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Liu Z, Meng R, Yang Y, Li K, Yin Z, Ren J, Shen C, Feng Z, Zhan S. Active Vaccine Safety Surveillance: Global Trends and Challenges in China. HEALTH DATA SCIENCE 2021; 2021:9851067. [PMID: 38487501 PMCID: PMC10880162 DOI: 10.34133/2021/9851067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/03/2021] [Indexed: 03/17/2024]
Abstract
Importance. The great success in vaccine-preventable diseases has been accompanied by vaccine safety concerns. This has caused vaccine hesitancy to be the top 10 in threats to global health. The comprehensive understanding of adverse events following immunization should be entirely based on clinical trials and postapproval surveillance. It has increasingly been recognized worldwide that the active surveillance of vaccine safety should be an essential part of immunization programs due to its complementary advantages to passive surveillance and clinical trials.Highlights. In the present study, the framework of vaccine safety surveillance was summarized to illustrate the importance of active surveillance and address vaccine hesitancy or safety concerns. Then, the global progress of active surveillance systems was reviewed, mainly focusing on population-based or hospital-based active surveillance. With these successful paradigms, the practical and reliable ways to create robust and similar systems in China were discussed and presented from the perspective of available databases, methodology challenges, policy supports, and ethical considerations.Conclusion. In the inevitable trend of the global vaccine safety ecosystem, the establishment of an active surveillance system for vaccine safety in China is urgent and feasible. This process can be accelerated with the consensus and cooperation of regulatory departments, research institutions, and data owners.
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Affiliation(s)
- Zhike Liu
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Ruogu Meng
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Yu Yang
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Keli Li
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingtian Ren
- Center for Drug Reevaluation, National Medical Products Administration, BeijingChina
| | - Chuanyong Shen
- Center for Drug Reevaluation, National Medical Products Administration, BeijingChina
| | - Zijian Feng
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
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Kappen S, Jürgens V, Freitag MH, Winter A. Attitudes Toward and Use of Prostate-Specific Antigen Testing Among Urologists and General Practitioners in Germany: A Survey. Front Oncol 2021; 11:691197. [PMID: 34150662 PMCID: PMC8213068 DOI: 10.3389/fonc.2021.691197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background In 2020, around 1.4 million new prostate cancer (PCa) cases were recorded worldwide. Early detection of PCa by prostate-specific antigen (PSA) screening remains debated, leading to different specialist-specific recommendations in PCa guidelines. This study aimed to assess attitudes toward and use of PSA testing among urologists in Germany and general practitioners (GPs) in Lower Saxony (Germany). Methods A nationwide questionnaire was sent to urologists via the mailing lists of the Professional Association of German Urologists and the German Urological Society. A version of the questionnaire for GPs was sent to email addresses via the Association of Statutory Health Insurance Physicians Lower Saxony. The online questionnaires covered use of PSA testing, information communication, handling of test results, and handling of/knowledge about national and international guidelines and recommendations on early detection of PCa. Statistical analysis was performed at a descriptive level. Results In total, 432 of 6,568 urologists (6.6%) and 96 of 1,579 GPs (6.1%) participated in this survey. Urologists and GPs differed in their attitudes and approaches toward PSA testing. Most urologists (86.8%, n=375) judged the test as “very meaningful” or “meaningful”, compared with 52.1% (n=50) of GPs. Almost two-thirds of the urologists (64.4%, n=278) viewed the PCa mortality reduction by PSA testing as proven, compared with one-fifth of GPs (20.8%, n=20). Almost 80% of male urologists (79.9%, n=291) indicated that they would undergo a PSA test in the future (again), compared with 55.1% of male GPs (n=38). In addition, 56.3% (n=243) of urologists stated that “considerably more than half” or “almost all” men aged 45 years or older received a PSA test, compared with 19.8% (n=19) of GPs. Conclusions Urologists are more convinced about the PSA test than GPs. PSA testing is therefore used more often in urological settings, although the preselected patient population must be considered. In accordance with specialist-specific recommendations, GPs show a more reserved approach toward PSA testing. Instead of focusing on different attitudes and recommendations on PSA testing, the exchange between specialist groups should be improved to achieve a consistent approach to PSA testing.
