%0 Book %A Institute of Medicine %E Burroughs, Tom %E Knobler, Stacey %E Lederberg, Joshua %T The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health: Workshop Summary %@ 978-0-309-08327-0 %D 2002 %U https://nap.nationalacademies.org/catalog/10338/the-emergence-of-zoonotic-diseases-understanding-the-impact-on-animal %> https://nap.nationalacademies.org/catalog/10338/the-emergence-of-zoonotic-diseases-understanding-the-impact-on-animal %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %K Agriculture %P 176 %X Zoonotic diseases represent one of the leading causes of illness and death from infectious disease. Defined by the World Health Organization, zoonoses are “those diseases and infections that are naturally transmitted between vertebrate animals and man with or without an arthropod intermediate.” Worldwide, zoonotic diseases have a negative impact on commerce, travel, and economies. In most developing countries, zoonotic diseases are among those diseases that contribute significantly to an already overly burdened public health system. In industrialized nations, zoonotic diseases are of particular concern for at-risk groups such as the elderly, children, childbearing women, and immunocompromised individuals. The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health, covers a range of topics, which include: an evaluation of the relative importance of zoonotic diseases against the overall backdrop of emerging infections; research findings related to the current state of our understanding of zoonotic diseases; surveillance and response strategies to detect, prevent, and mitigate the impact of zoonotic diseases on human health; and information about ongoing programs and actions being taken to identify the most important needs in this vital area. %0 Book %A Institute of Medicine %E Knobler, Stacey %E Lederberg, Joshua %E Pray, Leslie A. %T Considerations for Viral Disease Eradication: Lessons Learned and Future Strategies: Workshop Summary %@ 978-0-309-08414-7 %D 2002 %U https://nap.nationalacademies.org/catalog/10424/considerations-for-viral-disease-eradication-lessons-learned-and-future-strategies %> https://nap.nationalacademies.org/catalog/10424/considerations-for-viral-disease-eradication-lessons-learned-and-future-strategies %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 232 %X Since smallpox eradication, the science of eradication has changed and with it, our definitions of what diseases are possible to eradicate. However, eradication must not beget complacency. As has been learned from past control or eradication attempts with a variety of viral diseases, from yellow fever to influenza, accidental or intentional reintroduction is a real threat—one that could strike anywhere and for which we need to be fully prepared. The criteria for assessing eradicability of polio, measles, and other viral infections have been debated extensively. With the elimination and eradication of several viral diseases on the horizon, issues surrounding the cessation of immunization activities become exceedingly important. In an effort to better understand the dynamics of disease eradication and post—immunization policies, the Institute of Medicine Forum on Emerging Infections hosted a two-day workshop (February 1—2, 2001) on The Consequences of Viral Disease Eradication. This book explores the principles underlying the biological challenges, medical interventions, the continuing research agenda, and operational considerations for post—immunization strategies for vaccine—preventable viral diseases, and highlights important efforts that may facilitate wise decision making. %0 Book %A Institute of Medicine %E Davis, Jonathan R. %E Lederberg, Joshua %T Emerging Infectious Diseases from the Global to the Local Perspective: A Summary of a Workshop of the Forum on Emerging Infections %@ 978-0-309-07184-0 %D 2001 %U https://nap.nationalacademies.org/catalog/10084/emerging-infectious-diseases-from-the-global-to-the-local-perspective %> https://nap.nationalacademies.org/catalog/10084/emerging-infectious-diseases-from-the-global-to-the-local-perspective %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 134 %X In October 1999, the Forum on Emerging Infections of the Institute of Medicine convened a two-day workshop titled “International Aspects of Emerging Infections.” Key representatives from the international community explored the forces that drive emerging infectious diseases to prominence. Representatives from the Americas, Africa, Asia and the Pacific, and Europe made formal presentations and engaged in panel discussions. Emerging Infectious Diseases from the Global to the Local Perspective includes summaries of the formal presentations and suggests an agenda for future action. The topics addressed cover a wide range of issues, including trends in the incidence of infectious diseases around the world, descriptions of the wide variety of factors that contribute to the emergence and reemergence of these diseases, efforts to coordinate surveillance activities and responses within and across borders, and the resource, research, and international needs that remain to be addressed. %0 Book %A Institute of Medicine %E Davis, Jonathan R. %E Lederberg, Joshua %T Public Health Systems and Emerging Infections: Assessing the Capabilities of the Public and