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Zisman-Ilani Y, Chmielowska M, Dixon LB, Ramon S. NICE shared decision making guidelines and mental health: challenges for research, practice and implementation. BJPsych Open 2021; 7:e154. [PMID: 34470688 PMCID: PMC8444056 DOI: 10.1192/bjo.2021.987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
The National Institute for Health and Care Excellence (NICE) initiated an ambitious effort to develop the first shared decision making guidelines. The purpose of this commentary is to identify three main concerns pertaining to the new published guidelines for shared decision making research, practice, implementation and cultural differences in mental health.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, USA
| | - Marta Chmielowska
- Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Lisa B. Dixon
- Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, USA
| | - Shulamit Ramon
- Department of Allied Health, Midwifery and Social Work, University of Hertfordshire, UK
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Farrand E, Limper AH. Clinical Trials for Idiopathic Pulmonary Fibrosis and the Role of Health Systems. Clin Chest Med 2021; 42:287-294. [PMID: 34024404 DOI: 10.1016/j.ccm.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We are in the midst of transformative innovation in health care delivery and clinical trials in idiopathic pulmonary fibrosis (IPF). Health systems are uniquely positioned at the crossroad of these shifting paradigms, equipped with the resources to expand the research pipeline in IPF through visionary leadership and targeted investments. The authors hope that by prioritizing development of health information technology, supporting a broader range of clinical trial designs, and cultivating broad stakeholder engagement, health systems will generate data to address knowledge-evidence-practice gaps in IPF. This will continue to improve the ability to deliver high-quality, safe, and effective care.
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Affiliation(s)
- Erica Farrand
- 505 Parnassus Avenue, Room M1083, Box 0111, San Francisco, CA 94117, USA.
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Abstract
The use of machine learning (ML) in healthcare raises numerous ethical concerns, especially as models can amplify existing health inequities. Here, we outline ethical considerations for equitable ML in the advancement of healthcare. Specifically, we frame ethics of ML in healthcare through the lens of social justice. We describe ongoing efforts and outline challenges in a proposed pipeline of ethical ML in health, ranging from problem selection to postdeployment considerations. We close by summarizing recommendations to address these challenges.
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Affiliation(s)
- Irene Y Chen
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Emma Pierson
- Microsoft Research, Cambridge, Massachusetts 02143, USA
| | - Sherri Rose
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California 94305, USA
| | | | - Kadija Ferryman
- Department of Technology, Culture, and Society, Tandon School of Engineering, New York University, Brooklyn, New York 11201, USA
| | - Marzyeh Ghassemi
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Institute for Medical and Evaluative Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Fahim SM, Hsu CH, Lin FJ, Qian J, Chou C. Association between prior use of anti-diabetic medication and breast cancer stage at diagnosis. Expert Opin Drug Saf 2020; 20:235-243. [PMID: 33207942 DOI: 10.1080/14740338.2021.1853703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Knowledge regarding antidiabetic medication (ADM) use prior to breast cancer (BC) diagnosis remains limited. The objectives were to (1) evaluate if the prior use of ADM was associated with BC stage at diagnosis and (2) identify and compare patient characteristics among BC patients using different ADMs. RESEARCH DESIGN AND METHODS Newly diagnosed female BC patients exposed to any medication during one year prior to cancer diagnosis were identified in 2008-2013 Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Stage at diagnosis, categorized as early and advanced, was the primary outcome. Chi-square tests were used to compare characteristics and logistic regression models were applied to examine the effect while controlling for patient's characteristics. RESULTS A total of 1,719 female BC patients used ADM while 6,084 patients were non-ADM users. Although a higher proportion of ADM users (20.36%) were diagnosed with advanced stage compared to the non-ADM users (14.46%), the difference was not statistically significant after adjusting for the patients' characteristics. Besides, insulin users were more likely to be diagnosed with advanced stage (adjusted odds ratio 1.69; 95% CI 1.15, 2.48) compared to metformin users. CONCLUSIONS The association between ADM use and BC diagnostic characteristics varied based on different treatments.
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Affiliation(s)
- Shahariar Mohammed Fahim
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, the University of Arizona , Tucson, AZ, USA
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy & School of Pharmacy, College of Medicine, National Taiwan University , Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital , Taipei, Taiwan
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA.,Department of Medical Research, China Medical University Hospital , Taichung, Taiwan
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Abstract
Most of the medical practice has not been proven by controlled clinical trials, and there are no plans to conduct such trials in order to decrease clinician uncertainty. This happens partly due to the difficulty of making designs with scientific and ethical validity, the costs of this type of research and the time required to generate results, which can be several years. Clinical trials do not have the capability to generate information that allows to make decisions in some sectors of clinical care and public health, such as when an epidemic occurs. Therefore, medical science is based on observational studies, past practices and therapeutic tradition (1).
Observation of clinical data that have defined a clinical behavior precedes the clinical trial. The knowledge about scurvy, the fact that this pathology is considered a nutritional deficiency and its treatment with citrus fruits, originated thanks to the collection of clinical data on sailors, soldiers and prisoners of the British Crown in the 18th and 19th centuries (2). This clinical information, which was collected uniformly and served to produce new knowledge, is what is now known as Real World Data (RWD). A modern definition of RWD would be one that talks about data obtained by any non-interventionist methodology that is collected prospectively and retrospectively from observations of routine clinical practice, and which comes from various sources including data from patients, doctors, hospitals, payers, social data, etc (3).
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Affiliation(s)
- Mauricio Palacios
- Editor en Jefe, Revista Colombia Médica, Universidad del Valle. Cali, Colombia
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Pahus L, Jaffuel D, Vachier I, Bourdin A, Suehs CM, Molinari N, Chanez P. Randomised controlled trials in severe asthma: selection by phenotype or stereotype. Eur Respir J 2019; 53:1802187. [PMID: 30759420 DOI: 10.1183/13993003.02187-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Laurie Pahus
- Aix Marseille Univ, APHM, CIC 9502, Clinique des bronches, allergies et sommeil, Marseille, France
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
- Aix Marseille Univ, INSERM U1263, INRA 1260 (C2VN), Marseille, France
| | - Dany Jaffuel
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- Association pour l'Assistance et la Réhabilitation à Domicile (APARD), Montpellier, France
- Polyclinique Saint-Privat, Maladies Respiratoires et Troubles Respiratoires du Sommeil, Boujan sur Libron, France
| | - Isabelle Vachier
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- Association pour l'Assistance et la Réhabilitation à Domicile (APARD), Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Carey Meredith Suehs
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Pascal Chanez
- Aix Marseille Univ, APHM, CIC 9502, Clinique des bronches, allergies et sommeil, Marseille, France
- Aix Marseille Univ, INSERM U1263, INRA 1260 (C2VN), Marseille, France
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Rebuttal From Dr Tillotson. Chest 2016; 149:1133-5. [DOI: 10.1016/j.chest.2016.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 11/20/2022] Open
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