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Affiliation(s)
- Sanny Kappen
- Division of Epidemiology and Biometry, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Verena Jürgens
- Division of Epidemiology and Biometry, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michael H Freitag
- Division of General Practice, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Haque A, Milstein A, Fei-Fei L. Illuminating the dark spaces of healthcare with ambient intelligence. Nature 2020; 585:193-202. [PMID: 32908264 DOI: 10.1038/s41586-020-2669-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/14/2020] [Indexed: 11/09/2022]
Abstract
Advances in machine learning and contactless sensors have given rise to ambient intelligence-physical spaces that are sensitive and responsive to the presence of humans. Here we review how this technology could improve our understanding of the metaphorically dark, unobserved spaces of healthcare. In hospital spaces, early applications could soon enable more efficient clinical workflows and improved patient safety in intensive care units and operating rooms. In daily living spaces, ambient intelligence could prolong the independence of older individuals and improve the management of individuals with a chronic disease by understanding everyday behaviour. Similar to other technologies, transformation into clinical applications at scale must overcome challenges such as rigorous clinical validation, appropriate data privacy and model transparency. Thoughtful use of this technology would enable us to understand the complex interplay between the physical environment and health-critical human behaviours.
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Affiliation(s)
- Albert Haque
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Li Fei-Fei
- Department of Computer Science, Stanford University, Stanford, CA, USA. .,Stanford Institute for Human-Centered Artificial Intelligence, Stanford University, Stanford, CA, USA.
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Thomas R, Scott AM, Sims R, Craig L, Claase LA, Lowe J, Heal C, Hardiman L, Glasziou P. Exploring women's priorities for the potential consequences of a gestational diabetes diagnosis: A pilot community jury. Health Expect 2020; 23:593-602. [PMID: 32090415 PMCID: PMC7321745 DOI: 10.1111/hex.13036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is no international diagnostic agreement for gestational diabetes mellitus (GDM). In 2014, Australia adopted a new definition and testing procedure. Since then, significantly more women have been diagnosed with GDM but with little difference in health outcomes. We explored the priorities and preferences of women potentially impacted by a GDM diagnosis. METHOD We recruited 15 women from the Gold Coast, Australia, to participate in a pilot community jury (CJ). Over two days, the women deliberated on the following: (a) which important consequences of a diagnosis of GDM should be considered when defining GDM?; (b) what should Australian health practitioners call the condition known as GDM? RESULTS Eight women attended the pilot CJ, and their recommendations were a consensus. Women were surprised that the level of risk for physical harms was low but emotional harms were high. The final ranking of important consequences (high to low) was as follows: women's negative emotions; management burden of GDM; overmedicalized pregnancy; minimizing infant risks; improving lifestyle; and macrosomia. To describe the four different clinical states of GDM, the women chose three different labels. One was GDM. CONCLUSIONS The women from this pilot CJ prioritized the consequences of a diagnosis of GDM differently from clinicians. The current glucose threshold for GDM in Australia is set at a cut-point for adverse risks including macrosomia and neonatal hyperinsulinaemia. Definitions and guideline panels often fail to ask the affected public about their values and preferences. Community voices impacted by health policies should be embedded in the decision-making process.
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Affiliation(s)
- Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | - Louise Craig
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | | | - Julia Lowe
- University of Newcastle, Newcastle, NSW, Australia
| | - Clare Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Qld, Australia
| | - Leah Hardiman
- Maternity Choices Australia, Brisbane, Qld, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
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Kappen S, Jürgens V, Freitag MH, Winter A. Early detection of prostate cancer using prostate-specific antigen testing: an empirical evaluation among general practitioners and urologists. Cancer Manag Res 2019; 11:3079-3097. [PMID: 31114352 PMCID: PMC6489576 DOI: 10.2147/cmar.s193325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 02/18/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Prostate cancer (PCa) is the most frequent cancer and the third leading cause of cancer death among German men. One option for PCa early detection is prostate-specific antigen (PSA) testing, which is still under debate regarding its risk benefits. Besides recommendations on the early PCa detection, daily practice on PSA testing varies in, for example, information communication and usage of the test. This pilot study assessed potential differences between general practitioners (GPs) and urologists in handling PSA testing and guidelines on early detection of PCa. Methods: 172 GPs belonging to the teaching network of the University of Oldenburg in Lower Saxony and Bremen and 128 practicing urologists were included in the online survey focusing on PSA testing. The questionnaire covered 43 questions on topics as the usage of the test, information communication, handling of test results and handling of/knowledge about national and international guidelines on PCa. Wether PSA testing is used in accordance with guidelines was also explored in four standardized case scenarios. Statistical analysis was done at a descriptive level. Results: In total, 65 doctors participated in the survey (response proportion: 21.7%, n=65; 27.9%, n=48 [GPs]; 13.2%, n=17 [urologists]). Results of 41 GPs and 14 urologists were analyzed. The PSA test was judged as useful by all urologists, while almost half of the GPs valued the test as ambivalent or not useful. Urologists showed a more proactive approach of informing men on PSA testing. Regarding guidelines and recommendations on PSA testing, GPs were less familiar with them compared to the urologists. Doctors of both specialties did not always treat men in consistence with the guidelines. This was partially in contradiction to their self-appraisal. Conclusion: This pilot study is highlighting differences in PSA testing practices between GPs and urologists in Germany. Urologists showed a more proactive approach. For further verification, we plan a more comprehensive study covering several German states.
