6 Ekim 2020 Dergi makalesi Açık Erişim

Karanfil, Ozge; Sterman, John

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{
  "@context": "https://schema.org/", 
  "@id": 228066, 
  "@type": "ScholarlyArticle", 
  "creator": [
    {
      "@id": "https://orcid.org/0000-0002-2319-0818", 
      "@type": "Person", 
      "affiliation": "Koc Universitesi", 
      "name": "Karanfil, Ozge"
    }, 
    {
      "@id": "https://orcid.org/0000-0001-7476-6760", 
      "@type": "Person", 
      "affiliation": "Massachusetts Institute of Technology", 
      "name": "Sterman, John"
    }
  ], 
  "datePublished": "2020-10-06", 
  "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>", 
  "headline": "\"Saving lives or harming the healthy?\" Overuse and fluctuations in routine medical screening", 
  "identifier": 228066, 
  "image": "https://aperta.ulakbim.gov.tr/static/img/logo/aperta_logo_with_icon.svg", 
  "inLanguage": {
    "@type": "Language", 
    "alternateName": "eng", 
    "name": "English"
  }, 
  "keywords": [
    "evidence-based guidelines", 
    "system dynamics", 
    "clinical practice guidelines", 
    "health policy", 
    "cancer screening", 
    "population screening", 
    "medical screening", 
    "policy analysis"
  ], 
  "license": "https://creativecommons.org/licenses/by-nc/4.0/", 
  "name": "\"Saving lives or harming the healthy?\" Overuse and fluctuations in routine medical screening", 
  "url": "https://aperta.ulakbim.gov.tr/record/228066"
}