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Kalkman S, Wevers RA, Wijburg FA, Leeflang MMG. A framework for evaluating long-term impact of newborn screening. Eur J Hum Genet 2024; 32:146-149. [PMID: 37789082 PMCID: PMC10853266 DOI: 10.1038/s41431-023-01469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Shona Kalkman
- Health Council of the Netherlands, Bezuidenhoutseweg 30, The Hague, The Netherlands.
| | - Ron A Wevers
- Department of Human Genetics, Translational Metabolic Laboratory (TML), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frits A Wijburg
- Department of Metabolic Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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2
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Kalkman S, Wevers RA, Wijburg FA, Leeflang MMG. Correction: A framework for evaluating long-term impact of newborn screening. Eur J Hum Genet 2024; 32:247. [PMID: 38017188 PMCID: PMC10853264 DOI: 10.1038/s41431-023-01501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Affiliation(s)
- Shona Kalkman
- Health Council of the Netherlands, Bezuidenhoutseweg 30, The Hague, The Netherlands.
| | - Ron A Wevers
- Department of Human Genetics, Translational Metabolic Laboratory (TML), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frits A Wijburg
- Department of Metabolic Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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3
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Kalkman S, Dondorp W. The case for screening in early life for 'non-treatable' disorders: ethics, evidence and proportionality. A report from the Health Council of the Netherlands. Eur J Hum Genet 2022; 30:1155-1158. [PMID: 35132176 PMCID: PMC9554018 DOI: 10.1038/s41431-022-01055-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/25/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
In the Netherlands, the call to add 'non-treatable' disorders to the newborn bloodspot screening programme has found a sympathetic ear with the Government. In 2019, the Health Council of the Netherlands was formally asked for advice on the conditions under which bloodspot screening for such disorders might be offered. Here we present the reasoning and the recommendations of the resulting report, and briefly discuss its reception. The report holds on to the classical view that screening must benefit the child, but argues for a wider account of child benefit than only in terms of substantial health gains. However, screening for 'non-treatable' disorders would still require evidence of a favourable benefits to harm ratio. The report presents a framework for such screening, but concludes that apart perhaps from Duchenne Muscular Dystrophy (DMD), no or only very few 'non-treatable' disorders would at present meet its criteria. Setting up a screening programme that might benefit only a small percentage of families struggling with uncertainty about their child's diagnosis would not seem proportional. Instead, the Government is advised to invest in a better infrastructure for early referral, testing and care. The reaction to the report from proponents of such screening shows that the dividing line in the debate is not about whether screening neonates for 'non-treatable' disorders is acceptable in itself. It is rather whether such screening should be regarded as catering to a parental 'right to know', or as a public health service that should be subject to standards of evidence and proportionality.
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Affiliation(s)
- Shona Kalkman
- Health Council of the Netherlands, The Hague, the Netherlands
| | - Wybo Dondorp
- Dept of Health, Ethics & Society, School for Public Health & Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands.
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4
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Kalkman S, van Delden J, Banerjee A, Tyl B, Mostert M, van Thiel G. Patients' and public views and attitudes towards the sharing of health data for research: a narrative review of the empirical evidence. J Med Ethics 2022; 48:3-13. [PMID: 31719155 PMCID: PMC8717474 DOI: 10.1136/medethics-2019-105651] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION International sharing of health data opens the door to the study of the so-called 'Big Data', which holds great promise for improving patient-centred care. Failure of recent data sharing initiatives indicates an urgent need to invest in societal trust in researchers and institutions. Key to an informed understanding of such a 'social license' is identifying the views patients and the public may hold with regard to data sharing for health research. METHODS We performed a narrative review of the empirical evidence addressing patients' and public views and attitudes towards the use of health data for research purposes. The literature databases PubMed (MEDLINE), Embase, Scopus and Google Scholar were searched in April 2019 to identify relevant publications. Patients' and public attitudes were extracted from selected references and thematically categorised. RESULTS Twenty-seven papers were included for review, including both qualitative and quantitative studies and systematic reviews. Results suggest widespread-though conditional-support among patients and the public for data sharing for health research. Despite the fact that participants recognise actual or potential benefits of data research, they expressed concerns about breaches of confidentiality and potential abuses of the data. Studies showed agreement on the following conditions: value, privacy, risk minimisation, data security, transparency, control, information, trust, responsibility and accountability. CONCLUSIONS Our results indicate that a social license for data-intensive health research cannot simply be presumed. To strengthen the social license, identified conditions ought to be operationalised in a governance framework that incorporates the diverse patient and public values, needs and interests.
