Academic literature on the topic 'Medical policy – Europe'
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Journal articles on the topic "Medical policy – Europe"
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van Wymen, F. C. B. "Medical responsibility in Western Europe." Health Policy 6, no. 3 (January 1986): 301–3. http://dx.doi.org/10.1016/0168-8510(86)90041-2.
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FORSBACH, RALF. "Health Policy in Twentieth-Century Europe." Contemporary European History 15, no. 3 (July 19, 2006): 417–21. http://dx.doi.org/10.1017/s0960777306003390.
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Iris Borowy and Wolf D. Gruner eds., Facing Illness in Troubled Times: Health in Europe in the Interwar Years 1918–1939 (Frankfurt am Main: Peter Lang, 2005), 424 pp., €64.00 (hb), ISBN 363119486.Horst H. Freyhofer The Nuremberg Medical Trial: The Holocaust and the Origin of the Nuremberg Medical Code, Studies in Modern European History 53 (New York: Peter Lang, 2005), 209 pp., €30.00 (pb), ISBN 0820467979.Ulrike Lindner Gesundheitspolitik in der Nachkriegszeit. Großbritannien und die Bundesrepublik Deutschland im Vergleich, Veröffentlichungen des Deutschen Historischen Instituts London 57 (Munich: R. Oldenbourg Verlag, 2004), 581 pp., €64.00 (hb), ISBN 3486200143.
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Niederländer, Charlotte, Philip Wahlster, Christine Kriza, and Peter Kolominsky-Rabas. "Registries of implantable medical devices in Europe." Health Policy 113, no. 1-2 (November 2013): 20–37. http://dx.doi.org/10.1016/j.healthpol.2013.08.008.
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Schreyögg, Jonas, Michael Bäumler, and Reinhard Busse. "Balancing adoption and affordability of medical devices in Europe." Health Policy 92, no. 2-3 (October 2009): 218–24. http://dx.doi.org/10.1016/j.healthpol.2009.03.016.
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BURAU, VIOLA, DAVID WILSFORD, and GEORGE FRANCE. "Reforming medical governance in Europe. What is it about institutions?" Health Economics, Policy and Law 4, no. 3 (July 2009): 265–81. http://dx.doi.org/10.1017/s1744133109005003.
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AbstractThis article presents a cross-national analytical framework for understanding current attempts to reform medical governance – in particular, those by third parties to control the practice of medicine. The framework pays particular attention to the ways in which institutions shape policy reform. The article also outlines the main comparative findings of case studies of selected reforms and associated processes of negotiations in Denmark, Germany, Italy and the United Kingdom. These four countries were selected because they are characterised by theoretically interesting variations in the institutional contexts of medical governance. The analysis suggests that although all the four countries have pushed for more control over the way in which doctors practise medicine, in response to similar imperatives, each country differs in the path it has taken. More specifically, the instruments and techniques brought to bear in each case vary considerably and are directed by a country's political institutions towards a unique path.
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Garattini, Livio, Gianluigi Casadei, and Nick Freemantle. "Continuing medical education funding and management in Europe: room for improvement?" Journal of Medical Economics 12, no. 1 (January 2009): 56–59. http://dx.doi.org/10.3111/13696990902836787.
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Gutzwiller, Felix, Richard Chrzanowski, and Fred Paccaud. "Data Bases for the Assessment of Medical Technologies: Examples from Europe." International Journal of Technology Assessment in Health Care 4, no. 1 (January 1988): 65–73. http://dx.doi.org/10.1017/s0266462300003275.
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AbstractThe assessment of medical technologies has to answer several questions ranging from safety and effectiveness to complex economical, social, and health policy issues. The type of data needed to carry out such evaluation depends on the specific questions to be answered, as well as on the stage of development of a technology.Basically two types of data may be distinguished: (a) general demographic, administrative, or financial data which has been collected not specifically for technology assessment; (b) the data collected with respect either to a specific technology or to a disease or medical problem.On the basis of a pilot inquiry in Europe and bibliographic research, the following categories of type (b) data bases have been identified: registries, clinical data bases, banks of factual and bibliographic knowledge, and expert systems. Examples of each category are discussed briefly. The following aims for further research and practical goals are proposed: criteria for the minimal data set required, improvement to the registries and clinical data banks, and development of an international clearinghouse to enhance information diffusion on both existing data bases and available reports on medical technology assessments.
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Watson, Kenneth, and Rob Kottenhagen. "Patients’ Rights, Medical Error and Harmonisation of Compensation Mechanisms in Europe." European Journal of Health Law 25, no. 1 (December 11, 2018): 1–23. http://dx.doi.org/10.1163/15718093-12460348.
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Abstract In 1999 the Institute of Medicine reported that most medical injuries relate to unavoidable human error in a context of system failure. Patient safety improves when healthcare providers facilitate blame-free reporting and organisational learning. This is at odds with fault-based civil liability law, which discourages a more open (doctor-patient) communication on medical injuries. The absence of a clear-cut definition of ‘medical error’ complicates litigation and hence swift, appropriate patient compensation. No-fault systems perform better in this respect. A dual track liability system for medical malpractice is challenging to implement and operate, yet may be the only option for Pan-European harmonisation of medical liability.
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Carrera, Percivil, and Neil Lunt. "A European Perspective on Medical Tourism: The Need for a Knowledge Base." International Journal of Health Services 40, no. 3 (July 2010): 469–84. http://dx.doi.org/10.2190/hs.40.3.e.
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Since the early 1990s, medical tourism, whereby individuals choose to travel across national borders or overseas to receive treatments, has been increasingly recognized in the United States and Asia. This article highlights the emergence of medical tourism in the European context. It examines the drivers for such developments and situates medical tourism within the broader context of health globalization and forms of patient mobility in the European Union. In outlining the developments of medical tourism in Europe, the authors distinguish between two types of medical tourist: the citizen and the consumer. The discussion explores the need for greater empirical research on medical tourism in Europe and argues that such research will contribute toward knowledge of patient mobility and the broader theorization of medical tourism. The authors make suggestions about the content of this research agenda, including understanding the development of medical tourist markets, the nature of choice, equity implications, the role of brokers and intermediaries, and general issues for health management.
