EG-Sozialpolitik nach Verflechtungsfalle und Entscheidungslücke: Bewertungsmaßstäbe und Entwicklungstrends

Bis in die 1990er Jahre befand sich die EG-Sozialpolitik infolge weitestgehender Einstimmigkeitserfordernisse in einer ‚Politikverflechtungsfalle’ (Fritz W. Scharpf), die noch durch eine, korporatistische Entscheidungslücke’ (Wolfgang Streeck) ergänzt wurde. Der Maastrichter Vertrag brachte allerdings signifikante Neuerungen in Hinblick auf Handlungskompetenzen, Mehrheitsvoten und die korporatistische Einbeziehung der Sozialpartnerverbände. Dass diese Potenziale entgegen vielfachen Erwartungen auch praktisch zur Anwendung kamen, heißt allerdings noch nicht, dass die Problemlösungskapazität der EG-Sozialpolitik schon zufrieden stellend wäre. Dieser Beitrag analysiert unterschiedliche Beurteilungsmaßstäbe dafür und zeigt auf, dass die ‚soziale Dimension‘ bei Anwendung von inhaltlich vergleichsweise eng definierten Ansprüchen mittlerweile besser abschneidet, als oft erwartet wurde (Schließung akuter arbeitsrechtlicher Lücken; Kommissionsvorschläge im Vergleich zu Ratsbeschlüssen). Noch tut die Union allerdings wenig, um marktinduziertem Druck auf soziale Standards in den Mitgliedstaaten entgegenzuwirken. Bislang kaum ernsthaft diskutiert wurde auch die Nützung jener Potenziale für sozialgestaltende Politik auf supranationaler Ebene, die heute angesichts offener Märkte in den Mitgliedstaaten immer weniger bestehen. Als Entwicklungstrend zeichnet sich in allerjüngster Zeit eine völlig neue Rolle für die EG-Sozialpolitik im 21. Jahrhundert ab: als Motor und zugleich Korsett für auf nationaler Ebene entschiedene Reformen.Until the 1990s, eC social policy was characterised by a joint-decision trap (Fritz W. Scharpf) characterized by a joint decision trap and a concomitant ‘corporatist decision gap’ (Wolfgang Streeck). The Maastricht Treaty, however, brought significant innovation in terms of EC competencies, majority voting, and corporatist decision patterns. The fact that some of these potential improvements have actually been put into practice — surprisingly for many — does not, however, mean that the problem solving capacity of the EC in social policy is satisfying. This article analyses several quite different yardsticks and shows that the ‘social dimension’ is more successful than was often expected, in the light of the less ambitious standards (closing labour law gaps induced by the Internal Market; Commission proposals compared to Council decisions). By contrast, the EC does little to fight devaluative pressures on the national social standards, and it does not yet make use of the specific potential for improvements in social policy which nowadays tends to exist on the supranational level rather than on the national one. Very recently, however, there has been a trend towards a new role for EC social policy in the 21st century: as a catalyst and, at the same time, corset for reforms decided upon at the national level

Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes

Abstract Background Antibiotic-associated diarrhea (AAD) occurs in 2–25% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. However, probiotics are not routinely used in Dutch nursing homes. The objectives of this evaluation were to develop a procedure for the implementation of probiotics to prevent AAD in nursing homes, to evaluate effects on AAD occurrence, and to evaluate the implementation process of probiotics in daily care. Methods A pragmatic participatory evaluation (PPE) design was chosen, as it seemed a suitable approach for implementation of probiotics, as well as for evaluation of its effectiveness in daily nursing home practice. Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. Ninety-three residents provided data on 167 episodes of antibiotics use, of which 84 episodes that included supplementation with probiotics and 83 episodes with no probiotics supplementation. A multispecies probiotics was administered twice daily upon start of antibiotic treatment, up to 1 week after completing the antibiotics course. The occurrence of AAD was monitored and a process evaluation was conducted to assess facilitators and barriers of probiotics implementation. Results The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p = 0,022, Chi-square). No significant differences in the occurrence of AAD were found between the residents taking amoxicillin/clavulanic acid or ciprofloxacin. Reported facilitators for implementation were perceived benefits of probiotics and prescription by medical staff. Reported challenges were probiotics intake by residents and individual decision-making as to which resident would benefit from it. Conclusion Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents. Trial registration ISRCTN 94786163, retrospectively registered on 3 February 2020. </jats:sec

