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The article offers information on the updated position paper on the policies relating to HIV infection in the U.S. The position paper on HIV policy has been established in collaboration with the HIV Medicine Association of the Infectious Diseases Society of America and the American College of Physicians. The updated HIV policy highlights major advances on the treatment of HIV infection, the expansion of HIV as a pandemic and the prevalence of HIV transmission in health care settings. Details on these updates emphasizing public health and clinical imperatives in identifying HIV infection are discussed.

The last 50 years have seen great advances in the accuracy of external beam radiation therapy. Geometrical uncertainties have been reduced from a centimeter or more in presimulation, skin-mark guided days to 1–2 mm in today’s image-guided radiation therapy treatments. Medical physicists, with the support and guidance of the American Association of Physicists in Medicine (AAPM), have been, and continue to be, at the forefront of research, development and clinical implementation in this area. This article reviews some of the major contributions of physicists to the improvement of treatment accuracy and precision, and speculates as to what the future may bring. [ABSTRACT FROM AUTHOR]

In 2006, the American College of Clinical Pharmacy ( ACCP) released a position statement and a white paper to provide the College's viewpoints on the importance of postgraduate pharmacy residency training as a prerequisite for direct patient care practice and the vision that future clinical pharmacists engaged in direct patient care would be certified by the Board of Pharmacy Specialties ( BPS). Since the release of these papers, some members of the pharmacy profession have interpreted ACCP's position as maintaining that all pharmacists-regardless of the focus of their professional practice activities-should complete formal postgraduate residency training and be board-certified specialists. That interpretation is not accurate. In this commentary, ACCP further defines 'direct patient care' and states that it believes that clinical pharmacists engaged in direct patient care should be board certified (i.e., and residency-trained or otherwise board eligible) and have established a valid collaborative drug therapy management ( CDTM) agreement or have been formally granted clinical privileges. The rationale for this viewpoint is presented in detail. The pharmacy profession has appropriately invested substantial resources to ensure the quality of its accredited residency training programs and board certification processes. ACCP believes that these training and certification programs are essential steps in preparing clinical pharmacists to provide direct patient care. [ABSTRACT FROM AUTHOR]

Despite incredible technological advancements in diagnostics and treatment, medicine remains the last significant paper-based industry in the United States. In fits and starts, the American healthcare system is transitioning from paper charts to electronic records. The ultimate goal is a nationwide health information network that includes a comprehensive, interoperable electronic medical record for each patient. The effective use of health information technology (HIT) in physician offices, hospitals, and even patients' homes promises to hold down rising healthcare costs and improve Americans' health. Unfortunately, no overarching national strategy has emerged for designing and implementing such a system. Though federal officials increasingly promote the use of HIT, state efforts have driven most government progress. This dual-track regulatory strategy carries significant risks of interstate redundancy and incompatibility. This Note argues that a national policy of state experimentation would mitigate these risks and best exploit HIT's considerable potential. Building on the ideas of democratic experimentalism, such a framework would encourage state innovation but require interstate collaboration and adherence to emerging standards in return. This Note's proposal would establish a forum for interstate collaboration, require state participation through a designated HIT coordinator, mandate information sharing among state and federal officials, and create a mechanism to rein in potentially disruptive state policies. In addition to offering a roadmap for the nation's HIT transition, this Note also provides a lens through which to view-and an opportunity to address-several criticisms of democratic experimentalist theory. [ABSTRACT FROM AUTHOR]

The dialogue about the future of health care in the US has been impeded by flawed conceptions about medicine and business. The present paper re-examines some of the underlying assumptions about both medicine and business, and uses more nuanced readings of both terms to frame debates about the ACA and the emerging health care environment. [ABSTRACT FROM AUTHOR]

Introduction: A key objective of this paper is to describe some major challenges and opportunities facing the behavioral medicine field in the current decade. Amidst current US statistics that present a sobering image of the nation's health, there have been a number of notable achievements in the behavioral medicine field that span the scientific/health continuum. However, many of these achievements have received little notice by the public and decision makers. Methods: A case is presented for the potential of scientific narrative for presenting behavioral medicine evidence in ways that engage attention and compel action. Additional areas for behavioral medicine engagement include expanding interdisciplinary connections into new arenas, continuing the growth of activities involving emerging technologies, building international connections, and engaging with policy. Conclusion: Finally, the fundamental importance of an integrated behavioral medicine field that plays an active role in supporting and advancing its members and the field as a whole is discussed. [ABSTRACT FROM AUTHOR]

The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them. [ABSTRACT FROM AUTHOR]

