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Jessani NS, Williamson RT, Choonara S, Gautier L, Hoe C, Jafar SK, Khalid AF, Rodríguez Salas I, Turcotte-Tremblay AM, Rodríguez DC. Evidence attack in public health: Diverse actors' experiences with translating controversial or misrepresented evidence in health policy and systems research. Glob Public Health 2022; 17:3043-3059. [PMID: 34996335 DOI: 10.1080/17441692.2021.2020319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bringing evidence into policy and practice discussions is political; more so when evidence from health studies or programme data are deemed controversial or unexpected, or when results are manipulated and misrepresented. Furthermore, opinion and misinformation in recent years has challenged our notions about how to achieve evidence-informed decision-making (EIDM). Health policy and systems (HPS) researchers and practitioners are battling misrepresentation that only serves to detract from important health issues or, worse, benefit powerful interests. This paper describes cases of politically and socially controversial evidence presented by researchers, practitioners and journalists during the Health Systems Research Symposium 2020. These cases cut across global contexts and range from public debates on vaccination, comprehensive sexual education, and tobacco to more inward debates around performance-based financing and EIDM in refugee policy. The consequences of engaging in controversial research include threats to commercial profit, perceived assaults on moral beliefs, censorship, fear of reprisal, and infodemics. Consequences for public health include research(er) hesitancy, contribution to corruption and leakage, researcher reflexivity, and ethical concerns within the HPS research and EIDM fields. Recommendations for supporting researchers, practitioners and advocates include better training and support structures for responding to controversy, safe spaces for sharing experiences, and modifying incentive structures.
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Affiliation(s)
- Nasreen S Jessani
- Centre for Evidence-Based Health CareStellenbosch University, Cape Town, South Africa.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Shakira Choonara
- Shakira Choonara Development Consulting, Johannesburg, South Africa
| | - Lara Gautier
- Département de Gestion, d'Évaluation et de Politique de Santé, École de Santé Publique de l'Université de Montréal, Montreal, Canada
| | - Connie Hoe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sakeena K Jafar
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | - Irene Rodríguez Salas
- Canadian Institutes of Health Research, Health System Impact Fellowship, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Anne-Marie Turcotte-Tremblay
- Health & Science Section, La Nación Newspaper, San José, Costa Rica.,Department of Global Health and Population, Harvard T.H. Chan School of Public health, Cambridge, MA, USA
| | - Daniela C Rodríguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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2
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Robinson PD, Vaughan S, Missaghi B, Meatherall B, Pattullo A, Kuhn S, Conly J. A case series of infectious complications in medical tourists requiring hospital admission or outpatient home parenteral therapy. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:64-74. [PMID: 36340853 PMCID: PMC9603019 DOI: 10.3138/jammi-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/09/2021] [Accepted: 09/24/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Travelling for medical care is increasing, and this medical tourism (MT) may have complications, notably infectious diseases (ID). We sought to identify MT-related infections (MTRIs) in a large Canadian health region and estimate resulting costs. METHODS Retrospective and prospective capture of post-MT cases requiring hospital admission or outpatient parenteral antimicrobial therapy was completed by canvassing ID physicians practising in Calgary, Alberta, from January 2017 to July 2019. Cost estimates for management were made with the Canadian Institute for Health Information's (CIHI's) patient cost estimator database tool applied to estimated rates of Canadians engaging in MT from a 2017 Fraser Institute report. RESULTS We identified 12 cases of MT-related infectious syndromes. Eight had microbial etiologies identified. MTs were young (mean 40.3 [SD 12.2] y) and female (n = 11) and pursued surgical treatment (n = 11). Destination countries and surgical procedures varied but were largely cosmetic (n = 5) and orthopaedic (n = 3). Duration to organism identification (mean 5.3 wk) and treatment courses (mean 19 wk) appeared lengthy. CIHI cost estimates for management of relevant infectious complications of our cases ranged from $6,288 to $20,741, with total cost for cases with matching codes (n = 8) totalling $94,290. CONCLUSIONS In our series of MTRIs, etiologic organisms often found in Canadian-performed post-procedural infections were identified, and prolonged treatment durations were noted. Young women pursuing cosmetic surgery may be a population to target with public health measures to reduce the incidence of MTRIs and burden of disease.
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Affiliation(s)
- Paul D Robinson
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Stephen Vaughan
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Synder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Bayan Missaghi
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie Meatherall
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Andrew Pattullo
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Susan Kuhn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - John Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Synder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
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3
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Abstract
AbstractThe beauty of science lies within its core assumption that it seeks to identify the truth, and as such, the truth stands alone and does not depend on the person who proclaims it. However, people's proclivity to succumb to various stereotypes is well known, and the scientific world may not be exceptionally immune to the tendency to judge a book by its cover. An interesting example is geographical bias, which includes distorted judgments based on the geographical origin of, inter alia, the given work and not its actual quality or value. Here, we tested whether both laypersons (N = 1532) and scientists (N = 480) are prone to geographical bias when rating scientific projects in one of three scientific fields (i.e., biology, philosophy, or psychology). We found that all participants favored more biological projects from the USA than China; in particular, expert biologists were more willing to grant further funding to Americans. In philosophy, however, laypersons rated Chinese projects as better than projects from the USA. Our findings indicate that geographical biases affect public perception of research and influence the results of grant competitions.
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Lavorgna L, Brigo F, Esposito S, Abbadessa G, Sparaco M, Lanzillo R, Moccia M, Inglese M, Bonfanti L, Trojsi F, Spina E, Russo A, De Micco P, Clerico M, Tedeschi G, Bonavita S. Public Engagement and Neurology: An Update. Brain Sci 2021; 11:429. [PMID: 33800571 PMCID: PMC8065487 DOI: 10.3390/brainsci11040429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Public engagement (PE) is defined as the involvement of "specialists who listen, develop their understanding, and interact with non-specialists in non-profit activities of educational, cultural, and social nature to engage the public in science-related matters". The public health relevance of PE consists in building up a scientifically literate society, able to participate in and support scientific and technological developments and their implications for educational settings. Neurological disorders account for 35% of all diseases. PE could have a positive impact on the lives of people affected by neurological diseases. METHOD This review evaluates the role of PE in dementia, stroke, epilepsy, multiple sclerosis, Parkinson's disease, migraine, neurogenetics, and amyotrophic lateral sclerosis. RESULTS AND CONCLUSIONS PE can provide accessible information, support research activities and prevention through appropriate lifestyles, and increase knowledge and awareness of neurological disorders, improving their diagnosis and treatment.
