Report on the call for feedback about the scope of the European Quality Assurance scheme for Breast Cancer

In 2015 the European Commission Initiative for Breast Cancer (ECIBC) started the development of a voluntary Quality Assurance Scheme for Breast Cancer Services (the European QA scheme) under the Directorate-General Joint Research Centre (JRC) technical and scientific coordination. To support the JRC in this task, a Quality Assurance Scheme Development Group (QASDG), consisting of independent experts, was established. The European QA scheme's scope (The Scope) represented the first output of the development process of the European QA scheme. Via a public call for feedback, stakeholders and individual citizens were invited to provide their feedback on The Scope. The call was open from 17 February to 9 March 2016 and an on-line questionnaire via the EU Survey platform on the ECIBC website was made available. The JRC received a total of 63 valid responses, from 15 individuals (24% of total valid responses) and 48 organisations (76%). Considering individuals and organisations together, 23 out of 28 EU Member States (82%) contributed to this exercise. During a meeting held in Varese (Italy) in March 2016, the QASDG discussed how the results of the call for feedback should be reflected in The Scope. Decisions taken during that meeting were recorded in the meeting minutes and The Scope was modified accordingly. The Scope was finally approved by the QASDG on 16 May 2016 and made available for the public together with this report.JRC.F.1-Health in Societ

Integrated care in German mental health services as benefit for relatives – a qualitative study

Background: As mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives’ experiences with severely mentally ill patients in different integrated care service providers. Methods: Semi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. Results: Four main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges. Conclusion: Relatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community

European Commission Initiative on Breast Cancer (ECIBC): Plenary 2016

The European Commission Initiative on Breast Cancer (ECIBC) Plenaries are an opportunity to inform representatives from the 28 EU Member States and 7 other countries participating in the ECIBC, as well as patients and other stakeholders, policymakers, and the scientific and health policy communities, about the aims, activities and achievements of the ECIBC. They also provide a platform for the exchange of ideas, feedback and input into the ECIBC. The 2016 ECIBC Plenary, entitled “When science and policy collaborate for health”, took place on 24-25 November in Varese, Italy. Its main focus was the implementation of both the voluntary European Quality Assurance scheme for Breast Cancer Services (European QA scheme) and the European guidelines for breast cancer screening and diagnosis (European Breast Guidelines). In this context, the first concrete results were presented, with the launch of the first four European Breast Guidelines recommendations on screening. The first day of the Plenary was dedicated to the JRC informing the audience about the various tools that ECIBC is developing. The second day instead, gave the floor to the audience, who informed the JRC of their views in terms of the challenges and opportunities related to implementing the ECIBC in the respective European countries. The event opened with welcome speeches from the European Commission’s Joint Research Centre (JRC), a moving presentation from a breast cancer survivor and reflections on how to ensure science makes its way into policy. The JRC and ECIBC working group members then brought the audience up to date with progress on the European QA scheme, the European Breast Guidelines, as well as the Guidelines Platform, the template for training on digital mammography, as well as about how ECIBC plans to monitor its impact. Participants also received in-depth explanations of the accreditation framework selected for the European QA scheme, as well as two countries’ experiences of using the ISO 15189 standard for accreditation, which is foreseen for the European QA scheme. The second day saw a focus on the individual countries represented at the Plenary. Presentations assessed how the European QA scheme could potentially fit into three different health systems (Scotland, the Netherlands, Romania), while a special breakout session gave national representatives from the 27 countries present (out of the 35 countries participating in the ECIBC) the chance to discuss implementation of the European Breast Guidelines and the European QA scheme themselves. The results, collected through questionnaires, fed into a roundtable debate on what needs to be done at European and national level to ensure ECIBC implementation. The meeting was closed by Member of the European Parliament and President of MEPs Against Cancer (MACs), Alojz Peterle. An evaluation of the event revealed that the third ECIBC Plenary met its aims to inform stakeholders: all responding participants felt that the event succeeded in providing a comprehensive overview of how the ECIBC is progressing, and what the challenges are. Discussions also provided the JRC with valuable information and feedback. The fourth ECIBC Plenary will take place once the results from piloting the European QA scheme are available.JRC.F.1 - Health in Societ

The ECIBC Guidelines Platform for all breast care processes - With specific reference on sustainability and stakeholder involvement