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Affiliation(s)
- Shona Kalkman
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Benoît Tyl
- Cardiovascular Center for Therapeutic Innovation, Institut de Recherches Internationales Servier, Suresnes, France
| | - Menno Mostert
- Julius Center for Health Sciences and Primary Care, Medical Humanities, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ghislaine van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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5
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van Lier PAC, Kalkman S. [The value of booster vaccination against COVID-19]. Ned Tijdschr Geneeskd 2021; 165:D6623. [PMID: 35138763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The first vaccines against Covid-19 were approved in December 2020 and administered in the Netherlands from the beginning of January 2021. As of November 2021, The Dutch government has started its booster programme to administer an additional vaccine dose to the population.This paper discusses the current knowledge about the duration of protection of the Covid-19 vaccines that are used in the Netherlands, and the added value of booster vaccination.
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6
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Muller SHA, Kalkman S, van Thiel GJMW, Mostert M, van Delden JJM. The social licence for data-intensive health research: towards co-creation, public value and trust. BMC Med Ethics 2021; 22:110. [PMID: 34376204 PMCID: PMC8353823 DOI: 10.1186/s12910-021-00677-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background The rise of Big Data-driven health research challenges the assumed contribution of medical research to the public good, raising questions about whether the status of such research as a common good should be taken for granted, and how public trust can be preserved. Scandals arising out of sharing data during medical research have pointed out that going beyond the requirements of law may be necessary for sustaining trust in data-intensive health research. We propose building upon the use of a social licence for achieving such ethical governance. Main text We performed a narrative review of the social licence as presented in the biomedical literature. We used a systematic search and selection process, followed by a critical conceptual analysis. The systematic search resulted in nine publications. Our conceptual analysis aims to clarify how societal permission can be granted to health research projects which rely upon the reuse and/or linkage of health data. These activities may be morally demanding. For these types of activities, a moral legitimation, beyond the limits of law, may need to be sought in order to preserve trust. Our analysis indicates that a social licence encourages us to recognise a broad range of stakeholder interests and perspectives in data-intensive health research. This is especially true for patients contributing data. Incorporating such a practice paves the way towards an ethical governance, based upon trust. Public engagement that involves patients from the start is called for to strengthen this social licence. Conclusions There are several merits to using the concept of social licence as a guideline for ethical governance. Firstly, it fits the novel scale of data-related risks; secondly, it focuses attention on trustworthiness; and finally, it offers co-creation as a way forward. Greater trust can be achieved in the governance of data-intensive health research by highlighting strategic dialogue with both patients contributing the data, and the public in general. This should ultimately contribute to a more ethical practice of governance. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00677-5.
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Affiliation(s)
- Sam H A Muller
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands.
