Institute of Medicine - Böcker

The military, political, and economic preeminence of the United States during the post-World War II era is based to a substantial degree on its superior rate of achievement in science and technology, as well as on its capacity to translate these achievements into products and processes that contribute to economic prosperity and the national defense. The success of the U.S. scientific enterprise has been facilitated by many factors, important among them the opportunity for American scientists and engineers to pursue their research-and to communicate with each other-in a free and open environment. During the last two administrations, however, concern has arisen that the characteristically open U.S. scientific community has served as one of the channels through which critical information and know-how are flowing to the Soviet Union and to other potential adversary countries; openness in science is thus perceived to present short-term national security risks in addition to its longer-term national security benefits in improved U.S. military technology.The Panel on Scientific Communication and National Security was asked to examine the various aspects of the application of controls to scientific communication and to suggest how to balance competing national objectives so as to best serve the general welfare. The Panel held three two-day meetings in Washington at which it was briefed by representatives of the departments of Defense, State, and Commerce, and by representatives of the intelligence community, including the Central Intelligence Agency, the Federal Bureau of Investigation, the Defense Intelligence Agency, and the National Security Agency. The Panel also heard presentations by members of the research community and by university representatives. In addition to these briefings, the Rand Corporation prepared an independent analysis of the transfer of sensitive technology from the United States to the Soviet Union. To determine the views of scientists and administrators at major research universities, the Panel asked a group of faculty members and administrative officials at Cornell University to prepare a paper incorporating their own views and those of counterparts at other universities.The main thrust of the Panel's findings is completely reflected in this document. However, the Panel has also produced a classified version of the subpanel report based on the secret intelligence information it was given; this statement is available at the Academy to those with the appropriate security clearance.

"The book is well organized, well detailed, and well referenced; it is an invaluable sourcebook for researchers and clinicians working in the area of bereavement. For those with limited knowledge about bereavement, this volume provides an excellent introduction to the field and should be of use to students as well as to professionals," states Contemporary Psychology. The Lancet comments that this book "makes good and compelling reading...It was mandated to address three questions: what is known about the health consequences of bereavement; what further research would be important and promising; and whether there are preventive interventions that should either be widely adopted or further tested to evaluate their efficacy. The writers have fulfilled this mandate well."

Despite recent declines in infant mortality, the rates of low birthweight deliveries in the United States continue to be high. Part I of this volume defines the significance of the problems, presents current data on risk factors and etiology, and reviews recent state and national trends in the incidence of low birthweight among various groups. Part II describes the preventive approaches found most desirable and considers their costs. Research needs are discussed throughout the volume.

Written for a broad audience, including program administrators, policymakers, teachers, students, and health care professionals and their patients--anyone with an interest in preventing low birthweight--this summary is a condensation of the full report, Preventing Low Birthweight. It clearly and concisely covers most of the topics discussed in the comprehensive volume. 2-9 copies, $4.00 each; 10 or more copies, $2.50 each (no other discounts apply).

The United States is facing a vaccine shortage that may threaten public health. This book examines vaccine research and development, production and supply, and utilization and offers recommendations aimed at ensuring vaccine supply and promoting innovation. In addition, this comprehensive volume provides information on the adverse reactions associated with the range of vaccines used in the United States and contains the most thorough analysis ever published on the state of the law regarding vaccine-related injury and compensation for vaccine injury.

New drugs, new devices, improved surgical techniques, and innovative diagnostic procedures and equipment emerge rapidly. But development of these technologies has outpaced evaluation of their safety, efficacy, cost-effectiveness, and ethical and social consequences. This volume, which is "strongly recommended" by The New England Journal of Medicine "to all those interested in the future of the practice of medicine," examines how new discoveries can be translated into better care, and how the current system's inefficiencies prevent effective health care delivery. In addition, the book offers detailed profiles of 20 organizations currently involved in medical technology assessment, and proposes ways to organize U.S. efforts and create a coordinated national system for evaluating new medical treatments and technology.

