6 Ekim 2020 Dergi makalesi Açık Erişim

Karanfil, Ozge; Sterman, John

Citation Style Language JSON

{
  "URL": "https://aperta.ulakbim.gov.tr/record/228066", 
  "abstract": "<p>Tests to screen for certain diseases&mdash;for example, thyroid cancer screening, screening mammography,<br>\nand screening of high blood pressure for hypertension&mdash;are increasingly common in<br>\nmedical practice. However, guidelines for routine screening are contentious for many disorders<br>\nand often fluctuate over time. Some tests are over- or underused compared to available evidence<br>\nthat justifies their use, with clinical practice persistently deviating from evidence-based guidelines.<br>\nHere we develop an integrated, broad boundary feedback theory and formal model to<br>\nexplain the dynamics of routine population screening including fluctuations in policy-decision<br>\nthresholds and the expansion of selection criteria which may lead to inappropriate use. We present<br>\na behaviorally realistic, boundedly rational model of detection and selection for medical<br>\nscreening that explains the potential of endogenous oscillations in practice guidelines as<br>\ndecision-makers&mdash;including epidemiologists, clinicians, and patients, or policymakers from<br>\nguideline issuing organizations, perceive harms and benefits from potential outcomes and make<br>\ntrade-offs between sensitivity and specificity by altering the existing guidelines and actual practice.<br>\nThe model endogenously generates fluctuations in screening indications, test thresholds,<br>\ntest efficiency, and the target screening population, leading to long periods during which practice<br>\nguidelines are suboptimal even if the underlying evidence base is constant. We use cancer<br>\nscreening as a motivating example, but the model is generic with a wide range of potential applications<br>\nfor important managerial problems in medical contexts, such as screening for hypertension,<br>\nhypercholesterolemia, autism spectrum disorder, Alzheimer&rsquo;s disease, and related<br>\ndementia. It also applies to other managerial problems in nonmedical contexts, such as airport<br>\nscreening, background checks, tax audits, automotive emission tests, contentious jurisdiction, or<br>\nto consumers of other kinds of information who need to make a decision&mdash;on behalf of an individual,<br>\nor for the whole population.</p>", 
  "author": [
    {
      "family": "Karanfil", 
      "given": " Ozge"
    }, 
    {
      "family": "Sterman", 
      "given": " John"
    }
  ], 
  "container_title": "System Dynamics Review", 
  "id": "228066", 
  "issue": "3", 
  "issued": {
    "date-parts": [
      [
        2020, 
        10, 
        6
      ]
    ]
  }, 
  "language": "eng", 
  "note": "Bu akademik calisma BIDEB- 2232 programi tarafindan desteklenmistir. Proje No: 118C327.", 
  "page": "294-329", 
  "title": "\"Saving lives or harming the healthy?\" Overuse and fluctuations in routine medical screening", 
  "type": "article-journal", 
  "volume": "36"
}