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Andrews E, Harkins HN, Harmon PH, Hudson J. SHOCK SYNDROME FOLLOWING SUBCUTANEOUS INJECTION OF BILE OR BILE SALTS. Ann Surg 2007; 105:392-400. [PMID: 17856943 PMCID: PMC1390353 DOI: 10.1097/00000658-193703000-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tomasi C, Vitale V, Lupi A, Di Carmine C, Campanelli M, Herber A, Treffeisen R, Stone RS, Andrews E, Sharma S, Radionov V, von Hoyningen-Huene W, Stebel K, Hansen GH, Myhre CL, Wehrli C, Aaltonen V, Lihavainen H, Virkkula A, Hillamo R, Ström J, Toledano C, Cachorro VE, Ortiz P, de Frutos AM, Blindheim S, Frioud M, Gausa M, Zielinski T, Petelski T, Yamanouchi T. Aerosols in polar regions: A historical overview based on optical depth and in situ observations. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2007jd008432] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rubino A, Roskell N, Tennis P, Mines D, Weich S, Andrews E. Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study. BMJ 2007; 334:242. [PMID: 17164297 PMCID: PMC1790752 DOI: 10.1136/bmj.39041.445104.be] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2006] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the risk of suicide in adults using the antidepressant venlafaxine compared with citalopram, fluoxetine, and dothiepin. DESIGN Retrospective cohort study. SETTING UK General Practice Research Database. PARTICIPANTS 219,088 patients, aged 18-89 years, who were prescribed venlafaxine, citalopram, fluoxetine, or dothiepin from 1995 to 2005. MAIN OUTCOME MEASURES Completed suicide and attempted suicide. RESULTS Venlafaxine users had a higher burden of risk factors for suicide, including previous suicide attempts and proxies for severe depression or depression that was difficult to treat. In the analysis for completed suicides, unadjusted and adjusted hazard ratios for venlafaxine compared with citalopram were 2.44 (95% confidence interval 1.12 to 5.31) and 1.70 (0.76 to 3.80), for venlafaxine compared with fluoxetine were 2.85 (1.37 to 5.94) and 1.63 (0.74 to 3.59), and for venlafaxine compared with dothiepin were 2.54 (1.07 to 6.02) and 1.31 (0.53 to 3.25). Compared with other study drugs, venlafaxine was also associated with an increased risk of attempted suicide, but adjustment for measured confounders substantially reduced the hazard ratios. CONCLUSIONS Venlafaxine use was consistently associated with higher risk of suicide compared with citalopram, fluoxetine, and dothiepin. Venlafaxine users had a higher burden of suicide risk factors, however, and adjustment for measured confounders substantially reduced the excess risks. Since the secondary data used in this analysis allowed only indirect and partial measurements of potential confounders, it is possible that residual confounding explains much, if not all, of the observed excess risk.
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Tennis P, Andrews E, Hickman P, Miller D, Hollis K, Cook S. The relationship between dosing of alosetron and discontinuation patterns reported by patients participating in a follow-up programme. Aliment Pharmacol Ther 2007; 25:317-22. [PMID: 17217444 DOI: 10.1111/j.1365-2036.2006.03198.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alosetron was reintroduced for treatment of irritable bowel syndrome with a risk management programme in November 2002. Recommended starting dosage was 1 mg/day for 4 weeks. If symptoms remained uncontrolled, dosage could be changed to 2 mg/day. AIM To describe alosetron dosages and associated patient characteristics from the Lotronex follow-up survey programme. METHODS Patients reported dosages of alosetron at start and regular follow-up intervals. Analyses were limited to patients with the potential to have at least 1 year of follow-up (enrolled between 9 December 2002 and 31 December 2003). RESULTS At baseline, 75% of 2817 respondents reported starting on 1 mg/day, 17% on 2 mg/day and 8% on other doses. Adherence to recommended starting dosage did not vary by status at end of follow-up, previous alosetron experience or age. At last reported dose, 50% of respondents were using 1 mg/day; 29% were using 2 mg/day. Discontinuation was not related to baseline doses. Longer times to discontinuation were associated with previous use, symptoms for more than 6 months and dose change throughout follow-up. CONCLUSIONS High adherence to recommended dosing at baseline and follow-up suggests that the risk management programme is encouraging safe use of alosetron, including adherence to dosing recommendations.
