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The VA National Formulary generated controversy, which motivated
congressional scrutiny and a directive to the VA to commission this
report reviewing the experience with the National Formulary and
formulary system. This Institute of Medicine committee was pleased
to assist the Congress with this review, in part because the
committee saw in the VHA example an opportunity to understand and
anticipate problems that all publicly funded programs are likely to
encounter in this new age of pharmaceuticals. The Congress asked
the committee to review the restrictiveness of the National
Formulary, its impact on the costs and quality of care in the VHA,
and how it compared to formularies and drug management practices in
the private sector and in other public programs, especially
Medicaid. Detailed in the pages that follow, the committee's
findings and conclusions on these questions are, the committee
believes, highly instructive, though not always in the ways that we
anticipated.
In this report The Breast Cancer Research Foundation (BCRF) and the
Institute of Medicine (IOM) present a one-day symposium that was
held at the IOM to further disseminate the conclusions and
recommendations of the joint IOM and National Research Council
report, Saving Women's Lives: Strategies for Improving Breast
Cancer Detection and Diagnosis. The committee assembled for this
event was asked to share insights and consider ways in which the
objectives of the report could be achieved from the standpoint of
what women need to know, the best models of screening programs,
manpower, risk stratification, basic research, and payment. This
symposium seeks to provide continuing food for thought and ideas
for actions in support of breast cancer detection and diagnosis and
saving women's lives. Table of Contents Front Matter Abstract 1
Introduction 2 Plenary Session 3 Simultaneous Group Discussions
with Invited Speakers 4 Wrap-Up Session References Appendix:
Symposium Agenda
Non-heart-beating donors (individuals whose deaths are determined
by cessation of heart and respiratory function rather than loss of
whole brain function) could potentially be of major importance in
reducing the gap between the demand for and available supply of
organs for transplantation. Prompted by questions concerning the
medical management of such donors?specifically, whether
interventions undertaken to enhance the supply and quality of
potentially transplantable organs (i.e. the use of anticoagulants
and vasodilators) were in the best interests of the donor
patient?the U.S. Department of Health and Human Services asked the
Institute of Medicine to examine from scientific and ethical points
of view "alternative medical approaches that can be used to
maximize the availability of organs from [a] donor [in an
end-of-life situation] without violating prevailing ethical
norms...." This book examines transplantation supply and demand,
historical and modern conceptions of non-heart-beating donors, and
organ procurement organizations and transplant program policies,
and contains recommendations concerning the principles and ethical
issues surrounding the topic. Table of Contents Front Matter
Executive Summary 1 Introduction 2 Transplantation Supply and
Demand 3 Background 4 The Modern Non-Heart-Beating Donor 5 Survey
of Organ Procurement Organization and Transplant Program Policies 6
Analysis, Findings, and Recommendations References Appendix A
Appendix B Appendix C
The Health Insurance Portability and Accountability Act (HIPAA) of
1996 was enacted to improve the portability and continuity of
health insurance; promote medical savings accounts; improve access
to long-term care services and coverage; and simplify the
administration of health insurance. HIPAA's Administrative
Simplification provisions focus on facilitating the electronic
exchange of information for financial and administrative functions
related to patient care. However, the very advances that make it
easier to transmit information also present challenges to
preserving the confidentiality of potentially sensitive personal
information contained in medical records. In 2003, the President's
Cancer Panel discovered HIPAA Privacy Rule slowed research on
cancer survivors, as well as causing increased bureaucracy,
informed consent problems, and complications for clinical trials.
Effect of the HIPAA Privacy Rule on Health Research evaluates the
impact of HIPAA provisions and provides guidance to legislators on
amendments needed to make this law better serve the interests of
cancer survivors and others. Table of Contents Front Matter 1
Introduction 2 Prepared Presentationsand Discussion Glossary
Appendix Workshop Agenda
In Meeting Psychosocial Needs of Women with Breast Cancer, the
National Cancer Policy Board of the Institute of Medicine examines
the psychosocial consequences of the cancer experience. The book
focuses specifically on breast cancer in women because this group
has the largest survivor population (over 2 million) and this
disease is the most extensively studied cancer from the standpoint
of psychosocial effects. The book characterizes the psychosocial
consequences of a diagnosis of breast cancer, describes
psychosocial services and how they are delivered, and evaluates
their effectiveness. It assesses the status of professional
education and training and applied clinical and health services
research and proposes policies to improve the quality of care and
quality of life for women with breast cancer and their families.
Because cancer of the breast is likely a good model for cancer at
other sites, recommendations for this cancer should be applicable
to the psychosocial care provided generally to individuals with
cancer. For breast cancer, and indeed probably for any cancer, the
report finds that psychosocial services can provide significant
benefits in quality of life and success in coping with serious and
life-threatening disease for patients and their families. Table of
Contents Front Matter Executive Summary 1 Introduction 2
Epidemiology of Breast Cancer 3 Psychosocial Needs of Women with
Breast Cancer 4 Psychosocial Services and Providers 5 The
Effectiveness of Psychosocial Interventions for Women with Breast
Cancer 6 Delivering Psychosocial Services 7 Barriers to Appropriate
Use of Psychosocial Services 8 Research Appendix A Meeting
Psychosocial Needs of Women with Breast Cancer Appendix B Tables
and Boxes Summarizing Evidence from Clinical Trials
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