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The ability to see deeply affects how human beings perceive and
interpret the world around them. For most people, eyesight is part
of everyday communication, social activities, educational and
professional pursuits, the care of others, and the maintenance of
personal health, independence, and mobility. Functioning eyes and
vision system can reduce an adult's risk of chronic health
conditions, death, falls and injuries, social isolation,
depression, and other psychological problems. In children, properly
maintained eye and vision health contributes to a child's social
development, academic achievement, and better health across the
lifespan. The public generally recognizes its reliance on sight and
fears its loss, but emphasis on eye and vision health, in general,
has not been integrated into daily life to the same extent as other
health promotion activities, such as teeth brushing; hand washing;
physical and mental exercise; and various injury prevention
behaviors. A larger population health approach is needed to engage
a wide range of stakeholders in coordinated efforts that can
sustain the scope of behavior change. The shaping of socioeconomic
environments can eventually lead to new social norms that promote
eye and vision health. Making Eye Health a Population Health
Imperative: Vision for Tomorrow proposes a new population-centered
framework to guide action and coordination among various, and
sometimes competing, stakeholders in pursuit of improved eye and
vision health and health equity in the United States. Building on
the momentum of previous public health efforts, this report also
introduces a model for action that highlights different levels of
prevention activities across a range of stakeholders and provides
specific examples of how population health strategies can be
translated into cohesive areas for action at federal, state, and
local levels. Table of Contents Front Matter Summary 1 Introduction
2 Understanding the Epidemiology of Vision Loss and Impairment in
the United States 3 The Impact of Vision Loss 4 Surveillance and
Research 5 The Role of Public Health and Partnerships to Promote
Eye and Vision Health in Communities 6 Access to Clinical Vision
Services: Workforce and Coverage 7 Toward a High-Quality Clinical
Eye and Vision Service Delivery System 8 Meeting the Challenge of
Vision Loss in the United States: Improving Diagnosis,
Rehabilitation, and Accessibility 9 Eye and Vision Health:
Recommendations and a Path to Action Appendix A: Committee
Biographies Appendix B: Committee Meeting Agendas Appendix C:
Glossary Appendix D: Examples of Federal Entities Involved in
Advancing Eye Health and Safety Appendix E: Examples of Recommended
Eye Protection for Recreational Sports Appendix F: Eye and Vision
Care Professionals and Education Appendix G: Medicaid Vision
Coverage by State
Protecting 18 million United States health care workers from
infectious agents - known and unknown - involves a range of
occupational safety and health measures that include identifying
and using appropriate protective equipment. The 2009 H1N1 influenza
pandemic and the 2014 Ebola virus outbreak in West Africa have
called raised questions about how best to ensure appropriate and
effective use of different kinds of personal protective equipment
such as respirators, not only to promote occupational safety but
also to reduce disease transmission. The Use and Effectiveness of
Powered Air Purifying Respirators in Health Care is the summary of
a workshop convened by the Institute of Medicine Standing Committee
on Personal Protective Equipment for Workplace Safety and Health to
explore the current state of practices and research related to
powered air purifying respirator (PAPRs) and potential updates to
performance requirements. Presentations and discussions highlighted
current health care practices using PAPRs and outlined the research
to date on the use and effectiveness of PAPRs in health care
settings with a focus on the performance requirements. The Use and
Effectiveness of Powered Air Purifying Respirators in Health Care
focuses on efficacy, current training, maintenance, supplies, and
possible enhancements and barriers to use in inpatient, clinic,
nursing home, and community (home) settings. This report also
explores the strengths and weaknesses of using various approaches
to health care PAPR standards. Table of Contents Front Matter 1
Introduction 2 Defining PAPRs and Current Standards 3 Why, Where,
and How PAPRs Are Being Used in Health Care 4 Research and Design
Perspectives 5 Priorities and Opportunities for Improving PAPRs for
Use in Health Care References Appendix A: Agenda Appendix B:
Registered Attendees
Review of NASA's Evidence Reports on Human Health Risks 2014 Letter
Report is the second in a series of five reports from the Institute
of Medicine that will independently review more than 30 evidence
reports that the National Aeronautics and Space Administration has
compiled on human health risks for long-duration and exploration
space flights. This report builds on the 2008 IOM report Review of
NASA's Human Research Program Evidence Books: A Letter Report,
which provided an initial and brief review of the evidence reports.
