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E-raamat: Screening: Evidence and Practice

(Director of Programmes, UK National Screening Committee, and Director of S), (Consultant in Public Health, the NHS Screening Programmes, and Honorary Senior Lecturer, University of Bristol Medical School: Population Health Sciences, UK),
  • Formaat: EPUB+DRM
  • Ilmumisaeg: 06-Jun-2019
  • Kirjastus: Oxford University Press
  • Keel: eng
  • ISBN-13: 9780192528667
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  • Formaat: EPUB+DRM
  • Ilmumisaeg: 06-Jun-2019
  • Kirjastus: Oxford University Press
  • Keel: eng
  • ISBN-13: 9780192528667

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Screening programmes involve the systematic offer of testing for populations or groups of apparently healthy people to identify individuals who may be at future risk of a particular medical condition or disease, with the aim of offering intervention to reduce their risk.

For many years, screening was practised without debate, and without evidence, but in the 1960s serious challenges were raised about many of the screening procedures then being practised. Benefits and harms of screening must be measured in high quality trials, and the benefits of screening must be weighed alongside the negative side-effects. Concerns were raised about potential and actual harm arising when people without a health problem received dangerous and unnecessary investigations and treatments as a result of routine screening tests. Controversy raged, and it took some 50 years to achieve widespread recognition that evidence-based and quality assured programme delivery was essential, coupled with provision of balanced informed to enable informed choice for potential participants. Commercially motivated provision of poor quality and non-evidence based screening tests is increasing and screening remains a highly contested topic that has relevance in all health systems including for the general public and media.

This book serves as a practical and comprehensive guide to all aspects of screening. Following the international success of the first edition, this second edition brings extensive updates and new case study material. The first section deals with concepts, methods, and evidence, charts the story of screening back to 1861, and covers all aspects of a screening programme and how to research the full consequences. The second section is a practical guide to sound policy-making and to high quality delivery of best value screening. The controversies, paradoxes, uncertainties, and ethical dilemmas of screening are explained, and each chapter is packed with examples, real-life case histories, helpful summary points, and self-test questions. Reference is made to the NHS, a leader in screening, but the primary focus is on universal principles, making the book highly relevant across the globe.

Arvustused

This is the best textbook I have ever read on all facets of an often hotly debated topic and "aha" experiences are guaranteed. If only everyone involved in the many screening debates had read this book, we would be having more constructive and useful discussions, and take better decisions. * Matthias Egger, University of Bern, Switzerland * A readable, yet encyclopaedic guide to screening: its history, its key design elements, its implementation and its policy challenges. A must read for clinicians, managers, and policy-makers who would like to assist Raffle, Mackie, and Gray in achieving their goal: "to sort out the mess". * H. Gilbert Welch, Dartmouth College, USA * Essential reading for anyone touched by screening, the new edition is not just a superficial update, it has been radically revised, and I commend it to all, whether or not they are familiar with the original. * Bob Steele, UK National Screening Committee * This welcome second edition contains new and updated material, and rigorous emphasis throughout ... I commend this book for academics as well as practitioners, and for those in clinical specialties as well as public health. * Iain Chalmers, James Lind Library, UK *

1 How screening started
1(26)
The aim of the chapter
1(1)
Pre-modern screening
1(5)
Modern screening
6(15)
Post-modern screening
21(3)
Summary points
24(1)
Test yourself
25(2)
2 What screening is, and is not
27(20)
The aim of the chapter
27(1)
Definitions and meanings
27(1)
The kind of screening that this book is about
27(1)
Screening in everyday language
28(1)
Current meanings within health services across the globe
28(3)
Where screening fits in the disease pathway
31(2)
Odier kinds of testing in people without signs or symptoms
33(1)
Screening is different from clinical practice
34(2)
Principles of screening
36(7)
Genetics and screening
43(2)
Summary points
45(1)
Test yourself
45(2)
3 What screening does
47(22)
The aim of the chapter
47(1)
Putting people through the screening system
48(9)
The experience for those being screened
57(5)
The system and its outcomes
62(4)
Summary points
66(1)
Test yourself
67(2)
4 Measuring what a screening programme does
69(36)
The aim of the chapter
69(1)
Three main sources of bias in screening evaluation
70(8)
Three main methods for evaluating screening programmes
78(13)
Measures of test performance
91(2)
Two additional sources of information
93(3)
Summarizing all information on outcomes
96(3)
A note on sound science
99(2)
Summary points
101(1)
Test yourself
102(3)
5 Implementing screening programmes
105(22)
The aim of the chapter
105(1)
Drivers for unplanned screening
105(2)
Implementing from scratch
107(14)
Creating order out of chaos
121(3)
Summary points
124(1)
Test yourself
125(2)
6 Quality-assuring screening programmes
127(22)
The aim of the chapter
127(1)
Why quality assurance is essential in screening programmes
127(1)
Some history
128(4)
Applying quality assurance to screening programmes
132(13)
Summary points
145(1)
Test yourself
146(3)
7 Day-to-day management of screening programmes for public health practitioners and managers
149(28)
The aim of the chapter
149(1)
Coping with demand for, or provision of, harmful screening
150(9)
Problem-solving in existing national programmes
159(3)
Handling concerns about commercial sector screening
162(3)
Screening and the law
165(5)
Handling the media
170(4)
Summary points
174(1)
Test yourself
175(2)
8 Making policy on screening programmes
177(52)
The aim of this chapter
177(1)
Who makes policy decisions about screening programmes?
178(1)
What kind of decisions have to be made?
179(1)
How screening policy decisions are made
180(1)
Evidence and resources
180(2)
Using evidence for policy-making
182(23)
The importance of values
205(2)
The importance of beliefs
207(4)
The importance of commercial interests
211(3)
The ethics of policy-making
214(10)
To conclude
224(1)
Summary points
225(1)
Test yourself
226(3)
Answers 229(16)
Glossary 245(12)
References 257(20)
Index 277
Dr Angela Raffle has practised as a Consultant in Public Health in Bristol since 1990. Her involvement in local programme delivery for cervical screening began in 1986 whilst she was still in training. Data since 1977 for her Bristol area programme revealed the extent of the barely recognised yet growing overdiagnosis issue within cervical screening. With the support of colleagues in Bristol and nationally, she successfully published on this issue, despite strong opposition from those who regarded this as 'too controversial'. An advocate for honesty and informed consent, Angela has worked part time for the UK National Screening Programmes since it began, combining this with her Bristol-based public health work. In 1997 she was awarded the Skrabanek Prize for contribution to medical ethics.

Professor Anne Mackie lives in London, and fulfilled senior public health roles in the NHS before taking over from Muir Gray in 2007 as Programmes Director for the UK National Screening Programmes. Under her leadership, UK screening has become known for its high quality and robust policy making processes, and the public health ethos of screening is now firmly embedded in NHS culture. Despite continual NHS upheaval she has ensured that within screening there has been continual strengthening of processes for transparent policy making and review, quality assurance and measures, information provision for participants, and universal training and education for screening staff. Anne has also played a role in fostering international collaboration within public health focused screening.

Sir Muir Gray lives in Oxford and has worked in the British National Health Service since 1972, holding many senior positions during his career. He was instrumental in leading the transformation of NHS screening from a disorganised mess in the 1980s, into high quality, evidence based, nationally managed programmes based on informed choice. He was Programmes Director from 1996 when the UK National Screening Programmes were established, through to 2007. Muir also created the National Library of Health, was a key supporter of the Cochrane Collaboration when it was in its infancy, and he continues to influence the NHS through his work with Better Value Healthcare.