>Magister Scientiae - MSc / The introduction of biosimilars to health care markets across the globe has had some success in increasing competition and improving the cost of healthcare. While savings are important for driving the biosimilar uptake, this is not the only consideration for the growth of biosimilars onto emerging markets. A systematic review of the literature to assess the growth of biosimilars onto the emerging market was conducted using the following data sources: PubMed, Website of the Generics and Biosimilars Initiative (GaBI) journal, ProQuest, Google Scholar. Studies that provided evidence of biosimilars onto the emerging market through surveys and other sources of existing data were included. The systematic review process followed Wichor et al. (2018) and the PRISMA checklist (PRISMA, 2009). The search strategy for the review provided a total of 71studies, which underwent title, abstract and full text review to give 20 articles that fit the inclusion criteria for the aimed study. A quality assessment was conducted on the 20 articles and by using the Hawker et al. (2002) quality tool and directed research questions to set variables, the data analysis of 13 articles emerged. The included studies agreed on the growth of biosimilars onto the emerging market and on the switch to biosimilars to improve access to therapies. However, International Nonproprietary Name (INN) and physician confidence were still considered as hurdles. The two most successful drivers of the growth of biosimilars onto the emerging market based on this review was certainly the regulation of the process followed by the cost of biosimilars. To conclude, data analysis of 13 articles determined that the general perception of using biosimilars in emerging markets is positive. However, for successful integration into routine healthcare and uptake into these markets, there must be a direct focus on the regulation of Biosimilars

BACKGROUND: A recent study showed low adherence to the published treatment guidelines for axial spondyloarthritis (axSpA) / ankylosing spondylitis (AS). The aim of this study was to determine barriers to guideline adoption that are specific to axSpA / AS. METHODS: A systematic literature review was conducted to learn which general barriers to guideline adoption have been proposed in the literature. A second systematic literature review was conducted to identify strategies to increase response rates in the deployment of electronic surveys. A survey was developed based on the findings from the literature, aimed to interrogate the perspective of rheumatologists on barriers within their practice. A focus group was conducted to gain insight from experts in the field. RESULTS: The SLR identified 22 primary research articles on barriers to guideline adherence in axSpA / AS, almost all of which focused on drug therapy or physical therapy / exercise. Only 1 of the 22 studies was conducted in the US. The SLR on survey deployment methods identified 52 articles, 40 of which included sufficient information to calculate response rates. The mean response rate for online surveys distributed to rheumatologists was 0.33 with no statistically significant differences between surveys that contacted physicians once, twice or three or more times. From the literature, a framework was synthesized that captures relevant barriers to guideline adherence in 5 categories: guideline factors, health professional factors, patient factors, practice setting factors and societal factors. A survey was drafted, with questions targeting each of the five categories included in the framework. Suggestions from the experts participating in the focus group resulted in a revised survey consisting of 33 questions. Additionally, the focus group proposed ideas for survey dissemination, including strong support for the utilization of social media in addition to email invitations. CONCLUSION: The literature on barriers to guideline adherence in axSpA / AS is limited, in particular in the domains of disease activity monitoring, osteoporosis screening / monitoring, and other non-pharmacologic therapies. Only a single US study on barriers to guideline adherence in axSpA / AS was identified, indicating the need for more research in this field. The focus group provided firsthand perspective, allowing for modification of the survey to capture the most informative data. The focus group also provided insight into survey dissemination methods and ideas to maximize participation. The SLR on electronic survey deployment suggests an expected response rate of 0.33 for surveys administered to rheumatologists via email.

No description available.

Counterfactuals about what a patient would consent to, if he were able to consent, are often cited as justifications, or partial justifications, for acts of euthanasia. In virtue of this fact, they deserve special scrutiny by moral philosophers. In Chapter I, I examine terminology that is essential to further understanding the relationship between euthanasia and counterfactual consent. I propose a definition of 'euthanasia', an analysis of 'consent', and I present a brief description of counterfactuals. In Chapter II, I consider two questions. The first is, "When it is appropriate to invoke counterfactual consent in an attempt to justify an act of euthanasia?" By making use of an improved version of the voluntary, nonvoluntary, and involuntary distinction among acts of euthanasia, I am able to determine when it is appropriate to cite counterfactuals about consent in an attempt to justify an act of euthanasia. The second is, "to what end is counterfactual consent used?" I contend that counterfactual consent does morally justify some acts of euthanasia, and defend an argument for this claim. Finally, I look at the role of counterfactual consent as a possible legal justification for acts of euthanasia. In Chapter III, I use possible world semantics to analyze counterfactual consent. Traditional counterfactuals are determined to be true if in the closest world at which their antecedent is true, their consequent is also true. Counterfactuals about consent have a less straightforward reading. I consider and reject several possible ways of reading counterfactuals about consent, before settling on the correct reading of counterfactuals about consent. In Chapter IV, I consider evidence for the truth of claims about counterfactual consent. I consider and reject the claim that no counterfactual is either true or false. I examine both Living Wills and the practice of surrogacy, neither of which offers sufficient evidence for the truth of claims about counterfactual consent. In Chapter V, I contrast counterfactual consent with actual consent. I review and refute the arguments for the claim that actual consent is preferable to counterfactual consent. I conclude by presenting a principle about the relationship between actual and counterfactual consent.

