410 research outputs found
Public health opportunities to improve palliative care integration across Europe
The ageing of the European population results in a higher risk of suffering from cancer, neurodegenerative and chronic diseases. The integration of palliative
care in to the national healthcare systems, and in to those disciplines dealing with chronic and advanced
diseases, is of the utmost importance to guarantee equal access to appropriate palliative care for citizens in Europe
Recalibrating the âworld mapâ of palliative care development
Background: Despite growing interest from policy makers, researchers and activists, there is still little science to underpin the global development of palliative care. This study presents the methods deployed in the creation of a âworld mapâ of palliative care development. Building on two previous iterations, with improved rigour and taking into account reviewersâ feedback, the aim of the study is to determine the level of palliative care development in 198 countries in 2017, whilst ensuring comparability with previous versions. We present methods of data collection and analysis. Methods and analysis: Primary data on the level of palliative care development in 2017 was collected from in-country experts through an online questionnaire and, where required, supplemented by published documentary sources and grey literature. Population and per capita opioid consumption data were derived from independent sources. Data analysis was conducted according to a new scoring system and algorithm developed by the research team.
Ethics and dissemination: The study was approved by the University of Glasgow College of Social Sciences Research Ethics Committee. Findings of the study will be disseminated in peer-reviewed journals, as a contribution to the second edition of the Global Atlas of Palliative Care at the End-of-Life, and via social media, including the Glasgow End of Life Studies Group blog and the project website.
Limitations of the study: There are potential biases associated with self-reporting by key in-country experts. In some countries, the identified key expert failed to complete the questionnaire in whole or part and data limitations were potentially compounded by language restrictions, as questionnaires were available only in three European languages. The study relied in part on data from independent sources, the accuracy of which could not be verified
The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle
Background: Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). Methods: With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. Results: The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. Conclusions: The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers
Engaging European society at the forefront of cancer research and care
Cancer prevention; Cancer research; PolicyPrevenciĂł del cĂ ncer; Recerca del cĂ ncer; PolĂticaPrevenciĂłn del cĂĄncer; InvestigaciĂłn del cĂĄncer; PolĂticaEuropean cancer research stakeholders met in October 2022 in Heidelberg, Germany, at the 5th Gago conference on European Cancer Policy, to discuss the current cancer research and cancer care policy landscape in Europe. Meeting participants highlighted gaps in the existing European programmes focusing on cancer research, including Europe's Beating Cancer Plan (EBCP), the Mission on Cancer (MoC), Understanding Cancer (UNCAN.eu), and the joint action CRANE, and put forward the next priorities, in the form of the Heidelberg Manifesto for cancer research. This meeting report presents all discussions that shed light on how infrastructures can be effectively shaped for translational, prevention, clinical and outcomes cancer research, with a focus on implementation and sustainability and while engaging patients and the public. In addition, we summarize recommendations on how to introduce frameworks for the digitalization of European cancer research. Finally, we discuss what structures, commitment, and resources are needed to establish a collaborative cancer research environment in Europe to achieve the scale required for innovation.Research discussed by Elena Garralda has been funded by CaixaResearch Advanced Oncology Research Program supported by FundaciĂł La Caixa (LCF/PR/CE07/50610001) and by the European Union under grant agreements no. 965397 (CC-DART) and 101079984 (PCM4EU)
Mapping levels of Palliative Care development in 198 Countries: the situation in 2017
Context
Palliative care is gaining ground globally and is endorsed in high-level policy commitments, but service provision, supporting policies, education, and funding are incommensurate with rapidly growing needs.
Objectives
The objective of this study was to describe current levels of global palliative care development and report on changes since 2006.
Methods
An online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI), and Universal Health Coverage (UHC).
Results
Numbers (percentages) of countries in each development category were as follows: 1) no known palliative care activity, 47 (24%); 2) capacity-building, 13 (7%); 3a) isolated provision, 65 (33%); 3b) generalized provision, 22 (11%); 4a) preliminary integration into mainstream provision, 21 (11%); 4b) advanced integration, 30 (15%). Development levels were significantly associated with WBIL (rS = 0.4785), UHC (rS = 0.5558), and HDI (rS = 0.5426) with P < 0.001. Net improvement between 2006 and 2017 saw 32 fewer countries in Categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b.