| | - Shona Kalkman
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Ghislaine J M W van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Menno Mostert
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
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7
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Indrakusuma R, Kalkman S, Koelemay MJW, Balm R, Willems DL. Context-Relative Norms Determine the Appropriate Type of Consent in Clinical Biobanks: Towards a Potential Solution for the Discrepancy between the General Data Protection Regulation and the European Data Protection Board on Requirements for Consent. Sci Eng Ethics 2020; 26:3271-3284. [PMID: 33048326 PMCID: PMC7755864 DOI: 10.1007/s11948-020-00271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
Clinical biobanks processing data of participants in the European Union (EU) fall under the scope of the General Data Protection Regulation (GDPR), which among others includes requirements for consent. These requirements are further specified by the Article 29 Working Party (WP29)-an EU advisory body currently known as the European Data Protection Board (EDPB). Unfortunately, their guidance is cause for some confusion. While the GDPR allows participants to give broad consent for research when specific research purposes are still unknown, the WP29 guidelines suggest that additional consent for specific uses should be obtained in addition to broad consent when this becomes applicable. This discrepancy elicits the question whether clinical biobanks can fail the requirement of consent if they obtain broad consent, but not a specific consent for each biomedical study. We analysed this discrepancy within the framework of contextual integrity, in order to describe the context-relative informational norms that govern information flows in clinical biobanks. However, our analysis demonstrates that there is no uniform set of norms that can be applied to all clinical biobanks. As such, neither the GDPR nor the WP29 guidance can act as a "one size fits all" approach to all clinical biobanks. Rather, differences between clinical biobanks-especially regarding the scientific aims and patient populations-make the case for context-relative norms that determine the appropriate type of consent.
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Affiliation(s)
- R. Indrakusuma
- Amsterdam UMC, Department of Surgery, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - S. Kalkman
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | - M. J. W. Koelemay
- Amsterdam UMC, Department of Surgery, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - R. Balm
- Amsterdam UMC, Department of Surgery, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - D. L. Willems
- Amsterdam UMC, Department of General Practice, Section of Medical Ethics, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Riza E, Kalkman S, Coritsidis A, Koubardas S, Vassiliu S, Lazarou D, Karnaki P, Zota D, Kantzanou M, Psaltopoulou T, Linos A. Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices. Healthcare (Basel) 2020; 8:E115. [PMID: 32354069 PMCID: PMC7349376 DOI: 10.3390/healthcare8020115] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project. METHODS A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices. RESULTS In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7). CONCLUSION A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Alexandra Coritsidis
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8434, USA
| | - Sotirios Koubardas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Sofia Vassiliu
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Despoina Lazarou
- Institute of Human Sciences, Wadham College, University of Oxford, Oxford OX1 3PN, UK
| | - Panagiota Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athena Linos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
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9
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Kalkman S, Mostert M, Udo-Beauvisage N, van Delden JJ, van Thiel GJ. Responsible data sharing in a big data-driven translational research platform: lessons learned. BMC Med Inform Decis Mak 2019; 19:283. [PMID: 31888593 PMCID: PMC6936121 DOI: 10.1186/s12911-019-1001-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/09/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To foster responsible data sharing in health research, ethical governance complementary to the EU General Data Protection Regulation is necessary. A governance framework for Big Data-driven research platforms will at least need to consider the conditions as specified a priori for individual datasets. We aim to identify and analyze these conditions for the Innovative Medicines Initiative's (IMI) BigData@Heart platform. METHODS We performed a unique descriptive case study into the conditions for data sharing as specified for datasets participating in BigData@Heart. Principle investigators of 56 participating databases were contacted via e-mail with the request to send any kind of documentation that possibly specified the conditions for data sharing. Documents were qualitatively reviewed for conditions pertaining to data sharing and data access. RESULTS Qualitative content analysis of 55 relevant documents revealed overlap on the conditions: (1) only to share health data for scientific research, (2) in anonymized/coded form, (3) after approval from a designated review committee, and while (4) observing all appropriate measures for data security and in compliance with the applicable laws and regulations. CONCLUSIONS Despite considerable overlap, prespecified conditions give rise to challenges for data sharing. At the same time, these challenges inform our thinking about the design of an ethical governance framework for data sharing platforms. We urge current data sharing initiatives to concentrate on: (1) the scope of the research questions that may be addressed, (2) how to deal with varying levels of de-identification, (3) determining when and how review committees should come into play, (4) align what policies and regulations mean by "data sharing" and (5) how to deal with datasets that have no system in place for data sharing.
