scholarly journals Inequality of access to advanced therapies for patients with inflammatory arthritis: a postcode lottery?

2021 ◽  
Author(s):  
Arvind Kaul ◽  
Jatin Mistry ◽  
Annamaria Iagnocco ◽  
Xenofon Baraliakos ◽  
Ailsa Bosworth ◽  
...  
Keyword(s):  
Freedom Of Information ◽  
Equitable Access ◽  
England And Wales ◽  
Resistant Disease ◽  
Marked Variability ◽  
Advanced Therapies ◽  
Nice Guidance ◽  
Individual Hospital ◽  
The Way

Abstract Objectives Advanced therapies (AT) including biologics, biosimilars and JAK inhibitors have dramatically improved the quality of life of patients with Rheumatoid arthritis (RA), Psoriatic Arthritis (PsA) and Axial spondyloarthritis (axSpA). Evidence-based criteria for prescribing these drugs in England and Wales is formulated by the National Institute for Health and Care Excellence (NICE) through Health Technology Appraisals (HTAs) and guidelines with the aim of providing equitable access to AT for patients with severe or resistant disease. Similar bodies exist in some, but not all European countries with disparities in AT access between countries in AT access for RA. We examined whether this disparity was mirrored in England for RA, PsA and axSpA despite the NHS in England and Wales being legally obliged to provide funding for AT recommended by NICE’s HTA board, through commissioning bodies, Clinical Commissioning Groups (CCGs). Methods We requested AT pathways from CCGs in England. Where these were not available, individual hospital Trusts were contacted using Freedom of Information (FOI) requests. Results We found marked variability in the way that CCGs in England interpret NICE guidance. We found 41, 29 and 25 different pathways for RA, PsA and axSpA respectively. Similar disparities existed with sequential prescribing where one AT did not work, with limits on numbers of sequential AT in 54%, 59% and 59% of CCGs for RA, PsA and axSpA respectively, with these limits being different for the same condition between CCGs. Conclusion While patients at identical stages of their disease course should have access to the same NICE approved AT, we found this is not the case for large parts of England. Inequality of access was found between regions mirroring the variability which occurs between countries throughout Europe. Harmonisation of access needs to be addressed by policymakers, ensuring fairness in the way that clinicians and patients can access AT.

Strategic threats to energy security as risks of quality of people's life

2020 ◽  
Vol 16 (4) ◽  
pp. 730-744
Author(s):  
V.I. Loktionov
Keyword(s):  
Quality Of Life ◽  
Energy Security ◽  
Well Being ◽  
Scientific Methods ◽  
Analysis And Synthesis ◽  
General Scientific ◽  
And Performance ◽  
Economic Well Being ◽  
The Way

Subject. The article reviews the way strategic threats to energy security influence the quality of people's life. Objectives. The study unfolds the theory of analyzing strategic threats to energy security by covering the matter of quality of people's life. Methods. To analyze the way strategic threats to energy security spread across cross-sectoral commodity and production chains and influences quality of people's living, I applied the factor analysis and general scientific methods of analysis and synthesis. Results. I suggest interpreting strategic threats to energy security as risks of people's quality of life due to a reduction in the volume of energy supply. I identified mechanisms reflecting how the fuel and energy complex and its development influence the quality of people's life. The article sets out the method to assess such quality-of-life risks arising from strategic threats to energy security. Conclusions and Relevance. In the current geopolitical situation, strategic threats to energy security cause long-standing adverse consequences for the quality of people's life. If strategic threats to energy security are further construed as risk of quality of people's life, this will facilitate the preparation and performance of a more effective governmental policy on energy, which will subsequently raise the economic well-being of people.

The way to improve the quality of the application of lime fertilizers

2020 ◽  
Vol 1 (1) ◽  
pp. 88-91
Author(s):  
A.N. Sedashkin ◽  
◽  
A.A. Kostrigin ◽  
E.A. Milyushina ◽  
◽  
...  
Keyword(s):  
The Way

Analysis and Interpretation of Test Beam Data

2018 ◽  
Author(s):  
Richard Wigmans
Keyword(s):  
Energy Resolution ◽  
Particle Physics ◽  
Particle Beam ◽  
Test Beam ◽  
Term Energy ◽  
The Many ◽  
Physics Experiment ◽  
The Way

