy concerns in each country, different levers will have to be used to enable the delivery of appropriate care at affordable prices

Feasibility Study: Social Protection in South Central Somalia

In recent years, there has been a growing recognition by policy makers and the international development community that longer-term social protection programming has the potential to reduce poverty and inequality and serve as a foundation upon which, viable livelihoods can be built. In many countries, specially those that are frequently affected by climatic and conflict hazards, this has led to calls for a shift in approach away from interventions thatsimply address the symptoms of household vulnerability towards those which deal with the causes. For more than two decades Somalia has lurched from one humanitarian crisis to another. This debate around the potential of social protection is therefore particularly acute, as years of humanitarian programming seem to have had little impact on increasing household resilience to shocks. Furthermore, the country still ranks 165 out of the 170 countries included in the UN's Human Development Index, and number one on the US Fund for Peace 'Failed State Index'.A consortium of agencies working in Somalia commissioned this study: Adeso, ACF, DRC and Save the Children. The study is intended to further the discussion on the rationale and practicalities of social protection in South Central Somalia, and to serve as a starting point for the debate around moving away from short-term responses towards longer-term social protection interventions by these agencies, and others.The report comprises six parts: Part 1 describes the political economy in South Central Somalia and highlights some key challengesfor humanitarian actors; Part 2 defines the general concept of social protection and looks at the global evidence of the impact of social protection; Part 3 looks at social protection programs in African countries (particularly those in the Somalia region), and also in fragile states; Part 4 looks at current social protection mechanisms in South Central Somalia; Part 5 describes the actions that are currently needed before humanitarian programming can become predictable, and Part 6 summarizes the way forward, including recommendations and the conclusions from the study

Structural and Care Process Improvement of Ward-based Postoperative Care to Optimise Surgical Outcomes

Much of the variation seen in surgical outcomes can be explained by differences in the quality of management of post-operative complications and ward-based care. The surgical ward round (WR) is critical to determining post-operative care and serves as the primary point of interaction between clinician and patient. Despite this, it is an area not subject to training or assessment at present. This thesis demonstrates the high degree of variability which exists in the conduct of WRs. It establishes the link between suboptimal patient assessment and increased risk of preventable post-operative complications. These place patients not only at risk of short-term deterioration, but result in reduced long-term survival as well. In order to quantify WR quality, a novel assessment tool has been developed and validated within a simulated environment. Ward simulation is a nascent branch of simulation which has been only preliminarily explored to date. A simulation environment was developed to take advantage of the known benefits of simulation such as controllability, reproducibility, and recordability, whilst maintaining a high level of fidelity and realism. An evidence-based curriculum for surgical WR training was designed and implemented in a simulation-based course. By focusing on structured generic processes of patient assessment and management, this resulted in significant improvement of trainee performance in routine WRs. To ensure standardised and optimum management of specific conditions, checklists have proven themselves to be of great value in a number of surgical and medical disciplines. Surgical complications are common, yet their management often suboptimal. As part of this thesis, evidence-based protocols for the management of the six most common complications were designed and validated. The implementation of these in a simulation-based randomised, controlled trial has resulted in greatly increased adherence to evidence-based standards of care, as well as improved communication and clinician performance. This thesis explores the variance currently present in surgical ward rounds, and the potentially grave consequences of this for patient outcomes. To date, WRs have been one of the last areas of surgical care still dependent on the Halstedian principle of experiential learning alone. The tools have now been developed with which to assess, improve, and standardise critical structures and care processes in the assessment and management of the post-operative surgical patient. Future implementation of these and integration into surgical curricula will benefit clinician training, patient care, and surgical outcomes alike.Open Acces

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

From health care services to healthcare profiling within the COVID-19 emergency : the role of the health quality impact assessment inside the local health unit