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Abbing, Henriette D. C. Roscam. "Patients’ Rights in a Technology and Market Driven-Europe." European Journal of Health Law 17, no. 1 (2010): 11–22. http://dx.doi.org/10.1163/157180909x12604572349566.
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AbstractThis article deals with the impact on patients’ rights of medical and technological advances in a market oriented (European) society: what are the advantages and risks, what are the challenges that lay ahead of us? After introducing the subject matter, the first part deals with risks for patients’ rights in the European cross border context (health care, direct to the public screening offers and biomedical research). The second part sketches some of the implications of innovation in health care and medical technology for patients’ rights to autonomy and private life, particularly when third party interests are involved. The article ends with some suggestions on how best to protect patients’ rights in the perspective of innovation in health care and medical research.
Dissertations / Theses on the topic "Medical policy – Europe"
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Radin, Dagmar. "Too Ill to Find the Cure? - Health Care Sector Success in the New Democracies of Central and Eastern Europe." Thesis, University of North Texas, 2006. https://digital.library.unt.edu/ark:/67531/metadc5348/.
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This study examines the factors that have contributed to the success of some Central and Eastern European countries to improve their health care sector in the post communist period, while leaving others to its demise. While most literature has been focused on the political and economic transition of Eastern Europe, very little research has been done about the welfare aspects of the transition process, especially the health care sector. While the focus on political consequences and main macroeconomic reforms has shed light on many important processes, the lack of research of health care issues has lead to consequences on our ability to understand its impact on the future of the new democracies and their sustainability. This model looks at the impact of international (World Bank) and domestic institutions, corruption and public support and how they affect the ability of some countries to improve and reform their health care sector in the post-transition period.
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Kostera, Thomas. "When Europa meets Bismarck: cross-border healthcare and usages of Europe in the Austrian healthcare system." Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209268.
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In a series of landmark rulings on patient mobility and cross-border healthcare, the European Court of Justice (ECJ) has made clear that Member States’ healthcare systems have to comply with the rules of the EU’s Internal Market when it comes to individual patient rights and the non-discrimination of healthcare providers. The rulings increased the possibilities for EU Member State citizens to get medical treatment in another Member State (“cross-border healthcare”), yet providing that under certain conditions the home Member State has to pay for these treatments in the other country. After a decade of negotiations, these rulings have been codified in a European Directive. Assuming that European integration has an impact on national welfare states and taking the example of European rules on access to cross-border healthcare, this thesis suggests analyzes the domestic impact of European integration in terms of Europeanization of the Austrian healthcare system within the context of the interplay between actors’ interests and practices on the one hand, and institutional effects on the other. European cross-border healthcare in forms of regional projects and privately or publicly organized healthcare arrangements has already become a reality in many European countries, especially in border regions. The main research questions which guides this thesis can be be put as follows: How does European integration in healthcare impact on the interests, practices and strategies of national actors that operate between national institutional constraints and European opportunities? And if national actors’ interests and strategies change, does this in turn have repercussions on the national institutional rules of healthcare governance? Given that European integration in healthcare delivery is a rather a “recent” phenomenon, and based on the assumption that actors’ strategies change more easily than national institutions, the following hypothesis is tested: Even if national healthcare actors use Europe – and hence their practices and strategies change – their interests remain largely determined by the national institutional set-up of the healthcare system. The institutional boundaries of the national healthcare system may have become porous, but for the time being they remain intact. The main findings of this study confirm the hypothesis and can be summarized as follows: Austrian actors responsible for the delivery of healthcare actively integrate various usages Europe into their existing practices of healthcare governance. These usages of Europe are more frequent at European level than at national level. Those actors who have important legal competencies, financial resources, and hence power in healthcare governance at national level, are also in a better position to use Europe effectively than those actors who lack such national resources. Limited usages of Europe at national level by corporate actors can best be accounted for by practices of consensually governing a typically Bismarckian healthcare system. None of the actors analysed, no matter how critical their stance vis-à-vis their own healthcare system might be, puts into question the legitimacy of the national healthcare system in the light of increased European competencies in regulating cross-border healthcare. Advancing European integration, mainly through the ECJ’s rulings on cross-border healthcare, might have rendered national institutional boundaries porous, but national institutions retain – at least for the time being – their power of channelling actors’ interests and of influencing corresponding practices of healthcare governance. These results invite us to further investigate which kind of healthcare governance structures are being developed at European level in parallel to those existing at national level, and to what extent Bismarckian welfare regimes might be showing resistance to institutional change induced by European integration.Doctorat en Sciences politiques et sociales
info:eu-repo/semantics/nonPublished
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Palmedo, P. Christopher. "Equality, Trust and Universalism in Europe, Canada and the United States: Implications for Health Care Policy." PDXScholar, 2014. https://pdxscholar.library.pdx.edu/open_access_etds/1929.
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A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and generalized trust are positively associated with universalism is only partially true. Equality is positively associated (B = .301, p < .001), while generalized trust is negatively associated with universalism (B = -.052, p < .001). Not only do Americans show lower levels of support for income equality and universalism than Europeans, but the effect of being American holds even after controlling for socio-demographic and religious variables (B = .044, p < .01). When the model tests the association of equality and trust on universalism in each region, it explains approximately 17 percent of the variance of universalism for the United States, and approximately 13 percent in Europe and Canada.
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Beckhoven, Ellen van. "Decline and regeneration : policy responses to processes of change in post-WWII urban neighbourhoods /." Utrecht : Koninklijk Nederlands Aardrijkskundig Genootschap : Universiteit Utrecht, Faculteit Geowetenschappen, 2006. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=016413115&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Nickel, Christiane. "Insider und Outsider bei der Osterweiterung der europäischen Währungsunion /." Frankfurt : Lang, 2002. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=009495992&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Iosifides, Petros. "Media concentration policy in the European Union and the public interest." Thesis, University of Westminster, 1996. https://westminsterresearch.westminster.ac.uk/item/948x9/media-concentration-policy-in-the-european-union-and-the-public-interest.