This letter report reviews seven evidence reports and examines the
quality of the evidence, analysis, and overall construction of each
report; identifies existing gaps in report content; and provides
suggestions for additional sources of expert input. The report
analyzes each evidence report's overall quality, which included
readability; internal consistency; the source and breadth of cited
evidence; identification of existing knowledge and research gaps;
authorship expertise; and, if applicable, response to
recommendations from the 2008 IOM letter report. Table of Contents
Front Matter Review of NASA's Evidence Reports on Human Health
Risks: 2014 Letter Report References Appendix A: Meeting Agendas
Appendix B: Committee Biographical Sketches
Since its inception, the U.S. human spaceflight program has grown
from launching a single man into orbit to an ongoing space presence
involving numerous crewmembers. As the U.S. space program evolves,
propelled in part by increasing international and commercial
collaborations, long duration or exploration spaceflights - such as
extended stays on the International Space Station or missions to
Mars - become more realistic. These types of missions will likely
expose crews to levels of known risk that are beyond those allowed
by current health standards, as well as to a range of risks that
are poorly characterized, uncertain, and perhaps unforeseeable. As
the National Aeronautics and Space Administration (NASA) and
Congress discuss the next generation of NASA's missions and the
U.S. role in international space efforts, it is important to
understand the ethical factors that drive decision making about
health standards and mission design for NASA activities. NASA asked
the Institute of Medicine to outline the ethics principles and
practices that should guide the agency's decision making for future
long duration or exploration missions that fail to meet existing
health standards. Health Standards for Long Duration and
Exploration Spaceflight identifies an ethics framework, which
builds on the work of NASA and others, and presents a set of
recommendations for ethically assessing and responding to the
challenges associated with health standards for long duration and
exploration spaceflight.As technologies improve and longer and more
distant spaceflight becomes feasible, NASA and its international
and commercial partners will continue to face complex decisions
about risk acceptability. This report provides a roadmap for
ethically assessing and responding to the challenges associated
with NASA's health standards for long duration and exploration
missions. Establishing and maintaining a firmly grounded ethics
framework for this inherently risky activity is essential to guide
NASA's decisions today and to create a strong foundation for
decisions about future challenges and opportunities. Table of
Contents Front Matter Summary 1 Introduction 2 NASA Risk Management
and Health Standards 3 Health Risks 4 Risk Acceptance and
Responsibilities in Human Spaceflight and Terrestrial Activities 5
Recommendations for Ethics Principles 6 Recommendations for Ethics
Responsibilities and Decision Framework Appendix A: Meeting Agendas
Appendix B: Committee Biographical Sketches
In 2010, more than 105,000 people were injured or killed in the
United States as the result of a firearm-related incident. Recent,
highly publicized, tragic mass shootings in Newtown, CT; Aurora,
CO; Oak Creek, WI; and Tucson, AZ, have sharpened the American
public's interest in protecting our children and communities from
the harmful effects of firearm violence. While many Americans
legally use firearms for a variety of activities, fatal and
nonfatal firearm violence poses a serious threat to public safety
and welfare. In January 2013, President Barack Obama issued 23
executive orders directing federal agencies to improve knowledge of
the causes of firearm violence, what might help prevent it, and how
to minimize its burden on public health. One of these orders
directed the Centers for Disease Control and Prevention (CDC) to,
along with other federal agencies, immediately begin identifying
the most pressing problems in firearm violence research. The CDC
and the CDC Foundation asked the IOM, in collaboration with the
National Research Council, to convene a committee tasked with
developing a potential research agenda that focuses on the causes
of, possible interventions to, and strategies to minimize the
burden of firearm-related violence. Priorities for Research to
Reduce the Threat of Firearm-Related Violence focuses on the
characteristics of firearm violence, risk and protective factors,
interventions and strategies, the impact of gun safety technology,
and the influence of video games and other media.
Cardiac arrest often strikes seemingly healthy individuals without
warning and without regard to age, gender, race, or health status.
Representing the third leading cause of death in the United States,
cardiac arrest is defined as "a severe malfunction or cessation of
the electrical and mechanical activity of the heart ... [which]
results in almost instantaneous loss of consciousness and
collapse". Although the exact number of cardiac arrests is unknown,
conservative estimates suggest that approximately 600,000
individuals experience a cardiac arrest in the United States each
year. In June 2015, the Institute of Medicine (IOM) released its
consensus report Strategies to Improve Cardiac Arrest Survival: A
Time to Act, which evaluated the factors affecting resuscitation
research and outcomes in the United States. Following the release
of this report, the National Academies of Sciences, Engineering,
and Medicine was asked to hold a workshop to explore the barriers
and opportunities for advancing the IOM recommendations. This
publication summarizes the presentations and discussions from the
workshop. Table of Contents Front Matter 1 Introduction 2 Building
a National Cardiac Arrest Surveillance System 3 Advancing Cardiac
Arrest Research and Translation 4 Improving Public Awareness and
Training 5 Enhancing the Emergency Medical Services Response to
Cardiac Arrest 6 Enhancing Hospital Response to Cardiac Arrest 7
Effective Collaboration for Cardiac Arrest Appendix A:
Recommendations from the Institute of Medicine Report *Strategies
to Improve Cardiac Arrest Survival: A Time to Act* Appendix B:
Workshop Agenda
The nurse workforce constitutes the largest sector of health
professionals in the United States and includes individuals with
varying educational backgrounds and expertise. Like other health
professions, nursing includes a large number of specialties and
subspecialties. Nurses may seek certification, based on various
standards and criteria, from a wide range of organizations.