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Affiliation(s)
- Luigi Lavorgna
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), 39012 Merano, Italy;
| | - Sabrina Esposito
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Gianmarco Abbadessa
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Maddalena Sparaco
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Matilde Inglese
- Italy—OSPEDALE San Martino, IRCCS, University of Genova, 16132 Genoa, Italy;
| | - Luca Bonfanti
- Neuroscience Institute Cavalieri Ottolenghi (NICO), 10043 Orbassano, Italy;
- Department of Veterinary Sciences, University of Turin, 10095 Torino, Italy
| | - Francesca Trojsi
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Emanuele Spina
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Antonio Russo
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | | | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Torino, 10124 Turin, Italy;
| | - Gioacchino Tedeschi
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Simona Bonavita
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
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5
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Non-compliance with disease modifying therapies in patients with Multiple Sclerosis: A qualitative analysis. Mult Scler Relat Disord 2020; 41:102016. [DOI: 10.1016/j.msard.2020.102016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/17/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022]
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6
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Hynes SM, Ghahari S, Forwell SJ. "Waiting for Science to Catch up with Practice": an examination of 10-year YouTube trends in discussions of chronic cerebral spinal venous insufficiency treatment for multiple sclerosis. Inform Health Soc Care 2019; 44:327-337. [PMID: 30913949 DOI: 10.1080/17538157.2019.1582052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this longitudinal study examined, first, whether people with multiple sclerosis who previously advocated for angioplasty to treat chronic cerebral spinal venous insufficiency (CCSVI) through YouTube continued reporting benefits. Second, it examined a new cohort reporting on CCSVI treatment, and third, whether perspectives have changed.Method: YouTube videos from August 2011 to January 2019 related to CCSVI were retrieved. Once retrieved, all videos were compiled, classified and analyzed. Categorical data were reported and a pre-determined code-book was used to code videos. Data from the videos were extracted and analyzed using discourse analysis.Results: 1293 videos related to CCSVI were uploaded by 54 people with multiple sclerosis who met the inclusion criteria. YouTube videos uploaded by people with multiple sclerosis have shifted in volume and message. The initial surge in interest in CCSVI treatment has diminished, but there still exists strong advocates for its use. There appears to be an inconsistency between positive results, actual improvements in symptoms, and the overall messages reported. Very little long-term data was available as the procedure is relatively new.Conclusion: Practitioners may be faced with pressure to provide unproven treatments in the future and should be understanding but evidence-driven when supporting multiple sclerosis therapies.
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Affiliation(s)
- Sinéad M Hynes
- Discipline of Occupational Therapy, College of Medicine, Nursing and Health Sciences, Áras Moyola, National University of Ireland, Galway, Ireland
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.,Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Susan J Forwell
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
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7
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Benjaminy S, Lo C, Illes J, Traboulsee A. Reflections on translation: Views of participants in a multisite Canadian CCSVI clinical trial. Neurol Clin Pract 2018; 8:232-239. [PMID: 30105163 DOI: 10.1212/cpj.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/21/2018] [Indexed: 11/15/2022]
Abstract
Background We sought to characterize the perspectives of participants in Canada's phase I/II chronic cerebrospinal venous insufficiency (CCSVI) clinical trial prior to and after the disclosure of trial results. Methods This was a researcher-administered survey of individuals who participated in Canada's CCSVI trial (Clincialtrials.gov, NCT01864941) about their (1) motivations for participating, (2) understanding of the trial process, and (3) perspectives on the social value of the trial. Results A total of 63 participants completed the survey. Participants were motivated to participate by altruism (mean score = 4.56 out of 5) and a desire to access the intervention in Canada (mean score = 3.63 out of 5). Many participants expected medical benefits, such as partial disease reversal (mean score = 3.32 out of 5). Participants felt strongly that the crossover trial design promoted fairness (mean score = 4.65 out of 5). Participants' familiarity with the CCSVI controversy increased significantly after the results were revealed (p = 0.0001). Despite negative trial results, participants still felt that the trial was an appropriate use of tax dollars (mean score = 4.68 out of 5). Many (38%) upheld the belief that further CCSVI research is necessary (responses of 4 out of 5 or higher). Conclusions There is a strong movement in science today to ensure that research agendas reflect the perspectives of multiple stakeholders, including research participants. While previous work suggests that negative findings adversely affect trust in science, the perspectives of participants in this study demonstrate that good trial design and resilience can prevail over expected tensions.
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Affiliation(s)
- Shelly Benjaminy
- Neuroethics Canada (SB, CL, JI) and Division of Neurology, Department of Medicine (SB, CL, JI, AT), University of British Columbia, Vancouver, Canada. SB is currently affiliated with AbilityLab, Chicago, IL
| | - Cody Lo
- Neuroethics Canada (SB, CL, JI) and Division of Neurology, Department of Medicine (SB, CL, JI, AT), University of British Columbia, Vancouver, Canada. SB is currently affiliated with AbilityLab, Chicago, IL
| | - Judy Illes
- Neuroethics Canada (SB, CL, JI) and Division of Neurology, Department of Medicine (SB, CL, JI, AT), University of British Columbia, Vancouver, Canada. SB is currently affiliated with AbilityLab, Chicago, IL
| | - Anthony Traboulsee
- Neuroethics Canada (SB, CL, JI) and Division of Neurology, Department of Medicine (SB, CL, JI, AT), University of British Columbia, Vancouver, Canada. SB is currently affiliated with AbilityLab, Chicago, IL
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8
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Bajuk Studen K, Pfeifer M. Cardiometabolic risk in polycystic ovary syndrome. Endocr Connect 2018; 7:R238-R251. [PMID: 29844207 PMCID: PMC6026886 DOI: 10.1530/ec-18-0129] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/29/2018] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age. Besides hyperandrogenism, oligomenorrhea and fertility issues, it is associated with a high prevalence of metabolic disorders and cardiovascular risk factors. Several genetic polymorphisms have been identified for possible associations with cardiometabolic derangements in PCOS. Different PCOS phenotypes differ significantly in their cardiometabolic risk, which worsens with severity of androgen excess. Due to methodological difficulties, longer time-scale data about cardiovascular morbidity and mortality in PCOS and about possible beneficial effects of different treatment interventions is missing leaving many issues regarding cardiovascular risk unresolved.