This second volume in the Institute of Medicine's series on America's Aging explores the various productive roles that the growing number of elderly individuals can play in society through volunteer work. Some of the issues addressed include the main incentives and impediments to elderly volunteerism, the various forms of unpaid productive work and how they affect the health and well-being of the volunteer, and the recruitment of elderly volunteers that is done by various organizations. For policymakers, economists, sociologists, gerontologists, and social services agencies, this is an indispensable resource for the future.

Common diseases cost the developing world an enormous amount in terms of human life, health, and productivity, as well as lost economic potential. New and effective vaccines could not only improve the quality of life for millions of residents in developing countries, they could also contribute substantially to further economic development. Using data from the World Health Organization and other international agencies, this book analyzes disease burdens, pathogen descriptions, geographic distribution of diseases, probable vaccine target populations, alternative control measures and treatments, and future prospects for vaccine development. New Vaccine Development provides valuable insight into immunological and international health policy priorities.

This volume examines the complex medical, social, ethical, financial, and scientific problems arising from the AIDS epidemic and offers dozens of public policy and research recommendations for an appropriate national response to this dread disease.

Third in the series, this book addresses the social implications of architectural and interpersonal environments for older people. It suggests how society and its structures can enhance the productivity of, and preserve the quality of life for, older residents in a community. The study investigates new approaches to the problem, including new housing alternatives and new strategies for reflecting the needs of the elderly in housing construction.

For the first time, a single reference identifies medical technology assessment programs. A valuable guide to the field, this directory contains more than 60 profiles of programs that conduct and report on medical technology assessments. Each profile includes a listing of report citations for that program, and all the reports are indexed under major subject headings. Also included is a cross-listing of technology assessment report citations arranged by type of technology headings, brief descriptions of approximately 70 information sources of potential interest to technology assessors, and addresses and descriptions of 70 organizations with memberships, activities, publications, and other functions relevant to the medical technology assessment community.

"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government--federal, state, and local--at which these functions would best be handled.

There have always been homeless people in the United States, but their plight has only recently stirred widespread public reaction and concern. Part of this new recognition stems from the problem's prevalence: the number of homeless individuals, while hard to pin down exactly, is rising. In light of this, Congress asked the Institute of Medicine to find out whether existing health care programs were ignoring the homeless or delivering care to them inefficiently. This book is the report prepared by a committee of experts who examined these problems through visits to city slums and impoverished rural areas, and through an analysis of papers written by leading scholars in the field.

Scientific experiments using animals have contributed significantly to the improvement of human health. Animal experiments were crucial to the conquest of polio, for example, and they will undoubtedly be one of the keystones in AIDS research. However, some persons believe that the cost to the animals is often high. Authored by a committee of experts from various fields, this book discusses the benefits that have resulted from animal research, the scope of animal research today, the concerns of advocates of animal welfare, and the prospects for finding alternatives to animal use. The authors conclude with specific recommendations for more consistent government action.

In the past 50 years the development of a wide range of medical devices has improved the quality of people's lives and revolutionized the prevention and treatment of disease, but it also has contributed to the high cost of health care. Issues that shape the invention of new medical devices and affect their introduction and use are explored in this volume. The authors examine the role of federal support, the decision-making process behind private funding, the need for reforms in regulation and product liability, the effects of the medical payment system, and other critical topics relevant to the development of new devices.

How far have we come in the fight against AIDS since the Institute of Medicine released Confronting AIDS: Directions for Public Health, Health Care, and Research in 1986? This updated volume examines our progress in implementing the recommendations set forth in the first book. It also highlights new information and events that have given rise to the need for new directions in responding to this disease.

Computers and telecommunications have revolutionized the processes of scientific research. How is this information technology being applied and what difficulties do scientists face in using information technology? How can these difficulties be overcome? Information Technology and the Conduct of Research answers these questions and presents a variety of helpful examples. The recommendations address the problems scientists experience in trying to gain the most benefit from information technology in scientific, engineering, and clinical research.