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Affiliation(s)
- Sanny Kappen
- Division of Epidemiology and Biometry, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Verena Jürgens
- Division of Epidemiology and Biometry, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michael H Freitag
- Division of General Practice/Family Medicine, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Scott AM, Sims R, Degeling C, Carter S, Thomas R. Developing and applying a deductive coding framework to assess the goals of Citizen/Community Jury deliberations. Health Expect 2019; 22:537-546. [PMID: 30864216 PMCID: PMC6543138 DOI: 10.1111/hex.12880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/29/2019] [Accepted: 02/22/2019] [Indexed: 11/30/2022] Open
Abstract
Background Public participation in health policy decision making is thought to improve the quality of the decisions and enhance their legitimacy. Citizen/Community Juries (CJs) are a form of public participation that aims to elicit an informed community perspective on controversial topics. Reporting standards for CJ processes have already been proposed. However, less clarity exists about the standards for what constitutes a good quality CJ deliberation—we aim to begin to address this gap here. Methods We identified the goals that underlie CJs and searched the literature to identify existing frameworks assessing the quality of CJ deliberations. We then mapped the items constituting these frameworks onto the CJ goals; where none of the frameworks addressed one of the CJ goals, we generated additional items that did map onto the goal. Results This yielded a single operationalized deductive coding framework, consisting of four deliberation elements and four recommendation elements. The deliberation elements focus on the following: jurors’ preferences and values, engagement with each other, referencing expert information and enrichment of the deliberation. The recommendation elements focus on the following: reaching a clear and identifiable recommendation, whether the recommendation directly addresses the CJ question, justification for the recommendation and adoption of societal (rather than individual) perspective. To explore the alignment between this framework and the goals underlying CJs, we mapped the operationalized framework onto the transcripts of a CJ. Conclusion Results suggest that framework items map well onto what transpires in an actual CJ deliberation. Further testing of the validity, generalizability and reliability of the framework is planned.
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Affiliation(s)
- Anna Mae Scott
- Faculty of Health Sciences and Medicine, Centre for research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia
| | - Rebecca Sims
- Faculty of Health Sciences and Medicine, Centre for research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia
| | - Chris Degeling
- Research for Social Change, University of Wollongong, Wollongong, New South Wales, Australia
| | - Stacy Carter
- Research for Social Change, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Centre for research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia
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Thomas R, Sims R, Beller E, Scott AM, Doust J, Le Couteur D, Pond D, Loy C, Forlini C, Glasziou P. An Australian community jury to consider case-finding for dementia: Differences between informed community preferences and general practice guidelines. Health Expect 2019; 22:475-484. [PMID: 30714290 PMCID: PMC6543153 DOI: 10.1111/hex.12871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 01/13/2023] Open
Abstract
Background Case‐finding for dementia is practised by general practitioners (GPs) in Australia but without an awareness of community preferences. We explored the values and preferences of informed community members around case‐finding for dementia in Australian general practice. Design, setting and participants A before and after, mixed‐methods study in Gold Coast, Australia, with ten community members aged 50‐70. Intervention A 2‐day citizen/community jury. Participants were informed by experts about dementia, the potential harms and benefits of case‐finding, and ethical considerations. Primary and secondary outcomes We asked participants, “Should the health system encourage GPs to practice ‘case‐finding’ of dementia in people older than 50?” Case‐finding was defined as a GP initiating testing for dementia when the patient is unaware of symptoms. We also assessed changes in participant comprehension/knowledge, attitudes towards dementia and participants’ own intentions to undergo case‐finding for dementia if it were suggested. Results Participants voted unanimously against case‐finding for dementia, citing a lack of effective treatments, potential for harm to patients and potential financial incentives. However, they recognized that case‐finding was currently practised by Australian GPs and recommended specific changes to the guidelines. Participants increased their comprehension/knowledge of dementia, their attitude towards case‐finding became less positive, and their intentions to be tested themselves decreased. Conclusion Once informed, community jury participants did not agree case‐finding for dementia should be conducted by GPs. Yet their personal intentions to accept case‐finding varied. If case‐finding for dementia is recommended in the guidelines, then shared decision making is essential.
