No abstract

Italy has been heavily affected by the COVID‐19 pandemic. National and subnational authorities have introduced several measures to tackle the resulting crisis, including social distancing and restrictions on economic activities. However, as we will show in this contribution, such measures have sometimes resulted in uncertainty concerning the allocation of decision making powers along the central–local government continuum and regarding the exercise of administrative tasks by public authorities, thus producing conflict and variation within the policymaking and policy‐delivery processes in Italy. To show this, we review the relevant events that occurred during the pandemic in the country in light both of the literature on centralization and discretion and of the principles shaping the Italian legal system. Our analysis, based on a dialogue between political science and public law, allows us to read the Italian case as a mix of inadequate institutional coordination and insufficient and unclear central guidelines which ultimately produced uncertainty, which together had a direct impact on policymakers, policy‐deliverers, and citizens in general.

BackgroundOpioids are prescribed frequently and increasingly for the management of chronic non-cancer pain (CNCP). Current systematic reviews have a number of limitations, leaving uncertainty with regard to the benefits and harms associated with opioid therapy for CNCP. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using opioids in the treatment of CNCP and the risk of associated adverse events.Methods and designEligible trials will include those that randomly allocate patients with CNCP to treatment with any opioid or any non-opioid control group. We will use the guidelines published by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes that we collect and present. We will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to evaluate confidence in the evidence on an outcome-by-outcome basis. Teams of reviewers will independently and in duplicate assess trial eligibility, abstract data, and assess risk of bias among eligible trials. To ensure interpretability of our results, we will present risk differences and measures of relative effect for all outcomes reported and these will be based on anchor-based minimally important clinical differences, when available. We will conduct a priori defined subgroup analyses consistent with current best practices.DiscussionOur review will evaluate both the effectiveness and the adverse events associated with opioid use for CNCP, evaluate confidence in the evidence using the GRADE approach, and prioritize patient-important outcomes with a focus on functional gains guided by IMMPACT recommendations. Our results will facilitate evidence-based management of patients with CNCP and identify key areas for future research.Trial registrationOur protocol is registered on PROSPERO (CRD42012003023), http://www.crd.york.ac.uk/PROSPERO.

This article studies how different systems of policy advice are suited to provide relevant knowledge in times of acute crisis. The notion of evidence-based policymaking (EBP) originated in the successful 1997 New Labour program in the United Kingdom to formulate policy based not on ideology but on sound empirical evidence. We provide a brief overview of the history of the concept and the current debates around it. We then outline the main characteristics of the policy advisory systems in Germany, Switzerland, and Italy through which scientific knowledge—in the form of either person-bound expertise or evidence generated through standard scientific processes—was fed into policy formulation processes before the COVID-19 crisis. Whereas EBP takes place in the form of institutionalized advisory bodies and draws on expertise rather than on evidence in Germany, the system in Switzerland focuses more on the use of evidence provided through external mandates. Italy has a hybrid politicized expert system. The article then analyzes how this different prioritization of expertise vs. evidence in the three countries affects policymakers’ capacity to include scientific knowledge in policy decisions in times of acute crisis. The comparison of the three countries implies that countries with policy advisory systems designed to use expertise are better placed to incorporate scientific knowledge into their decisions in times of acute crisis than are countries with policy advisory systems that relied primarily on evidence before the COVID-19 crisis.