title: The age of personalized medicine—From patients to consumers: The digital environment, clickwrap contracts, and implications for autonomy

authors: Phillips, Andelka M.

subjects: direct-to-consumer genetic testing

abstract: How many online contracts have you entered into this year and how many of those did you actually read? This chapter explores the impact that the designed environment of websites and electronic contracts have on the exercise of individual autonomy in the context of the example of direct-to-consumer genetic tests (DTC). DTC tests for health purposes can be viewed as an example of Personalized Medicine, but as the mode of sale usually lacks the involvement of a physician or genetic counsellor and the industry is largely unregulated, companies often rely on their contracts and privacy policies to govern relationships with consumers. This chapter seeks to shed light on the impact that offering these services online and relying on electronic contracts, which people have grown accustomed to ignoring, has on the exercise of autonomy and an individual’s ability to make an informed choice in this context.

text: The age of personalized medicine—From patients to consumers: The digital environment, clickwrap contracts, and implications for autonomy How many online contracts have you entered into this year and how many of those did you actually read? This chapter explores the impact that the designed environment of websites and electronic contracts have on the exercise of individual autonomy in the context of the example of direct-to-consumer genetic tests (DTC). DTC tests for health purposes can be viewed as an example of Personalized Medicine, but as the mode of sale usually lacks the involvement of a physician or genetic counsellor and the industry is largely unregulated, companies often rely on their contracts and privacy policies to govern relationships with consumers. This chapter seeks to shed light on the impact that offering these services online and relying on electronic contracts, which people have grown accustomed to ignoring, has on the exercise of autonomy and an individual’s ability to make an informed choice in this context.

year: 2019

title: Proving the existence of solutions in logical arithmetic

authors: Cleary, John G.

subjects: computer science

abstract: Logical arithmetic is a logically correct technique for real arithmetic in Prolog which uses constraints over interval representations for its implementation.  Four problems with the technique are considered: answers are conditional and uninformative; iterative computations may lead to unboundedly large constraint networks; it is difficult and ineffective to deal with negation; and computing extrema is often not effective.  A solution to these problems is proposed in the form of "existential intervals" which record the existence of a solution to a set of constraints within an interval.  It is shown how to operate on existential intervals and how they solve the four problems.

text: Proving the existence of solutions in logical arithmetic Logical arithmetic is a logically correct technique for real arithmetic in Prolog which uses constraints over interval representations for its implementation.  Four problems with the technique are considered: answers are conditional and uninformative; iterative computations may lead to unboundedly large constraint networks; it is difficult and ineffective to deal with negation; and computing extrema is often not effective.  A solution to these problems is proposed in the form of "existential intervals" which record the existence of a solution to a set of constraints within an interval.  It is shown how to operate on existential intervals and how they solve the four problems.

year: 1993-10

title: How do colorectal cancer patients rate their GP: a mixed methods study

authors: Blackmore, Tania Louise

subjects: Science & Technology

abstract: Background: New Zealand (NZ) has a high incidence of colorectal cancer (CRC) and low rates of early diagnosis. With screening not yet nationwide, the majority of CRC is diagnosed through general practice. A good patient-general practitioner (GP) relationship can facilitate prompt diagnosis, but when there is a breakdown in this relationship, delays can occur. Delayed diagnosis of CRC in NZ receives a disproportionally high number of complaints directed against GPs, suggesting deficits in the patient-GP connection. We aimed to investigate patient-reported confidence and ratings of their GP following the diagnostic process. 
Methods: This study is a mixed methods analysis of responses to a structured questionnaire and free text comments from patients newly diagnosed with CRC in the Midland region of NZ. A total of 195 patients responded to the structured questionnaire, and 113 patients provided additional free text comments. Descriptive statistics were used to describe the study population and chi square analysis determined the statistical significance of factors possibly linked to delay. Free text comments were analysed using a thematic framework. 
Results: Most participants rated their GP as ‘Very good/Good’ at communication with patients about their health conditions and involving them in decisions about their care, and 6.7% of participants rated their overall level of confidence and trust in their GP as ‘Not at all’. Age, gender, ethnicity and a longer diagnostic interval were associated with lower confidence and trust. Free text comments were grouped in to three themes: 1. GP Interpersonal skills; (communication, listening, taking patient symptoms seriously), 2. Technical competence; (speed of referral, misdiagnoses, lack of physical examination), and 3. Organisation of general practice care; (appointment length, getting an appointment, continuity of care). 
Conclusions: Māori, females, and younger participants were more likely to report low confidence and trust in their GP. Participants associate a poor diagnostic experience with deficits in the interpersonal and technical skills of their GP, and health system factors within general practice. Short appointment times, access to appointments and poor GP continuity are important components of how patients assess their experience and are particularly important to ensure equal access for Māori patients.

text: How do colorectal cancer patients rate their GP: a mixed methods study Background: New Zealand (NZ) has a high incidence of colorectal cancer (CRC) and low rates of early diagnosis. With screening not yet nationwide, the majority of CRC is diagnosed through general practice. A good patient-general practitioner (GP) relationship can facilitate prompt diagnosis, but when there is a breakdown in this relationship, delays can occur. Delayed diagnosis of CRC in NZ receives a disproportionally high number of complaints directed against GPs, suggesting deficits in the patient-GP connection. We aimed to investigate patient-reported confidence and ratings of their GP following the diagnostic process. 
Methods: This study is a mixed methods analysis of responses to a structured questionnaire and free text comments from patients newly diagnosed with CRC in the Midland region of NZ. A total of 195 patients responded to the structured questionnaire, and 113 patients provided additional free text comments. Descriptive statistics were used to describe the study population and chi square analysis determined the statistical significance of factors possibly linked to delay. Free text comments were analysed using a thematic framework. 
Results: Most participants rated their GP as ‘Very good/Good’ at communication with patients about their health conditions and involving them in decisions about their care, and 6.7% of participants rated their overall level of confidence and trust in their GP as ‘Not at all’. Age, gender, ethnicity and a longer diagnostic interval were associated with lower confidence and trust. Free text comments were grouped in to three themes: 1. GP Interpersonal skills; (communication, listening, taking patient symptoms seriously), 2. Technical competence; (speed of referral, misdiagnoses, lack of physical examination), and 3. Organisation of general practice care; (appointment length, getting an appointment, continuity of care). 
Conclusions: Māori, females, and younger participants were more likely to report low confidence and trust in their GP. Participants associate a poor diagnostic experience with deficits in the interpersonal and technical skills of their GP, and health system factors within general practice. Short appointment times, access to appointments and poor GP continuity are important components of how patients assess their experience and are particularly important to ensure equal access for Māori patients.

year: 2021-04-08