Private Sectors: Workshop Summary %@ 978-0-309-06829-1 %D 2000 %U https://nap.nationalacademies.org/catalog/9869/public-health-systems-and-emerging-infections-assessing-the-capabilities-of %> https://nap.nationalacademies.org/catalog/9869/public-health-systems-and-emerging-infections-assessing-the-capabilities-of %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %K Conflict and Security Issues %P 128 %X The Forum on Emerging Infections was created in 1996 in response to a request from the Centers for Disease Control and Prevention and the National Institutes of Health. The goal of the forum is to provide structured opportunities for representatives from academia, industry, professional and interest groups, and government to examine and discuss scientific and policy issues that relate to research, prevention, detection, and management of emerging infectious diseases. A critical part of this mission has been the convening of a series of workshops. Public Health Systems and Emerging Infections summarizes the fourth in a series of five workshops. With a focus on our knowledge and understanding of the role of private and public health sectors in emerging infectious disease surveillance and response, the participants explored the effects of privatization of public health laboratories and the modernization of public health care. The issues discussed included epidemiological investigation, surveillance, communication, coordination, resource allocations, and economic support. %0 Book %A Institute of Medicine %E Tunis, Sean %E Korn, Allan %E Ommaya, Alex %T The Role of Purchasers and Payers in the Clinical Research Enterprise: Workshop Summary %@ 978-0-309-08349-2 %D 2002 %U https://nap.nationalacademies.org/catalog/10400/the-role-of-purchasers-and-payers-in-the-clinical-research-enterprise %> https://nap.nationalacademies.org/catalog/10400/the-role-of-purchasers-and-payers-in-the-clinical-research-enterprise %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 120 %X In a workshop organized by the Clinical Research roundtable, representatives from purchaser organizations (employers), payer organizations (health plans and insurance companies), and other stakeholder organizations (voluntary health associations, clinical researchers, research organizations, and the technology community) came together to explore: What do purchasers and payers need from the Clinical Research Enterprise? How have current efforts in clinical research met their needs? What are purchasers, payers, and other stakeholders willing to contribute to the enterprise? This book documents these discussions and summarizes what employers and insurers need from and are willing to contribute to clinical research from both a business and a national health care perspective. %0 Book %A Institute of Medicine %A National Research Council %E Hewitt, Maria %E Simone, Joseph V. %T Enhancing Data Systems to Improve the Quality of Cancer Care %@ 978-0-309-08649-3 %D 2000 %U https://nap.nationalacademies.org/catalog/9970/enhancing-data-systems-to-improve-the-quality-of-cancer-care %> https://nap.nationalacademies.org/catalog/9970/enhancing-data-systems-to-improve-the-quality-of-cancer-care %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 175 %X One of the barriers to improving the quality of cancer care in the United States is the inadequacy of data systems. Out-of-date or incomplete information about the performance of doctors, hospitals, health plans, and public agencies makes it hard to gauge the quality of care. Augmenting today's data systems could start to fill the gap. This report examines the strengths and weaknesses of current systems and makes recommendations for enhancing data systems to improve the quality of cancer care. The board's recommendations fall into three key areas: Enhance key elements of the data system infrastructure (i.e., quality-of-care measures, cancer registries and databases, data collection technologies, and analytic capacity). Expand support for analyses of quality of cancer care using existing data systems. Monitor the effectiveness of data systems to promote quality improvement within health systems. %0 Book %A Institute of Medicine %E Field, Marilyn J. %T Tuberculosis in the Workplace %@ 978-0-309-07330-1 %D 2001 %U https://nap.nationalacademies.org/catalog/10045/tuberculosis-in-the-workplace %> https://nap.nationalacademies.org/catalog/10045/tuberculosis-in-the-workplace %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 334 %X Before effective treatments were introduced in the 1950s, tuberculosis was a leading cause of death and disability in the United States. Health care workers were at particular risk. Although the occupational risk of tuberculosis has been declining in recent years, this new book from the Institute of Medicine concludes that vigilance in tuberculosis control is still needed in workplaces and communities. Tuberculosis in the Workplace reviews evidence about the effectiveness of control measures—such as those recommended by the Centers for Disease Control and Prevention—intended to prevent transmission of tuberculosis in health care and other workplaces. It discusses whether proposed regulations from the Occupational Safety and Health Administration would likely increase or sustain compliance with effective control measures and would allow