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Pellicano E, Heyworth M. The Foundations of Autistic Flourishing. Curr Psychiatry Rep 2023; 25:419-427. [PMID: 37552401 PMCID: PMC10506917 DOI: 10.1007/s11920-023-01441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW All people-including Autistic people-deserve to live flourishing lives. But what does a flourishing life look like for Autistic people? We suggest that the hidden biases, methodological errors, and key assumptions of autism science have obscured answers to this question. Here, we seek to initiate a broader discussion about what the foundations for a good Autistic life might be and how this discussion might be framed. RECENT FINDINGS We identify five ways in which autism science can help us all to secure those foundations, including by (1) giving Autistic well-being prominence in research, (2) amplifying Autistic autonomy, (3) attending better to everyday experiences, (4) acknowledging context, and (5) working in partnership with Autistic people and their families and allies to ensure that they are at the heart of research decision-making. Such an approach would direct the focus of autism research to help shape good Autistic lives.
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Affiliation(s)
- Elizabeth Pellicano
- Department of Clinical, Educational and Health Psychology, University College London, 26 Bedford Way, London, WC1H 0DS, UK.
- Macquarie School of Education, Macquarie University, 29 Wally's Walk, Sydney, Australia.
| | - Melanie Heyworth
- Macquarie School of Education, Macquarie University, 29 Wally's Walk, Sydney, Australia
- Reframing Autism, Warners Bay, NSW, Australia
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Braude M, Khaira G, Woolley I, Clarke D, Dev A, Sievert W. Integrating Hepatitis C Virus Treatment Programs Within Community Mental Health. Psychiatr Serv 2022; 73:946-949. [PMID: 34991342 DOI: 10.1176/appi.ps.202100375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Conventional models of health care for the hepatitis C virus (HCV) underserve people with serious mental illness. In a 6-month proof-of-concept study, colocated HCV care coordination was assessed within community mental health settings. The program, which relied on referrals to a visiting hepatologist and was augmented by a part-time nurse practitioner, received 18 referrals for HCV management. From this group, 11 individuals achieved sustained virological response at 12 weeks after direct-acting antiviral therapy. Seven individuals declined treatment or were lost to follow-up. Overall, colocated integrated services may play an important role in HCV health care parity for people with serious mental illness.
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Affiliation(s)
- Michael Braude
- Monash Health, Clayton, Victoria, Australia (Braude, Khaira, Woolley, Dev, Sievert); School of Clinical Sciences (Baude, Woolley, Dev, Sievert) and Psychological Medicine (Clarke),Monash University, Clayton, Victoria, Australia. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Gaganpreet Khaira
- Monash Health, Clayton, Victoria, Australia (Braude, Khaira, Woolley, Dev, Sievert); School of Clinical Sciences (Baude, Woolley, Dev, Sievert) and Psychological Medicine (Clarke),Monash University, Clayton, Victoria, Australia. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Ian Woolley
- Monash Health, Clayton, Victoria, Australia (Braude, Khaira, Woolley, Dev, Sievert); School of Clinical Sciences (Baude, Woolley, Dev, Sievert) and Psychological Medicine (Clarke),Monash University, Clayton, Victoria, Australia. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - David Clarke
- Monash Health, Clayton, Victoria, Australia (Braude, Khaira, Woolley, Dev, Sievert); School of Clinical Sciences (Baude, Woolley, Dev, Sievert) and Psychological Medicine (Clarke),Monash University, Clayton, Victoria, Australia. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Anouk Dev
- Monash Health, Clayton, Victoria, Australia (Braude, Khaira, Woolley, Dev, Sievert); School of Clinical Sciences (Baude, Woolley, Dev, Sievert) and Psychological Medicine (Clarke),Monash University, Clayton, Victoria, Australia. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - William Sievert
- Monash Health, Clayton, Victoria, Australia (Braude, Khaira, Woolley, Dev, Sievert); School of Clinical Sciences (Baude, Woolley, Dev, Sievert) and Psychological Medicine (Clarke),Monash University, Clayton, Victoria, Australia. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
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Abstract
This paper presents the concepts of "neurodiversity" and the "neurodiversity approaches" towards disability and discusses how confusion regarding the meaning of these concepts exacerbates debate and conflict surrounding the neurodiversity approaches. For example, some claim the neurodiversity approaches focus solely on society and deny contributions of individual characteristics to disability (a controversial stance), whereas this paper joins other literature in acknowledging the contributions of both individual and society to disability. This paper also addresses other controversies related to neurodiversity, such as uncertainty regarding the scope of the approaches - to whom do they apply? - and their implications for diagnostic categories. Finally, it provides recommendations for developmental researchers who wish to carry out neurodiversity-aligned research: scholars are urged to study both individual neurodivergent people and the contexts around them; to consider both strengths and weaknesses; to recognize their own biases; and to listen to and learn from neurodivergent people.