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Stohl A, Andrews E, Burkhart JF, Forster C, Herber A, Hoch SW, Kowal D, Lunder C, Mefford T, Ogren JA, Sharma S, Spichtinger N, Stebel K, Stone R, Ström J, Tørseth K, Wehrli C, Yttri KE. Pan-Arctic enhancements of light absorbing aerosol concentrations due to North American boreal forest fires during summer 2004. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2006jd007216] [Citation(s) in RCA: 189] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Miller D, Bennett L, Hollis K, Tennis P, Cook S, Andrews E. A patient follow-up survey programme for alosetron: assessing compliance to and effectiveness of the risk management programme. Aliment Pharmacol Ther 2006; 24:869-78. [PMID: 16918892 DOI: 10.1111/j.1365-2036.2006.03031.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In November 2002, alosetron HCl (Lotronex, GlaxoSmithKline Research Triangle Park, NC, USA) was re-introduced to the US marketplace for women with severe diarrhoea-predominant irritable bowel syndrome. In support of the re-introduction, a risk management programme was implemented, which included a patient follow-up study in which all users of alosetron could participate. AIM We report on the methods used and the effectiveness of key elements of the risk management programme. METHODS Patients voluntarily enroled in the study and completed questionnaires at baseline, after 5 and 10 weeks, and quarterly thereafter. Questions focussed on patient eligibility, knowledge of risks and benefits, and adherence to the recommended programme elements for education, prescribing and dispensing. RESULTS Between December 2002 and 2004, 4,803 patients enrolled in the study, and <3% were lost to follow-up. The average follow-up time was approximately 6 months, and the response rate for each assessment was >95%. A total of 90% of patients at baseline met the full clinical criteria recommended for the treatment. Patient adherence to the risk management programme was >87%. CONCLUSIONS Using the Lotronex risk management programme, patients met clinical criteria, were knowledgeable about treatment risks and benefits, and were adherent to the process elements of the programme. These patients seemed to engage in active dialogue with their physicians about symptoms and use of alosetron.
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Pahlow M, Feingold G, Jefferson A, Andrews E, Ogren JA, Wang J, Lee YN, Ferrare RA, Turner DD. Comparison between lidar and nephelometer measurements of aerosol hygroscopicity at the Southern Great Plains Atmospheric Radiation Measurement site. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2004jd005646] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Andrews E, Sheridan PJ, Fiebig M, McComiskey A, Ogren JA, Arnott P, Covert D, Elleman R, Gasparini R, Collins D, Jonsson H, Schmid B, Wang J. Comparison of methods for deriving aerosol asymmetry parameter. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2004jd005734] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hallar AG, Strawa AW, Schmid B, Andrews E, Ogren J, Sheridan P, Ferrare R, Covert D, Elleman R, Jonsson H, Bokarius K, Luu A. Atmospheric Radiation Measurements Aerosol Intensive Operating Period: Comparison of aerosol scattering during coordinated flights. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2005jd006250] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sharma S, Andrews E, Barrie LA, Ogren JA, Lavoué D. Variations and sources of the equivalent black carbon in the high Arctic revealed by long-term observations at Alert and Barrow: 1989–2003. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2005jd006581] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Strawa AW, Elleman R, Hallar AG, Covert D, Ricci K, Provencal R, Owano TW, Jonsson HH, Schmid B, Luu AP, Bokarius K, Andrews E. Comparison of in situ aerosol extinction and scattering coefficient measurements made during the Aerosol Intensive Operating Period. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2005jd006056] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hirst C, Cook S, Dai W, Perez-Gutthann S, Andrews E. A call for international harmonization in therapeutic risk management. Pharmacoepidemiol Drug Saf 2006; 15:839-49; discussion 850-1. [PMID: 16981215 DOI: 10.1002/pds.1319] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Therapeutic risk management is required to ensure that the benefits of a particular drug outweigh the risks in general practice. Current risk management strategies and handling of risk management and pharmacovigilance issues differ across borders. Differences in key regulatory decisions on the same product around the world, including the handling of safety issues with cisapride, dofetilide, and isotretinoin, bring into question the robustness of these decisions and the procedures currently in place to manage the risks to the public of products with potentially unfavorable risk-benefit balances. These differences may be partly due to differences in health care systems, regulatory requirements and procedures, and cultures. Greater international harmonization in approaches to risk management potentially would improve safety of medicines around the world by developing a greater uniformity in acquiring and interpreting risk-benefit evidence. The appropriateness and effectiveness of risk management interventions in different regions should be examined, and international strategies should be 'fine-tuned' for each regional health care setting. Recently issued international guidance on risk management and pharmacovigilance may help to improve consistency of decision-making around the world and promote better international communication and collaboration.