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Affiliation(s)
- Katica Bajuk Studen
- Nuclear Medicine DepartmentUniversity Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marija Pfeifer
- Faculty of MedicineUniversity of Ljubljana, Ljubljana, Slovenia
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9
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Benjaminy S, Schepmyer A, Illes J, Traboulsee A. Resilience, trust, and civic engagement in the post-CCSVI era. BMC Health Serv Res 2018; 18:366. [PMID: 29769084 PMCID: PMC5956844 DOI: 10.1186/s12913-018-3130-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 04/16/2018] [Indexed: 12/27/2022] Open
Abstract
Background Scientific and financial investments in chronic cerebrospinal venous insufficiency (CCSVI) research have been made to address both the hope for and scepticism over this interventional strategy for MS. Despite limited evidence in support of the CCSVI hypothesis, the funding of clinical research was responsive to a demand by the public rarely seen in the history of medicine. We characterize patient perspectives about the CCSVI research trajectory, with particular attention to its impact on other non-pharmaceutical areas of MS research with a focus on stem cell interventions. Methods Semi-structured interviews with 20 MS patients across Canada who did not have CCSVI interventions. Interviews were analysed for recurring themes and individual variations using the constant comparative approach. Results Participants had a critical view of the divestment of funds from longstanding research to support CCSVI trials. They retain a sense of optimism, however, about emerging evidence for stem cell interventions for MS, and highlight the need for greater caution and conscientious communication of advances in medicine and science. Conclusions The unrealized hopes for CCSVI challenged but did not undermine the resilience of patient communities. The narrative that unfolded highlights the importance of drawing a socially-minded space for public participation in science.
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Affiliation(s)
- Shelly Benjaminy
- Neuroethics Canada, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Illinois, Canada.,Current: Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Andrew Schepmyer
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Illinois, Canada
| | - Judy Illes
- Neuroethics Canada, University of British Columbia, Vancouver, Canada.
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Illinois, Canada.
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10
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Rotstein DL, Chen H, Wilton AS, Kwong JC, Marrie RA, Gozdyra P, Krysko KM, Kopp A, Copes R, Tu K. Temporal trends in multiple sclerosis prevalence and incidence in a large population. Neurology 2018; 90:e1435-e1441. [DOI: 10.1212/wnl.0000000000005331] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/16/2018] [Indexed: 12/30/2022] Open
Abstract
ObjectiveWe sought to better understand the reasons for increasing prevalence of multiple sclerosis (MS) by studying prevalence in relation to incidence, mortality rates, sex ratio, and geographic distribution of cases.MethodsWe identified MS cases from 1996 to 2013 in Ontario, Canada, by applying a validated algorithm to health administrative data. We calculated age- and sex-standardized prevalence and incidence rates for the province and by census division. Incidence and prevalence sex ratios for women to men were computed.ResultsThe prevalence of MS increased by 69% from 1.57 (95% confidence interval [CI]: 1.54–1.59) per 1,000 in 1996 (n = 12,155) to 2.65 (95% CI: 2.62–2.68) in 2013 (n = 28,192). Incidence remained relatively stable except for a spike in 2010, followed by a subsequent decline in 2011–2013, particularly among young people and men. Mortality decreased by 33% from 26.7 (95% CI: 23.5–30.3) per 1,000 to 18.0 (95% CI: 16.4–19.8) per 1,000. The incidence sex ratio was stable from 1996 to 2009, then declined in 2010, with partial rebound by 2013. MS prevalence and incidence showed no consistent association with latitude.ConclusionIn this large, population-based MS cohort, we found stable incidence and increasing prevalence of MS; the latter largely reflected declining mortality. A spike in incidence in 2010 among younger patients and men at a time of widespread media coverage of MS suggests that these groups may be vulnerable to delayed diagnosis. We did not find a latitudinal gradient; however, most Ontarians live between the 42nd and 46th parallels, reducing our ability to detect an effect of latitude.