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Affiliation(s)
- Rae Thomas
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Rebecca Sims
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Jenny Doust
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - David Le Couteur
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Dimity Pond
- School of Medicine and Public Health, The University of Newcastle, Sydney, New South Wales, Australia
| | - Clement Loy
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Cynthia Forlini
- Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
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'I just want to be able to make a choice': Results from citizen deliberations about mammography screening in Ontario, Canada. Health Policy 2018; 122:1364-1371. [PMID: 30297301 DOI: 10.1016/j.healthpol.2018.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022]
Abstract
Despite Canada's long history with mammography screening, little is known about citizens' perspectives about mammography and how best to support women to make informed choices about screening. To address this gap, a series of four citizen deliberation events were held in 2015-16 in Ontario, a Canadian province with an organized population-based breast screening program in place since 1990. Forty-nine individuals participated in four citizen panels, each comprising an information session highlighting the evidence about mammography, and large- and small-group deliberations about approaches to support informed decision making for screening. Following their engagement with the research evidence about mammography, participants expressed concern about their lack of full awareness of the risks and benefits and a strong desire for choice when it comes to screening. To support informed choice, mammography programs need to reflect the values of information sharing, trust and transparency, financial accountability, and allow for personal interactions and shared decision-making. Citizens are looking for balanced information about the risks and benefits of screening presented in an easy to understand, comprehensive, and transparent manner. Primary health care providers and organized screening programs are important sources of information about mammography and must be vigilant in their efforts to support informed decision-making in this area by ensuring that the information materials they are using are balanced and reflect current evidence.
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Baena-Cañada JM, Luque-Ribelles V, Quílez-Cutillas A, Rosado-Varela P, Benítez-Rodríguez E, Márquez-Calderón S, Rivera-Bautista JM. How a deliberative approach includes women in the decisions of screening mammography: a citizens' jury feasibility study in Andalusia, Spain. BMJ Open 2018; 8:e019852. [PMID: 29730621 PMCID: PMC5942446 DOI: 10.1136/bmjopen-2017-019852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To verify whether a citizens' jury study is feasible to the Andalusian population and to know if women, when better informed, are able to answer the research question of whether the Andalusian Public Health System must continue offering screening mammography to women aged 50-69. The reasons for the pertinent decision and recommendations to the political authorities will be stated. DESIGN Qualitative research study with the methodology of citizens' jury. SETTING Breast cancer screening programme in Andalusia (Spain). PARTICIPANTS Thirteen women aged 50-69 with secondary school or higher education accepted to participate as a jury. Two epidemiologists were the expert witnesses. The main researcher was the neutral moderator. INTERVENTIONS Jury met on Monday, 15 February 2016. The moderator indicated to the jury that it had to assess the screening programme's key benefits and main harm. On Tuesday, 16 February, the expert witnesses positioned for and against the programme. On Thursday, 18 February, the jury deliberated, reached final conclusions, submitted its vote and stated its recommendations to politicians. The deliberation session was transcribed and analysed with the support of ATLAS.ti.5.2 software. PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility in the Andalusian population, women's vote and opinion, reasons for votes and recommendations to political authorities. RESULTS Eleven participants voted yes and two voted no. There are three reasons to vote 'yes': health, the test nature, and individual freedom. Some women invoke the lack of efficacy and the cost to justify their negative vote, at least in universal terms. On completion, they made suggestions to be submitted to the pertinent authorities for the improvement of information, psychology services and research. CONCLUSIONS The deliberative strategy is feasible and causes a favourable positioning regarding screening mammography, although information changes the opinion of some women, who desire informed decision making and to keep or increase medicalisation in their lives.
