Problems and Pitfalls in Medical Literature


Book Description

This book aims to teach the skills for assessing the quality of a medical article. It focuses on problems and pitfalls that may interfere with the validity of an article so that readers know what problems to look for and how to tell if an article has successfully addressed them. It focuses on concepts rather than formulas. In each chapter, one article will be analyzed to illustrate a particular concept, demonstrating when to look for that pitfall, how to recognize it, what effect it would have on results, and how to tell if an author has successfully mitigated the pitfall. Written with clarity and precision, this invaluable resource ensures that readers develop a deep understanding of the critical elements that underpin the quality of medical literature. Each chapter presents a specific concept and employs a practical approach, utilizing the analysis of a real-world medical article to illustrate the concept in action. By dissecting the research, readers learn to identify common pitfalls, recognize their influence on the results, and determine whether the author has effectively addressed them. By exploring topics such as research methodology, bias detection, and result interpretation, Problems and Pitfalls in Medical Literature empowers readers to go beyond a superficial understanding of articles and critically evaluate their reliability and relevance.




Improving Diagnosis in Health Care


Book Description

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.




Transforming Clinical Research in the United States


Book Description

An ideal health care system relies on efficiently generating timely, accurate evidence to deliver on its promise of diminishing the divide between clinical practice and research. There are growing indications, however, that the current health care system and the clinical research that guides medical decisions in the United States falls far short of this vision. The process of generating medical evidence through clinical trials in the United States is expensive and lengthy, includes a number of regulatory hurdles, and is based on a limited infrastructure. The link between clinical research and medical progress is also frequently misunderstood or unsupported by both patients and providers. The focus of clinical research changes as diseases emerge and new treatments create cures for old conditions. As diseases evolve, the ultimate goal remains to speed new and improved medical treatments to patients throughout the world. To keep pace with rapidly changing health care demands, clinical research resources need to be organized and on hand to address the numerous health care questions that continually emerge. Improving the overall capacity of the clinical research enterprise will depend on ensuring that there is an adequate infrastructure in place to support the investigators who conduct research, the patients with real diseases who volunteer to participate in experimental research, and the institutions that organize and carry out the trials. To address these issues and better understand the current state of clinical research in the United States, the Institute of Medicine's (IOM) Forum on Drug Discovery, Development, and Translation held a 2-day workshop entitled Transforming Clinical Research in the United States. The workshop, summarized in this volume, laid the foundation for a broader initiative of the Forum addressing different aspects of clinical research. Future Forum plans include further examining regulatory, administrative, and structural barriers to the effective conduct of clinical research; developing a vision for a stable, continuously funded clinical research infrastructure in the United States; and considering strategies and collaborative activities to facilitate more robust public engagement in the clinical research enterprise.




Narrative Based Medicine


Book Description

Edited by two leading general practitioners and with contributions from over 20 authors, this book covers a wide range of topics to do with narrative in medicine. It includes a wealth of real examples of patients narratives and addresses theoretical and practical issues including the use of narrative as a therapeutic tool, teaching narrative to students, philosophical issues, narrative in legal and ethical decisions, narrative in nursing, and the narrative medical record.




When We Do Harm


Book Description

Medical mistakes are more pervasive than we think. How can we improve outcomes? An acclaimed MD’s rich stories and research explore patient safety. Patients enter the medical system with faith that they will receive the best care possible, so when things go wrong, it’s a profound and painful breach. Medical science has made enormous strides in decreasing mortality and suffering, but there’s no doubt that treatment can also cause harm, a significant portion of which is preventable. In When We Do Harm, practicing physician and acclaimed author Danielle Ofri places the issues of medical error and patient safety front and center in our national healthcare conversation. Drawing on current research, professional experience, and extensive interviews with nurses, physicians, administrators, researchers, patients, and families, Dr. Ofri explores the diagnostic, systemic, and cognitive causes of medical error. She advocates for strategic use of concrete safety interventions such as checklists and improvements to the electronic medical record, but focuses on the full-scale cultural and cognitive shifts required to make a meaningful dent in medical error. Woven throughout the book are the powerfully human stories that Dr. Ofri is renowned for. The errors she dissects range from the hardly noticeable missteps to the harrowing medical cataclysms. While our healthcare system is—and always will be—imperfect, Dr. Ofri argues that it is possible to minimize preventable harms, and that this should be the galvanizing issue of current medical discourse.