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Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, University of California at Davis, Davis, California, USA
- Department of Psychology, University of California at Davis, Davis, California, USA
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Gröning L, Haukvik UK, Morse SJ, Radovic S. Remodelling criminal insanity: Exploring philosophical, legal, and medical premises of the medical model used in Norwegian law. Int J Law Psychiatry 2022; 81:101776. [PMID: 35101774 DOI: 10.1016/j.ijlp.2022.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
This paper clarifies the conceptual space of discussion of legal insanity by considering the virtues of the 'medical model' model that has been used in Norway for almost a century. The medical model identifies insanity exclusively with mental disorder, and especially with psychosis, without any requirement that the disorder causally influenced the commission of the crime. We explore the medical model from a transdisciplinary perspective and show how it can be utilised to systematise and reconsider the central philosophical, legal and medical premises involved in the insanity debate. A key concern is how recent transdiagnostic and dimensional approaches to psychosis can illuminate the law's understanding of insanity and its relation to mental disorder. The authors eventually raise the question whether the medical model can be reconstructed into a unified insanity model that is valid across the related disciplinary perspectives, and that moves beyond current insanity models.
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Affiliation(s)
- Linda Gröning
- Faculty of Law, University of Bergen, University of Bergen, PB 7806 5020, Bergen, Norway; Regional Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital of Bergen, PB 1400, 5021, Bergen, Norway.
| | - Unn K Haukvik
- Department of Mental Health and Addiction, Institute for Clinical Medicine, University of Oslo & Centre for University of Bergen, Norway; Regional Centre for Research and Education in Forensic Psychiatry and Psychology, Oslo University Hospital, PB 4956, Nydalen, 0424 Oslo, Norway.
| | - Stephen J Morse
- Law School & Psychiatry Department, University of Pennsylvania, 3501 Sansom St., Philadelphia, PA 19104-6204, USA.
| | - Susanna Radovic
- Department of Philosophy, Linguistics and Theory of Science & Centre for Ethics, Law and Mental Health, University of Gothenburg, PB 100, SE-405 30 Gothenburg, Sweden.
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Glicksman A, Rodriguez M, Ring L, Liebman M. From Personalized Medicine to Personalized Aging Services. Innov Aging 2021; 5:igab047. [PMID: 34917775 PMCID: PMC8670719 DOI: 10.1093/geroni/igab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 12/02/2022] Open
Abstract
As medical models become more ubiquitous in developing strategies to provide long-term care services and support (LTSS), we need to ask whether these models adequately account for sources of diversity and disadvantage that affect access to and use of services by older adults. Medical models typically focus on categorizing information about the individual in order to clearly define current health status and appropriate treatment. Any individual, however, reflects the sum of their life experiences. Therefore, this medicalization approach can miss key factors in determining health outcomes including social determinants of health. Just as importantly, this approach can miss issues of values, beliefs, and assumptions that older adults can bring into the encounter with service providers. This issue is especially important when dealing with older migrant communities. Beliefs and attitudes shaped in their place of origin, as well as the migration experience, can influence levels of trust and resulting decisions regarding the use of LTSS. We need to integrate an understanding of how these beliefs and attitudes affect decision making into any model designed to improve the lives of older persons.
