Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus.

The purpose of this article is to investigate the common facilitators and barriers associated with the implementation of hospital-based health technology assessment (HB-HTA) across diverse hospital settings in seven countries. Through a two-round Delphi study, insights were gathered from a panel of 15 HTA specialists from France, Hungary, Italy, Kazakhstan, Poland, Switzerland, and Ukraine. Experts initially conducted a comprehensive review of the HB-HTA implementation in their respective countries, identifying the barriers and facilitators through descriptive analysis. Subsequently, panel experts ranked these identified barriers and facilitators on a seven-point Likert scale. A median agreement score ≥ 6 and interquartile range (IQR) ≤ 1 was accepted as reaching a consensus. Out of the 12 statements categorized as external and internal barriers and facilitators, the expert panel reached consensus on six statements (two barriers and four facilitators). The external barrier, which achieved consensus, was the lack of the formal recognition of the role of HB-HTA in national or regional legislations. The internal barrier reaching consensus was the limited availability of human resources dedicated to HB-HTA. This qualitative study indicates that HB-HTA still has progress to make before being formally accepted and integrated across most countries, although by building on the facilitating factors we identified there may be an opportunity for the implementation of internationally developed strategies to strengthen HB-HTA practices.

The effect of two mineral-vitamin premixes on the blood biochemical parameters, milk yield and composition of Holstein-Friesian cows in Kazakhstan.

The aim of this study was to determine the effect of two mineral-vitamin premixes on the health status (blood biochemical parameters), milk yield and composition of Holstein-Friesian (HF) cows in Kazakhstan. The study was performed on Holstein-Friesian cows kept on the Bek Plus dairy farm in the village of Korzhynkol, Fyodorovsky District, Kostanay Region. Forty primiparous cows, selected from the herd, were divided by the analogue method into two groups: a control group (C) and an experimental group (E) of 20 animals each. The diets fed to group E cows were supplemented with LI-R 18 PRO and PANTO® Mineral R-77 Premium mineral-vitamin premixes. The premixes positively affected cow productivity and blood biochemical parameters, whose values were higher in group E than in group C. Higher levels of glucose, albumins and globulins exerted a beneficial influence on the health status of cows. No cases of lameness or metabolic diseases were recorded in group E. The yields of milk, protein and fat were higher in group E than in group C. Dietary supplementation with two premixes had no significant effect on the chemical composition of milk, including the values of the following parameters: somatic cell count (SCC), dry matter (DM), lactose (Lse), casein (Cin), acidity (Aty), lactic acid (LA), density (Dty), free fatty acids (FFAs), glucose (Gse) and urea (Uea).

Effect of vitamin C fortification on the quality of cow's and goat's yoghurt.

Yoghurt is one of the well-known fermented dairy products that play an important role in the human diet. At present, products made of goat's milk are becoming more popular. This study was conducted to evaluate the effect of physicochemical properties of yoghurt fortified with vitamin C. Six different yoghurts were developed: from goat's and cow's milk without any addition, with L-ascorbic acid and acerola addition. The results showed that the addition of L-ascorbic acid significantly decreased pH. Based on the sensory evaluation, the natural cow's yoghurt has scored higher in the overall rating among yoghurts. The addition of L-ascorbic acid to natural goat's yoghurt positively affected the color, taste, flavor, and consistency. In the case of cow's milk yoghurt, the addition of L-ascorbic acid and acerola deteriorated the taste of the product.

Effect of modified atmosphere packaging and vacuum packaging on quality characteristics of lamb meat.

The aim of the study was to evaluate the effect of vacuum packaging and modified atmosphere packaging (80 % N 2   +  20 % CO 2 ) on the microbial and physicochemical parameters of lamb meat and the sensory properties of cooked meat. Musculus longissimus thoracis et lumborum samples were examined at 10 d intervals (0, 10, 20 and 30 d) during storage at 4  ∘ C. There was no significant effect of the packaging method and storage time used on cooking loss, natural drip loss, lightness, yellowness, and intensity of taste and aroma. An interaction between storage time, packaging method, and mesophilic aerobic bacteria and coliform counts was observed. Storage time significantly affected the number of aerobic psychrotrophic bacteria, redness, pH ( P ≤ 0.001 ), shear force value ( P = 0.006 ), and the desirability of aroma ( P < 0.026 ) and taste ( P < 0.01 ). During the storage time, an increase in red saturation from 11.92 to 13.33 and pH value from 5.69 to 5.80 was recorded. Moreover, the storage method affected sensory properties. Vacuum-packed meat was characterized by higher scores in juiciness, tenderness and taste desirability in comparison to MAP. The obtained results suggest that both packaging methods allow for maintaining high-quality lamb meat during a long period of storage under refrigeration conditions.

Implementation of the 2011 Therapeutic Activity Act: will commercialization improve the financial performance of Polish hospitals?

The Therapeutic Activity Act that came into force on 1 July 2011 was aimed at achieving a large-scale transformation of public hospitals into Commercial Code companies. The change of the legal form, from a public entity to a for-profit company, was expected to improve the poor economic efficiency of the public hospital sector. However, the mere change of the legal form does not guarantee a better financial performance of hospitals and thus the success of the Act. In many cases, deep internal changes are needed to achieve improvements in the financial performance of particular hospitals. In addition, a set of other measures at the national and regional levels, such as the mapping of health needs of the population, have to accompany the legal transformations in order to improve the efficiency of the hospital sector. The recent slowdown in the rate of the transformations is another factor that renders the success of the Act uncertain.