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Affiliation(s)
- S Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands.
- Servier Monde, 50 Rue Carnot, 92284, Suresnes, France.
| | - M Mostert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands
| | | | - J J van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands
| | - G J van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands
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10
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Riza E, Kalkman S, Karnaki P, Zota D, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, Linos A. Best practices addressing healthcare care access of migrants and refugees in European countries. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Mig-healthCare has identified sources in the countries and languages of the consortium providing guidance for community-based healthcare for migrants and refugees. A total of 54 sources that refer to best practices in seven European countries were identified. Results were categorized along with the themes: organization, communication, training, education and facilities & services. Successful organizational measures were a close collaboration with different governmental authorities, NGOs, community organizations and various local service providers. Moreover, engagement with members from both the host community and the migrant/refugee community in the design and implementation phases is essential. The need to track all activities through data collection and periodic evaluations is important in order to evaluate the effectiveness of systems. Funding was mentioned as important to secure continuity of projects and systems. Bridging communication barriers is a major facilitator to reduce health disparities. Differences in the types of practices and challenges per country were noted. Translators and cultural mediators are a key element in successful implementation, but across EU there is a need for more specialized staff to face the cultural barriers of the large variation in refugee/migrant backgrounds. The empowerment of migrants/refugees in promoting well-being through the engagement of the host community to help reduce stigma and discrimination is a successful strategy facilitating the access to care due to the increase of their health literacy skills. Finally, tailored services to give an answer to the specific needs of migrants and refugees are important, for example at first reception centres, standard medical screening and psychosocial risk assessment was recommended. Through this analysis, we can distinguish community-based care models elements facilitating the access of migrants and refugees to healthcare.
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Affiliation(s)
- E Riza
- National and Kapodistrian University of Athens, Athens, Greece
| | - S Kalkman
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - D Zota
- Prolepsis Institute, Athens, Greece
| | - A Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - E Durá-Ferrandis
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - J Garcés-Ferrer
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - A Linos
- Prolepsis Institute, Athens, Greece
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Kalkman S, Mostert M, Gerlinger C, van Delden JJM, van Thiel GJMW. Responsible data sharing in international health research: a systematic review of principles and norms. BMC Med Ethics 2019; 20:21. [PMID: 30922290 PMCID: PMC6437875 DOI: 10.1186/s12910-019-0359-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Large-scale linkage of international clinical datasets could lead to unique insights into disease aetiology and facilitate treatment evaluation and drug development. Hereto, multi-stakeholder consortia are currently designing several disease-specific translational research platforms to enable international health data sharing. Despite the recent adoption of the EU General Data Protection Regulation (GDPR), the procedures for how to govern responsible data sharing in such projects are not at all spelled out yet. In search of a first, basic outline of an ethical governance framework, we set out to explore relevant ethical principles and norms. METHODS We performed a systematic review of literature and ethical guidelines for principles and norms pertaining to data sharing for international health research. RESULTS We observed an abundance of principles and norms with considerable convergence at the aggregate level of four overarching themes: societal benefits and value; distribution of risks, benefits and burdens; respect for individuals and groups; and public trust and engagement. However, at the level of principles and norms we identified substantial variation in the phrasing and level of detail, the number and content of norms considered necessary to protect a principle, and the contextual approaches in which principles and norms are used. CONCLUSIONS While providing some helpful leads for further work on a coherent governance framework for data sharing, the current collection of principles and norms prompts important questions about how to streamline terminology regarding de-identification and how to harmonise the identified principles and norms into a coherent governance framework that promotes data sharing while securing public trust.