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Affiliation(s)
- Allen Glicksman
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Misha Rodriguez
- Asociación Puertorriqueños en Marcha, Philadelphia, Pennsylvania, USA
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Baum F, Ziersch A, Freeman T, Javanparast S, Henderson J, Mackean T. Strife of Interests: Constraints on integrated and co-ordinated comprehensive PHC in Australia. Soc Sci Med 2020; 248:112824. [PMID: 32058888 DOI: 10.1016/j.socscimed.2020.112824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Abstract
The 1978 World Health Organisation Alma Ata Declaration on Primary Health Care (PHC) emphasised a comprehensive view which stressed the importance of cure, prevention, promotion and rehabilitation delivered in a way that involved local communities and considered a social, economic and political perspective on health. Despite this, selective approaches have dominated. This paper asks why this has been the case in Australia through a multi-method study of regional PHC organisations. Interviews with senior policy players, focus groups with non-government organisations and document analysis inform an institutional and power analysis of PHC. The findings indicate that there are different interests competing for attention in PHC but that medical perspectives prove the most powerful and are reinforced by the actors, ideas and institutions that shape PHC. Community perspectives which stress lived experience and social perspectives on health are marginal concerns in the implementation of PHC. The other important interest is that of a neo-liberal perspective on health policy which stresses cost-containment, close measurement of activity and fragmented contracting out of services. This perspective is not compatible with a social determinants of health perspective and can also conflict with a medical view. The result of the interplay between competing interests and the distribution of power is a selective PHC system that is not likely to change without radical shifts in power and perspectives.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Level 2 Health Sciences Building, North Ridge Precinct, Registry Road, Bedford Park, 5042 GPO Box 2100, Adelaide SA 5001, Australia.
| | - Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, Level 2 Health Sciences Building, North Ridge Precinct, Registry Road, Bedford Park, 5042 GPO Box 2100, Adelaide SA 5001, Australia.
| | - Toby Freeman
- Southgate Institute for Health, Society and Equity, Flinders University, Level 2 Health Sciences Building, North Ridge Precinct, Registry Road, Bedford Park, 5042 GPO Box 2100, Adelaide SA 5001, Australia.
| | - Sara Javanparast
- Southgate Institute for Health, Society and Equity, Flinders University, Level 2 Health Sciences Building, North Ridge Precinct, Registry Road, Bedford Park, 5042 GPO Box 2100, Adelaide SA 5001, Australia.
| | - Julie Henderson
- Southgate Institute for Health, Society and Equity, Flinders University, Level 2 Health Sciences Building, North Ridge Precinct, Registry Road, Bedford Park, 5042 GPO Box 2100, Adelaide SA 5001, Australia.
| | - Tamara Mackean
- Southgate Institute for Health, Society and Equity, Flinders University, Level 2 Health Sciences Building, North Ridge Precinct, Registry Road, Bedford Park, 5042 GPO Box 2100, Adelaide SA 5001, Australia.
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Abstract
The management of hearing loss associated with otitis media is multifaceted. Clinical practice guidelines set the collaborative prescriptive standards for the medical management of otitis media in children. Treatment of this condition does not end with the medical practitioner. There are far-reaching effects of otitis media and its sequelae that permeate every aspect of patients' lives including physiological, educational, and psychosocial. Therefore, a comprehensive interprofessional treatment plan must be designed taking into consideration best practices from a range of professions to maximize clinical outcomes, including the treating physician, speech-language pathologist, clinical audiologist, educational audiologist, and professionals in the educational setting.
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Affiliation(s)
- Deborah R Welling
- Department of Speech-Language Pathology, Seton Hall University, 400 South Orange Avenue, South Orange, NJ 07079, USA.
