Early and unrestricted access to high-efficacy disease-modifying therapies: a consensus to optimize benefits for people living with multiple sclerosis

Early intervention with high-efficacy disease-modifying therapy (HE DMT) may be the best strategy to delay irreversible neurological damage and progression of multiple sclerosis (MS). In European healthcare systems, however, patient access to HE DMTs in MS is often restricted to later stages of the disease due to restrictions in reimbursement despite broader regulatory labels. Although not every patient should be treated with HE DMTs at the initial stages of the disease, early and unrestricted access to HE DMTs with a positive benefit–risk profile and a reasonable value proposition will provide the freedom of choice for an appropriate treatment based on a shared decision between expert physicians and patients. This will further optimize outcomes and facilitate efficient resource allocation and sustainability in healthcare systems and society.

KPC-39-mediated resistance to Ceftazidime-Avibactam in a Klebsiella pneumoniae ST307 clinical isolate

Resistance to ceftazidime–avibactam (CAZ-AVI) combination is being increasingly reported. Here, we report a CAZ-AVI resistant Klebsiella pneumoniae belonging to the high-risk ST307 clone and producing KPC-39, a single amino-acid variant of KPC-3 (A172T). Cloning experiments, steady state kinetic parameters and molecular dynamics simulations revealed a loss of carbapenemase activity and an increased affinity for ceftazidime. KPC-39 was identified in a patient without prior exposure to CAZ-AVI, suggesting silent dissemination in European healthcare settings.

Clinical Teaching as a Challenge in Transforming the Nursing Profession in Estonia

The changes in European healthcare education, building on the Bologna Process, aimed at the integration of clinical work and teaching and promoted a holistic patient and learner-centred professional paradigm. The article, based on the findings of two qualitative studies (2017–2019), focuses on the transformation of the nursing profession in the context of the Estonian healthcare curriculum reform. Thematic written interviews accompanied by a drawing task were collected from clinical nurse teachers and graduating students. The data was analysed using hermeneutic content and comparative analysis. The findings showed that the students had internalised the patient-centred paradigm and integrated teaching into their clinical work, but their learning was hampered by the institutional atmosphere dominated by clinical values. Among the nurses, only the “ideal clinical teachers” had combined clinical work and teaching in their professional paradigm. The tensions in the clinical internship limit the attainment of the reformed profession.

Health Politics Today

This chapter sets the stage for Health Politics in Europe: A Handbook by explaining the motivation for the HEALTHDOX study upon which it is based, introducing the key themes and concepts, and providing an overview of the historical development and institutions of European healthcare systems, as well as current political conflicts and policy trends. The chapter explains how European health systems have been shaped by several centuries of political development, featuring a series of regime crises and challenges. It takes a closer look at political and policy developments since 1989, which importantly included the privatization of most Eastern European healthcare systems and experiments with new public management in Western Europe, recapping the highlights of the book’s thirty-five country cases. The chapter provides definitions and examples of the main types of healthcare financing in Europe and highlights the variation in the public–private mix and extent of out-of-pocket payment. The main theories for analyzing health politics are presented, including the concept of political veto points, and their significance for health politics.

Impact on percutaneous coronary intervention for acute coronary syndromes during the COVID-19 outbreak in a non-overwhelmed European healthcare system: COVID-19 ACS-PCI experience in Ireland

AimsTo evaluate temporal trends of acute coronary syndromes (ACS) treated via percutaneous coronary intervention (PCI) throughout the COVID-19 outbreak in a European healthcare system affected but not overwhelmed by COVID-19-related pathology.Methods and resultsWe performed a retrospective multicentre analysis of the rates of PCI for the treatment of ACS within the period 2 months pre and post the first confirmed COVID-19 case in Ireland, as well as comparing PCI for ST-elevation myocardial infarction (STEMI) with the corresponding period in 2019. During the 2020 COVID-19 period (29 February–30 April 2020), there was a 24% decline in PCI for overall ACS (incidence rate ratio (IRR) 0.76; 95% CI 0.65 to 0.88; p<0.001), including a 29% reduction in PCI for non-ST-elevation ACS (IRR 0.71; 95% CI 0.57 to 0.88; p=0.002) and an 18% reduction in PCI for STEMI (IRR 0.82; 95% CI 0.67 to 1.01; p=0.061), as compared with the 2020 pre-COVID-19 period (1 January–28 February 2020). A 22% (IRR 0.78; 95% CI 0.65 to 0.93; p=0.005) reduction of PCI for STEMI was seen as compared with the 2019 reference period.ConclusionThis study demonstrates a significant reduction in PCI procedures for the treatment of ACS since the COVID-19 outbreak in Ireland. The reasons for this decline are still unclear but patients need to be encouraged to seek medical attention when cardiac symptoms appear, in order to avoid incremental cardiac morbidity and mortality due to a reduction in coronary revascularisation for the treatment of ACS.

Publisher Correction: LifeTime and improving European healthcare through cell-based interceptive medicine

A Correction to this paper has been published: https://doi.org/10.1038/s41586-021-03287-8.