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11
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Driedger SM, Maier R, Marrie RA, Brouwers M. Caught in a no-win situation: discussions about CCSVI between persons with multiple sclerosis and their neurologists - a qualitative study. BMC Neurol 2017; 17:176. [PMID: 28882115 PMCID: PMC5590111 DOI: 10.1186/s12883-017-0954-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/27/2017] [Indexed: 12/05/2022] Open
Abstract
Background In recent years, shared decision making (SDM) has been promoted as a model to guide interactions between persons with MS and their neurologists to reach mutually satisfying decisions about disease management – generally about deciding treatment courses of prevailing disease modifying therapies. In 2009, Dr. Paolo Zamboni introduced the world to his hypothesis of Chronic Cerebrospinal Venous Insufficiency (CCSVI) as a cause of MS and proposed venous angioplasty (‘liberation therapy’) as a potential therapy. This study explores the discussions that took place between persons with MS (PwMS) and their neurologists about CCSVI against the backdrop of the recent calls for the use of SDM to guide clinical conversations. Methods In 2012, study researchers conducted focus groups with PwMS (n = 69) in Winnipeg, Canada. Interviews with key informants were also carried out with 15 participants across Canada who were stakeholders in the MS community: advocacy organizations, MS clinicians (i.e. neurologists, nurses), clinical researchers, and government health policy makers. Results PwMS reported a variety of experiences when attempting to discuss CCSVI with their neurologist. Some found that there was little effort to engage in desired discussions or were dissatisfied with critical or cautious stances of their neurologist. This led to communication breakdowns, broken relationships, and decisions to autonomously access alternative opinions or liberation therapy. Other participants were appreciative when clinicians engaged them in discussions and were more receptive to more critical appraisals of the evidence. Key informants reported that they too had heard of neurologists who refused to discuss CCSVI with patients and that neurology as a whole had been particularly vilified for their response to the hypothesis. Clinicians indicated that they had shared information as best they could but recommended against seeking liberation therapy. They noted that being respectful of patient emotions, values, and hope were also key to maintaining good relationships. Conclusions While CCSVI proved a challenging context to carry out patient-physician discussions and brought numerous tensions to the surface, following the approach of SDM can minimize the potential for unfortunate outcomes as much as possible because it is based on principles of respect and more two-way communication. Electronic supplementary material The online version of this article (10.1186/s12883-017-0954-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ryan Maier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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Abstract
Although hearing loss is common in old age and associated with a variety of negative outcomes, hearing aids and related services are not covered by Medicare or many other forms of insurance. Out-of-pocket costs are expensive and thus serve as a barrier for many individuals. Efforts at the national level to broaden coverage can confront surprising or unexpected opposition from a variety of groups. This article discusses how an experience as an Atlantic Philanthropies Health and Aging Policy Fellow helped inform how gaining an understanding of the positions held by such stakeholder groups is critical to developing strategies to promote a more effective payment structure that would improve access to hearing care. The implications for nurses desiring to influence policy are also highlighted.
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13
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Bakker C, Stephenson C, Stephenson E, Chaves D. Public Funding and Open Access to Research: A Review of Canadian Multiple Sclerosis Research. J Med Internet Res 2017; 19:e52. [PMID: 28242594 PMCID: PMC5348618 DOI: 10.2196/jmir.6250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/15/2016] [Accepted: 01/31/2017] [Indexed: 11/13/2022] Open
Abstract
Background Multiple sclerosis (MS), a progressive demyelinating disease of the brain and spinal cord, is the leading cause of nontraumatic neurological damage in young adults. Canada has one of the highest reported incidents of MS, with estimates between 55 and 240 per 100,000 individuals. Between 2009 and 2014, the MS Society of Canada provided over Can $90 million to researchers and, since 2013, has encouraged researchers to make both current and previous research products openly available. Objective The goal of the study was to determine the open access (OA) cost implications and repository policies of journals frequently used by a sample of MS researchers. This study benchmarked current publishing preferences by MS Society of Canada researchers by examining the OA full-text availability of journal articles written by researchers funded between 2009 and 2014. Methods Researchers were identified from the 2009 to 2014 annual MS Society of Canada Research Summaries. Articles were identified through searches in Web of Science, Scopus, Medline and Embase (both via OVID). Journal level analysis included comparison of OA policies, including article processing charges (APCs) and repository policies. Data were analyzed using descriptive statistics. Results There were 758 articles analyzed in this study, of which 288 (38.0%) were OA articles. The majority of authors were still relying on journal policies for deposit in PubMed Central or availability on publisher websites for OA. Gold OA journals accounted for 10.2% of the journals in this study and were associated with significantly lower APCs (US $1900) than in hybrid journals (US $3000). Review of the journal self-archiving options highlighted the complexity of stipulations that authors would have to navigate to legally deposit a version of their article. Conclusions This study found that there are currently researcher- and publisher-imposed barriers to both the gold and green roads to OA. These results provide a current benchmark against which efforts to enhance openness can be measured and can serve as a reference point in future assessments of the impact of OA policies within this field. With funding agencies worldwide releasing OA mandates, future success in compliance will require changes to how researchers and publishers approach production and dissemination of research.
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Affiliation(s)
- Caitlin Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | - Carol Stephenson
- Council of Prairie and Pacific University Libraries, Vancouver, BC, Canada
| | - Erin Stephenson
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Debbie Chaves
- Library, Wilfrid Laurier University, Waterloo, ON, Canada
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Ghahari S, Forwell SJ. Social Media Representation of Chronic Cerebrospinal Venous Insufficiency Intervention for Multiple Sclerosis. Int J MS Care 2016; 18:49-57. [PMID: 27134577 DOI: 10.7224/1537-2073.2014-073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND We conducted a rigorous review of videos related to multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) treatment posted by people with MS on one social media website (YouTube) that describe symptoms before and after the surgical procedure, as well as videos presented by health-care professionals (HCPs). METHODS All relevant videos posted from December 2009 to July 2011 were downloaded, viewed, and systematically organized. Categorical data were classified, and dominant messages were gleaned. RESULTS A total of 1789 videos were extracted. A total of 621 videos by people with MS and 238 by HCPs were included. Eighty-six percent of people with MS anecdotally reported experiencing some improvement in at least one symptom. The most common message was that "CCSVI is not a miracle but worth trying." Most HCPs posting videos recommended the procedure but called for continued research. CONCLUSIONS Social media are conveying an anecdotal favorable message about CCSVI treatment for MS. The relative absence of videos offering a negative or more balanced perspective is a concern. Social persuasion through these videos creates a strong positive impression of CCSVI treatment, but the videos do not acknowledge the lack of supporting scientific evidence and the possible role of the placebo effect. Given the strong influence of social media on health-care decision making, researchers and clinicians should actively use social media to reach out to people with MS and describe the state of the evidence for MS treatments, both positive and negative.