Advances in Patient Safety


Book Description

v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.




Common System and Software Testing Pitfalls


Book Description

“Don’s book is a very good addition both to the testing literature and to the literature on quality assurance and software engineering... . [It] is likely to become a standard for test training as well as a good reference for professional testers and developers. I would also recommend this book as background material for negotiating outsourced software contracts. I often work as an expert witness in litigation for software with very poor quality, and this book might well reduce or eliminate these lawsuits....” –Capers Jones, VP and CTO, Namcook Analytics LLC Software and system testers repeatedly fall victim to the same pitfalls. Think of them as “anti-patterns”: mistakes that make testing far less effective and efficient than it ought to be. In Common System and Software Testing Pitfalls, Donald G. Firesmith catalogs 92 of these pitfalls. Drawing on his 35 years of software and system engineering experience, Firesmith shows testers and technical managers and other stakeholders how to avoid falling into these pitfalls, recognize when they have already fallen in, and escape while minimizing their negative consequences. Firesmith writes for testing professionals and other stakeholders involved in large or medium-sized projects. His anti-patterns and solutions address both “pure software” applications and “software-reliant systems,” encompassing heterogeneous subsystems, hardware, software, data, facilities, material, and personnel. For each pitfall, he identifies its applicability, characteristic symptoms, potential negative consequences and causes, and offers specific actionable recommendations for avoiding it or limiting its consequences. This guide will help you Pinpoint testing processes that need improvement–before, during, and after the project Improve shared understanding and collaboration among all project participants Develop, review, and optimize future project testing programs Make your test documentation far more useful Identify testing risks and appropriate risk-mitigation strategies Categorize testing problems for metrics collection, analysis, and reporting Train new testers, QA specialists, and other project stakeholders With 92 common testing pitfalls organized into 14 categories, this taxonomy of testing pitfalls should be relatively complete. However, in spite of its comprehensiveness, it is also quite likely that additional pitfalls and even missing categories of pitfalls will be identified over time as testers read this book and compare it to their personal experiences. As an enhancement to the print edition, the author has provided the following location on the web where readers can find major additions and modifications to this taxonomy of pitfalls: http://donald.firesmith.net/home/common-testing-pitfalls Please send any recommended changes and additions to dgf (at) sei (dot) cmu (dot) edu, and the author will consider them for publication both on the website and in future editions of this book.




Secondary Analysis of Electronic Health Records


Book Description

This book trains the next generation of scientists representing different disciplines to leverage the data generated during routine patient care. It formulates a more complete lexicon of evidence-based recommendations and support shared, ethical decision making by doctors with their patients. Diagnostic and therapeutic technologies continue to evolve rapidly, and both individual practitioners and clinical teams face increasingly complex ethical decisions. Unfortunately, the current state of medical knowledge does not provide the guidance to make the majority of clinical decisions on the basis of evidence. The present research infrastructure is inefficient and frequently produces unreliable results that cannot be replicated. Even randomized controlled trials (RCTs), the traditional gold standards of the research reliability hierarchy, are not without limitations. They can be costly, labor intensive, and slow, and can return results that are seldom generalizable to every patient population. Furthermore, many pertinent but unresolved clinical and medical systems issues do not seem to have attracted the interest of the research enterprise, which has come to focus instead on cellular and molecular investigations and single-agent (e.g., a drug or device) effects. For clinicians, the end result is a bit of a “data desert” when it comes to making decisions. The new research infrastructure proposed in this book will help the medical profession to make ethically sound and well informed decisions for their patients.




The Future of Public Health


Book Description

"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.




The Role of Telehealth in an Evolving Health Care Environment


Book Description

In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.