22,157 research outputs found

    The credibility of health economic models for health policy decision-making: the case of population screening for abdominal aortic aneurysm

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    <i>Objectives</i>: To review health economic models of population screening for abdominal aortic aneurysm (AAA) among elderly males and assess their credibility for informing decision-making. <i>Methods</i>: A literature review identified health economic models of ultrasound screening for AAA. For each model focussing on population screening in elderly males, model structure and input parameter values were critically appraised using published good practice guidelines for decision analytic models. <i>Results</i>: Twelve models published between 1989 and 2003 were identified. Converting costs to a common currency and base year, substantial variability in cost-effectiveness results were revealed. Appraisals carried out for the nine models focusing on population screening showed differences in their complexity, with the simpler models generating results most favourable to screening. Eight of the nine models incorporated two or more simplifying structural assumptions favouring screening; uncertainty surrounding these assumptions was not investigated by any model. Quality assessments on a small number of parameters revealed input values varied between models, methods used to identify and incorporate input data were often not described, and few sensitivity analyses were reported. <i>Conclusions</i>: Large variation exists in the cost-effectiveness results generated by AAA screening models. The substantial number of factors potentially contributing to such disparities means that reconciliation of model results is impossible. In addition, poor reporting of methods makes it difficult to identify the most plausible and thus most useful model of those developed

    The Return of Quarantinism and How to Keep It in Check: From Wishful Regulations to Political Accountability

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    Concerns about emerging and re-emerging infectious diseases have given a new lease of life to quarantinist measures: a series of time-honoured techniques for controlling the spread of infectious diseases through breaking the chain of human contagion. Since such measures typically infringe individual rights or privacy their use is subject to legal regulations and gives rise to ethical and political worries and suspicions. Yet in some circumstances they can be very effective. After considering some case studies that show how epidemics are unique, fluid and affected by a multitude of contingent factors, it is argued that the legal and ethical guidelines may not always be the best approach to discipline the use of quarantinist measures. An alternative model based on ex-post political accountability for reasonableness is proposed. This model restores the centrality of political decision and expert judgement in situations characterized by high risk, uncertainty and contingency. It is argued that such alternative model affords quicker and more flexible responses to serious outbreaks of infections, while providing adequate protection against abuses

    New Approaches to HIV Prevention: Accelerating Research and Ensuring Future Access

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    Summarizes the state of research on new HIV prevention approaches and recommends ways to accelerate research and ensure rapid access to new prevention methods

    Ethical decision-making, passivity and pharmacy

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    Background: Increasing interest in empirical ethics has enhanced understanding of healthcare professionals' ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights into how more than reasoning alone may contribute to decision-making. Aims: To explore how the four-stage model can increase understanding of decision-making in healthcare and describe the decision-making of an under-researched professional group. Methods: 23 purposively sampled UK community pharmacists were asked, in semi-structured interviews, to describe ethical problems in their work and how they were resolved. Framework analysis of transcribed interviews utilised the four decision-making stages, together with constant comparative methods and deviant-case analysis. Results: Pharmacists were often inattentive and constructed problems in legal terms. Ethical reasoning was limited, but examples of appeals to consequences, the golden rule, religious faith and common-sense experience emerged. Ethical intention was compromised by frequent concern about legal prosecution. Ethical inaction was common, typified by pharmacists' failure to report healthcare professionals' bad practices, and ethical passivity emerged to describe these negative examples of the four decision-making stages. Pharmacists occasionally described more ethically active decision-making, but this often involved ethical uncertainty. Discussion: The four decision-making stages are a useful tool in considering how healthcare professionals try to resolve ethical problems in practice. They reveal processes often ignored in normative theories, and their recognition and the emergence of ethical passivity indicates the complexity of decision-making in practice. Ethical passivity may be deleterious to patients' welfare, and concerns emerge about improving pharmacists' ethical training and promoting ethical awareness and responsibility

    Perceptions of HIV-positive kidney donations to HIV-positive recipients

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    BACKGROUND: Kidney transplantation is the preferred standard of care for patients who have both end stage renal disease (ESRD) and human immunodeficiency virus (HIV) infection. The first successful kidney transplant was done in 1954 and the first case of HIV/AIDS occurred in 1981. Until recently, HIV-positive patients who required an organ transplant received an HIV-negative organ because it was illegal to use HIV-positive organs in transplants in the United States. The HIV Organ Policy Equity (HOPE) Act was signed in 2013 and legalized the use of HIV-positive donor organs in organ transplants. The first of these transplants was completed in March 2016 with good results. LITERATURE REVIEW: Renal transplants have lower mortality than dialysis. HIV damages the kidney in multiple ways, including HIV associated nephropathy and HIV immune complex kidney disease, putting HIV patients at higher risk of ESRD. Studies from before the utilization of anti-retroviral therapy show that transplantation of HIV infected blood or organs do not cause failure of the transplanted organ. However, in 1997 most surgeons would not transplant kidneys to HIV-infected individuals. Success of antiretroviral therapy has allowed HIV patients to live longer, but patients experience complications including end organ damage. Providing transplants to ESRD patients with HIV infection has been preferred treatment since 2010. Due to improvements in both HIV and transplant science, transplant specialists today are likely to accept HIV-positive organs to HIV-positive transplant recipients. PROPOSED PROJECT: The proposed study is a survey of United States transplant professionals to determine their perceptions about these transplants. Researchers will collect data in the form of Likert scales as well as open-ended responses. The survey will also collect demographic information about surveyors. Investigators will then analyze the collected data for professional knowledge of the legal change, perceptions of efficacy and safety, and concerns. Researchers will analyze the data both as a whole and divided by demographic subgroups. CONCLUSIONS: To date, there has been no study that has assessed at the attitudes of the medical community involved in these transplants. This study is unique in that it attempts to obtain the perceptions and concerns the transplant specialists have about HIV-positive donor organs to HIV-positive transplant recipients. SIGNIFICANCE: The data from this study will help to establish what opinions are at this time, to determine if there are any regional discrepancies that may affect patient access to care, and to determine the concerns of transplant specialists at this time

    Too Good to be True?: The Opportunity and Cost of the $1 Building

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    A study commissioned by The Kresge Foundation's Arts & Culture Program finds that arts organizations have experienced a wide range of outcomes when acquiring low-cost or free buildings, also known as "$1 buildings." In many cases, the actual costs of acquiring such buildings were much higher than organizations anticipated, according to the study, conducted by Boston-based Technical Development Corp
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