This chapter describes some of the many pitfalls that may be encountered when developing the calorimeter system for a particle physics experiment. Several of the examples chosen for this chapter are based on the author’s own experience. Typically, the performance of a new calorimeter is tested in a particle beam provided by an accelerator. The potential pitfalls encountered in correctly assessing this performance both concern the analysis and the interpretation of the data collected in such tests. The analysis should be carried out with unbiased event samples. Several consequences of violating this principle are illustrated with practical examples. For the interpretation of the results, it is very important to realize that the conditions in a testbeam are fundamentally different than in practice. This has consequences for the meaning of the term “energy resolution”. It is shown that the way in which the results of beam tests are quoted may create a misleading impression of the quality of the tested instrument.

scholarly journals Evolution of university governance in Morocco: Which impacts?

2020 ◽  
Vol 9 (5) ◽  
pp. 94
Author(s):  
Khalid Ayad ◽  
Khaoula Dobli Bennani ◽  
Mostafa Elhachloufi
Keyword(s):  
Higher Education ◽  
Economic Development ◽  
Empirical Studies ◽  
University Governance ◽  
General Review ◽  
Theoretical Literature ◽  
Quality Of Higher Education ◽  
The Subject ◽  
The Way

The concept of governance has become ubiquitous since it is recognized as an important tool for improving quality in all aspects of higher education.In Morocco, few scientific articles have dealt with the subject of university governance. Therefore, we will present a general review of the evolution of governance through laws and reforms established by Moroccan Governments from 1975 to 2019. The purpose of the study is to detect the extent of the presence of university governance principles in these reforms.This study enriches the theoretical literature on the crisis of Moroccan university and opens the way to new empirical studies to better understand the perception of university governance concept in the Moroccan context and to improve the quality of higher education and subsequently the economic development of the country.The findings of this study show an increasing evolution of the presence of university governance principles in reforms and higher education laws.

scholarly journals P092 NICE biologics pathways for inflammatory arthritis exhibit regional variability due to modification by CCG’s: results from a national survey of pathways in England

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jatin Mistry ◽  
Diane Hill ◽  
Ailsa Bosworth ◽  
Arvind Kaul
Keyword(s):  
Inflammatory Arthritis ◽  
Good Practice ◽  
National Study ◽  
Freedom Of Information ◽  
Inadequate Response ◽  
Limited Sample ◽  
Regional Variability ◽  
Nice Guidance ◽  
Information Requests ◽  
Individual Funding

Abstract Background/Aims  NICE publishes guidance underpinned by act of Parliament and legally enforceable, on the use of biological therapies in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) which should allow harmonisation of access independent of region. However, sufficient guidance is not provided on the use of sequential biologics nor is a numerical cap placed on the number of biologics a patient can attempt if they have had an inadequate response. We have previously reported that in a limited sample, Clinical Commissioning Groups (CCGs) interpret NICE guidance variably and restrict access to NICE approved treatments depending on geography, the so-called “postcode lottery”. We determined the variability of biologics pathways in all CCG’s in England to examine whether a potentially unfair postcode lottery exists for sequential biologics use. Methods  All 135 England CCGs covering over 55 million people, were sent Freedom of Information requests, for their biologic pathways for RA, PsA and AS. Where CCGs did not have this information, the relevant acute trusts were contacted, with responses recorded under that CCG. For every CCG the local biologics pathways were examined for detail on the number and type of biologics commissioned before an Individual Funding Request was needed. “No Cap” was recorded if CCG’s responded with no restriction on the number of biologics. Results  Responses were obtained from 124/135 CCG’s for RA, 122/135 for PsA and AS, all covering an estimated population in excess of 45 million people. For RA, 55% CCG’s had no cap on the number of commissioned RA biologics. 45% had a variable cap from 3 to 6 commissioned biologics. For PsA, the figures were 54% with no cap and 46% with variable capping between 2-5 biologics allowed, for AS the figures were 51% and 49% respectively. In total this represented 41 different local pathways for RA, 29 different pathways for PsA and in AS where fewer biologics choices exist, 25 different pathways depending on CCG and location. Conclusion  There is wide regional variation in the interpretation of NICE guidance by CCG’s resulting in many different local pathways depending on geography. Approximately 50% of pathways restricted biologics prescribing by mandating the type and sequence of biologics used, potentially compromising patient care and delaying treatment by requiring an IFR for a NICE approved biologic. Moreover, pathways varied as to which biologics could be used at any point of management by region as well. As exemplars of good practice, approximately 50% of CCG’s had no cap, allowing clinical freedom to prescribe the most appropriate biologic. The results of this national study demonstrate the variability of biologics pathways in many areas of England ensuring a postcode lottery still exists in many regions. Disclosure  J. Mistry: None. D. Hill: None. A. Bosworth: None. A. Kaul: None.

scholarly journals The Relational Fit in Organizational Interventions—What Can Organizational Research Learn from Research in Psychotherapy?