Probiotics use for antibiotic-associated diarrhea : a pragmatic participatory evaluation in nursing homes

BACKGROUND: Antibiotic-associated diarrhea (AAD) occurs in 2-25% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. However, probiotics are not routinely used in Dutch nursing homes. The objectives of this evaluation were to develop a procedure for the implementation of probiotics to prevent AAD in nursing homes, to evaluate effects on AAD occurrence, and to evaluate the implementation process of probiotics in daily care. METHODS: A pragmatic participatory evaluation (PPE) design was chosen, as it seemed a suitable approach for implementation of probiotics, as well as for evaluation of its effectiveness in daily nursing home practice. Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. Ninety-three residents provided data on 167 episodes of antibiotics use, of which 84 episodes that included supplementation with probiotics and 83 episodes with no probiotics supplementation. A multispecies probiotics was administered twice daily upon start of antibiotic treatment, up to 1 week after completing the antibiotics course. The occurrence of AAD was monitored and a process evaluation was conducted to assess facilitators and barriers of probiotics implementation. RESULTS: The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p = 0,022, Chi-square). No significant differences in the occurrence of AAD were found between the residents taking amoxicillin/clavulanic acid or ciprofloxacin. Reported facilitators for implementation were perceived benefits of probiotics and prescription by medical staff. Reported challenges were probiotics intake by residents and individual decision-making as to which resident would benefit from it. CONCLUSION: Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents. TRIAL REGISTRATION: ISRCTN 94786163, retrospectively registered on 3 February 2020

Information Mode–Dependent Success Rates of Obtaining German Medical Informatics Initiative–Compliant Broad Consent in the Emergency Department: Single-Center Prospective Observational Study

BackgroundThe broad consent (BC) developed by the German Medical Informatics Initiative is a pivotal national strategy for obtaining patient consent to use routinely collected data from electronic health records, insurance companies, contact information, and biomaterials for research. Emergency departments (EDs) are ideal for enrolling diverse patient populations in research activities. Despite regulatory and ethical challenges, obtaining BC from patients in ED with varying demographic, socioeconomic, and disease characteristics presents a promising opportunity to expand the availability of ED data. ObjectiveThis study aimed to evaluate the success rate of obtaining BC through different consenting approaches in a tertiary ED and to explore factors influencing consent and dropout rates. MethodsA single-center prospective observational study was conducted in a German tertiary ED from September to December 2022. Every 30th patient was screened for eligibility. Eligible patients were informed via one of three modalities: (1) directly in the ED, (2) during their inpatient stay on the ward, or (3) via telephone after discharge. The primary outcome was the success rate of obtaining BC within 30 days of ED presentation. Secondary outcomes included analyzing potential influences on the success and dropout rates based on patient characteristics, information mode, and the interaction time required for patients to make an informed decision. ResultsOf 11,842 ED visits, 419 patients were screened for BC eligibility, with 151 meeting the inclusion criteria. Of these, 68 (45%) consented to at least 1 BC module, while 24 (15.9%) refused participation. The dropout rate was 39.1% (n=59) and was highest in the telephone-based group (57/109, 52.3%) and lowest in the ED group (1/14, 7.1%). Patients informed face-to-face during their inpatient stay following the ED treatment had the highest consent rate (23/27, 85.2%), while those approached in the ED or by telephone had consent rates of 69.2% (9/13 and 36/52). Logistic regression analysis indicated that longer interaction time significantly improved consent rates (P=.03), while female sex was associated with higher dropout rates (P=.02). Age, triage category, billing details (inpatient treatment), or diagnosis did not significantly influence the primary outcome (all P>.05). ConclusionsObtaining BC in an ED environment is feasible, enabling representative inclusion of ED populations. However, discharge from the ED and female sex negatively affected consent rates to the BC. Face-to-face interaction proved most effective, particularly for inpatients, while telephone-based approaches resulted in higher dropout rates despite comparable consent rates to direct consenting in the ED. The findings underscore the importance of tailored consent strategies and maintaining consenting staff in EDs and on the wards to enhance BC information delivery and consent processes for eligible patients. Trial RegistrationGerman Clinical Trials Register DRKS00028753; https://drks.de/search/de/trial/DRKS0002875