6 Ekim 2020 Dergi makalesi Açık Erişim

Karanfil, Ozge; Sterman, John

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        "affiliation": "Koc Universitesi", 
        "name": "Karanfil, Ozge", 
        "orcid": "0000-0002-2319-0818"
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        "affiliation": "Massachusetts Institute of Technology", 
        "name": "Sterman, John", 
        "orcid": "0000-0001-7476-6760"
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    "description": "<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>", 
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    "journal": {
      "issue": "3", 
      "pages": "294-329", 
      "title": "System Dynamics Review", 
      "volume": "36"
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    "keywords": [
      "evidence-based guidelines", 
      "system dynamics", 
      "clinical practice guidelines", 
      "health policy", 
      "cancer screening", 
      "population screening", 
      "medical screening", 
      "policy analysis"
    ], 
    "language": "eng", 
    "license": {
      "id": "cc-by-nc-4.0"
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    "notes": "Bu akademik calisma BIDEB- 2232 programi tarafindan desteklenmistir. Proje No: 118C327.", 
    "publication_date": "2020-10-06", 
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    "science_branches": [
      "Teknik Bilimler > End\u00fcstri M\u00fchendisli\u011fi > Benzetim > Sistem Dinami\u011fi", 
      "Sa\u011fl\u0131k Bilimleri > T\u0131p > Dahili T\u0131p Bilimleri > Halk Sa\u011fl\u0131\u011f\u0131", 
      "Temel Bilimler > Matematik > Ekonomi, Sosyal Bilimler ve Davran\u0131\u015f Bilimleri", 
      "Sa\u011fl\u0131k Bilimleri > T\u0131p > Temel T\u0131p Bilimleri > Fizyoloji", 
      "Teknik Bilimler > End\u00fcstri M\u00fchendisli\u011fi > Karar Kuram\u0131", 
      "Teknik Bilimler > End\u00fcstri M\u00fchendisli\u011fi > Karar Kuram\u0131 > Karar Destek Sistemleri", 
      "Teknik Bilimler > End\u00fcstri M\u00fchendisli\u011fi > Benzetim"
    ], 
    "title": "\"Saving lives or harming the healthy?\" Overuse and fluctuations in routine medical screening", 
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        "program": "DIGER", 
        "project_number": "118C327"
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