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Stewart, Emma J. "The European Union and conflict prevention : policy evolution and outcome /." Münster : LIT, 2006. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=014648755&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Cheiladaki, Maria. "Supranational institutions, path dependence and EU policy development : the cases of student and patient mobility." Thesis, University of Sussex, 2011. http://sro.sussex.ac.uk/id/eprint/7582/.
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The purpose of the present study is, by employing the methods of process-tracing and pattern-matching, to compare the policy-processes with regards to the cases of student and patient mobility. While the case-study approach to EU policy-making from a comparative perspective was introduced in the late 1970s, so far there has not been a study, which compares the cases of student and patient mobility. This gap in the academic literature is important in order to examine what conclusions can be drawn from such a comparison and as a result their consistency with previous theoretical work. In particular, and in contrast to current theoretical themes in the field of European studies and in the policy studies literature more generally, both of which stress policy change as opposed to policy stability, the comparison stresses the latter due to the interests of the most powerful member-states, that is, France, Germany and Britain. The role of interests is manifested with the adoption of the Erasmus Programme and of the European Health Insurance Card, which do not concern the free movement of students and patients. Through a synthesis between liberal intergovernmentalism and the concept of path-dependence it has been possible to create a model in order to explain why those particular policies were chosen when the alternative of free movement was also available. This interest-based account comes in direct opposition with those studies which stress the role of ideas in the policy-process but it also emphasizes the role played by the supranational institutions more specifically the Commission and the court.
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Costache, Andreea Madalina. "De-regulation of european media policy (2000-2014) The debate on media governance and media pluralism in the EU." Doctoral thesis, Universitat Autònoma de Barcelona, 2014. http://hdl.handle.net/10803/284884.
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Esta tesis doctoral analiza el caso de la regulación del pluralismo de los medios de comunicación a nivel de las instituciones de la Unión Europea. El objetivo principal es examinar si hay una evolución en el cambio de políticas de medios de la UE desde la estricta regulación gubernamental a un enfoque de gobernanza suave con respecto a la protección del pluralismo desde el 2000 hasta el 2014. En la primera parte se desarrolla el marco teórico, basado en dos conceptos teóricos: el pluralismo de los medios y la gobernanza suave. En este sentido, este estudio argumenta que el pluralismo de los medios de comunicación se puede proteger mejor si la regulación gubernamental a nivel de los Estados Miembros se complementa con medidas de regulación suave en el ámbito de la UE, teniendo en cuenta las circunstancias de la limitación de competencias de la Comisión Europea. En la segunda parte se analizan las acciones de política de medios de comunicación a nivel de la UE. Aquí se hace una distinción entre las acciones políticas e iniciativas para la protección del pluralismo de los medios de comunicación avanzadas por las instituciones de la UE como el Parlamento Europeo, El Consejo de Europa, organizaciones de la sociedad civil y los de la Comisión Europea. Las iniciativas gubernamentales, estrategias y argumentos y la regulación suave hacia la protección del pluralismo de medios, procedentes de todos los actores de la política de medios se discuten. De este modo, se puede evaluar si la Comisión Europea se aleja más del tema del pluralismo de medios o cierra la brecha hacia las iniciativas de los Estados Miembros para complementar estas iniciativas con iniciativas de la regulación suave a nivel de la UE.This PhD dissertation analyses the case of the regulation of media pluralism at the European Union’s institutions level. The main objective is to examine if there is an evolution on the EU media policy change from strict-government regulation to a soft-governance approach regarding the protection of pluralism from 2000 to 2014. In the first part the theoretical framework is developed, based on two theoretical concepts: media pluralism and soft-governance. In this regard, this study argues that media pluralism can be better protected if the statutory governance at national level of Member States is complemented with soft-regulatory measures at the EU level, considering the circumstances of the European Commission limitation of competences. In the second part are analyzed the media policy actions at the EU level. A distinction is made here between the policy actions and initiatives for the protection of media pluralism advanced by the EU institutions like European Parliament, the Council of Europe, civil society organizations and the ones of the European Commission. The hard-regulatory initiatives, strategies and arguments and soft-regulatory ones towards the protection of media pluralism, coming from all the media policy actors, are discussed. In this way, it can be assessed if the European Commission is distancing further more from the subject of media pluralism or is bridging the gap towards the initiatives of the Member States to complement these initiatives with soft-regulatory initiatives at the EU level.
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Schreiner, Patrick. "Staat und Sprache in Europa : nationalstaatliche Einsprachigkeit und die Mehrsprachenpolitik der Europäischen Union /." Frankfurt am Main [u.a.] : Lang, 2006. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=014628095&line_number=0004&func_code=DB_RECORDS&service_type=MEDIA.
Full textBooks on the topic "Medical policy – Europe"
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Health targets in Europe: Polity [i.e. policy], progress and promise. London: BMJ Books, 2002.
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Neuber, Joanne. Partnerships in health care Central & Eastern Europe. Washington, DC: US Agency for International Development, 1994.
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European Commission. Directorate-General for Employment, Industrial Relations, and Social Affairs. Directorate F., ed. Public health in Europe. Luxembourg: Office for Official Publications of the European Communities, 1997.
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Rütten, Alfred. Health promotion policy in Europe: Rationality, impact, and evaluation. München: Oldenbourg, 2000.
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B, Saltman Richard, Figueras Josep 1959-, and Sakellarides Constantino 1941-, eds. Critical challenges for health care reform in Europe. Buckingham: Open University Press, 1998.
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Elias, Mossialos, ed. Health systems governance in Europe: The role of EU law and policy. New York: Cambridge University Press, 2010.
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Osteria, Trinidad S. The health dimension of Asian migration to Europe. Manila, Philippines: Published and distributed by De La Salle University Publishing House, 2013.