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Affiliation(s)
- Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada (SG); Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (SG); and Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada (SJF)
| | - Susan J Forwell
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada (SG); Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (SG); and Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada (SJF)
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Racine E, Forlini C, Aspler J, Chandler J. Complementary and Alternative Medicine in the Context of Earlier Diagnoses of Alzheimer’s Disease: Opening the Conversation to Prepare Ethical Responses. J Alzheimers Dis 2016; 51:1-9. [DOI: 10.3233/jad-150534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eric Racine
- Institut de recherches cliniques de Montréal, Neuroethics Research Unit, Montréal, QC, Canada
- Université de Montréal, Department of Medicine and Department of Social and Preventive Medicine, Montréal, QC, Canada
- McGill University, Department of Neurology and Neurosurgery, Division of Experimental Medicine & Biomedical Ethics Unit, Montréal, QC, Canada
| | - Cynthia Forlini
- University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - John Aspler
- Institut de recherches cliniques de Montréal, Neuroethics Research Unit, Montréal, QC, Canada
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Griffiths F, Dobermann T, Cave JAK, Thorogood M, Johnson S, Salamatian K, Gomez Olive FX, Goudge J. The Impact of Online Social Networks on Health and Health Systems: A Scoping Review and Case Studies. POLICY & INTERNET 2015; 7:473-496. [PMID: 27134699 PMCID: PMC4841174 DOI: 10.1002/poi3.97] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/31/2015] [Accepted: 05/01/2015] [Indexed: 06/03/2023]
Abstract
Interaction through online social networks potentially results in the contestation of prevailing ideas about health and health care, and to mass protest where health is put at risk or health care provision is wanting. Through a review of the academic literature and case studies of four social networking health sites (PatientsLikeMe, Mumsnet, Treatment Action Campaign, and My Pro Ana), we establish the extent to which this phenomenon is documented, seek evidence of the prevalence and character of health-related networks, and explore their structure, function, participants, and impact, seeking to understand how they came into being and how they sustain themselves. Results indicate mass protest is not arising from these established health-related networking platforms. There is evidence of changes in policy following campaigning activity prompted by experiences shared through social networking such as improved National Health Service care for miscarriage (a Mumsnet campaign). Platform owners and managers have considerable power to shape these campaigns. Social networking is also influencing health policy indirectly through increasing awareness and so demand for health care. Transient social networking about health on platforms such as Twitter were not included as case studies but may be where the most radical or destabilizing influence on health care policy might arise.
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Curbing Inflammation in Multiple Sclerosis and Endometriosis: Should Mast Cells Be Targeted? Int J Inflam 2015; 2015:452095. [PMID: 26550518 PMCID: PMC4624887 DOI: 10.1155/2015/452095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 09/28/2015] [Indexed: 12/16/2022] Open
Abstract
Inflammatory diseases and conditions can arise due to responses to a variety of external and internal stimuli. They can occur acutely in response to some stimuli and then become chronic leading to tissue damage and loss of function. While a number of cell types can be involved, mast cells are often present and can be involved in the acute and chronic processes. Recent studies in porcine and rabbit models have supported the concept of a central role for mast cells in a “nerve-mast cell-myofibroblast axis” in some inflammatory processes leading to fibrogenic outcomes. The current review is focused on the potential of extending aspects of this paradigm into treatments for multiple sclerosis and endometriosis, diseases not usually thought of as having common features, but both are reported to have activation of mast cells involved in their respective disease processes. Based on the discussion, it is proposed that targeting mast cells in these diseases, particularly the early phases, may be a fruitful avenue to control the recurring inflammatory exacerbations of the conditions.
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Gordie Howe’s Stem Cell ‘Miracle’: A Qualitative Analysis of News Coverage and Readers’ Comments in Newspapers and Sports Websites. Stem Cell Rev Rep 2015; 11:667-75. [DOI: 10.1007/s12015-015-9606-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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19
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Koschack J, Weibezahl L, Friede T, Himmel W, Makedonski P, Grabowski J. Scientific Versus Experiential Evidence: Discourse Analysis of the Chronic Cerebrospinal Venous Insufficiency Debate in a Multiple Sclerosis Forum. J Med Internet Res 2015; 17:e159. [PMID: 26133525 PMCID: PMC4526971 DOI: 10.2196/jmir.4103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/02/2015] [Accepted: 04/19/2015] [Indexed: 01/26/2023] Open
Abstract
Background The vascular hypothesis of multiple sclerosis (MS), called chronic cerebrospinal venous insufficiency (CCSVI), and its treatment (known as liberation therapy) was immediately rejected by experts but enthusiastically gripped by patients who shared their experiences with other patients worldwide by use of social media, such as patient online forums. Contradictions between scientific information and lay experiences may be a source of distress for MS patients, but we do not know how patients perceive and deal with these contradictions. Objective We aimed to understand whether scientific and experiential knowledge were experienced as contradictory in MS patient online forums and, if so, how these contradictions were resolved and how patients tried to reconcile the CCSVI debate with their own illness history and experience. Methods By using critical discourse analysis, we studied CCSVI-related posts in the patient online forum of the German MS Society in a chronological order from the first post mentioning CCSVI to the time point when saturation was reached. For that time period, a total of 117 CCSVI-related threads containing 1907 posts were identified. We analyzed the interaction and communication practices of and between individuals, looked for the relation between concrete subtopics to identify more abstract discourse strands, and tried to reveal discourse positions explaining how users took part in the CCSVI discussion. Results There was an emotionally charged debate about CCSVI which could be generalized to 2 discourse strands: (1) the “downfall of the professional knowledge providers” and (2) the “rise of the nonprofessional treasure trove of experience.” The discourse strands indicated that the discussion moved away from the question whether scientific or experiential knowledge had more evidentiary value. Rather, the question whom to trust (ie, scientists, fellow sufferers, or no one at all) was of fundamental significance. Four discourse positions could be identified by arranging them into the dimensions “trust in evidence-based knowledge,” “trust in experience-based knowledge,” and “subjectivity” (ie, the emotional character of contributions manifested by the use of popular rhetoric that seemed to mask a deep personal involvement). Conclusions By critical discourse analysis of the CCSVI discussion in a patient online forum, we reconstruct a lay discourse about the evidentiary value of knowledge. We detected evidence criteria in this lay discourse that are different from those in the expert discourse. But we should be cautious to interpret this dissociation as a sign of an intellectual incapability to understand scientific evidence or a naïve trust in experiential knowledge. Instead, it might be an indication of cognitive dissonance reduction to protect oneself against contradictory information.
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Affiliation(s)
- Janka Koschack
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.
