Identifying stakeholder opinion regarding access to “high-cost medicines”: A systematic review of the literature

Open Medicine ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. 513-527 ◽  
Author(s):  
Philip Wahlster ◽  
Shane Scahill ◽  
Sanjay Garg ◽  
Zaheer-Ud-Din Babar
Keyword(s):  
Systematic Review ◽  
Ethical Issues ◽  
Treatment Options ◽  
System Level ◽  
Research Articles ◽  
Original Research ◽  
Review Of The Literature ◽  
Moral Issues ◽  
The Public ◽  
Patient Groups

AbstractObjective: To identify the viewpoints and perceptions of different stakeholders regarding high cost medicines (HCMs). Methods: A systematic review of the literature was performed to identify original research articles. Using predefined categories, data related to the viewpoints of different stakeholders was systematically extracted and analyzed. Results: Thirty seven original research articles matched the criteria. The main stakeholders identified include physicians, patients, public and health funding authorities. The influence of media and other economic and ethical issues were also identified in the literature. A large number of stakeholders were concerned about lack of access to HCMs. Physicians have difficulty balancing the the rational use of expensive drugs while at the same time acting as “patients’ advocate”. Patients would like to know about all treatment options, even if they may not be able to afford them. The process and criteria for reimbursement should be transparent and access has to be equitable across patient groups. Conclusion: Access to HCMs could be improved through transparency and involvement of all stakeholders, especially patients and the public. Moral issues and the “rule of rescue” could influence decision-making process significantly. At system level, objectivity is important to ensure that the system is equitable and transparent.

scholarly journals Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefano Granieri ◽  
Francesco Sessa ◽  
Alessandro Bonomi ◽  
Sissi Paleino ◽  
Federica Bruno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Meta Analysis ◽  
Treatment Options ◽  
Palliative Surgery ◽  
Review Of The Literature ◽  
Colovesical Fistula ◽  
Level Of Evidence ◽  
Meta Analyses

Abstract Background Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran’s Q test were computed to assess inter-studies’ heterogeneity. Results Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. Conclusions Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).

scholarly journals Recombinant Human Adenovirus-p53 Therapy for the Treatment of Oral Leukoplakia and Oral Squamous Cell Carcinoma: A Systematic Review

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 438
Author(s):  
Jagadish Hosmani ◽  
Shazia Mushtaq ◽  
Shahabe Saquib Abullais ◽  
Hussain Mohammed Almubarak ◽  
Khalil Assiri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Oral Cancer ◽  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Oral Leukoplakia ◽  
Research Articles ◽  
Original Research ◽  
Therapeutic Effects ◽  
The World

Background and Objectives: Oral cancer is the 6th most common cancer in the world and oral leukoplakia is an oral potentially malignant disorder that could develop into oral cancer. This systematic review focusses on randomized clinical trials for recombinant adenovirus p-53 (rAD-p53) therapy for the treatment of oral leukoplakia and cancer. Materials and Methods: We searched for research articles on various databases such as Pubmed/Medline, Embase, CNKI (China National Knowledge Infra-structure), Springerlink, cochrane and Web of sciences from 2003 to 2020. MeSH (Medical Subject Headings) terms were used for the search. Inclusion criteria included original research, randomized clinical trials and articles only in English language. Exclusion criteria were any articles that were not research articles, not randomized trials, non-human studies, etc. The articles were further graded on the Jadad scale. Results: 578 articles were assessed from various databases; only 3 articles were found to be appropriate for this review. Thus, meta-analysis was not performed because of heterogeneity and lack of data. In the three studies, whether rAD-p53 was used as a standalone therapy or with other therapies, there was a beneficial effect of the therapy. Furthermore, there were no serious adverse events and the only adverse events reported were fever, pain at the local injection site, flu-like symptoms and lowered WBC count. Conclusions: Thus, we can conclude that this therapy has a potential for beneficial therapeutic effects and further clinical trials with more patients need to be performed to get better understanding of the effect of rAD-p53 therapy, which probably will pave the way to its approval in other parts of the world.

scholarly journals Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice

2020 ◽  
pp. 026921632097427
Author(s):  
Guy Schofield ◽  
Mariana Dittborn ◽  
Richard Huxtable ◽  
Emer Brangan ◽  
Lucy Ellen Selman
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Clinical Practice ◽  
Ethical Issues ◽  
Clinical Care ◽  
Ethical Principles ◽  
Original Research ◽  
Specialist Palliative Care ◽  
Ethical Challenges ◽  
Ethical Practice