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Jansen, Brigitte E. S. Legal, ethical, social aspects of public health care in Europe and beyond: Croatia, Japan, Portugal and Turkey. München: AVM, 2010.
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Peter, Elmer, ed. The healing arts: Health, disease and society in Europe, 1500-1800. Manchester: Manchester University Press, 2004.
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Mossialos, Elias. Health systems governance in Europe: The role of European Union law and policy. New York, N.Y: Cambridge University Press, 2010.
Find full textBook chapters on the topic "Medical policy – Europe"
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Burchinsky, Sergei G., and Yuri K. Duplenko. "Computer-Aided Cluster Analysis of Citation Networks as a Tool of Research Policy in Biomedicine." In Medical Informatics Europe 1991, 919–21. Berlin, Heidelberg: Springer Berlin Heidelberg, 1991. http://dx.doi.org/10.1007/978-3-642-93503-9_164.
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Groot, L. M. J. "Diffusion of Medical Technology: A Case Study of Policy in Europe and the Netherlands." In The Economics of Medical Technology, 33–43. Berlin, Heidelberg: Springer Berlin Heidelberg, 1988. http://dx.doi.org/10.1007/978-3-642-72785-6_6.
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Wallace, Lauren J., Margaret E. MacDonald, and Katerini T. Storeng. "Introduction." In Global Maternal and Child Health, 1–13. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-84514-8_1.
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AbstractThis edited volume treats policy as an ethnographic object. Examining both policy spaces and sites of practice, the chapters illuminate both professionals’ and lay people’s intimate encounters with health policies. By ‘studying up’ and considering the multiplicity of actors and interests involved in global policies for improving maternal and reproductive health, the ten chapters in this volume track the processes and politics of policymaking and the mechanisms of their implementation in diverse contexts in Asia, Africa, Europe and South America. The chapters provide in-depth analyses of the complexities of policy formulation and implementation, the impact of socio-political contexts, as well as issues of local agency, equity and accessibility. Together, they demonstrate the value of ethnography as well as reproduction as a unique site for the generation of rich insights into the working of global health policies and their impacts. Such critical social science research is increasingly recognised as a crucial part of the evidentiary basis upon which people-centred and equitable health policy and systems everywhere are built. This volume will be of interest to scholars working at the intersection of critical global health, medical anthropology, and health policy and systems research, as well as to global public health practitioners.
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Donders, Karen. "Laws and policy instruments dealing with funding." In Public Service Media in Europe, 189–205. 1 Edition. | New York : Routledge, 2021. |: Routledge, 2021. http://dx.doi.org/10.4324/9781351105569-12.
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Donders, Karen. "‘Europe Decides’: Evaluating Public Broadcasting Schemes." In Public Service Media and Policy in Europe, 98–125. London: Palgrave Macmillan UK, 2012. http://dx.doi.org/10.1057/9780230349650_8.
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Donders, Karen. "Ideological divisions in national Public Service Media policy." In Public Service Media in Europe, 107–25. 1 Edition. | New York : Routledge, 2021. |: Routledge, 2021. http://dx.doi.org/10.4324/9781351105569-8.
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Murdock, Graham. "Another People: Communication Policy and the Europe of Citizens." In The Palgrave Handbook of European Media Policy, 143–71. London: Palgrave Macmillan UK, 2014. http://dx.doi.org/10.1057/9781137032195_9.
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Flew, Terry. "Convergent Media Policy." In European Media Policy for the Twenty-First Century, 219–37. New York: Routledge, 2016. | Series: Routledge advances in internationalizing media studies; 17: Routledge, 2016. http://dx.doi.org/10.4324/9781315719597-12.
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Donders, Karen. "Introduction, Aims and Methodology." In Public Service Media and Policy in Europe, 1–8. London: Palgrave Macmillan UK, 2012. http://dx.doi.org/10.1057/9780230349650_1.
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Donders, Karen. "Flanders." In Public Service Media and Policy in Europe, 147–71. London: Palgrave Macmillan UK, 2012. http://dx.doi.org/10.1057/9780230349650_10.
Full textConference papers on the topic "Medical policy – Europe"
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Gloria, Chrismatovanie. "Compliance with Complete Filling of Patient's Medical Record at Hospital: A Systematic Review." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.04.29.
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ABSTRACT Background: The health information system, especially medical records in hospitals must be carried out accurately and completely. Medical records are important as evidence for the courts, education, research, and policy makers. This study aimed to investigate the factors affecting the compliance with completeness of filling patient’s medical records at hospitals. Subjects and Methods: A systematic review was conducted by searching from ProQuest, Scopus, and National journals using keywords medical records, filling of medical records, and non- compliance filling medical records. The abstracts and full-text articles published between 2014 to 2019 were selected for this review. A total of 62,355 articles were conducted screening of eligibility criteria. The data were reported using PRISMA flow chart. Results: Eleven articles consisting of eight articles using observational studies and three articles using experimental studies met the eligible criteria. There were two articles analyzed systematically from the United States and India, two articles reviewed literature from the United States and England, and seven articles were analyzed statistically from Indonesia, America, Australia, and Europe. Six articles showed the significant results of the factors affecting non-compliance on the medical records filling at the Hospitals. Conclusion: Non-compliance with medical record filling was found in the hospitals under study. Health professionals are suggested to fill out the medical record completely. The hospital should enforce compliance with complete medical record filling by health professionals. Keywords: medical record, compliance, hospital Correspondence: Chrismatovanie Gloria. Hospital Administration Department, Faculty Of Public Health, Universitas Indonesia, Depok, West Java. Email: chrismatovaniegloria@gmail.com. Mobile: +6281321161896 DOI: https://doi.org/10.26911/the7thicph.04.29
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Juhra, Christian, Martin Hernandez, Kendall Ho, Andre Kushniruk, and Elizabeth Borycki. "The health policy guidance and practice of introducing technologies in health system in Europe." In 2016 Digital Media Industry & Academic Forum (DMIAF). IEEE, 2016. http://dx.doi.org/10.1109/dmiaf.2016.7574897.