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Affiliation(s)
- Shona Kalkman
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands.
| | - Menno Mostert
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands
| | - Christoph Gerlinger
- Statistics and Data Insights, Bayer AG, Berlin, Germany
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands
| | - Ghislaine J M W van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands
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12
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Kalkman S, van Thiel GJMW, Grobbee DE, van Delden JJM. Pragmatic clinical trials: ethical imperatives and opportunities. Drug Discov Today 2018; 23:1919-1921. [PMID: 29906514 DOI: 10.1016/j.drudis.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/08/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shona Kalkman
- Julius Center for Health Sciences Primary Care, University Medical Center Utrecht, Utrecht, Utrecht University, The Netherlands.
| | - Ghislaine J M W van Thiel
- Julius Center for Health Sciences Primary Care, University Medical Center Utrecht, Utrecht, Utrecht University, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences Primary Care, University Medical Center Utrecht, Utrecht, Utrecht University, The Netherlands
| | - Johannes J M van Delden
- Julius Center for Health Sciences Primary Care, University Medical Center Utrecht, Utrecht, Utrecht University, The Netherlands
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13
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Bulte JP, Halilovic A, Kalkman S, van Cleef PHJ, van Diest PJ, Strobbe LJA, de Wilt JHW, Bult P. Assessment of HER2 status in breast cancer biopsies is not affected by accelerated tissue processing. Histopathology 2018; 73:81-89. [PMID: 29495112 DOI: 10.1111/his.13507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/27/2022]
Abstract
AIMS To establish whether core needle biopsy (CNB) specimens processed with an accelerated processing method with short fixation time can be used to determine accurately the human epidermal growth factor receptor 2 (HER2) status of breast cancer. METHODS AND RESULTS A consecutive case-series from two high-volume breast clinics was created. We compared routine HER2 immunohistochemistry (IHC) assessment between accelerated processing CNB specimens and routinely processed postoperative excision specimens. Additional amplification-based testing was performed in cases with equivocal results. The formalin fixation time was less than 2 h and between 6 and 72 h, respectively. Fluorescence in-situ hybridisation and multiplex ligation-dependent probe amplification were used for amplification testing. One hundred and forty-four cases were included, 15 of which were HER2-positive on the routinely processed excision specimens. On the CNB specimens, 44 were equivocal on IHC and required an amplification-based test. Correlation between the CNB specimens and the corresponding excision specimens was high for final HER2 status, with an accuracy of 97% and a kappa of 0.85. CONCLUSIONS HER2 status can be determined reliably on CNB specimens with accelerated processing time using standard clinical testing methods. Using this accelerated technology the minimum 6 h of formalin fixation, which current guidelines consider necessary, can be decreased safely. This allows for a complete and expedited histology-based diagnosis of breast lesions in the setting of a one-stop-shop, same-day breast clinic.
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Affiliation(s)
- Joris P Bulte
- Department of General Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Altuna Halilovic
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Shona Kalkman
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Johannes H W de Wilt
- Department of General Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
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14
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Kalkman S, Kim SYH, van Thiel GJMW, Grobbee DE, van Delden JJM. Ethics of Informed Consent for Pragmatic Trials with New Interventions. Value Health 2017; 20:902-908. [PMID: 28712619 DOI: 10.1016/j.jval.2017.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Pragmatic trials evaluate the comparative benefits, risks, and burdens of health care interventions in real-world conditions. Such studies are now recognized as valuable to the perimarketing stage of drug development and evaluation, with early pragmatic trials (EPTs) being explored as a means to generate real-world evidence at the time of regulatory market approval. In this article, we present an analysis of the ethical issues involved in informed consent for EPTs, in light of the generally recognized concern that traditional ethical rules governing randomized clinical trials, such as lengthy informed consent procedures, could threaten the "real world" nature of such trials. Specifically, we examine to what extent modifications (waivers or alterations) to regulatory consent for EPTs would be ethical. METHODS We first identify broadly accepted necessary conditions for modifications of informed consent (namely, the research involves no more than minimal risk of harm, the research is impracticable with regulatory consent, and the alternative to regulatory consent does not violate legitimate patient expectations) and then apply those criteria to the premarket and early postmarket contexts. RESULTS AND CONCLUSIONS The analysis shows that neither waivers nor alterations of regulatory consent for premarket EPTs will be ethically permissible. For postmarket EPTs with newly approved interventions, waivers of consent will be ethically problematic, but some studies might be conducted in an ethical manner with alterations to regulatory consent.