Breast cancer is the most frequent cancer in Europe and accounts for 16.3% of female cancer deaths in Europe, being thus a major health problem. Improvements in the quality of care, in particular increasing the adherence to evidence-based guidelines/recommendations, are therefore welcome. Within the European Commission's Initiative on Breast Cancer (ECIBC), guidelines addressing breast cancer screening and diagnosis, henceforth mentioned as the European Breast Guidelines, are being developed by the Guidelines Development Group (GDG) under the coordination of the JRC Healthcare Quality Team. However, in order to cover all care processes, the guidelines developed by the GDG need to be complemented by the ECIBC Guidelines Platform (later referred to as the Guidelines Platform or platform) that will contain guidelines and recommendations for all breast care processes with main focus on those on treatment, rehabilitation, follow-up and palliative care. For the Guidelines Platform, breast cancer guidelines produced by different entities and stakeholder organisations, such as professional societies, have been searched from all publicly available sources. To be as inclusive as possible, also a public call for guidelines was organised. The identified evidence-based guidelines and those submitted by different stakeholder organizations (altogether more than 250 guidelines) are to be evaluated for their quality, clinical impact, geographical coverage and sustainability. Only those trustworthy guidelines fulfilling the carefully defined eligibility criteria will be included in the Guidelines Platform to be hosted in the ECIBC website. These guidelines - in addition to the European Breast Guidelines - will also become reference documents for the voluntary European quality assurance scheme for breast cancer services, henceforth mentioned as European QA scheme. Besides supporting the European QA scheme, the Guidelines Platform can be foreseen as a valuable resource of guidelines for professionals, policy makers, researchers, guidelines developers, as well as for citizens and patients. The ultimate impact of the Guidelines Platform would be to reduce unnecessary variability in healthcare services and hence contribute to improve the outcomes of breast cancer patients in terms of morbidity, mortality, and quality of life.JRC.F.1-Health in Societ

European Guidelines for Breast Cancer Screening and Diagnosis - the European Breast Guidelines

Policy context The Written Declaration of the European Parliament on the fight against breast cancer in the European Union (0017-2015) states that in order to reduce the breast cancer mortality rate, it is important to implement nationwide mammography screening programmes and provide comprehensive breast cancer care, as called for in the European Parliament resolutions of 2003 and 2006 and foreseen to be facilitated by the development of the European guidelines for breast cancer screening and diagnosis (European Breast Guidelines) and the European quality assurance scheme for breast cancer services (European QA Scheme). This report intends to inform stakeholders, policy makers in particular, about the methods used and outcomes delivered in the European Breast Guidelines within the European Commission Initiative on Breast Cancer (ECIBC). As a result of a complex process, involving a wide range of experts and patients, evidence-based recommendations on screening and diagnosis are being formulated to support the countries in defining relevant policies and strategies. Key conclusions The major impact of the European Breast Guidelines on EU policy is foreseen in the screening area, possible leading to updating needs for the Council Recommendations of 2003 on cancer screening. Screening is a population based intervention and, for instance, screening recommendations concerning the different age-ranges of women to be invited/covered by screening and/or the different techniques to be used may have a great impact on health policies across the EU, and beyond. The recommendations related to diagnosis, where costly investments may or may not be required will be of interest to policy makers, as well. In addition, the development of European Breast Guidelines will also contribute to several EU initiatives, summarised in the following figure.JRC.F.1 - Health in Societ

Report on the call for feedback about The Scope of the European guidelines for breast cancer screening and diagnosis: European Commission Initiative on Breast Cancer

In 2015, the European Commission Initiative on Breast Cancer (ECIBC) started the development of the European guidelines for breast cancer screening and diagnosis (henceforth the European Breast Guidelines) under the auspices of the Directorate-General for Health and Food Safety (DG SANTE) and the technical and scientific coordination of the Directorate-General Joint Research Centre (JRC). To support the JRC in this task, a Guidelines Development Group (GDG), consisting of independent experts and individuals, was established. The European Breast Guidelines’ scope (The Scope) represented the first output of the development process of the European Breast Guidelines. Via a public call for feedback, stakeholders and individual citizens were invited to provide their feedback on The Scope. The call for feedback was open from 18 December 2015 to 17 January 2016 and an online questionnaire was made available on the ECIBC web hub via the EU Survey platform. The JRC received a total of 82 valid responses, from 40 individuals from 18 different countries and from 42 organisations from 20 different countries. During a meeting held in Varese (Italy) in March 2016, the GDG discussed the new version of The Scope which was prepared taking into account the results of the call for feedback. The Scope was finalised and approved by the GDG after some minor editing on 6 September 2016 and was later made publicly available together with this report.JRC.F.1-Health in Societ