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Lugonjić, Marija. "Comparative Analysis of Medical Workers." In Organizations at Innovation and Digital Transformation Roundabout. University of Maribor Press, 2020. http://dx.doi.org/10.18690/978-961-286-388-3.33.
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Continuous Medical Education (CME) is becoming a minimum condition for adapting to today's changes and achieving success in professional and personal fields.The aim of this paper is a comparative analysis of CME in Serbia, the European Union, and the United Kingdom; US, Russian Federation and Iran. The aim of this comparative study was to assess the main countryspecific institutional settings applied by governments. Methods: A common scheme of analysis was applied to investigate the following variables: CME institutional framework; benefits and/or penalties to participants; types of CME activities and system of credits; accreditation of CME providers and events; CME funding and sponsorship. The analysis involved reviewing the literature on CME policy. Results: The US system has clear KME boundaries because it is implemented solely by credentialed institutions that organize dedicated meetings with the clear purpose of educating medical professionals.The European Union has not yet been able to reconcile the differences it has inherited from its members. Only "general" conditions are defined. Continuing medical education cannot be arbitrary, like any other organizational process. Everything has to be controlled in advance. Education in the Russian Federation is regulated by the law, Art. 2 and must be viewed as a whole. Doctors and healthcare professionals and their associates earn points through accredited continuing education programs for obtaining and renewing licenses of the Serbian Medical Chamber and KMSZTS - Chamber of Nurses and Health Technicians of Serbia. The Ordinance establishes the conditions for issuing, renewing and revoking the license for independent work, ie. License to Healthcare Professionals. (RS Official Gazette 102/2015) Conclusin: This comparative exercise provides an overview of the CME policies adopted by analyzed countries to regulate both demand and supply. The substantial variability in the organization and accreditation of schemes indicates that much could be done to improve effectiveness. Although further analysis is needed to assess the results of these policies in practice, lessons drawn from this study may help clarify the weaknesses and strengths of single domestic policies in the perspective.
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ZAWOJSKA, Aldona. "THE PROS AND CONS OF THE EU COMMON AGRICULTURAL POLICY." In RURAL DEVELOPMENT. Aleksandras Stulginskis University, 2018. http://dx.doi.org/10.15544/rd.2017.158.
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The Common Agricultural Policy (CAP) of the European Union has generated a great deal of attention and controversy among research community, practitioners and the wider population. The aim of this study is to overview and to discuss the thoughts and comments on the CAP which have been addressed by both its proponents and its opponents in the scientific publications, political commentaries, official reports, pubic opinion surveys and social-media-based public forums. While on the one hand, recent public opinion poll (Eurobarometer 2016) indicated broad support among EU citizens for the CAP; on the other hand, other sources give some strong arguments in favour of reducing or even scrapping the CAP. The CAP supporters (including European Commission itself) highlight, among others, the benefits of this policy (environmental; cultural; social vitality; food variety, quality and security; maintaining of rural employment, etc.) for all European citizens and not only for farmers, while CAP opponents stress its unfairness both to non-farmers (e.g. huge financial costs of its policy for taxpayers) and small farmers (large farmers benefit most), heavy administrative burden for farmers as well as the CAP’s destructing impact both on the EU states’ agriculture systems and developing countries’ agricultural markets. The CAP is basically the same for all EU member states but the EU countries differ considerably in terms of their rural development. According to some views, the CAP does not fit the Central and Eastern European countries. It represents a failure of the EU to adjust adequately from an exclusively Western European institution into a proper pan-European organization.
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Bitāns, Agris. "Datu otrreizēja izmantošana – jauni izaicinājumi vai jaunas iespējas?" In Latvijas Universitātes 80. starptautiskā zinātniskā konference. LU Akadēmiskais apgāds, 2022. http://dx.doi.org/10.22364/juzk.80.08.
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The article is dedicated to challenges regarding secondary use of personal medical data and social data. As recognised by European Commission, the digital transition should work for all, putting people first and opening new opportunities for business. According to latest Open Data Institute research, Latvia is placed in the middle amongst the EU countries regarding policy for secondary use of health data. Finish Act on the Secondary Use of Health and Social Data and FinData practical experience constitutes a good role model regarding secondary use of health and social data. Latvia has commenced drafting the law for secondary use of personal data, and there are several issues, which should be addressed in this draft law.
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Erdoğan, Mahmut, Ainura Turdalieva, and Raziya Abdiyeva. "Spatial Analysis of Subjective Well-Being Levels and Corruption across Regions in Kyrgyzstan." In International Conference on Eurasian Economies. Eurasian Economists Association, 2018. http://dx.doi.org/10.36880/c10.02088.
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Nowadays corruption becomes a universal phenomenon, which reduces the productivity of public administration, and causes harm to countries’ economic and social development. Consequently, it influences economic performance of Kyrgyzstan. The aim of this study is to visualize the spatial distribution of subjective well-being levels of individuals and personal perceptions and attitude towards corruption in 2016 by using the data provided by the European Bank for Reconstruction and Development on district (rayon) level in Kyrgyzstan.
The findings of this paper show that there is positive spatial autocorrelation for unofficial payments or gifts to road police, public education, and receive medical treatments. Similarly, local government representatives, tax officials, police and judges have higher Moran’s I scores. In addition, obtained results from analysis will help to understand issues related to corruption in Kyrgyzstan.
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Costin, Viorica. "The Synonymous Series in Medical Terminology." In Conferință științifică internațională "Filologia modernă: realizări şi perspective în context european". “Bogdan Petriceicu-Hasdeu” Institute of Romanian Philology, Republic of Moldova, 2022. http://dx.doi.org/10.52505/filomod.2022.16.49.
