Medicine's Landmark Research Articles

Quality of Care and Quality of Life: Balancing Patient Safety and Physician Burnout.

Since the publication of the Institute of Medicine's landmark report on medical errors in 2000, a large number of safety programs have been implemented in American hospitals. Concurrently, there has been a dramatic increase in the rate of burnout among physicians. Although there are many unrelated causes of burnout (eg, loss of autonomy), and multiple safety programs that are applauded by physicians (eg, The Safe Motherhood Initiative), other programs created in the name of safety improvements may be contributing to physician distress. In this piece, we review several of those programs, describe their limitations and costs to physician well-being, and discuss the manner in which they might be modified to retain their benefits while mitigating the burdens they place on physicians.

Beyond Bias: Aggregate Approaches to Conflicts of Interest Research and Policy in Biomedical Research.

Considerable efforts have been devoted to addressing the problem of conflicts of interest (COI) in health research, policy, education, and practice. An overwhelming body of evidence demonstrates that conflicts associate with deleterious outcomes for the biomedical research enterprise. Nevertheless, little has changed for research, specifically, since the Institute of Medicine's landmark Conflicts of Interest in Medical Research, Practice, and Education was published over a decade ago. In this article, we draw on interdisciplinary research on manufactured controversies in science-policy deliberation to argue that the development of meaningful COI policy has been stymied through argumentative "wedges" designed to delay consensus and policy formation. Argumentative wedges disrupt policy formation by mischaracterizing the evidence base, continuously redefining the terms of the debate and/or recommending overly narrow criteria for who should be allowed to participate in policy deliberation. In this article, we argue researchers and policymakers interested in better addressing the harmful effects of COI can improve their efforts through strategic efforts designed to disrupt the wedges of manufactured controversy. Additionally, we argue that efforts to address COI can be further enhanced through embracing a broader framework for COI inquiry. Specifically, we argue that aggregate approaches to COI can help to disrupt these wedges and provide a strong foundation for future policy.

Patient Safety

The Institute of Medicine's landmark report To Err Is Human drew attention to the large number of avoidable medical errors in the US health care system. Much of the response to the report was focused on hospitals, but safety concerns can arise in many settings. This month's DataGraphic highlights patient safety ranging from adverse events in the hospital to the safety performance of nursing homes and complaints made by patients in inpatient psychiatric settings. It also examines safety concerns regarding electronic health records and reports the results of an experiment using a surgical safety checklist in South Carolina.

Health Literacy Competencies for Registered Nurses: An e-Delphi Study.

The Institute of Medicine's landmark report, Health Literacy: A Prescription to End Confusion, recommends that health professionals be trained to effectively communicate with patients with limited health literacy. Nurse-specific competencies that explicitly address the needs of patients with low health literacy are lacking. A national group of nurse health literacy experts (N = 41) participated in a three-round e-Delphi study to identify essential health literacy competencies for RNs in any work setting. Based on partial replication of prior work by Coleman, Hudson, and Maine, a final list of 50 nursing health literacy core competencies were identified in round two and prioritized in round three. The final list of prioritized competencies generated in this study have been provided as a starting point for health literacy education efforts in practice. J Contin Educ Nurs. 2016;47(12):558-565.

Commercial sexual exploitation and sex trafficking of adolescents.

This review describes the current state of commercial sexual exploitation and sex trafficking of adolescents in the United States and globally, the legal and health implications of this severe form of abuse, and the roles that pediatric and adolescent healthcare providers can play in addressing this issue. Although this form of exploitation and abuse is shrouded in secrecy, pediatric and adolescent healthcare providers are well positioned to respond when it arises. However, awareness and understanding of the issue are generally lacking among healthcare professionals, currently limiting their effectiveness in combating this problem. Although the empirical evidence base available to guide clinical care of victims of trafficking remains limited given the secretive nature of the abuse, important contributions to the multidisciplinary literature on this issue have been made in recent years, including the Institute of Medicine's landmark report in the United States. Commercial sexual exploitation and sex trafficking of adolescents represent a human rights tragedy that remains inadequately addressed. As preeminent advocates for the health and well-being of adolescents, pediatric and adolescent healthcare providers can play a crucial role in advancing efforts not only to intervene but also to prevent further victimization of vulnerable youth.

Ensuring Quality in the NICU: Translating Research Into Appropriate Clinical Care.

Since the Institute of Medicine's landmark report To Err Is Human, extensive efforts to improve patient safety have been undertaken. However, wide-scale improvement has been limited, sporadic, and inconsistent. Implementation of evidence-based interventions remains a challenge, resulting in unwarranted variations in care. Three main categories of problems in healthcare delivery are defined as overuse, underuse, and misuse of medical services, resulting in inappropriate care, inefficiencies, and poor quality. Although broad acknowledgement that these categories of quality problems exist, there are limited standards for measuring their overall impact. This article aims to discuss the important role of implementation science in advancing evidence-based practice, using neonatal therapeutic hypothermia for the treatment of hypoxic-ischemic encephalopathy as an exemplar for examining appropriateness of care.

The Path to Equitable Health Care

The path to achieving equity for racial and ethnic underserved communities, which are at risk for experiencing health and health care disparities, has not been an easy one. The challenges of these disparities came to national attention in 1985 with the Report of the Secretary's Task Force on Black and Minority Health during President Reagan's administration (often referred to as the Heckler Report; Heckler 1985; Gamble and Stone 2006). In 1989, the American Medical Association (AMA) noted “unjustifiable” differences in treatments provided to African Americans that “must be eliminated” (AMA, 1990). And in 2003, the Institute of Medicine's landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care comprehensively documented continuing, pervasive disparities in our health care system (Smedley et al. 2003).