adequate flexibility to adapt measures to the degree of risk facing workers. %0 Book %A Institute of Medicine %E Knobler, Stacey L. %E Mahmoud, Adel A. F. %E Pray, Leslie A. %T Biological Threats and Terrorism: Assessing the Science and Response Capabilities: Workshop Summary %@ 978-0-309-08253-2 %D 2002 %U https://nap.nationalacademies.org/catalog/10290/biological-threats-and-terrorism-assessing-the-science-and-response-capabilities %> https://nap.nationalacademies.org/catalog/10290/biological-threats-and-terrorism-assessing-the-science-and-response-capabilities %I The National Academies Press %C Washington, DC %G English %K Conflict and Security Issues %K Health and Medicine %P 335 %X In the wake of September 11th and recent anthrax events, our nation's bioterrorism response capability has become an imminent priority for policymakers, researchers, public health officials, academia, and the private sector. In a three-day workshop, convened by the Institute of Medicine's Forum on Emerging Infections, experts from each of these communities came together to identify, clarify, and prioritize the next steps that need to be taken in order to prepare and strengthen bioterrorism response capabilities. From the discussions, it became clear that of utmost urgency is the need to cast the issue of a response in an appropriate framework in order to attract the attention of Congress and the public in order to garner sufficient and sustainable support for such initiatives. No matter how the issue is cast, numerous workshop participants agreed that there are many gaps in the public health infrastructure and countermeasure capabilities that must be prioritized and addressed in order to assure a rapid and effective response to another bioterrorist attack. %0 Book %A Institute of Medicine %A National Research Council %E Foley, Kathleen M. %E Gelband, Hellen %T Improving Palliative Care for Cancer %@ 978-0-309-07402-5 %D 2001 %U https://nap.nationalacademies.org/catalog/10149/improving-palliative-care-for-cancer %> https://nap.nationalacademies.org/catalog/10149/improving-palliative-care-for-cancer %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 343 %X In our society’s aggressive pursuit of cures for cancer, we have neglected symptom control and comfort care. Less than one percent of the National Cancer Institute’s budget is spent on any aspect of palliative care research or education, despite the half million people who die of cancer each year and the larger number living with cancer and its symptoms. Improving Palliative Care for Cancer examines the barriers—scientific, policy, and social—that keep those in need from getting good palliative care. It goes on to recommend public- and private-sector actions that would lead to the development of more effective palliative interventions; better information about currently used interventions; and greater knowledge about, and access to, palliative care for all those with cancer who would benefit from it. %0 Book %A Institute of Medicine %E Lewin, Marion Ein %E Altman, Stuart %T America's Health Care Safety Net: Intact but Endangered %@ 978-0-309-06497-2 %D 2000 %U https://nap.nationalacademies.org/catalog/9612/americas-health-care-safety-net-intact-but-endangered %> https://nap.nationalacademies.org/catalog/9612/americas-health-care-safety-net-intact-but-endangered %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 302 %X America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety net—with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety net—public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the system—rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environment—detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populations—children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless. %0 Book %A Institute of Medicine %T Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences %@ 978-0-309-18737-4 %D 2001 %U https://nap.nationalacademies.org/catalog/9838/health-and-behavior-the-interplay-of-biological-behavioral-and-societal %> https://nap.nationalacademies.org/catalog/9838/health-and-behavior-the-interplay-of-biological-behavioral-and-societal %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 395 %X Health and Behavior reviews our improved understanding of the complex interplay among biological, psychological, and social influences and explores findings suggested by recent research—including interventions at multiple levels that we can employ to improve human health. The book covers three main areas: What do biological, behavioral, and social sciences contribute to our understanding of health—including cardiovascular, immune system and brain functioning, behaviors that influence health, the role of social networks and socioeconomic status, and more. What can we learn from applied research on interventions to improve the health of individuals, families, communities, organizations, and larger populations? How can we expeditiously translate research findings into application? %0 Book %A Institute of Medicine %E Geiter, Lawrence %T Ending Neglect: The Elimination of Tuberculosis in the United States %@ 978-0-309-07028-7 %D 2000 %U https://nap.nationalacademies.org/catalog/9837/ending-neglect-the-elimination-of-tuberculosis-in-the-united-states %> https://nap.nationalacademies.org/catalog/9837/ending-neglect-the-elimination-of-tuberculosis-in-the-united-states %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 292 %X Tuberculosis emerged as an epidemic in the 1600s, began to decline as sanitation improved in the 19th century, and retreated further when effective therapy was developed in the 1950s. TB was virtually forgotten until a recent resurgence in the U.S. and around the world—ominously, in forms resistant to commonly used medicines. What must the nation do to eliminate TB? The distinguished committee from the Institute of Medicine offers recommendations in the key areas of epidemiology and prevention, diagnosis and treatment, funding and organization of public initiatives, and the U.S. role worldwide. The panel also focuses on how to mobilize policy makers and the public to effective action. The book provides important background on the pathology of tuberculosis, its history and status in the U.S., and the public and private response. The committee explains how the U.S. can act with both self-interest and humanitarianism in addressing the worldwide incidence of TB. %0 Book %A Institute of Medicine %T Crossing the Quality Chasm: A New Health System for the 21st Century %@ 978-0-309-46561-8 %D 2001 %U https://nap.nationalacademies.org/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the %> https://nap.nationalacademies.org/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 360 %X Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change. %0 Book %A Institute of Medicine %E Joellenbeck, Lois M. %E Zwanziger, Lee L. %E Durch, Jane S. %E Strom, Brian L. %T The Anthrax Vaccine: Is It Safe? Does It Work? %@ 978-0-309-08309-6 %D 2002 %U https://nap.nationalacademies.org/catalog/10310/the-anthrax-vaccine-is-it-safe-does-it-work %> https://nap.nationalacademies.org/catalog/10310/the-anthrax-vaccine-is-it-safe-does-it-work %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %K Conflict and Security Issues %P 288 %X The vaccine used to protect humans against the anthrax disease, called Anthrax Vaccine Adsorbed (AVA), was licensed in 1970. It was initially used to protect people who might be exposed to anthrax where they worked, such as veterinarians and textile plant workers who process animal hair. When the U. S. military began to administer the vaccine, then extended a plan for the mandatory vaccination of all U. S. service members, some raised concerns about the safety and efficacy of AVA and the manufacture of the vaccine. In response to these and other concerns, Congress directed the Department of Defense to support an independent examination of AVA. The Anthrax Vaccine: Is It Safe? Does It Work? reports the study’s conclusion that the vaccine is acceptably safe and effective in protecting humans against anthrax. The book also includes a description of advances needed in main areas: improving the way the vaccine is now used, expanding surveillance efforts to detect side effects from its use, and developing a better vaccine. %0 Book %A Institute of Medicine %E Ball, John R. %E Evans, Charles H., Jr. %T Safe Passage: Astronaut Care for Exploration Missions %@ 978-0-309-07585-5 %D 2001 %U https://nap.nationalacademies.org/catalog/10218/safe-passage-astronaut-care-for-exploration-missions %> https://nap.nationalacademies.org/catalog/10218/safe-passage-astronaut-care-for-exploration-missions %I The National Academies Press %C Washington, DC %G English %K Space and Aeronautics %P 317 %X Safe Passage: Astronaut Care for Exploration Missions sets forth a vision for space medicine as it applies to deep space voyage. As space missions increase in duration from months to years and extend well beyond Earth's orbit, so will the attendant risks of working in these extreme and isolated environmental conditions. Hazards to astronaut health range from greater radiation exposure and loss of bone and muscle density to intensified psychological stress from living with others in a confined space. Going beyond the body of biomedical research, the report examines existing space medicine clinical and behavioral research and health care data and the policies attendant to them. It describes why not enough is known today about the dangers of prolonged travel to enable humans to venture into deep space in a safe and sane manner. The report makes a number of recommendations concerning NASA's structure for clinical and behavioral research, on the need for a comprehensive astronaut health care system and on an approach to communicating health and safety risks to astronauts, their families, and the public. %0 Book %A Institute of Medicine %E Wunderlich, Gooloo S. %E Kohler, Peter O. %T Improving the Quality of Long-Term Care %@ 978-0-309-06498-9 %D 2001 %U https://nap.nationalacademies.org/catalog/9611/improving-the-quality-of-long-term-care %> https://nap.nationalacademies.org/catalog/9611/improving-the-quality-of-long-term-care %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 343 %X Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care. %0 Book %A Institute of Medicine %A National Research Council %E Nass, Sharyl J. %E Henderson, I. Craig %E Lashof, Joyce C. %T Mammography and Beyond: Developing Technologies for the Early Detection of Breast Cancer %@ 978-0-309-21656-2 %D 2001 %U