Purpose: The work considers the application of the quality of the care profile in hospital care, trying to obtain an overview of the resources used in the entire emergency management process in order to understand the information necessary for setting up improvement of activities. The analysis, combines theoretical reflections and empirical evidence relating to the treatment of the COVID-19 virus, develops the approach in question within the complex process of establishing a more effective and efficient care path. Design/Methodology/Approach: The choice of the field survey, is based on the qualitative method and in particular through the use of the case study, finds justification with the study objective and with the nature of the phenomenon investigated. This method lends itself to the need to observe the phenomena being analyzed in the environment of natural manifestation, even in the presence of other variables such as, the peculiarity of the managerial approach of the structure being investigated. Taking into account the current lack of knowledge on the subject being analyzed (COVID-19), the research is also based on a study of exploratory cases. Exploratory studies are appropriate when the understanding of the phenomenon under analysis from a theoretical (clinical) point of view is still in the embryonic stage. More generally, case studies are aimed at understanding complex organizational phenomena. The investigation concerns the Alfa Hospital in Calabria, selected as a study unit on the basis of some considerations. From a territorial point of view it operates in a vast provincial area. The strong focus on share capital is an important element in relation to the issue of quality as it represents a meta-condition for starting efficiency and planning processes. In addition, from an organizational point of view, the Company participated as a partner in projects on issues relating to emergency management. The Company is the regional reference hospital, DEA II level, regional HUB headquarters and COVID-19 Center. It is the reference point of the SPOKE centers, ensuring the highly specialized functions related to the emergency / urgency, coordinating the activity of the networks at local-regional and national level. Findings: The research focuses on the collection of data that represent the effort made by the Company in the construction of a theoretical-practical framework that acts as a reading key for the interrelation of emergency management with the Company's specific organizational-management model within the path concerning the provision of health services and the related care profiles having as central inspiring logic the centralization of the patient. Practical Implications: Consistent with what happened in other sectors of the Public Administration, where the process of change has as its objective the search for efficiency and efficacy, in Italy there is growing awareness that an efficient, effective and fair health service must be considered a critical success factor for the economic and social development of the country. The health system is at the center of great attention, having to demonstrate that it is adequately using the constantly decreasing resources available to it, in the face of a growing demand for health. Originality/value: The need for a growing orientation towards performance and the use of programming tools in the healthcare sector has been consolidated in the overall process of public administration corporatization. In this context, pathologies characterized by the length of care paths and high complexity in terms of treatment and complications must be considered. These pathologies are important in epidemiological terms, absorbed resources and potential for improvement from the point of view of intervention policies, public health services and efficiency.peer-reviewe

Philanthropy on the Road to Nationhood in Singapore Philanthropy in Asia: Working Paper No. 1

This paper attempts to address the gap in knowledge on the contributions by philanthropic players to national development in Singapore. Using grounded research, it explores the evolution of giving by individuals, the community and the private sector in Singapore from the end of World War II in 1945 to today. It looks at how each group gives towards prevailing social needs, unexpected events and crises as well as government calls for community support across fve key phases in Singapore's journey to nationhood. To provide context to the giving, the political and socio-economic situation of each time frame and concurrent government social welfare provisions in each phase are also described

Training of Crisis Mappers and Map Production from Multi-sensor Data: Vernazza Case Study (Cinque Terre National Park, Italy)

This aim of paper is to presents the development of a multidisciplinary project carried out by the cooperation between Politecnico di Torino and ITHACA (Information Technology for Humanitarian Assistance, Cooperation and Action). The goal of the project was the training in geospatial data acquiring and processing for students attending Architecture and Engineering Courses, in order to start up a team of "volunteer mappers". Indeed, the project is aimed to document the environmental and built heritage subject to disaster; the purpose is to improve the capabilities of the actors involved in the activities connected in geospatial data collection, integration and sharing. The proposed area for testing the training activities is the Cinque Terre National Park, registered in the World Heritage List since 1997. The area was affected by flood on the 25th of October 2011. According to other international experiences, the group is expected to be active after emergencies in order to upgrade maps, using data acquired by typical geomatic methods and techniques such as terrestrial and aerial Lidar, close-range and aerial photogrammetry, topographic and GNSS instruments etc.; or by non conventional systems and instruments such us UAV, mobile mapping etc. The ultimate goal is to implement a WebGIS platform to share all the data collected with local authorities and the Civil Protectio

Allocation of Public Expenditures in the post-war Kosovo: A critical analysis

How public expenditures are allocated can have profound effects on the macro-fiscal environment of a country. This research project analyzes how the Government of Kosovo allocates its public expenditures. Two particular strategic documents are examined—the Economic Vision 2011-2014 and the National Development Strategy 2016-2021. It does so by analyzing whether or not the priorities set in these strategies are translated in Medium-Term Expenditure Frameworks and the Budget Laws. Finally, this research project examines how the allocated public expenditures are realized. The research concludes that despite the well-established written strategies, a wide gap exists between the priorities set and their actual execution

Trade policy in West Germany.

Außenwirtschaftspolitik; Deutschland;