A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions. (PRISMS Practical systematic RevIew of Self-Management Support for long-term conditions)

Background: Despite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked. Aim: To undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts. Methods: Self-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support. Results: We included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need. Conclusions: Supporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations. Study registration: This study is registered as PROSPERO CRD42012002898. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Upgrading PVC and PP drainage pipes cutting of company Arcont d. d.

Za potrebe izdelave odtočne inštalacije v sanitarnih bivalnih enotah (kontejnerjih) je potrebno rezanje standardnih PVC oziroma PP odtočnih cevi na ustrezne dolžine. Zaradi lažjega vstavljanja odrezanega konca cevi v spojko je potrebno odrezan konec cevi iz zunanje smeri konusno pobrusiti. Zato so v podjetju Arcont d. d. želeli, da se na to delovno mesto vključi nova priprava za odrezovanje cevi, ki bi izboljšala proizvodni proces in varnost. Na osnovi zastavljenih ciljev smo preučili obstoječe stanje in potrebe na področju rezanja PVC in PP cevi. Na podlagi tega smo poiskali napravo, ki zadovoljuje vse potrebe. Priprava izboljša obstoječe stanje, saj omogoča hitro in enostavno odrezovanje ter posnetje cevi različnih premerov. Izpolnjuje kriterije, ki jih zahtevajo navodila z varnosti pri delu.For the needs of making a drainage installation in sanitary living units (containers), it is necessary to cut standard PVC or PP drainage pipes to custom lengths. To make it easier to insert the cut end of the pipe into the coupling, it is necessary to conically grind the cut end of the pipe from the outside. That is why in the company Arcont d. d. wanted a new pipe cutting device, which would improve the production process and safety. Based on the main goals, we examined the existing situation and needs of PVC and PP pipes cutting. Based on this, we managed to find a device that meets all wanted specifications. The device improves the existing condition, as it enables quick and easy pipe cutting and chamfering for pipes of various diameters. It also meets the criteria required by occupational safety instructions

HORIZONTAL APPROACH TO CONSUMER PROTECTION REGULATION IN THE EUROPEAN UNION

Varstvo potrošnikov v Evropski uniji je področje, ki je v zadnjih nekaj letih predmet številnih razprav. Vedno bolj postaja jasno, da je potrošniški notranji trg še vedno v veliki meri neizkoriščen. Razlogi, zakaj je temu tako, so številni in različni. Med poglavitnimi pa so vsekakor različna nacionalna pravila za varstvo potrošnikov, ki so jih proizvajalci in ponudniki storitev dolžni upoštevati. K odpravi tega problema bo delno pripomogla v letu 2011 sprejeta Direktiva 2011/83/EU o pravicah potrošnikov (direktiva) in tako omogočila lažje delovanje potrošniškega notranjega trga. V diplomski nalogi obravnavam nov, horizontalni pristop k urejanju varstva potrošnikov v EU. Po dosedanji ureditvi je bila posamezna oziroma specifična problematika s tega področja urejena v ločeni direktivi. Začetek pregleda potrošniškega pravnega reda, v letu 2004, se je pričel obetavno, saj je vključeval kar osem direktiv, kar je nakazovalo na celovito ureditev tega področja. Predlog Direktive o pravicah potrošnikov pa je pokazal, da bo nova direktiva zajela le štiri direktive in da obseg urejanja ne bo tako celovit, kot je bilo sprva predvideno. Prav tako se z novo direktivo spreminja tudi pristop k harmonizaciji tega področja. Gre za prehod s t.i. minimalne harmonizacije, v okviru katere lahko države članice vprašanja, ki jih ureja direktiva, uredijo tudi strožje, k maksimalni harmonizaciji, kjer odmiki niso dovoljeni. Minimalna harmonizacija je povzročila razdrobljenost notranjega trga na 27 različnih ureditev, kar povzroča težave tako potrošnikom, kot tudi proizvajalcem in prodajalcem. Z maksimalno harmonizacijo naj bi bila ta razdrobljenost odpravljena.Consumer protection in the EU is an area which has been a subject of many discussions in recent years. It is becoming increasingly clear that the consumer internal market is still largely untapped. The reasons for that are many and varied. One of the main reasons is definitely a set of different national consumer protection rules which manufacturers and service providers are obliged (required) to comply. Directive 2011/83/EU on consumer rights adopted in 2011 will partly help to remedy this problem and thus allow easier operation of the internal consumer market. The thesis deals with new, horizontal approach to the regulation of consumer protection in the EU. According to the current regime the individual or specific problems in this area were regulated in separate directive. Initiation of a review of the consumer acquis in 2004 started promisingly, as it comprised eight directives, which indicated an overall regulation of this area. Proposal for a directive on consumer rights has shown that the new directive will encompass only four directives and that the range of regulations will not be as comprehensive as it was initially intended. Also, the new directive amends the approach of harmonization in this area. It is a transition from the so-called minimum harmonization, under which Member States may regulate the issues covered by the Directive more strictly, to the maximum harmonization where derogations are not allowed. Minimum harmonization has resulted in fragmentation of the internal market into 27 different regulations, which causes problems for consumers on the one hand, as well as producers and sellers on the other hand. With the maximum harmonization the fragmentation would be eliminated