Similarly, organizations may participate in nursing credentialing
programs, which typically reflect the attainment of various nursing
care standards and outcome measures. It is, however, unclear how
this additional training and education affects health care quality
and patient health. Future Directions of Credentialing Research in
Nursing examines short- and long-term strategies to advance
research on nurse certification and organizational credentialing.
This report summarizes a workshop convened by the Institute of
Medicine in September 2014 to examine a new framework and research
priorities to guide future research on the impact of nurse
credentialing and certification on outcomes for nurses,
organizations, and patients. Over 100 people attended the workshop,
which focused on topics such as emergent priorities for research in
nursing credentialing; critical knowledge gaps and methodological
limitations in the field; promising developments in research
methodologies, health metrics, and data infrastructures to better
evaluate the impact of nursing credentialing; and short- and
long-term strategies to encourage continued activity in nursing
credentialing research. Future Directions of Credentialing Research
in Nursing is a record of the presentations, discussion, and
break-out sessions of this event. Table of Contents Front Matter 1
Introduction 2 A New Framework for Credentialing Research in
Nursing 3 Strengthening Data and Health Informatics for
Credentialing Research 4 Challenges and Opportunities in
Credentialing Research Methodologies 5 Assessing Core Competencies
in Nursing Credentialing 6 Nursing Credentialing Within a Complex
Health Care Landscape 7 Taking the Temperature: Stakeholder
Reactions and Suggestions References Appendix A: Workshop Agenda
Appendix B: Glossary
From the origin of the leak, to the amount of oil released into the
environment, to the spill's duration, the 2010 Gulf of Mexico oil
spill poses unique challenges to human health. The risks associated
with extensive, prolonged use of dispersants, with oil fumes, and
with particulate matter from controlled burns are also uncertain.
There have been concerns about the extent to which hazards, such as
physical and chemical exposures and social and economic
disruptions, will impact the overall health of people who live and
work near the area of the oil spill. Although studies of previous
oil spills provide some basis for identifying and mitigating the
human health effects of these exposures, the existing data are
insufficient to fully understand and predict the overall impact of
hazards from the Deepwater Horizon oil spill on the health of
workers, volunteers, residents, visitors, and special populations.
"Assessing the Effects of the Gulf of Mexico Oil Spill on Human
Health" identifies populations at increased risks for adverse
health effects and explores effective communication strategies to
convey health information to these at-risk populations. The book
also discusses the need for appropriate surveillance systems to
monitor the spill's potential short- and long-term health effects
on affected communities and individuals. "Assessing the Effects of
the Gulf of Mexico Oil Spill on Human Health" is a useful resource
that can help policy makers, public health officials, academics,
community advocates, scientists, and members of the public
collaborate to create a monitoring and surveillance system that
results in "actionable" information and that identifies emerging
health risks in specific populations.
Cardiac arrest can strike a seemingly healthy individual of any
age, race, ethnicity, or gender at any time in any location, often
without warning. Cardiac arrest is the third leading cause of death
in the United States, following cancer and heart disease. Four out
of five cardiac arrests occur in the home, and more than 90 percent
of individuals with cardiac arrest die before reaching the
hospital. First and foremost, cardiac arrest treatment is a
community issue - local resources and personnel must provide
appropriate, high-quality care to save the life of a community
member. Time between onset of arrest and provision of care is
fundamental, and shortening this time is one of the best ways to
reduce the risk of death and disability from cardiac arrest.