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Synonymy in medical terminology is a natural phenomenon, an indispensable attribute of specialized language, triggered by the continuous evolution of medical science, which implicitly reveals new aspects, new valences, specialized knowledge that needs to be designated. The purpose of our paper is to reveal the role of synonymous series in structuring the language semantic dimension through the organic exteriorization of the semantic aspects of similarity at the level of lexemes in medical terminology. We also pay special attention to numerically different synonymous series (bi-member and poli-member) as well as the place they hold in medical language at all three lexical levels (non-terminological, scientific and terminological). Finally, aspects related to the research of synonyms are discussed based on the semantic, integral and differential characteristics, which make possible the semantic nuance in the paradigms they form (structure of the synonymous series, core, periphery, etc.).
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Węcławowicz-Gyurkovich, Ewa. "Image of a Hanseatic city in the latest Polish architectural solutions." In International Conference Virtual City and Territory. Barcelona: Centre de Política de Sòl i Valoracions, 2016. http://dx.doi.org/10.5821/ctv.8086.
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The problem of the reconstruction of centres of Polish towns and cities after the destructions of the World War II evoke discussions even today. Over the first years after the war, in numerous cases the centres of historical cities and towns were lost; in the place of former market squares and networks of streets with tenements crowned with endwall trims, randomly dispersed concrete blocks of flats were erected, in order to satisfy urgent housing demands. The situation changed after 1980, when in Elbląg, Gdańsk, Szczecin, Kołobrzeg, a rule was adopted according to which the peripheral development of city quarters was to be recreated, restoring tenements located in historical plots of land, but contemporary in style, maintaining the silhouettes and sizes from years before. It is also possible to observe other activities in the solutions of the latest public utility buildings, which - often by using a sophisticated intellectual play - restore the climate and character of cities remembered and known from the past centuries. In the west and north of Europe there are many towns and cities, predominantly ports, which used to be members of Hansa. The organisation of Hansa, the origins of which reach back to the Middle Ages, associated a number of cities which could decide about the provision of goods to cities within a specific territory, and secure markets for products manufactured in them. Thanks to that, cities that belonged to Hansa were developing more rapidly and effectively, and the beginnings of their development within the territory of Germany and in the Baltic states date back to the 13th and 14th centuries. The peak period of the development of Hanseatic cities, where merchants were engaged in free trade with people from European countries, fell in the 14th and 15th centuries, but already in the 17th century there was a complete decline of Hansa, resulting from the occurrence of competition in the form of associations of Dutch and English cities, as well as the Scandinavian ones. From amongst Polish towns and cities, members of Hansa were e.g. Szczecin, Gdańsk, Kołobrzeg, Elbląg, as well as Cracow. In 1980 an association of partner cities of North Europe, dubbed a New Hansa, was established, the objective of which is to attract attention to the common development of tourism and trade. Nowadays, this New Hansa associates over a hundred cities, similarly to what once was in the medieval Hansa. Numerous Polish cities faced the problem of reconstruction after the destruction of the World War II. The effects varied. By adopting the programme of satisfying predominantly housing demands in the 1960s and 1970s, historical old towns in dozens of cities from amongst nearly 2 hundred destroyed by warfare of the World War II in the north and west of Poland were lost forever. Today we can still encounter ruins of Gothic churches in Głogów or Gubin, where in the place of a market square and tenements of townsmen, randomly located rows of typical four- or five-storey blocks of flats have been erected.
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Hasselqvist-Axe, I., P. Nordberg, J. Herlitz, L. Svensson, M. Jonsson, J. Lindqvist, M. Ringh, et al. "7 Dispatch of fire-fighters and police officers in out-of-hospital cardiac arrest: a nationwide prospective cohort trial." In Meeting abstracts from the second European Emergency Medical Services Congress (EMS2017). British Medical Journal Publishing Group, 2017. http://dx.doi.org/10.1136/bmjopen-2017-emsabstracts.7.
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Litoiu, Nicoleta. "USING ICT IN APPROACHING CAREER COUNSELLING PROCESS AND CAREER MANAGEMENT SKILLS' DEVELOPMENT." In eLSE 2015. Carol I National Defence University Publishing House, 2015. http://dx.doi.org/10.12753/2066-026x-15-122.
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Over the last two years, the E.U. Member States have adopted a series of policy documents that draw up priorities in the fields of schools, vocational education and training, higher education, adult education, employment, youth and social inclusion. These priorities highlighted by the policy documents set up a general framework for action at European and national levels, mainly referring to: reducing early school-leaving; increasing learning mobility; making VET system more attractive; modernizing higher education; promoting adult learning and validation of non-formal and informal learning; combating youth unemployment; implementing flexicurity policies; fighting poverty and social exclusion. In this context, the Europe 2020 Strategy is designed to create 'smart, sustainable and inclusive growth' over the decade 2010-2020. The three main objectives for 2020 all require effective and efficient lifelong guidance policies. Based on the need to provide lifelong career counselling and guidance services, the present paper is aimed to analyze the use of appropriate ICT tools in delivering specific interventions in career counseling process, closely related to the career management skills' development and practice. From this perspective, the paper's approach tries to emphasize the benefits and limitations in using ICT in career counselling process, the role of the practitioner and the role of ICT, taking into consideration the key concepts like distance career counseling, social media, virtual career centers, and integrated ICT-based career resources and services. On the other hand, the paper is addresses to all education experts, teachers and counselling specialists and practitioners in order to stimulate their personal reflection on the cross-cutting nature of career counseling and career management concepts and to encourage initiative and further analysis. From this perspective, we try to investigate the general context, models and principles for developing the career management skills, bringing examples and comments of relevant practice based on a transversal and comparative curricular approach of Romanian education system's levels, with a specific reference to the curriculum area "Guidance and Counselling". Not the last, the role of experts and practitioners in career counselling domain is to mobilize all available resources with a view to enhancing lifelong career guidance policies and services at national and local levels. In line with all mentioned above, using ICT tools in implementing career counselling process and the career management skills focuses on learning about the economic environment, personal and professional development, being able to evaluate oneself, being able to describe the competences one has acquired in formal, informal and non-formal education settings, understanding education, training and qualifications systems.