2021 ◽  
Vol 18 (15) ◽  
pp. 8104
Author(s):  
Malene Friis Andersen ◽  
Karina Nielsen ◽  
Jeppe Zielinski Nguyen Ajslev
Keyword(s):  
Well Being ◽  
Positive Outcomes ◽  
Organizational Research ◽  
Organizational Interventions ◽  
Therapist Factors ◽  
Positive Results ◽  
The Way

There is a growing interest in organizational interventions (OI) aiming to increase employees’ well-being. An OI involves changes in the way work is designed, organized, and managed. Studies have shown that an OI’s positive results are increased if there is a good fit between context and intervention and between participant and intervention. In this article, we propose that a third fit—the Relational Fit (R-Fit)—also plays an important role in determining an intervention’s outcome. The R-Fit consists of factors related to 1) the employees participating in the OI, 2) the intervention facilitator, and 3) the quality of the relation between participants and the intervention facilitator. The concept of the R-Fit is inspired by research in psychotherapy documenting that participant factors, therapist factors, and the quality of the relations explain 40% of the effect of an intervention. We call attention to the importance of systematically evaluating and improving the R-Fit in OIs. This is important to enhance the positive outcomes in OIs and thereby increase both the well-being and productivity of employees. We introduce concrete measures that can be used to study and evaluate the R-Fit. This article is the first to combine knowledge from research in psychotherapy with research on OIs.

scholarly journals Strategies for the management of pulmonary arterial hypertension in patients with congenital heart disease

2020 ◽  
Vol 4 (S1) ◽  
Author(s):  
Nathalie Liew ◽  
Zoya Rashid ◽  
Robert Tulloh
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Standard Management ◽  
Advanced Therapies ◽  
Pulmonary Arterial ◽  
The Uk

Abstract Background Pulmonary hypertension (PH) is commonly seen in adults who have congenital heart disease (CHD). Therapy is available for pulmonary arterial hypertension (PAH) and has greatly benefitted many patients with PAH related to CHD (PAH-CHD) over the last 15 years, with evidence of improved quality of life and prognosis in those with Eisenmenger syndrome and repaired PAH-CHD. In this review, we describe the standard management and advanced therapies for PAH, which are available in specialist PH centres around the UK and Ireland, and how these are used in PAH-CHD. Decisions around the choice of therapy are governed by commissioning and available evidence. Conclusion We explain the different pathways for action and the variety of medications now at our disposal to help this important group of patients.

scholarly journals Failure Modes in Electricity and Telecommunication Facilities in Dwellings in Spain

2021 ◽  
Vol 11 (11) ◽  
pp. 5274
Author(s):  
Manuel J. Carretero-Ayuso ◽  
Gonzalo Sánchez-Barroso ◽  
Jaime González-Domínguez ◽  
Justo García-Sanz-Calcedo
Keyword(s):  
Failure Modes ◽  
Functional Deterioration ◽  
The Way

The value of a house depends not only on the quality of the construction elements but also on the functionality of its installations. Making mistakes during the design and even execution phases of installations in newly built homes is common. This paper determines, catalogues, and quantifies faults in electrical and telecommunications installations in dwellings based on owners’ complaints and using the ‘learning from faults’ philosophy. To this end, 154 complaints concerning these installations in all of Spain were analyzed and protocolized. The results show that, in all types of dwellings, the most common fault was ‘alterations and malfunctions’ (81%), followed by ‘incorrect or lack of placement of elements’ (14%). The pathological origin with the greatest presence in the research was ‘shortcomings and omissions in the installation’ (40%) and ‘anomalies in the installation’ (36%). Moreover, all functional deterioration processes as well as the type of dwelling where each of these parameters occurred most were defined and quantified (association between each fault and its cause). Finally, the ‘probability factor’ (PF) was determined, which numerically quantifies the probable existence of complaints according to four ranges. The results will pave the way for more precise inspections during the construction phase.

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