Prior Authorization as a Potential Support of Patient-Centered Care.

We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order to argue how at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident

Emotion may predict susceptibility to fake news but emotion regulation does not help

Misinformation is a serious concern for societies across the globe. To design effective interventions to combat the belief in and spread of misinformation, we must understand which psychological processes influence susceptibility to misinformation. This paper tests the widely assumed -- but largely untested -- claim that people are worse at identifying true versus false headlines when the headlines are emotionally provocative. Consistent with this proposal, we found correlational evidence that overall emotional response at the headline level is associated with diminished truth discernment, except for experienced anger which was associated with increased truth discernment. A second set of studies tested a popular emotion regulation intervention where people were asked to apply either emotional suppression or emotion reappraisal techniques when considering the veracity of several headlines. In contrast to the correlation results, we found no evidence that emotion regulation helped people distinguish false from true news headlines

COMPRENDO: Focus and approach

Tens of thousands of man-made chemicals are in regular use and discharged into the environment. Many of them are known to interfere with the hormonal systems in humans and wildlife. Given the complexity of endocrine systems, there are many ways in which endocrine-disrupting chemicals (EDCs) can affect the body’s signaling system, and this makes unraveling the mechanisms of action of these chemicals difficult. A major concern is that some of these EDCs appear to be biologically active at extremely low concentrations. There is growing evidence to indicate that the guiding principle of traditional toxicology that “the dose makes the poison” may not always be the case because some EDCs do not induce the classical dose–response relationships. The European Union project COMPRENDO (Comparative Research on Endocrine Disrupters—Phylogenetic Approach and Common Principles focussing on Androgenic/Antiandrogenic Compounds) therefore aims to develop an understanding of potential health problems posed by androgenic and antiandrogenic compounds (AACs) to wildlife and humans by focusing on the commonalities and differences in responses to AACs across the animal kingdom (from invertebrates to vertebrates)

Public involvement in the governance of population-level biomedical research: unresolved questions and future directions.

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Legitimate priority-setting: refining accountability for reasonableness and its application within NICE

In this dissertation, I examine Daniels and Sabinâs theory for fair and legitimate procedures, accountability for reasonableness (AFR), and its relationship to the National Institute for Health and Care Excellence (NICE). AFR has been widely adopted as an exemplar model of procedural decision-making for healthcare limit-setting. Despite the prominence of AFR, few institutions have fully adopted it, so NICE, which claims AFR enhances its legitimacy, is an important example of how the theory translates into practice. The dissertation addresses challenges to AFR as a theory. I first argue that the substantive constraints in AFRâs procedure are left too vague to answer criticisms of the theory. I refine the definition of relevant reasons, focusing on mutual justifiability and raise a novel problem about whether agreement on reasons to determine their relevance is based on normative objective standards or empirical agreement. I also make a new argument that the four conditions of AFR are not sufficient for legitimacy. I argue that we need a condition of fair consideration in order to ensure legitimacy in limit-setting procedures that follow AFR. Fair consideration requires decision makers to take relevant reasons seriously. The latter part of the dissertation examines NICEâs adoption of AFR. As a public body NICE needs to demonstrate the legitimacy of its decisions, and it supports its claim to legitimacy with AFR as a framework of procedural justice. I argue that NICE meets the conditions of AFR, but it also supplements AFR with additional procedural principles, demonstrating that AFR is not specific enough and does not meet the needs of an actual priority-setting body. NICE strengthens its claims to legitimacy with its procedural principles, however it fails to implement fair consideration of reasons, so it misses out on an essential element for legitimacy, as I argue the revised account of AFR requires. NICE could further enhance its legitimacy with fair consideration. NICEâs application of AFR illustrates how problems in the theory translate into challenges for practice. I address some of these challenges to legitimacy with the additional requirement of fair consideration.</p

Legitimate priority-setting: refining accountability for reasonableness and its application within NICE

In this dissertation, I examine Daniels and Sabin’s theory for fair and legitimate procedures, accountability for reasonableness (AFR), and its relationship to the National Institute for Health and Care Excellence (NICE). AFR has been widely adopted as an exemplar model of procedural decision-making for healthcare limit-setting. Despite the prominence of AFR, few institutions have fully adopted it, so NICE, which claims AFR enhances its legitimacy, is an important example of how the theory translates into practice. The dissertation addresses challenges to AFR as a theory. I first argue that the substantive constraints in AFR’s procedure are left too vague to answer criticisms of the theory. I refine the definition of relevant reasons, focusing on mutual justifiability and raise a novel problem about whether agreement on reasons to determine their relevance is based on normative objective standards or empirical agreement. I also make a new argument that the four conditions of AFR are not sufficient for legitimacy. I argue that we need a condition of fair consideration in order to ensure legitimacy in limit-setting procedures that follow AFR. Fair consideration requires decision makers to take relevant reasons seriously. The latter part of the dissertation examines NICE’s adoption of AFR. As a public body NICE needs to demonstrate the legitimacy of its decisions, and it supports its claim to legitimacy with AFR as a framework of procedural justice. I argue that NICE meets the conditions of AFR, but it also supplements AFR with additional procedural principles, demonstrating that AFR is not specific enough and does not meet the needs of an actual priority-setting body. NICE strengthens its claims to legitimacy with its procedural principles, however it fails to implement fair consideration of reasons, so it misses out on an essential element for legitimacy, as I argue the revised account of AFR requires. NICE could further enhance its legitimacy with fair consideration. NICE’s application of AFR illustrates how problems in the theory translate into challenges for practice. I address some of these challenges to legitimacy with the additional requirement of fair consideration.</p