Institute of Environmental Medicine

A collaborative project has been initiated to develop a standards-based, comprehensive technology infrastructure that will enable encoding and dissemination of interoperable, electronic clinical practice guidelines (CPG's). Three key deliverables of this large scale ($18M), 3-year project include: An interoperable guideline model, a guideline authoring/encoding workbench, and a guideline deployment system. Our approach will be to employ and extend existing informatics standards, and to collaborate closely with standards development organizations. The project methodology will build on earlier efforts in this field, and will be driven by requirements specific to supporting active deployment of guideline content within clinical information system (CIS) workflow.

This chapter reviews two behavioral substance abuse treatments: The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT). Both of these programs were built on the concept that an individual's recovery is greatly affected by his or her unique environment. This environment, or reinforcing "community," is composed of family, friends, work/school, social activities, and perhaps spiritual affiliations. CRA, the first of these two programs to be developed, was created specifically for the problem drinker (Hunt & Azrin, 1973). The goal of CRA is to rearrange multiple aspects of an individual's "community" so that a clean and sober lifestyle is more rewarding than one that is dominated by alcohol and drugs. Subsequently, CRAFT was developed for the many individuals with substance abuse problems who are vehemently opposed to treatment (Institute of Medicine, 1990). CRAFT works through concerned family members and friends o...

Higher serum levels of the main circulating form of vitamin D, 25-hydroxyvitamin D (25(OH)D), are associated with substantially lower incidence rates of colon, breast, ovarian, renal, pancreatic, aggressive prostate and other cancers. Epidemiological findings combined with newly discovered mechanisms suggest a new model of cancer etiology that accounts for these actions of 25(OH)D and calcium. Its seven phases are disjunction, initiation, natural selection, overgrowth, metastasis, involution, and transition (abbreviated DINOMIT). Vitamin D metabolites prevent disjunction of cells and are beneficial in other phases. It is projected that raising the minimum year-around serum 25(OH)D level to 40 to 60 ng/mL (100-150 nmol/L) would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three fourths of deaths from these diseases in the United States and Canada, based on observational studies combined with a randomized trial. Such ...

Errors in health care can have serious consequences, not only for patients but for society as a whole, given the considerable national expenditures required to address these errors. Because of the number of patients treated and the acuity of emergency situations, eliminating errors should be a priority in emergency medical services (EMS) systems. In a recent report, the Institute of Medicine called for improvements in patient safety, which it defined as freedom from accidental injury. Recent efforts have focused on integrating EMS systems into error analyses of the total health care system. However, EMS systems must take the initiative in addressing their own major error-prone areas using the best and most current data available. Unfortunately, addressing the problem of medical errors in EMS systems still suffers from a paucity of data, owing to a lack of organized, funded programs backed by legislation and dedicated government coordination. We recommend that EMS medical directors consider specific error audits to decrease sources of errors and to be better able to identify EMS providers who would benefit from retraining. Error audits might first be focused on the following potentially serious errors: equipment malfunction, failure to check oxygen saturation, failure to immobilize the patient, use of incorrect protocol or algorithm, failure to check glucose levels, failure to recognize patient deterioration, failure to detect misplaced endotracheal tubes, and use of wrong drug or drug dose. PREHOSPITAL EMERGENCY CARE 2002;6:107-113

The medical malpractice tort system is a failure. Judged on economic terms, more than fifty percent of the dollars are lost to transaction costs, and the instability of the market disrupts the orderly delivery of medical care. Judged on public health terms, it not only fails to provide incentives for better medical care, but its irrationality actually impedes the adoption

The autism-mercury hypothesis first described by Bernard et al. has generated much interest and controversy. The Institute of Medicine (IOM) reviewed the connection between mercury-containing vaccines and neurodevelopmental disorders, including autism. They concluded that the hypothesis was biologically plausible but that there was insufficient evidence to accept or reject a causal connection and recommended a comprehensive research program. Without citing new experimental evidence, a number of observers have offered opinions on the subject, some of which reject the IOM's conclusions. In a recent review, Nelson and Bauman argue that a link between the preservative thimerosal, the source of the mercury in childhood vaccines, is improbable. In their defense of thimerosal, these authors take a narrow view of the original hypothesis, provide no new evidence, and rely on selective citations and flawed reasoning. We provide evidence here to refute the Nelson and Bauman critique and to...

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™) is a systematic approach developed by the Department of Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ) to integrate teamwork into practice. It is designed to improve the quality, safety, and the efficiency of health care. TeamSTEPPS is based on 25 years of research related to teamwork, team training, and culture change. As a direct outcome of the 1999 Institute of Medicine (IOM) report, To Err is Human, TeamSTEPPS introduces tools and strategies to improve team performance in health care. This article describes the evolution of the TeamSTEPPS program and its research foundation, development, and implementation. To date, the DoD has taught TeamSTEPPS at over 68 facilities, creating approximately 1,500 trainers/coaches, who have trained over 5,000 staff members. Beginning with the public release of TeamSTEPPS resources in November 2006, AHRQ began its effort to disseminate TeamST...

BackgroundIn 2000, the Institute of Medicine reported disturbing numbers on the scope it covers and the impact of medical error in the process of health delivery. Nevertheless, a solution to this problem may lie on the adoption of adverse event reporting and learning systems that can help to identify hazards and risks. It is crucial to apply models to identify

Background: Reference standards for resting energy expenditure (REE) are widely used. Current standards are based on measure- ments made in the first part of the past century in various races and locations. Objective: The aim of the present study was to investigate the application of the World Health Organization (WHO) equations from 1985 in healthy subjects living in a modern,