Nonadherence with the recommendations of health care providers results in reduced quality of health, poorer social adjustment, and tremendous strain on our already fragile health care economy. This study includes 283 patients evaluated by the Psychiatric Emergency Service (PES) in the emergency room of an 800-bed medical center in an urban setting in the Northeastern United States. Adherence in this study was operationally defined as attending the first outpatient follow-up appointment after referral from the emergency room. Baseline levels of adherence with treatment recommendations were determined in a first group. Patients seen in a second group received a reminder letter as a treatment prompt. In a third group, a set of five Likert Scale questions evaluated the patient's perception of their experience in the emergency room and rated the availability of social supports. Objective aspects of patient care such as the length of time waiting for treatment in the emergency room and length of the interval before the first appointment were also recorded. Other variables such as insurance type, referral site and history of prior treatment at the referral site were studied. Data analysis revealed that the interventions of receiving a reminder letter and completing a questionnaire concerning the emergency room experience both were associated with increased adherence. Several aspects of patient care were also significantly associated with increased adherence, including waiting shorter periods for evaluation, and waiting fewer weeks for the first outpatient appointment. Increased adherence was associated with referral to HMO clinics and private practitioners as compared to referrals to community clinics. Having insurance also was associated with increased adherence, ranked in the following order: HMO insurance, commercial insurance, Medicare, and Medicaid, with the uninsured population having the lowest adherence rates. A history of prior treatment at the referral clinic, being satisfied with emergency room treatment, feeling in need of treatment, and having social supports for treatment all were significantly associated with outpatient referral adherence.

The aim of this study was to explore factors contributing to the success of health communication strategies and supporting visual communication tool(s) designed to explain antiretroviral medication (ART) adherence, and motivate young people who live with HIV to follow an adherence regime. The study drew from the social sciences, including psychology, health sciences and communication. Currently there are an estimated 6.8 million people living with HIV in South Africa, making it the site of the largest HIV epidemic in the world (UNAIDS, 2014). Antiretroviral Therapy (ART) is the only effective treatment for HIV and is one of the most demanding medicine regimes, requiring a 90% compliance. Various studies have documented worryingly poor levels of adherence to ART, especially amongst adolescents and young adults in South Africa. The empirical research consisted of a qualitative case study in Khayelitsha, a periurban township on the edge of Cape Town. It focused on young people from Khayelitsha and health care professionals - doctors, nurses, HIV counsellors and pharmacists. Using grounded theory data collection was carried out during two phases of fieldwork, interspersed with periods for data processing and analysis. The principal methods used were focus groups, semi-structured interviews and participant observation. Two key factors emerged from the data that form the basis of a new theoretical understanding: first, concerning how young people become motivated to learn about treatment and adhere to it, and second, concerning how information about treatment can best be communicated to them. In relation to the first of these, findings showed that young people were traumatised by an HIV diagnosis, fearing both that they would get sick and suffer an early death and also that they would be rejected by their belonging groups. This meant that they could not take in the factual information offered, and in addition, had no motivation to do so because the diagnosis resulted in a loss of hope for their present and future lives. According to young people, motivation was an outcome of re-connecting to one or more trusted significant other(s) from within their belonging group, who accepted and supported them. This in turn affirmed their prior belonging identities of son, daughter, cousin or close friend and then reconnected them to their present and future hopes. This renewed motivation to live was the basis for their becoming motivated to learn about treatment and adhere to it. In relation to the second factor, this study found that current communications about treatment were not effective. Specifically, the use of metaphors, which was seen among clinicians as a method of simplifying the complexity of ART adherence messages, was in fact creating confusion. Also, the use of printed information in isolation was not effective; communication was much more effective when it provided a space for discussion. These two key factors form the basis of a health communication strategy for young people who live with HIV and need to adhere to ART. Following on from these findings the study included the production of a film and animation that were identified as the visual communication media that would best support young people's understanding and motivation to adherence. The film presents a case study of a young person who overcame their initial diagnosis shock and, through the acceptance and support of his family, learned to live a normal life with HIV. Young people had said that they wanted to be able to view a film of this kind soon after their diagnosis. The animation, which was designed using a participatory process, used 'iso-type' as the central visual language. It was piloted, and this showed that the best use of a visual communication tool was in a setting that allowed young people to talk about prior losses to HIV within their families and community and about their confusion about treatment, and to ask questions about the meaning of complex biomedical concepts such as an undetectable viral load. All young people who visited the clinics, irrespective of test results, said that they wanted to learn about ART so that they could support friends and family members who lived with HIV, change perceptions about HIV among peers and better prepare in the case of becoming HIV positive themselves. Therefore it is recommended that communication strategies should target patients, their belonging groups and the wider community. This substantive theory contributes knowledge relevant to how ART adherence is communicated to young people. More broadly, this thesis argues that an interdisciplinary approach is required if communication practitioners are to properly understand the meaning that a population attributes to a health challenge; especially in the context of motivation and understanding. It is only when those meanings are fully identified through consolidated social science research that a communication strategy and supporting visual tools can be successfully designed.

No description available.

No description available.

No description available.

No description available.