What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework

Responsiveness is a key objective of national health systems. Responsive health systems anticipate and adapt to existing and future health needs, thus contributing to better health outcomes. Of all the health systems objectives, responsiveness is the least studied, which perhaps reflects lack of comprehensive frameworks that go beyond the normative characteristics of responsive services. This paper contributes to a growing, yet limited, knowledge on this topic. Herewith, we review the current frameworks for understanding health systems responsiveness and drawing on these, as well as key frameworks from the wider public services literature, propose a comprehensive conceptual framework for health systems responsiveness. This paper should be of interest to different stakeholders who are engaged in analysing and improving health systems responsiveness. Our review shows that existing knowledge on health systems responsiveness can be extended along the three areas. First, responsiveness entails an actual experience of people’s interaction with their health system, which confirms or disconfirms their initial expectations of the system. Second, the experience of interaction is shaped by both the people and the health systems sides of this interaction. Third, different influences shape people’s interaction with their health system, ultimately affecting their resultant experiences. Therefore, recognition of both people and health systems sides of interaction and their key determinants would enhance the conceptualisations of responsiveness. Our proposed framework builds on, and advances, the core frameworks in the health systems literature. It positions the experience of interaction between people and health system as the centrepiece and recognises the determinants of responsiveness experience both from the health systems (eg, actors, processes) and the people (eg, initial expectations) sides. While we hope to trigger further thinking on the conceptualisation of health system responsiveness, the proposed framework can guide assessments of, and interventions to strengthen, health systems responsiveness

Responding effectively to adult mental health patient feedback in an online environment: A coproduced framework

Background: Responding to online patient feedback is considered integral to patient safety and quality improvement. However, guidance on how to respond effectively is limited, with limited attention paid to patient perceptions and reactions. Objectives: To identify factors considered potentially helpful in enhancing response quality; coproduce a best-practice response framework; and quality-appraise existing responses. Design: A four-stage mixed methodology: (i) systematic search of stories published on Care Opinion about adult mental health services in the South West of England; (ii) collaborative thematic analysis of responses to identify factors potentially helpful in enhancing response quality; (iii) validation of identified factors by a patient-carer group (n = 12) leading to the coproduction of a best-practice response framework; and (iv) quality appraisal of existing responses. Results: A total of 245 stories were identified, with 183 (74.7%) receiving a response. Twenty-four (9.8%) had been heard but not yet responded to. 1.6% (n = 4/245) may lead to a change. Nineteen factors were considered influential in response quality. These centred around seven subject areas: (i) introductions; (ii) explanations; (iii) speed of response; (iv) thanks and apologies; (v) response content; (vi) signposting; and (vii) response sign-off that were developed into a conceptual framework (the Plymouth, Listen, Learn and Respond framework). Quality appraisal of existing responses highlighted areas for further improvement demonstrating the framework's utility. Conclusion: This study advances existing understanding by providing previously unavailable guidance. It has clear practical and theoretical implications for those looking to improve health-care services, patient safety and quality of care. Further validation of the conceptual framework is encouraged.Full Tex

Numerical Simulation of a Passive Control of the Flow Around an Aerofoil Using a Flexible, Self Adaptive Flaplet

© 2018 The Author(s) Self-activated feathers are used by almost all birds to adapt their wing characteristics to delay stall or to moderate its adverse effects (e.g., during landing or sudden increase in angle of attack due to gusts). Some of the feathers are believed to pop up as a consequence of flow separation and to interact with the flow and produce beneficial modifications of the unsteady vorticity field. The use of self adaptive flaplets in aircrafts, inspired by birds feathers, requires the understanding of the physical mechanisms leading to the mentioned aerodynamic benefits and the determination of the characteristics of optimal flaps including their size, positioning and ideal fabrication material. In this framework, this numerical study is divided in two parts. Firstly, in a simplified scenario, we determine the main characteristics that render a flap mounted on an aerofoil at high angle of attack able to deliver increased lift and improved aerodynamic efficiency, by varying its length, position and its natural frequency. Later on, a detailed direct numerical simulation analysis is used to understand the origin of the aerodynamic benefits introduced by the flaplet movement induced by the interaction with the flow field. The parametric study that has been carried out, reveals that an optimal flap can deliver a mean lift increase of about 20% on a NACA0020 aerofoil at an incidence of 20 o degrees. The results obtained from the direct numerical simulation of the flow field around the aerofoil equipped with the optimal flap at a chord Reynolds number of 2 × 10 4 shows that the flaplet movement is mainly induced by a cyclic passage of a large recirculation bubble on the aerofoil suction side. In turns, when the flap is pushed downward, the induced plane jet displaces the trailing edge vortices further downstream, away from the wing, moderating the downforce generated by those vortices and regularising the shedding cycle that appears to be much more organised when the optimal flaplet configuration is selected