The move toward setting scientific standards for the content of medical review articles

In 1987, while Editor of the Annals of Internal Medicine, I wrote and published an editorial with the title ‘Needed: review articles with more scientific rigor’. I was prompted to do this by a paper I had initially rejected but eventually accepted for publication in the Annals with my accompanying editorial commentary. In retrospect, Cynthia Mulrow’s ‘The medical review article: state of the science’ can now be seen as a landmark in medicine’s long road from ‘experience and expertise’ to ‘evidence’ as the justification for particular medical treatments. When and where this road begins will remain a matter for argument: The James Lind Library offers many candidate ‘beginnings’. Despite the growing development during the 18th, 19th and 20th centuries of quantitative data for judgements on treatments, clinicians in these periods continued to rely on ‘expert’ judgements for choices of treatments. The challenge facing doctors who wish to identify evidence relevant to their practice among the plethora of potentially relevant reports was recognized as a problem at least as early as the 18th century. Andrew Duncan’s editorial Introduction to the first issue of Philosophical and Medical Commentaries, published in 1773, has a remarkably familiar ring:

Seven wonders in the world of rheumatology: a short story of romance, reminiscences and renaissance

AbstractGenesis and evolution of contemporary rheumatology is many centuries old. The lessons of medical history, its triumphs and failures, its twists and turns, have all facilitated today's science. Even in the ancient era some rheumatic diseases have been described with vivid accuracy. Among these are gout, spinal afflictions, osteoporosis and rheumatoid arthritis, as we recognize them today. Ancient systems of medicine such as Ayurveda in India led to the introduction of gold salts. Invention of the microscope paved the way to the birth of microbiology, unfolding infective, and later inflammatory diseases, cellular pathology and immunology. Progress in therapeutics was slow and physicians and rheumatologists had to borrow drugs from other medical disciplines, for example antimalarials and cytotoxics. The Nobel Prize‐winning discovery and development of cortisone was a major landmark in medicine, while also treating rheumatoid arthritis. Thanks to the advent of molecular medicine, rapid strides have been accomplished, and we now have new agents of biotechnology research. Orthopedics with computer‐assisted and robotic surgeries, are becoming almost fail‐safe for specific indications. The nature of chronic rheumatic diseases, necessitating long‐term treatments, have led to the popularity of alternative medicines. Seven significant episodes are essayed herein. Rheumatology is on the threshold of exciting medical progress, enabling the majority of rheumatic patients to enjoy enhanced quality of life.

An Ounce of Prevention: Medical–Legal Aspects of Burn Injury

Since the 1999 Institute of Medicine's landmark report, “To Err is Human,” and the implementation of patient safety initiatives, medical errors and claims for injury as a result of these errors continue to be an area of concern for hospitals, physicians, nurses, and industry. The end of the decade saw the cost of medical malpractice insurance steadily increasing as a result of increasing awards against hospitals and physicians. This article reviews the medical–legal aspects of burn injury.

Keeping Patients Safe

Translating the recommendations from the Institute of Medicine's landmark report, Keeping Patients Safe: Transforming the Work Environment of Nurses, into practice and healthcare policy will require an extensive collaboration among nurse administrators and nurse researchers. The insights and skills of both groups are critical for evaluating the recommendations and their implications for practice, for filling gaps in research, and for influencing significant health system change.

Electronic Health Records: Can Promise Be Fulfilled?

Electronic Health Records: Can Promise Be Fulfilled?

Patient and Nurse Safety

The Institute of Medicine's landmark report asserted medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology can shore up weak systems. For nursing, information technology plays a key role in protecting patients by eliminating nursing mistakes and protecting nurses by reducing their negative exposure. However, managing information technology is a function of managing the people who use it. This article examines critical issues that impact patient and nurse safety, both physical and professional. It discusses the importance of eliminating the culture of blame, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.

Health Care Disparities in Emergency Medicine

AbstractThe Institute of Medicine's landmark report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.

Health Care Disparities in Emergency Medicine

The Institute of Medicine's landmark report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.

Landmarks in medicine

Landmarks in medicine

Landmarks in medicine.

Reference is made to the empiric methods of the practice of medicine in ancient times. Epidemics were rampant centuries ago; a few are discussed. Causes of death several decades ago are compared with causes of death today. The seriousness of accidental deaths, particularly those due to automobile accidents, is emphasized. A few social problems related to medicine are presented.

Landmarks in Medicine. Laity Lectures of the New York Academy of Medicine.

Landmarks in Medicine. Laity Lectures of the New York Academy of Medicine.

Landmarks in Medicine.

Landmarks in Medicine.

Landmarks in Medicine. Laity Lectures of the New York Academy of Medicine. Introduction by Dr. James Alexander Miller, Public Health Services. By Norman Wilson, Economical Administration of Health Insurance Benefits (Part I). By Walter Pryll and Health in Handcuffs. By J. A. Kingsbury

Landmarks in Medicine. Laity Lectures of the New York Academy of Medicine. Introduction by Dr. James Alexander Miller, Public Health Services. By Norman Wilson, Economical Administration of Health Insurance Benefits (Part I). By Walter Pryll and Health in Handcuffs. By J. A. Kingsbury