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Affiliation(s)
- Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Scott Y H Kim
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ghislaine J M W van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Oude Rengerink K, Kalkman S, Collier S, Ciaglia A, Worsley SD, Lightbourne A, Eckert L, Groenwold RHH, Grobbee DE, Irving EA. Series: Pragmatic trials and real world evidence: Paper 3. Patient selection challenges and consequences. J Clin Epidemiol 2017; 89:173-180. [PMID: 28502808 DOI: 10.1016/j.jclinepi.2016.12.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/02/2016] [Accepted: 12/12/2016] [Indexed: 12/29/2022]
Abstract
This paper addresses challenges of identifying, enrolling, and retaining participants in a trial conducted within a routine care setting. All patients who are potential candidates for the treatments in routine clinical practice should be considered eligible for a pragmatic trial. To ensure generalizability, the recruited sample should have a similar distribution of the treatment effect modifiers as the target population. In practice, this can be best achieved by including-within the selected sites-all patients without further selection. If relevant heterogeneity between subgroups is expected, increasing the relative proportion of the subgroup of patients in the heterogeneous trial could be considered (oversampling) or a separate trial in this subgroup can be planned. Selection will nevertheless occur. Low enrollment and loss to follow-up can introduce selection and can jeopardize validity as well as generalizability. Pragmatic trials are conducted in clinical practice rather than in a dedicated research setting, which could reduce recruitment rates. However, if a trial poses a minimal burden to the physician and the patient and routine clinical practice is maximally adhered to, the participation rate may be high and loss to follow-up will not be a specific problem for pragmatic trials.
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Affiliation(s)
- Katrien Oude Rengerink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands.
| | - Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands
| | - Susan Collier
- RD Respiratory Fibrosis DPU Clinical Development Pharma Research and Development GSK Stockley Park West, 1-3 Ironbridge Road, Uxbridge, Middlesex UB11 1BT, UK
| | - Antonio Ciaglia
- International Alliance of Patients' Organizations, 49-51 East Road, London N1 6AH, UK
| | - Sally D Worsley
- Real World Study Delivery, GSK Research & Development, Gunnels Wood Rd, Stevenage SG1 2NY, UK
| | - Alison Lightbourne
- International Alliance of Patients' Organizations, 49-51 East Road, London N1 6AH, UK
| | - Laurent Eckert
- Health Economics and Outcome Research, Sanofi Global Maket Access Center of Excellence, Chilly-Mazarin, France
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands; Julius Clinical, Broederplein 41-43, Zeist 3703 CD, The Netherlands
| | - Elaine A Irving
- Real World Study Delivery, GSK Research & Development, Gunnels Wood Rd, Stevenage SG1 2NY, UK
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16
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Kalkman S, van Thiel G, van der Graaf R, Zuidgeest M, Goetz I, Grobbee D, van Delden J. The Social Value of Pragmatic Trials. Bioethics 2017; 31:136-143. [PMID: 28060433 DOI: 10.1111/bioe.12315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 08/29/2016] [Accepted: 10/06/2016] [Indexed: 06/06/2023]
Abstract
Pragmatic trials aim to directly inform health care decision-making through the collection of so-called 'real world data' from observations of comparative treatment effects in clinical practice. In order to ensure the applicability and feasibility of a pragmatic trial, design features may be necessary that deviate from standard research ethics requirements. Examples are traditional requirements to seek written informed consent and to perform extensive data and safety monitoring. Proposals for deviations from standard research ethics practice have resulted in controversy about their ethical acceptability. One of the justifications for altered procedures is the allegedly high social value of pragmatic trials. In order to properly operationalize the concept in the ethical assessment of pragmatic trial designs, specification is warranted. We identified three determinants from common claims about a pragmatic trial's social value: (1) the extent to which the research question has real world relevance, (2) the trial design's ability to generate a real world answer and (3) the probability of direct uptake of the results by decision-makers in practice. Subsequently, we discuss how these determinants should be applied to the practice of pragmatic trials, and to what extent they might be applicable to explanatory trials.
