How to improve efficiency in cancer care: dimensions, methods, and areas of evaluation

Efficiency in healthcare is crucial since available resources are scarce, and the cost of inefficient allocation is measured in prior outcomes. This is particularly relevant for cancer. The aim of this paper is to gain a comprehensive overview of the areas and dimensions to improve efficiency, and establish the indicators, different methods, perspectives, and areas of evaluation, to provide recommendations for how to improve efficiency and measure gains in cancer care.Methods: We conducted a two-phase design. First, a comprehensive scoping literature review was conducted, searching four databases. Studies published between 2000 and 2021 were included if they described experiences and cases of efficiency in cancer care or methods to evaluate efficiency. The results of the literature review were then discussed during two rounds of online consultation with a panel of 15 external experts invited to provide insight and comments to deliberate policy recommendations.Results: 46 papers met the inclusion criteria. Based on the papers retrieved we identified six areas for achieving efficiency gains throughout the entire care pathway and, for each area of efficiency, we categorized the methods and outcomes used to measure efficiency gain.Conclusion: This is the first attempt to systemize a scattered body of literature on how to improve efficiency in cancer care and identify key areas of improvement. Policy summary: There are many opportunities to improve efficiency in cancer care. We defined seven policy recommendations on how to improve efficiency in cancer care throughout the care pathway and how to improve the measurement of efficiency gains

Probability for Primordial Black Holes Pair in 1/R Gravity

The probability for quantum creation of an inflationary universe with a pair of black holes in 1/R - gravitational theory has been studied. Considering a gravitational action which includes a cosmological constant ($\Lambda$) in addition to $\delta R^{- 1}$ term, the probability has been evaluated in a semiclassical approximation with Hartle-Hawking boundary condition. We obtain instanton solutions determined by the parameters $\delta$ and $\Lambda$ satisfying the constraint $\delta \leq \frac{4 \Lambda^{2}}{3}$. However, we note that two different classes of instanton solutions exists in the region $0 < \delta < \frac{4 \Lambda^{2}}{3}$. The probabilities of creation of such configurations are evaluated. It is found that the probability of creation of a universe with a pair of black holes is strongly suppressed with a positive cosmological constant except in one case when $0 < \delta < \Lambda^{2}$. It is also found that gravitational instanton solution is permitted even with $\Lambda = 0$ but one has to consider $\delta < 0$. However, in the later case a universe with a pair of black holes is less probable.Comment: 15 pages, no figure. submitted to Phys. Rev.

The European Cancer Patient’s Bill of Rights, update and implementation 2016

In this implementation phase of the European Cancer Patient’s Bill of Rights (BoR), we confirm the following three patient-centred principles that underpin this initiative: 1: The right of every European citizen to receive the most accurate information and to be proactively involved in his/her care. 2: The right of every European citizen to optimal and timely access to a diagnosis and to appropriate specialised care, underpinned by research and innovation. 3: The right of every European citizen to receive care in health systems that ensure the best possible cancer prevention, the earliest possible diagnosis of their cancer, improved outcomes, patient rehabilitation, best quality of life and affordable health care. The key aspects of working towards implementing the BoR are: - Agree our high-level goal. The vision of 70% long-term survival for patients with cancer in 2035, promoting cancer prevention and cancer control and the associated progress in ensuring good patient experience and quality of life. - Establish the major mechanisms to underpin its delivery. (1) The systematic and rigorous sharing of best practice between and across European cancer healthcare systems and (2) the active promotion of Research and Innovation focused on improving outcomes; (3) Improving access to new and established cancer care by sharing best practice in the development, approval, procurement and reimbursement of cancer diagnostic tests and treatments. - Work with other organisations to bring into being a Europe based centre that will (1) systematically identify, evaluate and validate and disseminate best practice in cancer management for the different countries and regions and (2) promote Research and Innovation and its translation to maximise its impact to improve outcomes

Methods of evaluation, elements of input and policy support.

Health care reforms have now become a universal process in most of the countries, regardless of the political setting, type of health care system and level of economic development. Often, the approach is purely political with little insight into the more structural and objective data based information. On the other hand, too often too little is done to monitor the process and to perform efficient structured evaluation. Health policy needs triangulation in order to comprehensively approach the process that it intends to steer. Evidence base from different professional fields seems necessary. The workshop aims at offering reflections on the possible methodologies used and discusses other important issues in policy support in health services research. Inputs for evidence-based policy require results from analyses and research together with clearly defined goals and objectives. Only such a combination provides the necessary means to support decisions in all the necessary aspects, which are part of a modern policy-driven process of reform in the important segment such as health care. (aut.ref.