Unhealthy Politics

2020 ◽  
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
United States ◽  
Health Care ◽  
Scientific Evidence ◽  
The United States ◽  
Evidence Base ◽  
Medical Industry ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Delivery Of Medical Care ◽  
Based Medicine

The U.S. medical system is touted as the most advanced in the world, yet many common treatments are not based on sound science. This book sheds new light on why the government's response to this troubling situation has been so inadequate, and why efforts to improve the evidence base of U.S. medicine continue to cause so much political controversy. The book paints a portrait of a medical industry with vast influence over which procedures and treatments get adopted, and a public burdened by the rising costs of health care yet fearful of going against “doctor's orders.” It offers vital insights into the limits of science, expertise, and professionalism in American politics. The book explains why evidence-based medicine is important. First, the delivery of unproven care can expose patients to serious risks. Second, the slow integration of evidence can lead to suboptimal outcomes for patients who receive treatments that work less well for their conditions than alternatives. Third, the failure to implement evidence-based practices encourages wasteful spending, causing the health care system to underperform relative to its level of investment. This book assesses whether the delivery of medical care in the United States is evidence based. It argues that by systematically ignoring scientific evidence (or the lack thereof), the United States is substantially out of balance.

Introduction

2020 ◽  
pp. 1-20
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
United States ◽  
Health Care ◽  
Resource Allocation ◽  
Scientific Evidence ◽  
The United States ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Delivery Of Medical Care ◽  
Based Medicine

This introductory chapter explains why evidence-based medicine is important. The sluggish incorporation of medical evidence into clinical practice is a concern for three key reasons: safety, quality, and the efficiency of resource allocation. First, the delivery of unproven care can expose patients to serious risks. Second, the slow integration of evidence can lead to suboptimal outcomes for patients who receive treatments that work less well for their conditions than alternatives. Third, the failure to implement evidence-based practices encourages wasteful spending, causing the health care system to underperform relative to its level of investment. This book assesses whether the delivery of medical care in the United States is evidence based. It argues that by systematically ignoring scientific evidence (or the lack thereof), the United States is substantially out of balance.

What Can Feminist Epistemology Do for Surgery?

Hypatia ◽  
2014 ◽  
Vol 29 (2) ◽  
pp. 404-421 ◽  
Author(s):  
Mary Jean Walker ◽  
Wendy Rogers
Keyword(s):  
Health Care ◽  
Evidence Base ◽  
Feminist Epistemology ◽  
Cultural Barriers ◽  
Evidence Based ◽  
Surgical Practice ◽  
Lack Of Fit ◽  
What Works ◽  
Based Medicine ◽  
Contemporary Health Care

Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence‐based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies.

scholarly journals Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management, Part I: Introduction and General Considerations

2008 ◽  
Vol 2;11 (3;2) ◽  
pp. 161-186
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Critical Appraisal ◽  
Evidence Based Practice ◽  
The United States ◽  
Evidence Based ◽  
Interventional Pain Management ◽  
Based Medicine