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17
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Kalkman S, van Delden JJM. It Takes Two Teams to Save Integrity. Ann Thorac Surg 2016; 102:1789. [DOI: 10.1016/j.athoracsur.2016.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/02/2016] [Indexed: 11/29/2022]
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18
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Kalkman S, van Thiel GJMW, Grobbee DE, Meinecke AK, Zuidgeest MGP, van Delden JJM. Stakeholders' views on the ethical challenges of pragmatic trials investigating pharmaceutical drugs. Trials 2016; 17:419. [PMID: 27550379 PMCID: PMC4994208 DOI: 10.1186/s13063-016-1546-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We explored the views of key stakeholders to identify the ethical challenges of pragmatic trials investigating pharmaceutical drugs. A secondary aim was to capture stakeholders' attitudes towards the implementation of pragmatic trials in the drug development process. METHODS We conducted semistructured, in-depth interviews among individuals from different key stakeholder groups (academia and independent research institutions, the pharmaceutical industry, regulators, Health Technology Assessment (HTA) agencies and patients' organizations) through telephone or face-to-face sessions. Interviews were structured around the question "what challenges were experienced or perceived during the design, conduct and/or review of pragmatic trials." Respondents were additionally asked about their views on implementation of pragmatic trials in the drug development process. Thematic analysis was used to identify the ethically relevant features across data sets. RESULTS We interviewed 34 stakeholders in 25 individual sessions and four group sessions. The four perceived challenges of ethical relevance were: (1) less controlled conditions creating safety concerns, (2) comparison with usual care potentially compromising clinical equipoise, (3) tailored or waivers of informed consent affecting patient autonomy, and (4) minimal interference with "real-world" practice reducing the knowledge value of trial results. CONCLUSIONS We identified stakeholder concerns regarding risk assessment, use of suboptimal usual care as a comparator, tailoring of informed consent procedures and ensuring the social value of pragmatic trials. These concerns increased when respondents were asked about pragmatic trials conducted before market authorization.
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Affiliation(s)
- Shona Kalkman
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Ghislaine J M W van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Mira G P Zuidgeest
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
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19
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Kalkman S, van Thiel GJMW, Grobbee DE, van Delden JJM. Pragmatic randomized trials in drug development pose new ethical questions: a systematic review. Drug Discov Today 2015; 20:856-62. [PMID: 25794600 DOI: 10.1016/j.drudis.2015.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/02/2015] [Accepted: 03/11/2015] [Indexed: 11/19/2022]
Abstract
Implementation of pragmatic design elements in drug development could bridge the evidence gap that currently exists between the knowledge we have regarding the efficacy of a drug versus its true, comparative effectiveness in real life. We performed a review of the literature to identify the ethical challenges thus far related to pragmatic trials. The three central ethical questions identified for pragmatic trials are: (i) what level of oversight should pragmatic trials require; (ii) do randomized patients face additional risks; and (iii) is a waiver of informed consent ethically defensible? Despite the fact all reviewed publications dealt with post-launch pragmatic trials, these results could serve as an important starting point for conceptualizing which challenges could potentially arise in the pre-launch setting.