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Snyder J, Adams K, Chen YY, Birch D, Caulfield T, Cohen IG, Crooks VA, Illes J, Zarzeczny A. Navigating physicians' ethical and legal duties to patients seeking unproven interventions abroad. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2015; 61:584-e298. [PMID: 26175363 PMCID: PMC4501596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Jeremy Snyder
- Associate Professor in the Faculty of Health Sciences at Simon Fraser University in Burnaby, BC.
| | - Krystyna Adams
- Doctoral candidate in the Faculty of Health Sciences at Simon Fraser University
| | - Y Y Chen
- Doctoral candidate in juridical science in the Faculty of Law at the University of Toronto in Ontario
| | - Daniel Birch
- Associate Professor in the Department of Surgery at the Universityof Alberta in Edmonton
| | - Timothy Caulfield
- Canada Research Chair in Health Law and Policy and Professor in the Faculty of Law and the School of Public Health at the University of Alberta
| | - I Glenn Cohen
- Professor of Law at Harvard Law School in Cambridge, Mass
| | - Valorie A Crooks
- Associate Professor in the Department of Geography at Simon Fraser University
| | - Judy Illes
- Professor of Neurology and Canada Research Chair in Neuroethics at the University of British Columbia in Vancouver
| | - Amy Zarzeczny
- Assistant Professor in the Johnson-Shoyama Graduate School of Public Policy at the University of Regina in Saskatchewan
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21
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Driedger SM, Weimer J. Factiva and Canadian Newsstand Major Dailies. ONLINE INFORMATION REVIEW 2015. [DOI: 10.1108/oir-11-2014-0276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Scholars rely on electronic databases to conduct searches and locate relevant citations. The purpose of this paper is to compare the retrieval results on the same topic (multiple sclerosis and liberation therapy) of two commonly used databases for searching print news media: ProQuest’s Canadian Newsstand Major Dailies and Dow Jones’ Factiva.
Design/methodology/approach
– A case study comparing two electronic searchable databases using the same keywords, date range, and newspaper-specific search parameters across three Canadian university institutions.
Findings
– Considerable differences were found between institutional searches using Factiva. Factiva allows all individual users the capacity to establish systems-wide “administrator” privileges, thereby controlling the output for subsequent users if these preferences are not changed. The capacity for individual users to tailor searches within Canadian Newsstand Major Dailies was more in line with standard protocols for institutions paying for single user accounts with access to multiple sessions within that same institution: any user-specific searching/retrieval preferences are individually contained within a search and do not influence the searches of a different user.
Research limitations/implications
– What began as a comparative analysis of two commonly used databases for searching print news media turned into an examination of larger systemic problems. The findings call into question several factors: the integrity of a researcher-generated data set; the quality of results published in peer-reviewed journals based on researcher-generated data sets derived from established e-resource databases; the reliability of the same e-resource database across multiple institutions; and the quality of e-resource databases for scholarly research when developed to serve primarily non-academic clients.
Originality/value
– No comparison of this kind for these particular e-resource databases has been documented in the literature. In fact, the scholarly publications that address questions of functionality and reliability of either Factiva or Proquest have not brought this issue into the discussion. Therefore, this study furthers academic discourse on the nature and reliability of database use at any academic institution and illustrates that researchers, in a variety of academic fields, cannot depend on the reliability of their search results without thoroughly consulting the various settings of their database.
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22
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Rosenfield D, Strickland M, Hepburn CM. Translating evidence into impact: The case of 'supermagnet' desk toys. Paediatr Child Health 2015; 20:175-8. [PMID: 26038632 DOI: 10.1093/pch/20.4.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Matt Strickland
- Department of Surgery, University of Toronto, Toronto, Ontario
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23
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Ploughman M, Manning OJ, Beaulieu S, Harris C, Hogan SH, Mayo N, Fisk JD, Sadovnick AD, O'Connor P, Morrow SA, Metz LM, Smyth P, Allderdice PW, Scott S, Marrie RA, Stefanelli M, Godwin M. Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case-control study. BMC Health Serv Res 2015; 15:161. [PMID: 25881078 PMCID: PMC4424567 DOI: 10.1186/s12913-015-0835-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/06/2015] [Indexed: 11/17/2022] Open
Abstract
Background Following the initial reports of Chronic Cerebrospinal Venous Insufficiency (CCSVI) and the purported curative potential of venoplasty, (coined the ‘liberation’ procedure) Canadians living with multiple sclerosis (MS) began to travel abroad to receive the unregulated procedure, often placing them at odds with their health providers. The purpose of this study was to determine the factors influencing older MS patients’ decision to undergo the procedure in order to develop more specific and targeted health information. Methods We performed secondary analysis of data collected as part of the ‘Canadian Survey of Health Lifestyle and Aging with MS’ from people over the age of 55 years with MS symptoms for 20 or more years. The survey consisted of self-reported information on impairments, disability, participation, demographics, personal and environmental factors. In order to compare respondents who underwent the procedure to those who did not and to develop a predictive model, we created a comparison group using a case–control algorithm, controlling for age, gender and education, and matching procedure cases to controls 1:3. We used multivariate stepwise least likelihood regression of ‘a priori’ variables to determine predictive factors. Results The prevalence of the ‘liberation’ procedure in our sample was 12.8% (95/743), substantially lower than reported in previous studies of complementary/alternative treatments in MS. The predictive model contained five factors; living alone (Odds ratio 0.24, 95%CI 0.09-0.63), diagnosis of anxiety (Odds ratio 0.29, 95%CI 0.10 - 0.84), rating of neurologist’s helpfulness (Odds ratio 0.56, 95%CI 0.44 -0 .71), Body Mass Index (Odds ratio 0.93, 95%CI, 0.89 - 0.98) and perceived physical impact of MS (Odds ratio 1.02, 95%CI 1.01 - 1.04). Conclusions Predictive factors differed from previous studies of complementary/alternative treatment use likely due to both the invasiveness of the procedure and the advanced age of our study cohort. Our findings suggest that health professionals should target information on the risks and benefits of unregulated procedures to those patients who feel dissatisfied with their neurologist and they should include family members in discussions since they may be providing the logistical support to travel abroad and undergo the ‘liberation’ procedure. Our findings may be applicable to others with chronic disabling conditions who contemplate the user-pay unregulated invasive procedures available to them. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0835-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Ploughman
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | - Olivia J Manning
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | | | - Chelsea Harris
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | - Stephen H Hogan
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | - Nancy Mayo
- Clinical Epidemiology, McGill University, Montreal, QC, Canada.
| | - John D Fisk
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - A Dessa Sadovnick
- Department of Medical Genetics and Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Paul O'Connor
- Department of Neurology, St. Michaels Regional Hospital, Toronto, ON, Canada.
| | | | - Luanne M Metz
- Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
| | - Penelope Smyth
- Department of Neurology, University of Alberta, Edmonton, AB, Canada.
| | - Penelope W Allderdice
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | - Susan Scott
- Clinical Epidemiology, McGill University, Montreal, QC, Canada.