Specific actions can be implemented now to decrease this time, and
recent advances in science could lead to new discoveries in the
causes of, and treatments for, cardiac arrest. However, specific
barriers must first be addressed. Strategies to Improve Cardiac
Arrest Survival examines the complete system of response to cardiac
arrest in the United States and identifies opportunities within
existing and new treatments, strategies, and research that promise
to improve the survival and recovery of patients. The
recommendations of Strategies to Improve Cardiac Arrest Survival
provide high-priority actions to advance the field as a whole. This
report will help citizens, government agencies, and private
industry to improve health outcomes from sudden cardiac arrest
across the United States. Table of Contents Front Matter Summary 1
Introduction 2 Understanding the Public Health Burden of Cardiac
Arrest: The Need for National Surveillance 3 The Public Experience
with Cardiac Arrest 4 Emergency Medical Services Response to
Cardiac Arrest 5 In-Hospital Cardiac Arrest and Post-Arrest Care 6
Resuscitation Research and Continuous Quality Improvement 7
Recommendations and Key Opportunities A-- Acronyms B-- Meeting
Agendas C-- Committee Biographies D-- Selected Results from
Commissioned Analyses E-- Map of U.S. States with CPR Training as a
High School Graduation Requirement F-- Utstein Guideline - Endorsed
Data Elementsfor Reporting Out-of-Hospital Cardiac Arrest
Health care in the United States is more expensive than in other
developed countries, costing $2.7 trillion in 2011, or 17.9 percent
of the national gross domestic product. Increasing costs strain
budgets at all levels of government and threaten the solvency of
Medicare, the nation's largest health insurer. At the same time,
despite advances in biomedical science, medicine, and public
health, health care quality remains inconsistent. In fact,
underuse, misuse, and overuse of various services often put
patients in danger. Many efforts to improve this situation are
focused on Medicare, which mainly pays practitioners on a
fee-for-service basis and hospitals on a diagnoses-related group
basis, which is a fee for a group of services related to a
particular diagnosis. Research has long shown that Medicare
spending varies greatly in different regions of the country even
when expenditures are adjusted for variation in the costs of doing
business, meaning that certain regions have much higher volume
and/or intensity of services than others. Further, regions that
deliver more services do not appear to achieve better health
outcomes than those that deliver less. Variation in Health Care
Spending investigates geographic variation in health care spending
and quality for Medicare beneficiaries as well as other
populations, and analyzes Medicare payment policies that could
encourage high-value care. This report concludes that regional
differences in Medicare and commercial health care spending and use
are real and persist over time. Furthermore, there is much
variation within geographic areas, no matter how broadly or
narrowly these areas are defined. The report recommends against
adoption of a geographically based value index for Medicare
payments, because the majority of health care decisions are made at
the provider or health care organization level, not by geographic
units. Rather, to promote high value services from all providers,
Medicare and Medicaid Services should continue to test payment
reforms that offer incentives to providers to share clinical data,
coordinate patient care, and assume some financial risk for the
care of their patients. Medicare covers more than 47 million
Americans, including 39 million people age 65 and older and 8
million people with disabilities. Medicare payment reform has the
potential to improve health, promote efficiency in the U.S. health
care system, and reorient competition in the health care market
around the value of services rather than the volume of services
provided. The recommendations of Variation in Health Care Spending
are designed to help Medicare and Medicaid Services encourage
providers to efficiently manage the full range of care for their
patients, thereby increasing the value of health care in the United
States.
Review of NASA's Evidence Reports on Human Health Risks: 2013
Letter Report is the first in a series of five reports from the
Institute of Medicine that will independently review more than 30
evidence reports that the National Aeronautics and Space
Administration has compiled on human health risks for long-duration
and exploration space flights. This report builds on the 2008 IOM
report Review of NASA's Human Research Program Evidence Books: A
Letter Report, which provided an initial and brief review of the
evidence reports. This letter report reviews three evidence reports
and examines the quality of the evidence, analysis, and overall
construction of each report; identifies existing gaps in report
content; and provides suggestions for additional sources of expert
input. The report analyzes each evidence report's overall quality,
which included readability; internal consistency; the source and
breadth of cited evidence; identification of existing knowledge and
research gaps; authorship expertise; and, if applicable, response
to recommendations from the 2008 IOM letter report. Table of
Contents Front Matter Review of NASA's evidence reports on human
health risks: 2013 letter report. References Appendix A: Meeting
Agendas Appendix B: Committee Biosketches
Interim Report of the Committee on Geographic Variation in Health
Care Spending and Promotion of High-Value Health Care: Preliminary
Committee Observations is designed to provide the committee's
preliminary observations for the 113th Congress as it considers
further Medicare reform. This report contains only key preliminary
observations related primarily to the committee's commissioned
analyses of Medicare Parts A (Hospital Insurance program), B
(Supplementary Medical Insurance program) and D (outpatient
prescription drug benefit), complemented by other empirical
investigations. It does not contain any observations related to the
committee's commissioned analyses of the commercial insurer
population, Medicare Advantage, or Medicaid, which will be
presented in the committee's final report after completion of
quality-control activities. This interim report excludes
conclusions or recommendations related to the committee's
consideration of the geographic value index or other payment
reforms designed to promote highvalue care. Additional analyses are
forthcoming, which will influence the committee's deliberations.
These analyses include an exploration of how Medicare Part C
(Medicare Advantage) and commercial spending, utilization, and
quality vary compared with, and possibly are influenced by,
Medicare Parts A and B spending, utilization, and quality. The
committee also is assessing potential biases that may be inherent
to Medicare and commercial claims-based measures of health status.
Based on this new evidence and continued review of the literature,
the committee will confirm the accuracy of the observations
presented in this interim report and develop final conclusions and
recommendations, which will be published in the committee's final
report. Table of Contents Front Matter Interim Report REFERENCES
Appendix A: Glossary Appendix B: Statement of Task
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