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Affiliation(s)
- Shona Kalkman
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Ghislaine J M W van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Diederick E Grobbee
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
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20
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Kalkman S, van Diest PJ. Brief fixation and hormone receptor expression in breast cancer: authors' reply. Am J Surg Pathol 2015; 39:425-6. [PMID: 25581735 DOI: 10.1097/pas.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Shona Kalkman
- Department of Pathology, University Medical Center Utrecht, Utrecht The Netherlands
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21
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Kalkman S, Bulte JP, Halilovic A, Bult P, van Diest PJ. Brief fixation does not hamper the reliability of Ki67 analysis in breast cancer core-needle biopsies: a double-centre study. Histopathology 2014; 66:380-7. [PMID: 25234295 DOI: 10.1111/his.12521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/03/2014] [Indexed: 12/20/2022]
Abstract
AIMS Immunohistochemical assessment of Ki67 expression in core-needle biopsies (CNBs) is increasingly playing a role in therapeutic decision-making for breast cancer patients. Within the framework of same-day diagnosis of breast lesions, fixation times are markedly decreased. We therefore attempted to validate Ki67 analysis in briefly fixed breast cancer CNBs. METHODS AND RESULTS CNBs of 136 consecutive patients with invasive breast cancer diagnosed through the same-day diagnosis programme of both the University Medical Centre Utrecht (UMCU) and the Radboud University Medical Centre (RUMC) were included. CNBs were fixed in formaldehyde for approximately 45 min at the UMCU and for between 60 and 90 min at the RUMC. Immunohistochemistry for Ki67 expression was compared between the briefly fixed CNBs and conventionally fixed resection specimens of the same tumour. The overall agreement between CNBs and resections was 122 of 142 (85.9%) (κ = 0.71; 95% CI 0.60-0.83). Positive and negative predictive values were 79.7% (95% CI 67-88%) and 91.0% (95% CI 82-96%), respectively. CONCLUSIONS Overall agreement for Ki67 expression was good between briefly fixed CNBs and conventionally fixed resection specimens, and within the range of studies comparing conventionally fixed CNBs and resections.
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Affiliation(s)
- Shona Kalkman
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
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22
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Kalkman S, Barentsz MW, van Diest PJ. The effects of under 6 hours of formalin fixation on hormone receptor and HER2 expression in invasive breast cancer: a systematic review. Am J Clin Pathol 2014; 142:16-22. [PMID: 24926080 DOI: 10.1309/ajcp96ydqstybxwu] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES A systematic review of the literature was performed to identify whether minimum formalin fixation time may be reduced for reliable immunohistochemical assessment of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). METHODS PubMed, EMBASE, and the Cochrane Library were systematically searched for studies addressing effects of brief tissue fixation (<6 hours) on the analysis of ER, PR, or HER2 expression in patients with breast cancer. RESULTS Five publications reported effects of brief fixation on ER, PR, or HER2 expression. Four studies showed similar receptor expression of short fixation compared with recommended fixation time (6-72 hours). One publication found that a minimum fixation time of 6 to 8 hours is necessary for reliable ER results. CONCLUSIONS Available data on the effect of brief fixation on receptor status are limited. However, brief fixation of very highly expressing breast cancers does not seem to alter ER, PR, and HER2 status. Nevertheless, scoring inconsistencies have been observed. Further research is required in larger study populations with more low-expressing cases for future validation.
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Affiliation(s)
- Shona Kalkman
- Departments of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Paul J. van Diest
- Departments of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Hokken W, Kalkman S, Blanken WC, van Asbeck FW. A dynamic pronation orthosis for the C6 tetraplegic arm. Arch Phys Med Rehabil 1993; 74:104-5. [PMID: 8420510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Tetraplegic arms of patients with spinal cord injury at C5 or C6 level are often held in a flexed supinated position. In supination the function of the hand is limited. This report presents a newly developed orthosis giving active pronation of the forearm for a C6 complete tetraplegic. The orthosis consists of a pretightened coiled spring that gives a torque around the longitudinal axis of the forearm. The distal part of the spring is connected to a cuff around the wrist, and the proximal part to two fitting planes on the upper arm. With the orthosis, a 27-year-old patient with a C5-C6 spinal cord injury was able to participate in activities of daily living and to perform table top activities. This new orthosis provides pronation and markedly increases the patient's degree of independence.
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Affiliation(s)
- W Hokken
- Centre for Physical Rehabilitation de Hoogstraat, Utrecht, The Netherlands
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