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Affiliation(s)
- José M Baena-Cañada
- Department of Medical Oncology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Violeta Luque-Ribelles
- Department of Psychology, School of Educational Sciences, Universidad de Cadiz, Cadiz, Spain
| | | | - Petra Rosado-Varela
- Hospital Universitario de Puerto Real, Medical Oncology, Puerto Real, Andalucía, Spain
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Tomlinson T, De Vries RG, Kim HM, Gordon L, Ryan KA, Krenz CD, Jewell S, Kim SYH. Effect of deliberation on the public's attitudes toward consent policies for biobank research. Eur J Hum Genet 2018; 26:176-185. [PMID: 29348694 PMCID: PMC5838972 DOI: 10.1038/s41431-017-0063-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 11/02/2017] [Accepted: 11/18/2017] [Indexed: 01/07/2023] Open
Abstract
In this study, we evaluate the effect of education and deliberation on the willingness of members of the public to donate tissue to biobank research and on their attitudes regarding various biobank consent policies. Participants were randomly assigned to a democratic deliberation (DD) group, an education group that received only written materials, and a control group. Participants completed a survey before the deliberation and two surveys post-deliberation: one on (or just after) the deliberation day, and one 4 weeks later. Subjects were asked to rate 5 biobank consent policies as acceptable (or not) and to identify the best and worst policies. Analyses compared acceptability of different policy options and changes in attitudes across the three groups. After deliberation, subjects in the DD group were less likely to find broad consent (defined here as consent for the use of donations in an unspecified range of future research studies, subject to content and process restrictions) and study-by-study consent acceptable. The DD group was also significantly less likely to endorse broad consent as the best policy (OR = 0.34), and more likely to prefer alternative consent options. These results raise ethical challenges to the current widespread reliance on broad consent in biobank research, but do not support study-by-study consent.
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Affiliation(s)
- Tom Tomlinson
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA.
| | - Raymond G De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - H Myra Kim
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Linda Gordon
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chris D Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Scott Jewell
- Van Andel Research Institute, Grand Rapids, MI, USA
| | - Scott Y H Kim
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Teo CH, Ling CJ, Ng CJ. Improving Health Screening Uptake in Men: A Systematic Review and Meta-analysis. Am J Prev Med 2018; 54:133-143. [PMID: 29254551 DOI: 10.1016/j.amepre.2017.08.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Globally, uptake of health screening in men remains low and the effectiveness of interventions to promote screening uptake in men is not well established. This review aimed to determine the effectiveness of interventions in improving men's uptake of and intention to undergo screening, including interventions using information and communication technology and a male-sensitive approach. EVIDENCE ACQUISITION Studies were sourced from five electronic databases (October 2015), experts, and references of included studies. This study included RCTs or cluster RCTs that recruited men and reported uptake of or intention to undergo screening. Two researchers independently performed study selection, appraisal, and data extraction. The interventions were grouped into those that increase uptake and those that promote informed decision making. They were further sub-analyzed according to types of intervention, male-sensitive, and web- and video-based interventions. The analysis was completed in December 2016. EVIDENCE SYNTHESIS This review included 58 studies. Most studies were on prostate cancer (k=31) and HIV (k=11) screening. Most of the studies had low methodologic quality (79.3%) and after excluding them from the analysis, one study found that educational intervention (which was also male-sensitive) was effective in improving men's intention to screen (risk ratio=1.36, 95% CI=1.23, 1.50, k=1) and partner educational intervention increased men's screening uptake (risk ratio=1.77, 95% CI=1.48, 2.12, k=1). Video-based educational interventions reduced prostate cancer screening uptake (risk ratio=0.89, 95%CI=0.80, 0.99, k=1) but web-based interventions did not change men's screening intention or uptake. CONCLUSIONS This review highlights the need to conduct more robust studies to provide conclusive evidence on the effectiveness of different interventions to improve men's screening behavior.