Evidence-based medicine, systematic reviews, and guidelines are part of modern interventional pain management. As in other specialties in the United States, evidence-based medicine appears to motivate the search for answers to numerous questions related to costs and quality of health care as well as access to care. Scientific, relevant evidence is essential in clinical care, policy-making, dispute resolution, and law. Consequently, evidence based practice brings together pertinent, trustworthy information by systematically acquiring, analyzing, and transferring research findings into clinical, management, and policy arenas. In the United States, researchers, clinicians, professional organizations, and government are looking for a sensible approach to health care with practical evidence-based medicine. All modes of evidence-based practice, either in the form of evidence-based medicine, systematic reviews, meta-analysis, or guidelines, evolve through a methodological, rational accumulation, analysis, and understanding of the evidentiary knowledge that can be applied in clinical settings. Historically, evidence-based medicine is traceable to the 1700s, even though it was not explicitly defined and advanced until the late 1970s and early 1980s. Evidence-based medicine was initially called “critical appraisal” to describe the application of basic rules of evidence as they evolve into application in daily practices. Evidence-based medicine is defined as a conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based practice is defined based on 4 basic and important contingencies, which include recognition of the patient’s problem and construction of a structured clinical question, thorough search of medical literature to retrieve the best available evidence to answer the question, critical appraisal of all available evidence, and integration of the evidence with all aspects and contexts of the clinical circumstances. Systematic reviews provide the application of scientific strategies that limit bias by the systematic assembly, critical appraisal, and synthesis of all relevant studies on a specific topic. While systematic reviews are close to meta-analysis, they are vastly different from narrative reviews and health technology assessments. Clinical practice guidelines are systematically developed statements that aim to help physicians and patients reach the best health care decisions. Appropriately developed guidelines incorporate validity, reliability, reproducibility, clinical applicability and flexibility, clarity, development through a multidisciplinary process, scheduled reviews, and documentation. Thus, evidence-based clinical practice guidelines represent statements developed to improve the quality of care, patient access, treatment outcomes, appropriateness of care, efficiency and effectiveness and achieve cost containment by improving the cost benefit ratio. Part 1 of this series in evidence-based medicine, systematic reviews, and guidelines in interventional pain management provides an introduction and general considerations of these 3 aspects in interventional pain management. Key words: Evidence-based medicine, systematic reviews, clinical guidelines, narrative reviews, health technology assessments, grading of evidence, recommendations, grading systems, strength of evidence.

Analysis of antibiotic use in a large network of emergency departments

2019 ◽  
Vol 76 (21) ◽  
pp. 1753-1761 ◽  
Author(s):  
Fredrick O’Neal ◽  
Joan Kramer ◽  
Mandelin Cooper ◽  
Edward Septimus ◽  
Sanya Sharma ◽  
...  
Keyword(s):  
United States ◽  
Health System ◽  
Emergency Departments ◽  
The United States ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Evidence Based Practices ◽  
Infectious Origin ◽  
Tract Infections ◽  
Susceptibility Patterns

Abstract Purpose To assess antibiotic selection, administration, and prescribing practices in emergency departments across a large hospital system using evidence-based practices and susceptibility patterns. Methods This retrospective data review was conducted using health system–level electronic data compiled from 145 emergency departments (EDs) across the United States. Data were examined for national generalizability, most common diagnoses of infectious origin seen in nonadmitted patients in the ED, most commonly administered antibiotics in the ED, and geographically defined areas’ unique patterns of antibiotic resistance and susceptibility. Results More than 627,000 unique patient encounters and 780,000 antibiotic administrations were assessed for trends in patient demographics, antibiotics administered for a diagnosis of infectious origin, and corresponding susceptibility patterns. Results indicated that practices in the EDs of this health system aligned with evidence-based practices for streptococcal pharyngitis, otitis media, cellulitis, and uncomplicated urinary tract infections. Conclusion These results provide a representative sample of the current state of practices within many EDs across the United States for nonadmitted patients. A similar data reconstruction can be completed by other health systems to assess their prescribing practices in the ED to improve and elevate care for patients visiting the emergency room and treated as outpatients.

Is It Possible to Consider Management of Chronic Diseases as Method of Population Screening in Ukraine?

2016 ◽  
pp. 41-44
Author(s):  
Pavlo Kolesnik ◽  
Ivanna Shushman ◽  
Yevheniia Sinevich
Keyword(s):  
United States ◽  
Health Care ◽  
Comparative Analysis ◽  
Chronic Diseases ◽  
Developed Countries ◽  
The United States ◽  
Evidence Base ◽  
Population Screening ◽  
Level Of Evidence ◽  
High Level

The article presents a comparative analysis of the effectiveness of different methods used during the management of diseases based on the Order of the Ministry of Health Care of Ukraine № 728 from 27.08.2010. and methods used in highly developed countries of Europe and the United States as a mandatory screening with high level of evidence base.