Background: Ethical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners about day-to-day ethical challenges has not previously been synthesised. This evidence is crucial to inform education and adequately support staff. Aim: To synthesise the evidence regarding the ethical challenges which specialist palliative care practitioners encounter during clinical practice. Design: Systematic review with narrative synthesis (PROSPERO registration CRD42018105365). Quality was dual-assessed using the Mixed-Methods Appraisal Tool. Tabulation, textural description, concept mapping and thematic synthesis were used to develop and present the narrative. Data sources: Seven databases (MEDLINE, Philosopher’s Index, EMBASE, PsycINFO, LILACS, Web of Science and CINAHL) were searched from inception to December 2019 without language limits. Eligible papers reported original research using inductive methods to describe practitioner-reported ethical challenges. Results: A total of 8074 records were screened. Thirteen studies from nine countries were included. Challenges were organised into six themes: application of ethical principles; delivering clinical care; working with families; engaging with institutional structures and values; navigating societal values and expectations; philosophy of palliative care. Challenges related to specific scenarios/contexts rather than the application of general ethical principles, and occurred at all levels (bedside, institution, society, policy). Conclusion: Palliative care practitioners encounter a broad range of contextual ethical challenges, many of which are not represented in palliative care ethics training resources, for example, navigating institutional policies, resource allocation and inter-professional conflict. Findings have implications for supporting ethical practice and training practitioners. The lack of low- and middle- income country data needs addressing.

scholarly journals Efficacy of Transcutaneous Transseptal Orbital Decompression in Treating Acute Retrobulbar Hemorrhage and a Literature Review

2014 ◽  
Vol 7 (1) ◽  
pp. 17-26 ◽  
Author(s):  
Rüdiger Zimmerer ◽  
Katrin Schattmann ◽  
Harald Essig ◽  
Philipp Jehn ◽  
Marc Metzger ◽  
...  
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Treatment Options ◽  
Orbital Decompression ◽  
Review Of The Literature ◽  
Orbital Trauma ◽  
Time Period ◽  
Retrobulbar Hemorrhage

Decreasing visual acuity secondary to orbital trauma may be caused by sudden space-occupying or expanding intraorbital lesions, including retrobulbar hemorrhage (RBH), herniation, or swelling. RBH must be diagnosed and treated immediately. This article addresses the efficacy of transcutaneous transseptal orbital decompression in a combination with a systematic review of the literature for a comparison of this method with existing treatment options. For this study the department's database was retrospectively screened for patients with acute RBH who were treated between 2009 and 2011 using the authors’ approach. Patients presenting with RBH were classified into RBH classes I to III according to three different clinical and radiological manifestations of acute RBH. The efficacy of transcutaneous transseptal orbital decompression was assessed by postoperative visual acuities. The literature review was performed by using the MEDLINE database. The time period for the study was between 2009 and 2011 during which 10 patients were diagnosed with suspected RBH and 9 were treated with the authors’ technique. Visual acuities were reconstituted or maintained in almost 86% of patients who were diagnosed and treated according to the authors approach and who survived initial trauma. It was concluded that transcutaneous transseptal orbital decompression provides an efficient and rapid approach for treating patients with acute RBH. By distinguishing three different manifestations of acute RBH, the authors present a diagnostic tool that may facilitate classification of RBH and determination of treatment options.

scholarly journals Delving Into the Details of Evaluating Public Engagement Initiatives Comment on "Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review"

2019 ◽  
Vol 8 (4) ◽  
pp. 247-249
Author(s):  
Marion Danis
Keyword(s):  
Systematic Review ◽  
Health Policy ◽  
Public Engagement ◽  
Public Discourse ◽  
Public Support ◽  
System Level ◽  
Systematic Evaluation ◽  
Policy Decisions ◽  
Evaluation Tools ◽  
The Public

Initiatives to engage the public in health policy decisions have been widely endorsed and used, yet agreed upon methods for systematically evaluating the effectiveness of these initiatives remain to be developed. Dukhanin, Topazian, and DeCamp have thus developed a useful taxonomy of evaluation criteria derived from a systematic review of published evaluation tools that might serve as the basis for systematic evaluation. In considering the application of such a taxonomy, it is important to appreciate the political space in which health policy decisions occur. In this context, public engagement initiatives are likely to have a modest and unpredictable impact on policy decisions. Other goals, aside from influencing policy decisions, such as informing the public about issues, identifying the public’s values, enhancing public support for decisions, and promoting public discourse, are likely to be more feasible. While Dukanan and colleagues did not aim to do so, future efforts to align guidance for planning public engagement initiatives with evaluation tools would be useful to promote the success of public engagement initiatives.

scholarly journals Technological Competences: A Systematic Review of the Literature in 22 Years of Study

2019 ◽  
Vol 14 (04) ◽  
pp. 4 ◽  
Author(s):  
Norma Candolfi Arballo ◽  
Maria Elena Chan Nuñez ◽  
Bernabé Rodriguez Tapia
Keyword(s):  
Systematic Review ◽  
Technological Capability ◽  
Time Span ◽  
Research Articles ◽  
Review Of The Literature ◽  
Gray Literature ◽  
Technological Competence ◽  
Technological Competences

In this Systematic Review of the Literature (SRL) the term “technological competence” is analyzed. The analysis is conducted within the areas of knowledge in which the term has been studied, considering the definitions that have been associated to the term, the approaches proposed by the authors that make use of the term, the transformation of the concept throughout the time, and the boundaries of application with other similar terms, such as technological capability and technological skill. A total of 140 publications focused on technological competences are analyzed. The publications correspond to a time span ranging from 1994 to 2016, and include research articles from recognized databases and, to a lesser extent, gray literature articles. Finally, the term technological competence applied in the productive sector is redefined such as it allows focusing on projects for technological absorption or training in industry.