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Mark Stefanelli
- Department of Neurology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
| | - Marshall Godwin
- Primary Health Care Research Unit, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
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Tsivgoulis G, Faissner S, Voumvourakis K, Katsanos AH, Triantafyllou N, Grigoriadis N, Gold R, Krogias C. "Liberation treatment" for chronic cerebrospinal venous insufficiency in multiple sclerosis: the truth will set you free. Brain Behav 2015; 5:3-12. [PMID: 25722945 PMCID: PMC4321389 DOI: 10.1002/brb3.297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/19/2014] [Accepted: 10/23/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Chronic cerebrospinal venous insufficiency (CCSVI) has recently been introduced as a chronic state of impaired cerebral or cervical venous drainage that may be causally implicated in multiple sclerosis (MS) pathogenesis. Moreover, percutaneous transluminal angioplasty of extracranial veins termed "Liberation treatment" has been proposed (based on nonrandomized data) as an alternative therapy for MS. METHODS A comprehensive literature search was conducted to identify available published, peer-reviewed, clinical studies evaluating (1) the association of CCSVI with MS, (2) the reproducibility of proposed ultrasound criteria for CCSVI detection (3) the safety and efficacy of "Liberation treatment" in open-label and randomized-controlled trial (RCT) settings. RESULTS There is substantial heterogeneity between ultrasound case-control studies investigating the association of CCSVI and MS. The majority of independent investigators failed to reproduce the initially reported high prevalence rates of CCSVI in MS. The prevalence of extracranial venous stenoses evaluated by other neuroimaging modalities (contrast or MR venography) is similarly low in MS patients and healthy individuals. One small RCT failed to document any benefit in MS patients with CCSVI receiving "Liberation treatment", while an exacerbation of disease activity was observed. "Liberation treatment" has been complicated by serious adverse events (SAEs) in open-label studies (e.g., stroke, internal jugular vein thrombosis, stent migration, hydrocephalus). CONCLUSION CCSVI appears to be a poorly reproducible and clinically irrelevant sonographic construct. "Liberation treatment" has no proven efficacy, may exacerbate underlying disease activity and has been complicated with SAEs. "Liberation treatment" should stop being offered to MS patients even in the settings of RCTs.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens Athens, Greece ; International Clinical Research Center, Department of Neurology, St. Anne's University Hospital Brno, Czech Republic ; Department of Neurology, University of Tennessee Health Science Center Memphis, TN
| | - Simon Faissner
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Konstantinos Voumvourakis
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens Athens, Greece
| | - Aristeidis H Katsanos
- Department of Neurology, School of Medicine, University of Ioannina Ioannina, Greece
| | - Nikos Triantafyllou
- First Department of Neurology, "Eginition" Hospital, School of Medicine, University of Athens Athens, Greece
| | - Nikolaos Grigoriadis
- Department of Neurology, Laboratory of Experimental Neurology and Neuroimmunology, AHEPA Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
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Murray CL, Ploughman M, Harris C, Hogan S, Murdoch M, Stefanelli M. The Liberation Procedure Decision-Making Experience for People With Multiple Sclerosis. Glob Qual Nurs Res 2014; 1:2333393614551413. [PMID: 28462292 PMCID: PMC5287319 DOI: 10.1177/2333393614551413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/12/2014] [Indexed: 11/16/2022] Open
Abstract
Despite the absence of scientific evidence demonstrating the efficacy of the "liberation procedure" in treating multiple sclerosis (MS), thousands of MS patients worldwide have undergone the procedure. The study objective was to explore the experience of liberation procedure decision making for individuals with MS. Fifteen adults in Newfoundland and Labrador, Canada, each participated in an in-depth interview. The data analysis revealed three groups of people: "waiters," "early embracers," and "late embracers." Using van Manen's hermeneutic phenomenological approach, we identified three themes each in the stories of the early and late embracers and four themes in the waiters' stories. A characteristic of the late embracers and waiters was skepticism, whereas desperation set the embracers apart from the waiters. With a deeper understanding of the experience, nurses can be more attuned to the perspectives of MS patients while helping them make informed decisions about undergoing the liberation procedure.