Prenatal care programs have proven effective in improving birth outcomes and preventing low birthweight. Yet over one-fourth of all pregnant women in the United States do not begin prenatal care in the first 3 months of pregnancy, and for some groups--such as black teenagers--participation in prenatal care is declining. To find out why, the authors studied 30 prenatal care programs and analyzed surveys of mothers who did not seek prenatal care. This new book reports their findings and offers specific recommendations for improving the nation's maternity system and increasing the use of prenatal care programs.

With estimates of their numbers ranging from one million to almost four million people, allied health care personnel make up a large part of the health care work force. Yet, they are among the least studied elements of our health care system. This book describes the forces that drive the demand for and the supply of allied health practitioners--forces that include demographic change, health care financing policies, and career choices available to women. Exploring such areas as credentialing systems and the employment market, the study offers a broad range of recommendations for action in both the public and private sectors, so that enough trained people will be in the right place at the right time.

This is the first part of an in-depth study focusing on medical liability and its effect on access to and delivery of obstetrical care. The book addresses such questions as: * Do liability concerns impede the use of new technologies? * Have liability issues affected the physician-patient relationship? * Are community health and maternity centers being harmed? * What specific remedies are being considered and what are their prospects for success?

The second volume of an overall look at the "malpractice crisis" sheds fresh light on the civil justice and insurance systems, medical liability issues, and their combined effect on health care for mothers and children. Topics include the liability implications of the rising rate of Cesarean sections, an evaluation of the American Medical Association's proposed alternative to the justice system for resolving medical liability disputes, and a review of legislative proposals under consideration.

In this congressionally mandated study, an expert committee of the Institute of Medicine takes a close look at where treatment for people with alcohol problems seems to be headed, and provides its best advice on how to get there. Careful consideration is given to how the creative growth of treatment can best be encouraged while keeping costs within reasonable limits. Particular attention is devoted to the importance of developing therapeutic approaches that are sensitive to the special needs of the many diverse groups represented among those who have developed problems related to their use of "man's oldest friend and oldest enemy." This book is the most comprehensive examination of alcohol treatment to date.

Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate. This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.

A guiding principle of the Council on Health Care Technology is a special focus on medical technology assessment measures that coincide with patient well-being, quality of health care, and quality of life. Of particular concern is care of the elderly, which constitutes a special and vulnerable patient population. This comprehensive book discusses the appropriate use of technology to minimize risks posed to the elderly patient in the delivery of health care services. It covers home and community care as well as acute hospital care, and system resources and constraints.

The field of health care technology assessment focuses on the use of medical technologies--their impacts on safety, efficacy, and effectiveness; cost-effectiveness and cost benefit; quality; and their social, legal, and ethical implications. This wide-ranging monograph addresses some of the gaps in understanding health status and quality of life, such as the use of quality-of-life measures in technology assessment, organ transplantation, and pharmaceutical trials. One chapter provides basic references for the technical attributes of many established measures and some lesser known ones. The final chapter offers recommendations concerning the appropriate applications of these measures and highlights areas for cooperative research.

Technology assessment can lead to the rapid application of essential diagnostic technologies and prevent the wide diffusion of marginally useful methods. In both of these ways, it can increase quality of care and decrease the cost of health care. This comprehensive monograph carefully explores methods of and barriers to diagnostic technology assessment and describes both the rationale and the guidelines for meaningful evaluation. While proposing a multi-institutional approach, it emphasizes some of the problems involved and defines a mechanism for improving the evaluation and use of medical technology and essential resources needed to enhance patient care.

This book results from a study by a committee of the Institute of Medicine and the National Research Council's Board on Agriculture. The committee examined the scientific foundations of medically assisted conception and developed an agenda for basic research in reproductive and developmental biology that would contribute to advances in the clinical and agricultural practice of in vitro fertilization and embryo transfer. The volume also discusses some barriers to progress in research and ways of lowering them, and explains the scientific issues important to ethical decision making.