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Affiliation(s)
- Chin Hai Teo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Jun Ling
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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McGuiness CE, Turnbull D, Wilson C, Duncan A, Flight IH, Zajac I. Thinking Style as a Predictor of Men's Participation in Cancer Screening. Am J Mens Health 2017; 11:318-329. [PMID: 27923966 PMCID: PMC5675288 DOI: 10.1177/1557988316680913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 12/21/2022] Open
Abstract
Men's participation in cancer screening may be influenced by their thinking style. Men's need for cognition (NFC) and faith in intuition were measured to explore whether they varied by demographic variables or predicted screening behavior. Australian males ( n = 585, aged 50-74 years) completed surveys about past screening and were subsequently offered mailed fecal occult blood tests (FOBTs). Demographic predictors included age, socioeconomic status, educational attainment, and language spoken at home. The screening behaviors were self-reported prostate cancer screening (prostate-specific antigen testing and digital rectal examinations [DREs]), and colorectal cancer screening (self-reported FOBT participation and recorded uptake of the FOBT offer). Analysis comprised principal component analysis and structural equation modelling. NFC was positively related to demographic variables education, socioeconomic status, and speaking English at home. Faith in intuition was negatively related to educational attainment. NFC predicted variance in self-reported DRE participation ( r = .11, p = .016). No other relationships with thinking style were statistically significant. The relationship of NFC to DRE participation may reflect the way certain attributes of this screening method are processed, or alternatively, it may reflect willingness to report participation. The relationship of thinking style to a range of healthy behaviors should be further explored.
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Affiliation(s)
- Clare E. McGuiness
- The University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men’s Health, Adelaide, South Australia, Australia
- Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Deborah Turnbull
- The University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men’s Health, Adelaide, South Australia, Australia
| | - Carlene Wilson
- Cancer Council SA, Eastwood, South Australia, Australia
- Flinders University, Bedford Park, South Australia, Australia
| | - Amy Duncan
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Ingrid H. Flight
- Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Flinders University, Bedford Park, South Australia, Australia
| | - Ian Zajac
- Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
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13
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Thomas R, Sims R, Degeling C, Street JM, Carter SM, Rychetnik L, Whitty JA, Wilson A, Ward P, Glasziou P. CJCheck Stage 1: development and testing of a checklist for reporting community juries - Delphi process and analysis of studies published in 1996-2015. Health Expect 2016; 20:626-637. [PMID: 27704684 PMCID: PMC5513001 DOI: 10.1111/hex.12493] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 12/25/2022] Open
Abstract
Background Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer‐reviewed literature is unknown. Adequate reporting of methodology enables others to judge process quality, compare outcomes, facilitate critical reflection and potentially repeat a process. We aimed to identify important elements for reporting CJs, to develop an initial checklist and to review published health and health policy CJs to examine reporting standards. Design Using the literature and expertise from CJ researchers and policy advisors, a list of important CJ reporting items was suggested and further refined. We then reviewed published CJs within the health literature and used the checklist to assess the comprehensiveness of reporting. Results CJCheck was developed and examined reporting of CJ planning, juror information, procedures and scheduling. We screened 1711 studies and extracted data from 38. No studies fully reported the checklist items. The item most consistently reported was juror numbers (92%, 35/38), while least reported was the availability of expert presentations (5%, 2/38). Recruitment strategies were described in 66% of studies (25/38); however, the frequency and timing of deliberations was inadequately described (29%, 11/38). Conclusions Currently CJ publications in health and health policy literature are inadequately reported, hampering their use in policy making. We propose broadening the CJCheck by creating a reporting standards template in collaboration with international CJ researchers, policy advisors and consumer representatives to ensure standardized, systematic and transparent reporting.