Reports on the topic "Medical policy – Europe"
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Udupa, Sahana. Small Platforms and the Gray Zones of Deep Extreme Speech. MediaWell, Social Science Research Council, October 2021. http://dx.doi.org/10.35650/md.2093.d.2021.
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Recent trends of migration to smaller social media platforms among right wing actors have raised a caution that an excessive focus on large, transnational social media companies might lose sight of the volatile spaces of homegrown and niche platforms, which have begun to offer diverse “alternative” avenues to extreme speech. Such trends, which drew global media attention during Trump supporters’ attempted exodus to Parler, are also gaining salience in Europe and the global South. Turning the focus to these developments, this article pries open three pertinent features of extreme speech on small platforms: its propensity to migrate between platforms, its embeddedness in domestic regulatory and technological innovations, and its evolving role in facilitating hateful language and disinformation in and through deep trust-based networks. Rather than assuming that smaller platforms are on an obvious trajectory toward progressive alternatives, their diverse entanglements with exclusionary extreme speech, I suggest, should be an important focal point for policy measures.
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Arora, Sanjana, and Olena Koval. Norway Country Report. University of Stavanger, 2022. http://dx.doi.org/10.31265/usps.232.
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This report is part of a larger cross-country comparative project and constitutes an account and analysis of the measures comprising the Norwegian national response to the COVID-19 pandemic during the year of 2020. This time period is interesting in that mitigation efforts were predominantly of a non-medical nature. Mass vaccinations were in Norway conducted in early 2021. With one of the lowest mortality rates in Europe and relatively lower economic repercussions compared to its Nordic neighbours, the Norwegian case stands unique (OECD, 2021: Eurostat 2021; Statista, 2022). This report presents a summary of Norwegian response to the COVID-19 pandemic by taking into account its governance, political administration and societal context. In doing so, it highlights the key features of the Nordic governance model and the mitigation measures that attributed to its success, as well as some facets of Norway’s under-preparedness. Norway’s relative isolation in Northern Europe coupled with low population density gave it a geographical advantage in ensuring a slower spread of the virus. However, the spread of infection was also uneven, which meant that infection rates were concentrated more in some areas than in others. On the fiscal front, the affluence of Norway is linked to its petroleum industry and the related Norwegian Sovereign Wealth Fund. Both were affected by the pandemic, reflected through a reduction in the country’s annual GDP (SSB, 2022). The Nordic model of extensive welfare services, economic measures, a strong healthcare system with goals of equity and a high trust society, indeed ensured a strong shield against the impact of the COVID-19 pandemic. Yet, the consequences of the pandemic were uneven with unemployment especially high among those with low education and/or in low-income professions, as well as among immigrants (NOU, 2022:5). The social and psychological effects were also uneven, with children and elderly being left particularly vulnerable (Christensen, 2021). Further, the pandemic also at times led to unprecedented pressure on some intensive care units (OECD, 2021). Central to handling the COVID-19 pandemic in Norway were the three national executive authorities: the Ministry of Health and Care services, the National directorate of health and the Norwegian Institute of Public Health. With regard to political-administrative functions, the principle of subsidiarity (decentralisation) and responsibility meant that local governments had a high degree of autonomy in implementing infection control measures. Risk communication was thus also relatively decentralised, depending on the local outbreak situations. While decentralisation likely gave flexibility, ability to improvise in a crisis and utilise the municipalities’ knowledge of local contexts, it also brought forward challenges of coordination between the national and municipal level. Lack of training, infection control and protection equipment thereby prevailed in several municipalities. Although in effect for limited periods of time, the Corona Act, which allowed for fairly severe restrictions, received mixed responses in the public sphere. Critical perceptions towards the Corona Act were not seen as a surprise, considering that Norwegian society has traditionally relied on its ‘dugnadskultur’ – a culture of voluntary contributions in the spirit of solidarity. Government representatives at the frontline of communication were also open about the degree of uncertainty coupled with considerable potential for great societal damage. Overall, the mitigation policy in Norway was successful in keeping the overall infection rates and mortality low, albeit with a few societal and political-administrative challenges. The case of Norway is thus indeed exemplary with regard to its effective mitigation measures and strong government support to mitigate the impact of those measures. However, it also goes to show how a country with good crisis preparedness systems, governance and a comprehensive welfare system was also left somewhat underprepared by the devastating consequences of the pandemic.
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Droogan, Julian, Lise Waldek, Brian Ballsun-Stanton, and Jade Hutchinson. Mapping a Social Media Ecosystem: Outlinking on Gab & Twitter Amongst the Australian Far-right Milieu. RESOLVE Network, September 2022. http://dx.doi.org/10.37805/remve2022.6.
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Attention to the internet and the online spaces in which violent extremists interact and spread content has increased over the past decades. More recently, that attention has shifted from understanding how groups like the self-proclaimed Islamic State use the internet to spread propaganda to understanding the broader internet environment and, specifically, far-right violent extremist activities within it. This focus on how far right violent extremist—including far-right racially and ethnically motivated violent extremists (REMVEs) within them—create, use, and exploit the online networks in which they exist to promote their hateful ideology and reach has largely focused on North America and Europe. However, in recent years, examinations of those online dynamics elsewhere, including in Australia, is increasing. Far right movements have been active in Australia for decades. While these movements are not necessarily extremist nor violent, understanding how violent far right extremists and REMVEs interact within or seek to exploit these broader communities is important in further understanding the tactics, reach, and impact of REMVEs in Australia. This is particularly important in the online space access to broader networks of individuals and ideas is increasingly expanding. Adding to a steadily expanding body of knowledge examining online activities and networks of both broader far right as well as violent extremist far right populations in Australia, this paper presents a data-driven examination of the online ecosystems in which identified Australian far-right violent extremists exist and interact,1 as mapped by user generated uniform resource locators (URL), or ‘links’, to internet locations gathered from two online social platforms—Twitter and Gab. This link-based analysis has been used in previous studies of online extremism to map the platforms and content shared in online spaces and provide further detail on the online ecosystems in which extremists interact. Data incorporating the links was automatically collected from Twitter and Gab posts from users existing within the online milieu in which those identified far right extremists were connected. The data was collected over three discrete one-month periods spanning 2019, the year in which an Australian far right violent extremist carried out the Christchurch attack. Networks of links expanding out from the Twitter and Gab accounts were mapped in two ways to explore the extent and nature of the online ecosystems in which these identified far right Australian violent extremists are connected, including: To map the extent and nature of these ecosystems (e.g., the extent to which other online platforms are used and connected to one another), the project mapped where the most highly engaged links connect out to (i.e., website domain names), and To explore the nature of content being spread within those ecosystems, what sorts of content is found at the end of the most highly engaged links. The most highly engaged hashtags from across this time are also presented for additional thematic analysis. The mapping of links illustrated the interconnectedness of a social media ecosystem consisting of multiple platforms that were identified as having different purposes and functions. Importantly, no links to explicitly violent or illegal activity were identified among the top-most highly engaged sites. The paper discusses the implications of the findings in light of this for future policy, practice, and research focused on understanding the online ecosystems in which identified REMVE actors are connected and the types of thematic content shared and additional implications in light of the types of non-violent content shared within them.
