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This Week in PLOS Medicine: Dementia Guidelines, COIs & Disease Definitions, Cervical Cancer Neglect in LMIC, & HIV

This week PLOS Medicine publishes the following new articles:

Image Credit: Dierk Schaefer, Flickr
Image Credit: Dierk Schaefer, Flickr

Ethical issues are important for clinical practice guidelines (CPG) to address, for the medical profession to understand how to approach patient care, and for patients, their relatives, and the general public seeking information and advice. Daniel Strech and colleagues find that twelve national dementia CPGs include only half of 31 ethical issues identified as important in patient care. The study suggests that, although clinical practice guidelines are meant to improve standards through evidence-based information on benefits and harms, clinical practice guideline development manuals worldwide fail to address how to include disease-specific ethical issues.

Ray Moynihan and colleagues assess expert members of panels making decisions about definitions or diagnostic criteria for common conditions in the US, which were published in heathcare guidelines, and report that most members had industry ties. Disease definitions were widened between 2000 and 2013 for multiple conditions including high blood pressure, Alzheimer disease, and rheumatoid arthritis. The study does not investigate the merits of these changes; however, findings that diagnostic thresholds are being lowered by panels dominated by those with financial ties to multiple companies, which may benefit directly from those decisions, raises questions about current processes of disease definition.

While there have been substantial improvements in mortality rates and an increase in access to reproductive health interventions in low- and middle-income countries (LMICs), Ruby Singhrao and colleagues argue that the global health community is neglecting prevention, screening, and treatment for cervical cancer in LMICs. Arguing that cervical cancer screening and treatment should be included in the post-2015 development agenda,  the authors conclude that there exists feasible, affordable, and effective prevention options to make dramatic global reductions in cervical cancer incidence a realistic goal in our lifetime.

Amitabh Suthar and colleagues describe the evidence base for different HIV testing and counseling services (HTC) provided outside of health facilities. These findings suggest that community-based HTC can achieve high rates of HTC uptake, can reach HIV-positive individuals earlier, and can link people to care. Although further studies are needed to evaluate community-based HTC outside of Africa and North America, these findings suggest that offering community-based HTC in HIV programs, in addition to facility-based testing, could support the increased access to HIV prevention and care that is required for the intensification of HIV/AIDS elimination efforts.



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