Efforts to build a complementary and alternative medicine (CAM) education and research infrastructure have been productive. Development has focused largely on graduate, postgraduate, and professional level training. This paper examines baccalaureate programs, looking at the prevalence and characteristics of CAM and holistic health training in the United States.A comprehensive literature and web site search was conducted to find educational institutions offering baccalaureate programs in CAM or holistic health. Search criteria included accredited undergraduate programs terminating in a minor, an AA, or a BA/BS degree.A search of health and education databases produced marginal results. Internet searches, by contrast, were very productive in locating CAM or holistic health-related programs generally and baccalaureateprograms specifically. The most effective search strings included terms such as 'holistic health,' 'minor,' 'certificate,'and 'undergraduate.' Using these terms, 5 programs were found in the United States that met the inclusioncriteria: Arizona State University East, Bastyr University, San Francisco State University, MetropolitanState College of Denver, and Georgian Court College.Preparing tomorrow's scholars and clinicians to contribute meaningfully to this emerging healthcare paradigm will require a plan that integrates all elements of higher education. The creation of a trulyeffective workforce of CAM-competent M.D.s, nurses, health educators, pharmacists, and other allied healthprofessionals will increasingly necessitate baccalaureate preparation. Curriculum discussions at the campus,state, and national levels are needed. [ABSTRACT FROM AUTHOR]

The federal government has played a significant role in the financing the education of healthcare professionals since the introduction of Medicare in 1965. However, professional psychology's limited ability to argue the critical nature of its services to the welfare of the nation, and its lack of national workforce information and policy, has hindered its inclusion in Medicare's Graduate Medical Education (GME) program. This paper discusses the evolution and current status of healthcare workforce policy in the United States, and the implications for psychology and the training of future professionals. Also described are recent efforts by the American Psychological Association (APA) and a few psychologists to include professional psychology in the GME program. The importance of organized psychology's sustained involvement in national health policy is emphasized. [ABSTRACT FROM AUTHOR]

The format of the paper is to allow three authors to discuss what they believe are the most significant political issues facing emergency medicine (EM) in their country or region. Each author writes independently and does not see any other contributing author's work, therefore potential overlap of subject matter is inevitable. However, we were soliciting their individual opinions about the serious issues confronting us today, rather than a consensus. An additional author, well familiar with the topics being discussed, wrote the Commentary from an overview perspective on the writings of the other authors. This supplemental opinion was offered as a method for enhanced cohesiveness in describing the political situations impacting the specialty of emergency medicine. The three authors for the United States are James Hoekstra, Professor and Chair, Wake Forest University Health Sciences; Robert McNamara, Professor and Chair, Temple University School of Medicine, and Robert Schafermeyer, Associate Chair, Department of Emergency Medicine, North Carolina School of Medicine. Between them, they represent more than 50 years experience in clinical and academic emergency medicine. They write from a personal perspective. Their views are their own, and do not represent any organization(s) with which they may have or had affiliations. [ABSTRACT FROM AUTHOR]

This paper reviews the evolution of patient empowerment in the United States over the last thirty years and ways the practice of evidence-based medicine (EBM) has impacted and paralleled the history of the American consumer health movement. EBM is the practice of supporting clinical decision making with systematic research, while taking into account the personal values, unique biology, and individual concerns of each patient. EBM has improved medical practice by judiciously integrating the best studies (better evidence) into the medical decision-making process. In this era of patient-centered care, EBM impacts not only the decisions consumers make about their health care, but the professional and consumer health literature used to inform and support medical decision making. While an evidence-based consumer health literature is still nascent, twenty-first century medicine is now seeing resources created to translate systematic research in a format and language appropriate for the general public. [ABSTRACT FROM AUTHOR]

Despite uncertainty being intrinsic to economic evaluation of health care, existing techniques for handling uncertainty remain underdeveloped compared to the formal techniques commonly applied in the business sector. This paper develops an alternative approach to handling uncertainty in economic evaluation based on 'option-pricing' techniques. The presence of uncertainty and the degree of irreversibility of a decision make it clear that some flexibility in the timing of a decision is often a desirable characteristic with an economic value. We demonstrate how option-pricing techniques can be applied to the decision rules for economic evaluation in health care. The key determinants of an option value are the presence and type of uncertainty; the ability to defer a decision; and the irreversibility of the decision. The relative significance of each of these for a particular economic evaluation will depend on the particular characteristics of the technology under consideration. [ABSTRACT FROM AUTHOR]

Presents news related to resident physicians in the U.S. as of February 13, 1991. Adoption of a policy by the American Medical Association House of Delegates for implementing resident work-hour reform; Resolution adopted by the AMA Resident Physicians Section for the recycling of paper products.

Introduces articles in the tenth Contempo issue of the 'Journal of the American Medical Association.' Inclusion of papers on medical ethics; Public's relationship to medical practice; Inadequacy and maldistribution of funds for health care; Technical and biological advances in medicine; Moral and economic concerns pervading clinical practice.