Disruption of ionic interactions between the nucleotide binding domain 1 (NBD1) and middle (M) domain in Hsp100 disaggregase unleashes toxic hyperactivity and partial independence from Hsp70.

Hsp100 chaperones cooperate with the Hsp70 chaperone system to disaggregate and reactivate heat-denatured aggregated proteins to promote cell survival after heat stress. The homology models of Hsp100 disaggregases suggest the presence of a conserved network of ionic interactions between the first nucleotide binding domain (NBD1) and the coiled-coil middle subdomain, the signature domain of disaggregating chaperones. Mutations intended to disrupt the putative ionic interactions in yeast Hsp104 and bacterial ClpB disaggregases resulted in remarkable changes of their biochemical properties. These included an increase in ATPase activity, a significant increase in the rate of in vitro substrate renaturation, and partial independence from the Hsp70 chaperone in disaggregation. Paradoxically, the increased activities resulted in serious growth impediments in yeast and bacterial cells instead of improvement of their thermotolerance. Our results suggest that this toxic activity is due to the ability of the mutated disaggregases to unfold independently from Hsp70, native folded proteins. Complementary changes that restore particular salt bridges within the suggested network suppressed the toxic effects. We propose a novel structural aspect of Hsp100 chaperones crucial for specificity and efficiency of the disaggregation reaction.

[Occupational health service management--the concept and application of lean management]. / Zarzadzanie podmiotami sluzby medycyny pracy--koncepcja i zastosowanie lean management.

One of the most effective management systems is the so-called lean management (LM) aimed at loss minimization of institutions' activities while maximizing value and satisfaction to the clients. The system implementation comprises not only typical business areas but also health care sectors. The aim of the article is to present the concept and opportunity of improving the management of occupational health units. Due to its multi-profile nature of tasks and diverse relations with the environment occupational health could be a good institutional example of LM implementation. Operational perspective consists of five guidelines: describing values expected by final clients, setting value flow eliminating needless elements, creating the integrated, coherent and smooth sequence of valuable activities, offering the values to clients, and aiming at continuing improvement. LM could be implemented in occupational health units in the following areas: timing and tasks coordination, leaning some tasks and expanding others in order to maximize clients' value, cost rationalizing, improving the quality of services by eliminating mistakes, avoiding repetition of activities.

Poland health system review.

Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures, particularly in areas such as pharmaceuticals, are highly regressive. The health status of the Polish population has improved substantially, with average life expectancy at birth reaching 80.2 years for women and 71.6 years for men in 2009. However, there is still a vast gap in life expectancy between Poland and the western European Union (EU) countries and between life expectancy overall and the expected number of years without illness or disability. Given its modest financial, human and material health care resources and the corresponding outcomes, the overall financial efficiency of the Polish system is satisfactory. Both allocative and technical efficiency leave room for improvement. Several measures, such as prioritizing primary care and adopting new payment mechanisms such as diagnosis-related groups (DRGs), have been introduced in recent years but need to be expanded to other areas and intensified. Additionally, numerous initiatives to enhance quality control and build the required expertise and evidence base for the system are also in place. These could improve general satisfaction with the system, which is not particularly high. Limited resources, a general aversion to cost-sharing stemming from a long experience with broad public coverage and shortages in health workforce need to be addressed before better outcomes can be achieved by the system. Increased cooperation between various bodies within the health and social care sectors would also contribute in this direction. The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services, and the role of the main actors in health systems; they describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis.

Opportunities for and constraints to integration of health services in Poland.

At the beginning of the article the typologies, expected outcomes and forces aiming at health care integration are discussed. Integration is recognised as a multidimensional concept. The suggested typologies of integration are based on structural configurations, co-ordination mechanisms (including clinical co-ordination), and driving forces. A review of the Polish experience in integration/disintegration of health care systems is the main part of the article. Creation of integrated health care management units (ZOZs) in the beginning of the 1970s serves as an example of structural vertical integration missing co-ordination mechanisms. ZOZs as huge, costly and inflexible organisations became subjects of public criticism and discredited the idea of health care integration. At the end of the 1980s and in the decade of the 1990s, management of public health care was decentralised, the majority of ZOZs dismantled, and many health care public providers got the status of independent entities. The private sector developed rapidly. Sickness funds, which in 1999 replaced the previous state system, introduced "quasi-market" conditions where health providers have to compete for contracts. Some providers developed strategies of vertical and horizontal integration to get a competitive advantage. Consolidation of private ambulatory clinics, the idea of "integrated care" as a "contracting package", development of primary health care and ambulatory specialist clinics in hospitals are the examples of such strategies. The new health policy declared in 2002 has recognised integration as a priority. It stresses the development of payment mechanisms and information base (Register of Health Services--RUM) that promote integration. The Ministry of Health is involved directly in integrated emergency system designing. It seems that after years of disintegration and deregulation the need for effective integration has become obvious.