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Hynes N, Mahendran B, Manning B, Andrews E, Courtney D, Sultan S. The Influence of Subintimal Angioplasty on Level of Amputation and Limb Salvage Rates in Lower Limb Critical Ischaemia: A 15-year Experience. Eur J Vasc Endovasc Surg 2005; 30:291-9. [PMID: 15939635 DOI: 10.1016/j.ejvs.2005.04.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 04/04/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study is to assess the influence of subintimal angioplasty (SIA) on lower limb amputation rate and level in critically ischaemic limbs. METHODS Between January 1989 and March 2004, 1268 patients were admitted for treatment of lower limb critical ischaemia. Eight hundred and twenty-nine patients underwent revascularisation (bypass 671 and angioplasty 158), while 439 patients had primary amputations. A retrospective analysis of a prospectively maintained vascular registry was performed. Patients were divided into two groups, those who were admitted prior to the availability of subintimal angioplasty and those treated post-introduction of angioplasty. The two groups were compared with regards to age, sex, diabetes mellitus, ASA grade, Rutherford classification and level of disease. Outcome was assessed by the limb salvage rate, 30-day morbidity and mortality, and length of hospital stay. RESULTS The average number of revascularisation increased with the introduction of subintimal angioplasty, from 53 to 96 per year (p<0.001). The overall limb salvage rate increased significantly from 42 to 70% (p<0.001). The cumulative limb salvage rate following revascularisation rose from 72 to 86% (p<0.001). The level of amputation (AKA:BKA) did not vary significantly. Thirty-day morbidity, mortality and length of hospital stay were significantly lower in the post-angioplasty group. CONCLUSIONS Technical advances have resulted in a steadying of amputation numbers despite an ageing population.
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Hynes N, Mahendran B, Asad J, Andrews E, Tawfik S, Ishtiaq A, O’Sullivan G, Sultan S. A prospective observational study of carotid artery stenting (CAST) under neuro-protection and carotid endarterectomy (CEA) in high-risk patients. Technical and clinical outcome. Ir J Med Sci 2005. [DOI: 10.1007/bf03170153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Andrews E, Dombeck M. The role of scientific evidence of risks and benefits in determining risk management policies for medications. Pharmacoepidemiol Drug Saf 2004; 13:599-608. [PMID: 15362082 DOI: 10.1002/pds.899] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent changes in the regulatory environment have called attention to the need for and potential benefits of greater and more detailed evidence to inform decisions based on the risk-benefit profile of medications. Nevertheless, access to potentially beneficial therapies continues to be impeded by a lack of sufficient information that could help optimize benefits and minimize risks of treatments for patients. Over-reliance on pre-marketing clinical trials and the FDA's spontaneous reporting adverse event system to support regulatory decisions has sustained an information void. Clinical trials are the gold standard for demonstrating efficacy, but they cannot fully predict safety when drugs are used in the real world. Spontaneous reporting can identify new signals, but cannot quantify those signals or place them in appropriate clinical context. In the face of new safety signals, absence of better information on how medications are used and how they perform in the real world setting, regulators are often limited to either continuing drug marketing without significant changes or withdrawing a medication from the market. Experience shows that information collected proactively, to better understand the background risks associated with the underlying disease and to better quantify the product risks, can influence these decisions to include a wider range of options regarding a product's availability, labeling and additional risk management strategies. This article presents several case studies of medications, including those in which insufficient data were available to address important safety signals and decisions were made to withdraw products, as well as those in which epidemiologic data were available to provide reassurance of product safety and allow continued product use, even though some may be marketed with additional risk management programs. More extensive and earlier epidemiologic assessment of risks and benefits of new products will create a new standard of evidence for industry and regulators and is likely to result in more effective and balanced regulatory actions, thereby affording better care for patients.