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Bourrier, Mathilde, Michael Deml, and Farnaz Mahdavian. Comparative report of the COVID-19 Pandemic Responses in Norway, Sweden, Germany, Switzerland and the United Kingdom. University of Stavanger, November 2022. http://dx.doi.org/10.31265/usps.254.
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The purpose of this report is to compare the risk communication strategies and public health mitigation measures implemented by Germany, Norway, Sweden, Switzerland, and the United Kingdom (UK) in 2020 in response to the COVID-19 pandemic based on publicly available documents. The report compares the country responses both in relation to one another and to the recommendations and guidance of the World Health Organization where available. The comparative report is an output of Work Package 1 from the research project PAN-FIGHT (Fighting pandemics with enhanced risk communication: Messages, compliance and vulnerability during the COVID-19 outbreak), which is financially supported by the Norwegian Research Council's extraordinary programme for corona research. PAN-FIGHT adopts a comparative approach which follows a “most different systems” variation as a logic of comparison guiding the research (Przeworski & Teune, 1970). The countries in this study include two EU member States (Sweden, Germany), one which was engaged in an exit process from the EU membership (the UK), and two non-European Union states, but both members of the European Free Trade Association (EFTA): Norway and Switzerland. Furthermore, Germany and Switzerland govern by the Continental European Federal administrative model, with a relatively weak central bureaucracy and strong subnational, decentralised institutions. Norway and Sweden adhere to the Scandinavian model—a unitary but fairly decentralised system with power bestowed to the local authorities. The United Kingdom applies the Anglo-Saxon model, characterized by New Public Management (NPM) and decentralised managerial practices (Einhorn & Logue, 2003; Kuhlmann & Wollmann, 2014; Petridou et al., 2019). In total, PAN-FIGHT is comprised of 5 Work Packages (WPs), which are research-, recommendation-, and practice-oriented. The WPs seek to respond to the following research questions and accomplish the following: WP1: What are the characteristics of governmental and public health authorities’ risk communication strategies in five European countries, both in comparison to each other and in relation to the official strategies proposed by WHO? WP2: To what extent and how does the general public’s understanding, induced by national risk communication, vary across five countries, in relation to factors such as social capital, age, gender, socio-economic status and household composition? WP3: Based on data generated in WP1 and WP2, what is the significance of being male or female in terms of individual susceptibility to risk communication and subsequent vulnerability during the COVID-19 outbreak? WP4: Based on insight and knowledge generated in WPs 1 and 2, what recommendations can we offer national and local governments and health institutions on enhancing their risk communication strategies to curb pandemic outbreaks? WP5: Enhance health risk communication strategies across five European countries based upon the knowledge and recommendations generated by WPs 1-4. Pre-pandemic preparedness characteristics All five countries had pandemic plans developed prior to 2020, which generally were specific to influenza pandemics but not to coronaviruses. All plans had been updated following the H1N1 pandemic (2009-2010). During the SARS (2003) and MERS (2012) outbreaks, both of which are coronaviruses, all five countries experienced few cases, with notably smaller impacts than the H1N1 epidemic (2009-2010). The UK had conducted several exercises (Exercise Cygnet in 2016, Exercise Cygnus in 2016, and Exercise Iris in 2018) to check their preparedness plans; the reports from these exercises concluded that there were gaps in preparedness for epidemic outbreaks. Germany also simulated an influenza pandemic exercise in 2007 called LÜKEX 07, to train cross-state and cross-department crisis management (Bundesanstalt Technisches Hilfswerk, 2007). In 2017 within the context of the G20, Germany ran a health emergency simulation exercise with WHO and World Bank representatives to prepare for potential future pandemics (Federal Ministry of Health et al., 2017). Prior to COVID-19, only the UK had expert groups, notably the Scientific Advisory Group for Emergencies (SAGE), that was tasked with providing advice during emergencies. It had been used in previous emergency events (not exclusively limited to health). In contrast, none of the other countries had a similar expert advisory group in place prior to the pandemic. COVID-19 waves in 2020 All five countries experienced two waves of infection in 2020. The first wave occurred during the first half of the year and peaked after March 2020. The second wave arrived during the final quarter. Norway consistently had the lowest number of SARS-CoV-2 infections per million. Germany’s counts were neither the lowest nor the highest. Sweden, Switzerland and the UK alternated in having the highest numbers per million throughout 2020. Implementation of measures to control the spread of infection In Germany, Switzerland and the UK, health policy is the responsibility of regional states, (Länders, cantons and nations, respectively). However, there was a strong initial centralized response in all five countries to mitigate the spread of infection. Later on, country responses varied in the degree to which they were centralized or decentralized. Risk communication In all countries, a large variety of communication channels were used (press briefings, websites, social media, interviews). Digital communication channels were used extensively. Artificial intelligence was used, for example chatbots and decision support systems. Dashboards were used to provide access to and communicate data.
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.
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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.