https://nap.nationalacademies.org/catalog/10030/mammography-and-beyond-developing-technologies-for-the-early-detection-of %> https://nap.nationalacademies.org/catalog/10030/mammography-and-beyond-developing-technologies-for-the-early-detection-of %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 310 %X Each year more than 180,000 new cases of breast cancer are diagnosed in women in the U.S. If cancer is detected when small and local, treatment options are less dangerous, intrusive, and costly-and more likely to lead to a cure. Yet those simple facts belie the complexity of developing and disseminating acceptable techniques for breast cancer diagnosis. Even the most exciting new technologies remain clouded with uncertainty. Mammography and Beyond provides a comprehensive and up-to-date perspective on the state of breast cancer screening and diagnosis and recommends steps for developing the most reliable breast cancer detection methods possible. This book reviews the dramatic expansion of breast cancer awareness and screening, examining the capabilities and limitations of current and emerging technologies for breast cancer detection and their effectiveness at actually reducing deaths. The committee discusses issues including national policy toward breast cancer detection, roles of public and private agencies, problems in determining the success of a technique, availability of detection methods to specific populations of women, women's experience during the detection process, cost-benefit analyses, and more. Examining current practices and specifying research and other needs, Mammography and Beyond will be an indispensable resource to policy makers, public health officials, medical practitioners, researchers, women's health advocates, and concerned women and their families. %0 Book %A Institute of Medicine %T Preserving Public Trust: Accreditation and Human Research Participant Protection Programs %@ 978-0-309-07328-8 %D 2001 %U https://nap.nationalacademies.org/catalog/10085/preserving-public-trust-accreditation-and-human-research-participant-protection-programs %> https://nap.nationalacademies.org/catalog/10085/preserving-public-trust-accreditation-and-human-research-participant-protection-programs %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 232 %X Amid increasing concern for patient safety and the shutdown of prominent research operations, the need to improve protections for individuals who volunteer to participate in research has become critical. Preserving Public Trust: Accreditation and Human Research Participant Protection Programs considers the possible impact of creating an accreditation system to raise the performance of local protection mechanisms. In the United States, the system for human research participant protections has centered on the Institutional Review Board (IRB); however, this report envisions a broader system with multiple functional elements. In this context, two draft sets of accreditation standards are reviewed (authored by Public Responsibility in Medicine & Research and the National Committee for Quality Assurance) for their specific content in core areas, as well as their objectivity and validity as measurement tools. The recommendations in the report support the concept of accreditation as a quality improvement strategy, suggesting that the model should be initially pursued through pilot testing of the proposed accreditation programs. %0 Book %A Institute of Medicine %T Protecting Data Privacy in Health Services Research %@ 978-0-309-07187-1 %D 2000 %U https://nap.nationalacademies.org/catalog/9952/protecting-data-privacy-in-health-services-research %> https://nap.nationalacademies.org/catalog/9952/protecting-data-privacy-in-health-services-research %I The National Academies Press %C Washington, DC %G English %K Computers and Information Technology %P 208 %X The need for quality improvement and for cost saving are driving both individual choices and health system dynamics. The health services research that we need to support informed choices depends on access to data, but at the same time, individual privacy and patient-health care provider confidentiality must be protected. %0 Book %A Institute of Medicine %E Field, Marilyn J. %T Setting Priorities for Clinical Practice Guidelines %@ 978-0-309-05247-4 %D 1995 %U https://nap.nationalacademies.org/catalog/4959/setting-priorities-for-clinical-practice-guidelines %> https://nap.nationalacademies.org/catalog/4959/setting-priorities-for-clinical-practice-guidelines %I The National Academies Press %C Washington, DC %G English %K Health and Medicine %P 176 %X This book examines methods for selecting topics and setting priorities for clinical practice guideline development and implementation. Clinical practice guidelines are "systematically defined statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." In its assessment of processes for setting priorities, the committee considers the principles of consistency with the organization's mission, implementation feasibility, efficiency, utility of the results to the organization, and openness and defensibility—a principle that is especially important to public agencies. The volume also examines the implications of health care restructuring for priority setting and topic selection, including the link between national and local approaches to guidelines development.