| | - Carol A Ukstins
- Newark Public Schools, Office of Special Education, 2 Cedar Street, Newark, NJ 07102, USA
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Abstract
Medicalization appears to be an issue that is both ubiquitous and unquestionably problematic as it seems to signal at once a social and existential threat. This perception of medicalization, however, is nothing new. Since the first main writings in the 1960s and 1970s, it has consistently been used to describe inappropriate or abusive instances of medical authority. Yet, while this standard approach claims that medicalization is a growing problem, it assumes that there is simply one "medical model" and that the expanding realm of "the medical" can be more or less clearly delineated. Moreover, while intended to establish the reality of this growing threat, this research often requires making arbitrary or unjustified distinctions between different practices. To better clarify the concept of medicalization, I will focus more on capturing the variety of medical practices than on the sociological aspects of medical discourse. In doing so, I will explore the distinction between medicalization and pathologization, a distinction that is often overlooked and that brings with it many conceptual and practical implications. After defining these terms, I will use some examples to show that while pathologizing is closely tied to medicalizing, both can occur independently. I will then further develop this distinction in terms of the different individual and social effects of these practices.
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Affiliation(s)
- Jonathan Sholl
- Department of Philosophy and History of Ideas, Aarhus University, Jens Chr. Skous Vej 7, 8000, Aarhus, Denmark.
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Yakushi T, Kuba T, Nakamoto Y, Fukuhara H, Koda M, Tanaka O, Kondo T. Usefulness of an educational lecture focusing on improvement in public awareness of and attitudes toward depression and its treatments. BMC Health Serv Res 2017; 17:126. [PMID: 28183303 PMCID: PMC5301371 DOI: 10.1186/s12913-017-2071-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/03/2017] [Indexed: 01/25/2023] Open
Abstract
Background There is an urgent need to establish effective strategies for suicide prevention. Stigma against depression may be a potential anti-protective factor for suicide. Thus, we investigated baseline levels of awareness and attitudes toward depression and its treatment among the general population by our original 18-item questionnaire, which we aimed to validate in the present study. Next, we conducted two types of educational interventions and examined the results to clarify the difference in the quality of these lectures. Methods Subjects were 834 citizens (245 males and 589 females) who received an anti-stigma-targeted (n = 467) or non-targeted lecture (n = 367). An 18-item questionnaire assessing levels of awareness and attitudes toward depression and its treatments was administered to each participant before and after the lecture. A chi-square test was used to investigate categorical variables for background data on the participants. Factor analysis of baseline scores was conducted on the 18 questionnaire items. Student’s t-test was used for analysis of the gender effect. A two-way analysis of variance (ANOVA) was used for comparison among the 5 age groups and comparison of the effect of the two lectures. Multiple regression analysis was applied to examine the determinants of improved attitudes after intervention. Results Public attitudes toward depression consisted of 4 distinct elements, which were disease-model attitudes, help-seeking behavior, negative affect toward depression, and non-medication solutions. Older participants had poorer disease-model attitudes and more negative affect toward depression, whereas younger participants showed poorer help-seeking behavior (p < 0.05). The anti-stigma-targeted lecture was superior to the non-targeted lecture in improving disease-model attitudes and non-medication solutions (p < 0.05). Multiple regression analyses revealed that each subscale score at post-lecture was strongly dependent on its own baseline subscale score (p < 0.01), and that baseline disease-model attitudes also affected post-lecture scores on negative affect toward depression and non-medication solutions (p < 0.01). Conclusions The educational intervention appears useful for acquiring accurate attitudes toward depression in a medical model. However, other strategies should be considered to enhance help-seeking behavior, especially in younger people.