Displaced Acetabular Fracture in Elderly Patients: Is Acute Arthroplasty an Effective Option?

2019 ◽  
Vol 157 (06) ◽  
pp. 676-683 ◽  
Author(s):  
Zhengming Yang ◽  
Stephan Maximillian Röhrl ◽  
Lars Nordsletten
Keyword(s):  
Systematic Review ◽  
Elderly Patients ◽  
Acetabular Fracture ◽  
Treatment Options ◽  
Treatment Recommendation ◽  
Acetabular Fractures ◽  
Review Of The Literature ◽  
Effective Treatment Option ◽  
Elderly Individuals ◽  
Effective Option

Abstract Background and study aim Elderly individuals are the most rapidly growing subgroup of patients currently sustaining acetabular fractures, and total hip arthroplasty (THA) is being applied more and more in the treatment of acetabular fractures. The purpose of this study was to review the available literature regarding displaced acetabular fractures in elderly patients treated with acute THA. Study design A search was conducted using the electronic databases Medline, PubMed, ISI Web of Knowledge, and Scopus on papers published between January 1960 and November 2018 using the terms “acetabular fracture” plus “elderly patients” plus “arthroplasty”. A systematic review of the literature on the different treatment options for acute THA is presented. Results The search yielded a total of 320 articles, and 9 articles were selected for review. The indications, techniques, approaches, and complications of THA are discussed, and a treatment recommendation based on the selected articles is given. Conclusion We consider acute arthroplasty an effective treatment option for displaced acetabular fractures in elderly patients, while different techniques should be used for different displaced acetabular fractures in this patient group.

scholarly journals Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies

2016 ◽  
Vol 47 (4) ◽  
pp. 701-716 ◽  
Author(s):  
Bethany Alice Jones ◽  
Jon Arcelus ◽  
Walter Pierre Bouman ◽  
Emma Haycraft
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Sport Participation ◽  
Research Articles ◽  
Evidence Based ◽  
Competitive Sport ◽  
Competitive Sports ◽  
Review Of The Literature ◽  
Negative Experience ◽  
Transgender People

Abstract Background Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation. Objective To the authors’ knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature. Method Eight research articles and 31 sport policies were reviewed. Results In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport’s policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based. Conclusion Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.

scholarly journals Management of Digital Tendon Avulsion at the Musculotendinous Junction of the Forearm: A Systematic Review

Hand ◽  
2012 ◽  
Vol 7 (2) ◽  
pp. 134-142 ◽  
Author(s):  
Jessica Collins ◽  
Yoshihiro Ishihara ◽  
Achilleas Thoma
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Proximal Phalanx ◽  
Optimal Management ◽  
Challenging Problem ◽  
Review Of The Literature ◽  
Musculotendinous Junction ◽  
Patient Demographics ◽  
Work Accidents ◽  
Tendon Avulsion

Background Tendon avulsion at the musculotendinous junction caused by digit avulsion amputation or closed injury is a challenging problem, for which the literature lacks definitive recommendations regarding treatment. We have provided a systematic review and developed an algorithm to delineate optimal management of this injury. Methods Two independent reviewers undertook a systematic review of the literature to identify articles discussing management of forearm tendons avulsed at their musculotendinous junction. Patient demographics, injury mechanism, injury pattern, type of repair, and outcome were investigated. These data were analyzed to reveal tendencies in management, which were then organized into an algorithm. Results Twenty articles fit our criteria for a total of 91 tendons. Cases were mostly males involved in work accidents. Treatment options were tendon resection, reattachment to muscle, tendon transfer, and side-to-side repair. When the digit was replanted, tendons avulsed through avulsion amputations were preferentially treated by reattachment in the case of the thumb, transfers for the index and long fingers, and resection for the ring and small fingers. Reattachment was favored for metacarpophalangeal level amputations, while transfer was selected for proximal phalanx levels. For closed avulsion injuries, flexors were preferentially treated with reattachment or transfer, while extensors underwent transfer or side-to-side repair. Conclusions In the management of tendon avulsions at the musculotendinous junction, specific procedures are favored depending on the mechanism of injury, the type of tendon and digit involved, and the level of bone amputation. An algorithm is presented to facilitate optimal treatment based on these injury characteristics.

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