Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness.

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management

withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

n/

Patient’s Knowledge, Perception and Belief about the Reasons of Low Back Pain

Patients with chronic low back pain (LBP) hold various knowledge, perceptions and beliefs about their pain which are based on prior learning and social conditions. Since LBP is a bio- psycho-social phenomenon and there are not any reports about awareness and attitude of Iranian patients’ views regarding it, this descriptive study was employed to earn this information P to apply its results in health education planning. For data gathering, deeply interviewing with 24 patients were performed. Volunteer patients were from Rheumatology Research Center of Tehran University of Medical Science from July 1st to Sep 1st 2003 who had inclusive criteria such as: 18 years old or more, suffering from LBP more than 90 d and not having experience of surgical operation in last two years. Interviews were individually held at rheumatic disease center which was convenient to the participants and were being continued to earn data saturation regarding patient’s knowledge, perception and belief about LBP. The findings showed that the most popular risky behavior for LBP was hard manual activities, also this study revealed that knowledge of the patients about LBP and its risk factors was little and LBP was not understood by the majority of patients (74%).Only a few people (11%) believed risk factors and risky behaviors could deteriorate it. From this study it can be concluded that health educators should emphasize on perception and attitude of the patients regarding LBP for changing behavior and complying of recommended body mechanics