Who gets coached? A qualitative inquiry into community clinicians’ decisions to use caregiver coaching

Autism ◽  
2021 ◽  
pp. 136236132110594
Author(s):  
Liza Tomczuk ◽  
Rebecca E Stewart ◽  
Rinad S Beidas ◽  
David S Mandell ◽  
Melanie Pellecchia
Keyword(s):  
United States ◽  
Early Intervention ◽  
The United States ◽  
Evidence Based ◽  
Autistic Children ◽  
Evidence Based Practices ◽  
Quality Of Evidence ◽  
Marginalized Groups ◽  
Vulnerable Families

Clinicians’ beliefs about an intervention’s fit with an individual family influence whether they use it with that family. The factors that influence clinicians’ decisions to implement evidence-based practices for young autistic children have yet to be evaluated systematically. These factors may partially account for the significant disparities in quality of and access to early intervention. We examined disparities in clinicians’ reported use of caregiver coaching, an evidence-based practice, with families from minoritized or structurally marginalized groups, and the perceived reasons for those disparities, to assess the factors that influence clinicians’ use of caregiver coaching. We conducted semi-structured interviews with 36 early intervention clinicians from publicly funded early intervention agencies in two distinct geographic regions in the United States. Clinicians identified social and structural factors, including perceived family characteristics and stigma, that influenced their beliefs about the fit of coaching with families from minoritized or structurally marginalized groups. These findings point to the presence of beliefs that likely exacerbate disparities in access to evidence-based practices and reduce the quality of care for minoritized families of young autistic children. These findings highlight the need to develop and deploy equity-focused implementation strategies to improve both access to and quality of evidence-based practices for young autistic children from minoritized groups. Lay abstract Providers’ beliefs about an intervention’s fit with a family can affect whether or not they use that intervention with a family. The factors that affect providers’ decisions to use evidence-based practices for young autistic children have not been studied. These factors may play a role in the major differences we see in the quality of and access to early intervention services in the community. We looked at differences in providers’ use of caregiver coaching, an evidence-based practice, with families from minority or vulnerable backgrounds, and the possible reasons for those differences. We did this to figure out what factors affect providers’ use of caregiver coaching. We interviewed 36 early intervention providers from early intervention agencies in two different parts of the United States. Providers pointed out things like what they thought about a family’s circumstances that affected their beliefs about how well coaching fits with minority and vulnerable families. Our findings bring attention to these beliefs that likely make accessing evidence-based practices for minority and vulnerable families harder and lessen the quality of care for these families of young autistic children. These findings highlight the need to come up with and use strategies to improve both access to and the quality of evidence-based practices for young autistic children from minority and vulnerable groups.

Juvenile Homicide in the United States: Sizing Up the Problem and Moving Forward

2021 ◽  
pp. 108876792110438
Author(s):  
Kathleen M. Heide
Keyword(s):  
United States ◽  
The United States ◽  
Evidence Based ◽  
Court Cases ◽  
Evidence Based Practices ◽  
Juvenile Violence ◽  
Us Supreme Court ◽  
Juvenile Homicide ◽  
Juvenile Arrests ◽  
Juvenile Murderers

Juvenile murder arrests in the United States increased dramatically from 1984 to 1993, leading experts to forecast an epidemic of continued violence. Juvenile arrests for murder from 1995 to 2019 are examined to assess whether this prediction was correct. Changes in the laws in response to juvenile violence and US Supreme Court cases that addressed constitutional limitations to the punishment of juvenile murderers are synthesized. The evolution of research on juvenile homicide offenders over the last two decades is highlighted. Recommendations about ways to move forward by using evidence-based practices to prevent juvenile violence and to reduce recidivism are discussed.

Evidence-Based Clinical Guidelines and Their Impact on Prevention of Catheter-Related Bloodstream Infections

2012 ◽  
Vol 5 (1) ◽  
pp. 18-30
Author(s):  
Paula McCauley
Keyword(s):  
United States ◽  
Health Care ◽  
Clinical Practice ◽  
Health Care Professionals ◽  
Bloodstream Infections ◽  
The United States ◽  
Evidence Based ◽  
Hospital Acquired Infections ◽  
Equity And Efficiency ◽  
Hospital Acquired

The growing concern for hospital-acquired infections in health care has stimulated the development of evidence-based practice (EBP) guidelines. Health care institutions across the United States are increas- ing their focus on the implementation of clinical practice guidelines using current EBP. Adherence to these guidelines by health care professionals is expected to improve the quality, equity, and efficiency of patient care.

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