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Affiliation(s)
- Cynthia L Murray
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Chelsea Harris
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Stephen Hogan
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Murdoch
- Coalition of Persons With Disabilities, St. John's, Newfoundland and Labrador, Canada
| | - Mark Stefanelli
- Memorial University, St. John's, Newfoundland and Labrador, Canada
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Snyder J, Adams K, Crooks VA, Whitehurst D, Vallee J. "I knew what was going to happen if I did nothing and so I was going to do something": faith, hope, and trust in the decisions of Canadians with multiple sclerosis to seek unproven interventions abroad. BMC Health Serv Res 2014; 14:445. [PMID: 25265935 PMCID: PMC4263058 DOI: 10.1186/1472-6963-14-445] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 09/23/2014] [Indexed: 11/23/2022] Open
Abstract
Background Chronic cerebrospinal venous insufficiency (CCSVI) treatment is an unproven intervention aimed at relieving some of the symptoms of multiple sclerosis (MS). Despite limited evidence of the efficacy and safety of this intervention, Canadians diagnosed with MS have been traveling abroad to access this procedure as it is not available domestically outside of limited clinical trials. This paper discusses the experiences of Canadians with MS seeking CCSVI treatment abroad. Methods This paper presents a secondary analysis of 15 interviews with participants who had gone abroad for CCSVI treatment. Interviews were conducted over the phone between October 2012 and December 2012. All interviews were digitally recorded and transcribed verbatim. Transcripts were hand coded for: 1) why CCSVI treatment was sought and where it was obtained; 2) the role of having hope for a cure in seeking CCSVI; 3) the impact of MS on everyday life; and 4) the role other people played in the decision to go abroad. Results The authors identified loss of faith, hope, and trust as themes emerging from the transcripts. The participants experienced a loss of faith with the Canadian health system and especially the neurologists who were responsible for their care and the classification of MS as a neurological disease. Access to CCSVI treatment abroad generated hope in these participants, but they were cautious in their expectations, focusing on symptom management rather than a cure. Trust in their caregivers abroad was generated through the recommendations of other MS sufferers and the credentials of their caregivers abroad. Conclusions By deciding to seek an unproven intervention abroad, these individuals took on responsibility for their care from the Canadian health system. While evidence of the efficacy of CCSVI treatment is limited, the participants felt that they were making a rational care decision, focusing on the empowerment and renewed hope generated by seeking this intervention. Health professionals and policy makers globally should consider the causes of loss of faith in their domestic care systems and balance the benefits of empowerment and renewed hope against concerns that unproven interventions may create new health risks.
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Affiliation(s)
- Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, Canada.
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Affiliation(s)
- Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Mike P Wattjes
- MS Center Amsterdam, Department of Radiology, Nuclear Medicine, and PET Research, VU University Medical Center, Amsterdam, Netherlands
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Ploughman M, Harris C, Hogan SH, Murray C, Murdoch M, Austin MW, Stefanelli M. Navigating the "liberation procedure": a qualitative study of motivating and hesitating factors among people with multiple sclerosis. Patient Prefer Adherence 2014; 8:1205-13. [PMID: 25228799 PMCID: PMC4164287 DOI: 10.2147/ppa.s65483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The debate within the multiple sclerosis (MS) community initiated by the chronic cerebrospinal venous insufficiency (CCSVI) hypothesis and the subsequent liberation procedure placed some people with MS at odds with health care professionals and researchers. OBJECTIVE This study explored decision making regarding the controversial liberation procedure among people with MS. SUBJECTS AND METHODS Fifteen people with MS (procedure, n=7; no procedure, n=8) participated in audiotaped semistructured interviews exploring their thoughts and experiences related to the liberation procedure. Data were transcribed and analyzed using an iterative, consensus-based, thematic content-analysis approach. RESULTS Participants described an imbalance of motivating factors affirming the procedure compared to hesitating factors that provoked the participant to pause or reconsider when deciding to undergo the procedure. Collegial conversational relationships with trusted sources (eg, MS nurse, neurologist) and ability to critically analyze the CCSVI hypothesis were key hesitating factors. Fundraising, family enthusiasm, and the ease of navigation provided by medical tourism companies helped eliminate barriers to the procedure. CONCLUSION Knowledge of factors that helped to popularize the liberation procedure in Canada may inform shared decision making concerning this and future controversies in MS.
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Affiliation(s)
- Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John’s, NL, Canada
- Correspondence: Michelle Ploughman, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, 4th floor, LA Miller Centre, 100 Forest Road, St John’s, NL A1A 1E5, Canada, Tel +1 709 777 2099, Email
| | - Chelsea Harris
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John’s, NL, Canada
| | - Stephen H Hogan
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John’s, NL, Canada
| | - Cynthia Murray
- School of Nursing, Memorial University, St John’s, NL, Canada
| | - Michelle Murdoch
- Coalition of Persons with Disabilities, Memorial University, St John’s, NL, Canada
| | - Mark W Austin
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John’s, NL, Canada
| | - Mark Stefanelli
- Department of Neurology, Faculty of Medicine, Memorial University, St John’s, NL, Canada
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Zivadinov R, Chung CP. Potential involvement of the extracranial venous system in central nervous system disorders and aging. BMC Med 2013; 11:260. [PMID: 24344742 PMCID: PMC3866257 DOI: 10.1186/1741-7015-11-260] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 11/22/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system. DISCUSSION A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow. SUMMARY Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
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Van den Berg PJ, Visser LH. The fluctuating natural course of CCSVI in MS patients and controls, a prospective follow-up. PLoS One 2013; 8:e78166. [PMID: 24260106 PMCID: PMC3833990 DOI: 10.1371/journal.pone.0078166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/16/2013] [Indexed: 11/22/2022] Open
Abstract
Objectives A new treatable venous disorder, chronic cerebrospinal venous insufficiency (CCSVI), has been proposed in patients with multiple sclerosis. The natural course of CCSVI has not been examined yet. This is crucial given the fact that surgical procedures are increasingly offered to MS patients to treat venous stenosis. Methods To document the natural course of venous haemodynamics we performed extra- and transcranial echo colour Doppler (ECD) in 52 multiple sclerosis patients and 28 healthy controls (HC) and re-examined this group after a median period of 16 weeks. The reexamination was done being blinded to the initial findings and the patients did not undergo any intervention. Results The ECD examination at baseline showed CCSVI in 5 (9.6%) of the 52 multiple sclerosis patients and 0 HC (P = 0.26). At follow-up the diagnosis CCSVI could not be reconfirmed in 3 out of 5 patients at follow-up, while 2 new CCSVI-positive multiple sclerosis patients were detected. Conclusions ECD examination shows a fluctuating natural course of the extracranial venous haemodynamics, which makes determination of CCSVI by ECD examination unreliable.
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Affiliation(s)
| | - Leo H. Visser
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
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Rasminsky M, terBrugge K. Goodbye to all that: a short history of CCSVI. Mult Scler 2013; 19:1425-7. [DOI: 10.1177/1352458513502400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Rasminsky
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Karel terBrugge
- Department of Radiology, University of Toronto, Toronto, Canada
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