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Affiliation(s)
- Rae Thomas
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
| | - Rebecca Sims
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
| | - Chris Degeling
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Jackie M Street
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jennifer A Whitty
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Paul Ward
- Discipline of Public Health, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
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14
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Kirpalani H, Truog WE, D'Angio CT, Cotten M. Recent controversies on comparative effectiveness research investigations: Challenges, opportunities, and pitfalls. Semin Perinatol 2016; 40:341-347. [PMID: 27423511 PMCID: PMC5222533 DOI: 10.1053/j.semperi.2016.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of comparative effectiveness research (CER) is to improve health outcomes by developing and disseminating evidence-based information about which currently available interventions and practices are most effective for patients. Randomized Controlled Trials (RCT) are the hallmark of scientific proof, and have been used to compare interventions used in variable ways by different clinicians (comparative effectiveness RCTs, CER-RCTs). But such CER-RCTs have at times generated controversy. Usually the background for the CER-RCT is a range of "standard therapy" or "standard of care." This may have been adopted on observational data alone, or pilot data. At times, such prior data may derive from populations that differ from the population in which the widely variable standard approach is being applied. We believe that controversies related to these CER-RCTs result from confusing "accepted" therapies and "rigorously evaluated therapies." We first define evidence-based medicine and consider how well neonatology conforms to that definition. We then contrast the approach of testing new therapies and those already existing and widely adopted, as in CER-RCTs. We next examine a central challenge in incorporating the control arm within CER-RCTs and aspects of the "titrated" trial. We finally briefly consider some ethical issues that have arisen, and discuss the wide range of neonatology practices that could be tested by CER-RCTs or alternative CER-based strategies that might inform practice. Throughout, we emphasize the lack of awareness of the lay community, and indeed many researchers or commentators, in appreciating the wide variation of standard of care. There is a corresponding need to identify the best uses of available resources that will lead to the best outcomes for our patients. We conclude that CER-RCTs are an essential methodology in modern neonatology to address many unanswered questions and test unproven therapies in newborn care.
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Affiliation(s)
- Haresh Kirpalani
- Professor Pediatrics Division Neonatology, The Children's Hospital of Philadelphia at University Pennsylvania Philadelphia PA USA ; and Emeritus Professor Clinical Epidemiology McMaster University Ontario
| | | | - Carl T. D'Angio
- Professor of Pediatrics and Medical Humanities & Bioethics, Division of Neonatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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15
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Gornick MC, Scherer AM, Sutton EJ, Ryan KA, Exe NL, Li M, Uhlmann WR, Kim SYH, Roberts JS, De Vries RG. Effect of Public Deliberation on Attitudes toward Return of Secondary Results in Genomic Sequencing. J Genet Couns 2016; 26:122-132. [PMID: 27307100 DOI: 10.1007/s10897-016-9987-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/02/2016] [Indexed: 01/16/2023]
Abstract
The increased use of genomic sequencing in clinical diagnostics and therapeutics makes imperative the development of guidelines and policies about how to handle secondary findings. For reasons both practical and ethical, the creation of these guidelines must take into consideration the informed opinions of the lay public. As part of a larger Clinical Sequencing Exploratory Research (CSER) consortium project, we organized a deliberative democracy (DD) session that engaged 66 participants in dialogue about the benefits and risks associated with the return of secondary findings from clinical genomic sequencing. Participants were educated about the scientific and ethical aspects of the disclosure of secondary findings by experts in medical genetics and bioethics, and then engaged in facilitated discussion of policy options for the disclosure of three types of secondary findings: 1) medically actionable results; 2) adult onset disorders found in children; and 3) carrier status. Participants' opinions were collected via surveys administered one month before, immediately following, and one month after the DD session. Post DD session, participants were significantly more willing to support policies that do not allow access to secondary findings related to adult onset conditions in children (Χ 2 (2, N = 62) = 13.300, p = 0.001) or carrier status (Χ 2 (2, N = 60) = 11.375, p = 0.003). After one month, the level of support for the policy denying access to secondary findings regarding adult-onset conditions remained significantly higher than the pre-DD level, although less than immediately post-DD (Χ 2 (1, N = 60) = 2.465, p = 0.041). Our findings suggest that education and deliberation enhance public appreciation of the scientific and ethical complexities of genome sequencing.
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Affiliation(s)
- Michele C Gornick
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA. .,Ann Arbor Veterans Affairs Health Services Research & Development, Ann Arbor, MI, USA.
| | - Aaron M Scherer
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA
| | - Erica J Sutton
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA
| | - Nicole L Exe
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA
| | - Ming Li
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Wendy R Uhlmann
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA.,Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA.,Molecular Medicine & Genetics, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Scott Y H Kim
- Department of Bioethics, National Institutes of Health, Bethesda, MA, USA
| | - J Scott Roberts
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA.,Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Raymond G De Vries
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 16, 457S, Ann Arbor, MI, 48109-2800, USA.,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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