Bøker av Institute of Medicine

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

In recent years, the field of oncology has witnessed a number of technological advances, including more precise radiation therapy and minimally invasive surgical techniques. Three-dimensional (3D), stereotactic, and proton-beam radiation therapy, as well as laparoscopy and robotic surgery, can enhance clinician's ability to treat conditions that were clinically challenging with conventional technologies, and may improve clinical outcomes or reduce treatment-related problems for some patients. Both patients and physicians seek access to these new technologies, which are rapidly being adopted into standard clinical practice. Such demand is often propelled by marketing that portrays the new technologies as the latest and greatest treatments available. However, evidence is often lacking to support these claims, and these novel technologies usually come with higher price tags and are often used to treat patients who might have achieved similar benefits from less expensive, conventional treatment.The increased cost of novel treatments without adequate assessment of how they affect patient outcomes is a pressing concern given that inappropriate use of expensive technologies is one of the key factors that threaten the affordability of cancer care in the United States. To explore these issues further, the National Cancer Policy Forum (NCPF) of the Institute of Medicine organized a workshop in July 2015. This is the third NCPF workshop in a series examining the affordability of cancer care. Participants explored clinical benefits and comparative effectiveness of emerging advanced technologies for cancer treatment in radiation therapy and surgery and potential strategies to assess the value and promote optimal use of new technologies in cancer treatment. This report summarizes the presentations and discussions from the workshop.

Provides guidelines and principles for exploiting the potential benefits of aggregated health data - without jeopardizing confidentiality. Experts identify characteristics of health database organizations (HDOs). This work explores topics such as how HDOs can maintain the quality of data, and what policies and practices they should adopt.

Provides an exploration of the biological, ethical, and funding questions prompted by the therapeutic potential of undifferentiated human cells. This book also presents an overview of the moral and ethical problems that arise from the use of embryonic stem cells.

Presents the links between common childhood vaccines - tetanus, diphtheria, measles, mumps, polio, Haemophilus influenzae b, and hepatitis B - and specific types of disorders or death. This book discusses approaches to evidence and causality and examine the consequences - neurologic and immunologic disorders and death - linked with immunization.

Provides a survey of what is known about injuries, and suggests that there is a vast need to know more. This book traces findings on the epidemiology of injuries, prevention of injuries, injury biomechanics and the prevention of impact injury, treatment, rehabilitation, and administration of injury research.

Evaluating claims based on pain poses problems for the Social Security Administration (SSA) and other disability insurers. This volume covers the epidemiology and physiology of pain; psychosocial contributions to pain and illness behavior; promising ways of assessing and measuring chronic pain and dysfunction; and clinical aspects of prevention.

As many as 20 to 25 percent of American adults - or one in every four people - have been victimized by, witnesses of, or perpetrators of family violence in their lifetimes. This book offers recommendations, such as creating education and research centers that would help raise awareness of the problem on various levels.

Part of a series that provides recommended intakes, such as Recommended Dietary Allowances (RDAs), for use in planning nutritionally adequate diets for individuals based on age and gender. This volume determines Tolerable Upper Intake levels for each nutrient reviewed where adequate scientific data are available in specific population subgroups.

Examines the scientific basis for connecting musculoskeletal disorders with the workplace, considering people, job tasks, and work environments. This work draws conclusions about the likelihood of causal links and the effectiveness of intervention strategies. It offers recommendations for what actions can be considered on the basis of information.

Despite overwhelming evidence of tobacco's harmful effects and pressure from anti-smoking advocates, surveys show that about one-quarter of various adults in the United States are smokers. This book addresses the problems in evaluating whether such products actually do reduce the health risks of tobacco use.

Brain disorders - neurological, psychiatric, and developmental - affect at least 250 million people in the developing world, and this number is expected to rise as life expectancy increases. This work describes the causes and risk factors associated with brain disorders.

Since 1994, the Institute of Medicine's Food and Nutrition Board has been involved in developing an expanded approach to developing dietary reference standards. This book provides guidance to nutrition and health research professionals on the application of the new DRIs. It represents both a "how to" manual and a "why" manual.

Summarizes what we know about marijuana from evidence-based medicine. This book helps the reader understand what science has to say about medical marijuana but also the logic behind the scientific conclusions. It addresses the science base and the therapeutic effects of marijuana use for medical conditions such as glaucoma and multiple sclerosis.

Rapid advancements in medical technologies, improvements in pharmaceuticals, and other developments in biomedical research have helped develop cures for many illnesses and improve the lives of those with chronic diseases. This book identifies those promising areas of social science and behavioral research that may address public health needs.

Examines the basic strategies that finance the national immunization system in health care climate. This book explores the evolution of the system in light of changing US demographics, development of vaccines, and other factors. It is useful for those responsible for maintaining our nation's vaccine vigilance.

Discusses the role of vitamin C, vitamin E, selenium, and the carotenoids in human physiology and health. This book provides reference intakes, such as Recommended Dietary Allowances (RDAs), for use in planning nutritionally adequate diets for different groups based on age and gender, along with a reference intake.

Provides a picture of how cancer care is delivered. This book explains how lack of medical coverage, social and economic status, patient beliefs, physician decision-making, and other factors can affect the best possible care. The National Cancer Policy Board defines quality care and recommends how to monitor, measure, and extend quality care.