6 Ekim 2020 Dergi makalesi Açık Erişim

Karanfil, Ozge; Sterman, John

DataCite XML

<?xml version='1.0' encoding='utf-8'?>
<resource xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://datacite.org/schema/kernel-4" xsi:schemaLocation="http://datacite.org/schema/kernel-4 http://schema.datacite.org/meta/kernel-4.1/metadata.xsd">
  <identifier identifierType="DOI">10.48623/aperta.228066</identifier>
  <creators>
    <creator>
      <creatorName>Karanfil, Ozge</creatorName>
      <givenName>Ozge</givenName>
      <familyName>Karanfil</familyName>
      <nameIdentifier nameIdentifierScheme="ORCID" schemeURI="http://orcid.org/">0000-0002-2319-0818</nameIdentifier>
      <affiliation>Koc Universitesi</affiliation>
    </creator>
    <creator>
      <creatorName>Sterman, John</creatorName>
      <givenName>John</givenName>
      <familyName>Sterman</familyName>
      <nameIdentifier nameIdentifierScheme="ORCID" schemeURI="http://orcid.org/">0000-0001-7476-6760</nameIdentifier>
      <affiliation>Massachusetts Institute of Technology</affiliation>
    </creator>
  </creators>
  <titles>
    <title>"Saving Lives Or Harming The Healthy?" Overuse And Fluctuations In Routine Medical Screening</title>
  </titles>
  <publisher>Aperta</publisher>
  <publicationYear>2020</publicationYear>
  <subjects>
    <subject>evidence-based guidelines</subject>
    <subject>system dynamics</subject>
    <subject>clinical practice guidelines</subject>
    <subject>health policy</subject>
    <subject>cancer screening</subject>
    <subject>population screening</subject>
    <subject>medical screening</subject>
    <subject>policy analysis</subject>
  </subjects>
  <dates>
    <date dateType="Issued">2020-10-06</date>
  </dates>
  <language>en</language>
  <resourceType resourceTypeGeneral="Text">Journal article</resourceType>
  <alternateIdentifiers>
    <alternateIdentifier alternateIdentifierType="url">https://aperta.ulakbim.gov.tr/record/228066</alternateIdentifier>
  </alternateIdentifiers>
  <relatedIdentifiers>
    <relatedIdentifier relatedIdentifierType="DOI" relationType="IsVersionOf">10.48623/aperta.228065</relatedIdentifier>
  </relatedIdentifiers>
  <rightsList>
    <rights rightsURI="https://creativecommons.org/licenses/by-nc/4.0/">Creative Commons Attribution-NonCommercial</rights>
    <rights rightsURI="info:eu-repo/semantics/openAccess">Open Access</rights>
  </rightsList>
  <descriptions>
    <description descriptionType="Abstract">&lt;p&gt;Tests to screen for certain diseases&amp;mdash;for example, thyroid cancer screening, screening mammography,&lt;br&gt;
and screening of high blood pressure for hypertension&amp;mdash;are increasingly common in&lt;br&gt;
medical practice. However, guidelines for routine screening are contentious for many disorders&lt;br&gt;
and often fluctuate over time. Some tests are over- or underused compared to available evidence&lt;br&gt;
that justifies their use, with clinical practice persistently deviating from evidence-based guidelines.&lt;br&gt;
Here we develop an integrated, broad boundary feedback theory and formal model to&lt;br&gt;
explain the dynamics of routine population screening including fluctuations in policy-decision&lt;br&gt;
thresholds and the expansion of selection criteria which may lead to inappropriate use. We present&lt;br&gt;
a behaviorally realistic, boundedly rational model of detection and selection for medical&lt;br&gt;
screening that explains the potential of endogenous oscillations in practice guidelines as&lt;br&gt;
decision-makers&amp;mdash;including epidemiologists, clinicians, and patients, or policymakers from&lt;br&gt;
guideline issuing organizations, perceive harms and benefits from potential outcomes and make&lt;br&gt;
trade-offs between sensitivity and specificity by altering the existing guidelines and actual practice.&lt;br&gt;
The model endogenously generates fluctuations in screening indications, test thresholds,&lt;br&gt;
test efficiency, and the target screening population, leading to long periods during which practice&lt;br&gt;
guidelines are suboptimal even if the underlying evidence base is constant. We use cancer&lt;br&gt;
screening as a motivating example, but the model is generic with a wide range of potential applications&lt;br&gt;
for important managerial problems in medical contexts, such as screening for hypertension,&lt;br&gt;
hypercholesterolemia, autism spectrum disorder, Alzheimer&amp;rsquo;s disease, and related&lt;br&gt;
dementia. It also applies to other managerial problems in nonmedical contexts, such as airport&lt;br&gt;
screening, background checks, tax audits, automotive emission tests, contentious jurisdiction, or&lt;br&gt;
to consumers of other kinds of information who need to make a decision&amp;mdash;on behalf of an individual,&lt;br&gt;
or for the whole population.&lt;/p&gt;</description>
    <description descriptionType="Other">Bu akademik calisma BIDEB- 2232 programi tarafindan desteklenmistir. Proje No: 118C327.</description>
  </descriptions>
  <fundingReferences>
    <fundingReference>
      <funderName>Türkiye Bilimsel ve Teknolojik Araştirma Kurumu</funderName>
      <funderIdentifier funderIdentifierType="Crossref Funder ID">https://doi.org/10.13039/501100004410</funderIdentifier>
      <awardNumber>118C327</awardNumber>
    </fundingReference>
  </fundingReferences>
</resource>