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Andrews E, Gilsenan A, Cook S. Therapeutic Risk Management Interventions: Feasibility and Effectiveness. J Am Pharm Assoc (2003) 2004; 44:491-500. [PMID: 15372870 DOI: 10.1331/1544345041475670] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review the effectiveness and feasibility of risk management strategies implemented for drugs with significant known risks. DATA SOURCES Published medical literature and regulatory archives, including proceedings of Food and Drug Administration advisory committee meetings. Iterative searches of the medical literature, the Internet, and Web-based government information sources were conducted throughout 2002-2003. Search terms were related to risk management, drug safety, and the names of specific medications known to be subject to risk management programs. STUDY SELECTION Key studies that illustrated examples of risk management and evaluated risk management programs were selected by the authors. DATA EXTRACTION Performed manually by the authors. DATA SYNTHESIS Much of the information regarding the effectiveness of risk management interventions in reducing risk is anecdotal; little information has been published. Given the demand for evidence-based clinical decision making, pharmaceutical manufacturers and the health care community must understand whether these programs are achieving their ultimate goals of reducing risks to patients, while making needed therapies available. This paucity of evidence points to new opportunities for researchers across disciplines to better understand the feasibility and effectiveness of these interventions and the impact of the interventions at the patient, practitioner, and public health levels. Such research needs to be published so that future programs and policy can be informed by these early examples. CONCLUSION For interventions to be effective in reducing risk, they must effect change in physician prescribing, pharmacist dispensing, and patient adherence. Risk intervention programs that are overly burdensome to physicians, pharmacists, or patients are unlikely to succeed in achieving the desired outcome of reducing individual risk. In addition, risk management programs should be scaleable and implemented in a systematic fashion to accommodate multiple simultaneous programs that can effectively manage the risk, rather than through a piecemeal approach.
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Dowdall JF, Winter DC, Andrews E, Laug WE, Wang JH, Redmond HP. Soluble interleukin 6 receptor (sIL-6R) mediates colonic tumor cell adherence to the vascular endothelium: a mechanism for metastatic initiation? J Surg Res 2002; 107:1-6. [PMID: 12384057 DOI: 10.1006/jsre.2001.6222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The mechanisms by which surgery increases metastatic proliferation remain poorly characterized, although endotoxin and immunocytes play a role. Recent evidence suggests that endothelial adherence of tumor cells may be important in the formation of metastases. Soluble receptors of interleukin-6 (sIL-6R) shed by activated neutrophils exert IL-6 effects on endothelial cells, which are unresponsive under normal circumstances. This study examined the hypothesis that sIL-6R released by surgical stress increases tumor cell adherence to the endothelium. Neutrophils (PMN) were stimulated with lipopolysaccharide, C-reactive protein (CRP), and tumor necrosis factor-alpha. Soluble IL-6R release was measured by enzyme-linked immunosorbent assay. Colonic tumor cells transfected with green fluorescent protein and endothelial cells were exposed to sIL-6R, and tumor cell adherence and transmigration were measured by fluorescence microscopy. Basal release of sIL-6R from PMN was 44.7 +/- 8.2 pg/ml at 60 min. This was significantly increased by endotoxin and CRP (131 +/- 16.8 and 84.1 +/- 5.3, respectively; both P < 0.05). However, tumor necrosis factor-alpha did not significantly alter sIL-6R release. Endothelial and tumor cell exposure to sIL-6R increased tumor cell adherence by 71.3% within 2 h but did not significantly increase transmigration, even at 6 h. Mediators of surgical stress induce neutrophil release of a soluble receptor for IL-6 that enhances colon cancer cell endothelial adherence. Since adherence to the endothelium is now considered to be a key event in metastatic genesis, these findings have important implications for colon cancer treatment strategies.
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Quinn PK, Miller TL, Bates TS, Ogren JA, Andrews E, Shaw GE. A 3-year record of simultaneously measured aerosol chemical and optical properties at Barrow, Alaska. ACTA ACUST UNITED AC 2002. [DOI: 10.1029/2001jd001248] [Citation(s) in RCA: 208] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bhateja S, Rieke J, Andrews E. Impact-Fatigue Response of Ultrahigh Molecular Weight Linear Polyethylene. 3. Morphological Effects. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/i360076a024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Andrews E. Evolving your safety process. OCCUPATIONAL HEALTH & SAFETY (WACO, TEX.) 2001; 70:30-2, 36. [PMID: 11421091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Young A, Andrews E. Parents' Experience of Universal Neonatal Hearing Screening: A Critical Review of the Literature and Its Implications for the Implementation of New UNHS Programs. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2001; 6:149-160. [PMID: 15451846 DOI: 10.1093/deafed/6.3.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article presents a critical review of literature reporting the effects on parents of universal neonatal hearing screening (UNHS). It explores how parents experience the process and outcome of screening and in particular focuses on debates surrounding false positive identification, the evidence base for maternal/parental anxiety, consent, and family cultural/sociodemographic influences on the effective implementation of UNHS programs. These issues are then set within the context of events in the United Kingdom, where the Department of Health has recently initiated a program to pilot the introduction of universal neonatal hearing screening at 20 sites in England.
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