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Affiliation(s)
- Takashi Yakushi
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
| | - Teizo Kuba
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Yuzuru Nakamoto
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Hiroshi Fukuhara
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Munenaga Koda
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Osamu Tanaka
- Aomori Prefectural Center for Mental Health and Welfare, 353-92 Sannai Sawabe, Aomori, 038-0031, Japan
| | - Tsuyoshi Kondo
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
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Heerkens YF, de Weerd M, Huber M, de Brouwer CPM, van der Veen S, Perenboom RJM, van Gool CH, Ten Napel H, van Bon-Martens M, Stallinga HA, van Meeteren NLU. Reconsideration of the scheme of the international classification of functioning, disability and health: incentives from the Netherlands for a global debate. Disabil Rehabil 2017; 40:603-611. [PMID: 28129712 DOI: 10.1080/09638288.2016.1277404] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The ICF (International Classification of Functioning, Disability and Health) framework (used worldwide to describe 'functioning' and 'disability'), including the ICF scheme (visualization of functioning as result of interaction with health condition and contextual factors), needs reconsideration. The purpose of this article is to discuss alternative ICF schemes. METHOD Reconsideration of ICF via literature review and discussions with 23 Dutch ICF experts. Twenty-six experts were invited to rank the three resulting alternative schemes. RESULTS The literature review provided five themes: 1) societal developments; 2) health and research influences; 3) conceptualization of health; 4) models/frameworks of health and disability; and 5) ICF-criticism (e.g. position of 'health condition' at the top and role of 'contextual factors'). Experts concluded that the ICF scheme gives the impression that the medical perspective is dominant instead of the biopsychosocial perspective. Three alternative ICF schemes were ranked by 16 (62%) experts, resulting in one preferred scheme. CONCLUSIONS There is a need for a new ICF scheme, better reflecting the ICF framework, for further (inter)national consideration. These Dutch schemes should be reviewed on a global scale, to develop a scheme that is more consistent with current and foreseen developments and changing ideas on health. Implications for Rehabilitation We propose policy makers on community, regional and (inter)national level to consider the use of the alternative schemes of the International Classification of Functioning, Disability and Health within their plans to promote functioning and health of their citizens and researchers and teachers to incorporate the alternative schemes into their research and education to emphasize the biopsychosocial paradigm. We propose to set up an international Delphi procedure involving citizens (including patients), experts in healthcare, occupational care, research, education and policy, and planning to get consensus on an alternative scheme of the International Classification of Functioning, Disability and Health. We recommend to discuss the alternatives for the present scheme of the International Classification of Functioning, Disability and Health in the present update and revision process within the World Health Organization as a part of the discussion on the future of the International Classification of Functioning, Disability and Health framework (including ontology, title and relation with the International Classification of Diseases). We recommend to revise the definition of personal factors and to draft a list of personal factors that can be used in policy making, clinical practice, research, and education and to put effort in the revision of the present list of environmental factors to make it more useful in, e.g., occupational health care.
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Affiliation(s)
- Yvonne F Heerkens
- a Dutch Institute of Allied Health Care , Amersfoort , The Netherlands.,b Research Group Occupation & Health , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | | | - Machteld Huber
- d Institute for Positive Health , Amersfoort , The Netherlands
| | - Carin P M de Brouwer
- e Department of Epidemiology, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Sabina van der Veen
- f Innovation Health Care Professions & Education , Dutch Health Care Institute , Diemen , The Netherlands
| | | | - Coen H van Gool
- g WHO Collaborating Centre for the Family of International Classifications in The Netherlands, National Institute for Public Health and the Environment , Bilthoven , The Netherlands
| | - Huib Ten Napel
- g WHO Collaborating Centre for the Family of International Classifications in The Netherlands, National Institute for Public Health and the Environment , Bilthoven , The Netherlands
| | - Marja van Bon-Martens
- h The Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht , The Netherlands
| | - Hillegonda A Stallinga
- i School of Nursing & Health, University Medical Center, University of Groningen , Groningen , The Netherlands
| | - Nico L U van Meeteren
- j Topsector Life Sciences and Health (Health ∼ Holland) , The Hague , The Netherlands.,k CAPHRI, Maastricht University , Maastricht , The Netherlands
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Abstract
Background The increased and accelerating utilization of 3D printing in medicine opens up questions regarding safety and efficacy in the use of medical models. The authors recognize an important shift towards point-of-care manufacturing for medical models in a hospital environment. This change, and the role of the radiologist as a central facilitator of these services, opens discussion about topics ranging from clinical uses to patient safety to regulatory implications. Results This project first defines three groups of patients for whom 3D printing positively impacts patient care. The steps needed for each group are described. Conclusions We provide our opinions regarding the regulatory role that we feel is most appropriate, balancing safety and efficacy with the autonomy of individuals in the field to make the greatest positive impact on healthcare.
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Affiliation(s)
| | - Frank J Rybicki
- 2Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,3The Ottawa Hospital Research Institute, Ottawa, ON Canada
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