Conclusion
Palliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health-related suffering amenable to palliative care interventions is predicted by 2060. With an increasing need, palliative care is not reaching the levels required by at least half of the global population
The Porto European Cancer Research Summit 2021
Ensayos clĂnicos/preventivos; Centros integrales del cĂĄncer; InvestigaciĂłn de resultadosAssaigs clĂnics/preventius; Centres integrals del cĂ ncer; Recerca de resultatsClinical/prevention trials; Comprehensive cancer centres; Outcomes researchKey stakeholders from the cancer research continuum met in May 2021 at the European Cancer Research Summit in Porto to discuss priorities and specific action points required for the successful implementation of the European Cancer Mission and Europe's Beating Cancer Plan (EBCP). Speakers presented a unified view about the need to establish high-quality, networked infrastructures to decrease cancer incidence, increase the cure rate, improve patient's survival and quality of life, and deal with research and care inequalities across the European Union (EU). These infrastructures, featuring Comprehensive Cancer Centres (CCCs) as key components, will integrate care, prevention and research across the entire cancer continuum to support the development of personalized/precision cancer medicine in Europe. The three pillars of the recommended European infrastructures â namely translational research, clinical/prevention trials and outcomes research â were pondered at length. Speakers addressing the future needs of translational research focused on the prospects of multiomics assisted preclinical research, progress in Molecular and Digital Pathology, immunotherapy, liquid biopsy and science data. The clinical/prevention trial session presented the requirements for next-generation, multicentric trials entailing unified strategies for patient stratification, imaging, and biospecimen acquisition and storage. The third session highlighted the need for establishing outcomes research infrastructures to cover primary prevention, early detection, clinical effectiveness of innovations, health-related quality-of-life assessment, survivorship research and health economics. An important outcome of the Summit was the presentation of the Porto Declaration, which called for a collective and committed action throughout Europe to develop the cancer research infrastructures indispensable for fostering innovation and decreasing inequalities within and between member states. Moreover, the Summit guidelines will assist decision making in the context of a unique EU-wide cancer initiative that, if expertly implemented, will decrease the cancer death toll and improve the quality of life of those confronted with cancer, and this is carried out at an affordable cost
Palliative care coverage across European National Health Systems: proposal of a synthetic indicator
Background: The coverage of palliative care (PC) may be understood as a countryâs capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countriesÂŽ coverage capacities. Method: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. Results: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. Conclusion: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs
Development of an atlas of palliative care in the Eastern Mediterranean Region through a stakeholder participative process
Background: The increasing number of people experiencing serious health-related suffering due to severe illness is an urgent issue in the WHO Eastern Mediterranean Region (EMR). Although palliative care can mitigate much of this suffering, its current development and indicators to measure progress remain unknown.
Aims: To describe the development of the Atlas of palliative care in the Eastern Mediterranean Region 2021.
Methods: Recently, the WHO Regional Office for the Eastern Mediterranean, together with a network of palliative care experts, identified the best indicators and collected data across the Region. These indicators include national palliative care strategies, number of specialized palliative care services per population, inclusion of palliative care in the health benefits package and national health budget, and the use of pain medication. These and other useful information form the Atlas of palliative care in the Eastern Mediterranean Region 2021.
Results: The Atlas shows that provision of specialized palliative care services and pain medication in the Region is low. Several of the indicators suitable to the region are new and include the level of public awareness of palliative care, inclusion of palliative care in health insurance plans, availability of centres of excellence for palliative clinical care, and availability of grants to finance palliative care research.
Conclusion: Adoption of favourable policies, educational initiatives, and the involvement of stakeholders, represent an opportunity for future development of palliative care in the EMR
Region-specific macroindicators on palliative care development in the Eastern Mediterranean region: a Delphi study
Background: The World Health Organization Office for the Eastern Mediterranean Region (WHO/EMRO), and the recently created palliative care experts network for the Eastern Mediterranean Region (EMR), decided to develop region-specific indicators for monitoring national palliative care development in the Region.
Aims: To identify relevant and feasible macro-indicators for palliative care development for the EMR.
Methods: Palliative care experts from the EMR were nominated and invited to complete a 2-round Delphi study to rate macro-indicators from previous studies and propose new ones based on the EMR regional characteristics. All indicators were assessed according to regional relevance (R) and feasibility (F). A content validity index (CVI) was calculated. Indicators with CVI â„ 0.7/1, and scoring â„ 7/9 for the R and F averages were selected.
Results: Twelve of the 22 countries in the Region were represented in the study. In the first round, 11 indicators were selected and 13 new ones proposed. In the second round, 15 indicators matched R, F and CVI criteria. Top-scored indicators were: existence of a current national palliative care strategy (R = 8, F = 8, CVI = 1); ratio of specialized services (for adults and children) in the country per population (R = 8, F = 7, CVI = 1); allocation of funds for palliative care in the national health budget by the Ministry of Health or equivalent government agency (R = 8, F = 6, CVI = 1); education for prequalification of doctors/nurses (R = 8, F = 8, CVI = 0.9); and availability of morphine and other strong opioids (R =8, F = 8, CVI= 0.9).
Conclusion: A baseline set of 15 region-specific indicators for measuring the development of palliative care were validated by experts in the EMR
Les dents moustériennes de la grotte Boccard, lieu-dit Bas-de-Morant (commune de Créancey, CÎte-d'Or, Bourgogne)
La grotte Boccard se situe sur le territoire de la commune de CrĂ©ancey en CĂŽte-d'Or. Une stratigraphie assez simple y a Ă©tĂ© dĂ©ïŹ Â nie avec une couche moustĂ©rienne qui a livrĂ© trois dents humaines permanentes : une incisive latĂ©rale supĂ©rieure gauche, une deuxiĂšme prĂ©molaire supĂ©rieure droite et une deuxiĂšme molaire infĂ©rieure droite. Les Ă©tudes morphologique et mĂ©trique, descriptive et comparative de ces vestiges nous permettent de les intĂ©grer dans la variabilitĂ© des dents nĂ©andertaliennes et de les exclure de celle des Homo sapiens sapiens rĂ©cents. Ces dents sont saines, de dimensions moyennes. On ne note aucun trait particulier, si ce n'est pour la molaire infĂ©rieure qui prĂ©senterait, peut-ĂȘtre, une importante calciïŹcation de la pulpe dentaire.The Boccard cave is located in the CrĂ©ancey municipality of the CĂŽte-dâOr. A clear stratigraphy has been defined with a Mousterian layer in which three human permanent teeth were discovered: a lateral upper left incisor, an upper second right premolar and a lower second right molar. The metrical and morphological, descriptive and comparative studies of these remains enable us to integrate them within the variability of Neanderthal teeth and to exclude them from the variability of recent Homo sapiens sapiens. The Boccard cave teeth have no evidence of pathology, their dimensions are average and they present no special characteristics, except perhaps the lower molar, which may present a voluminous calciïŹcation of its pulp
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