LEADER 01267nam--2200397---450- 001 990001734550203316 005 20090325135030.0 010 $a2-8027-1695-6 035 $a000173455 035 $aUSA01000173455 035 $a(ALEPH)000173455USA01 035 $a000173455 100 $a20040608d2003----km-y0enga50------ba 101 0 $afre 102 $aBE 105 $ay---z---001yy 200 1 $aMaintien de la paix et diplomatie coercitive$el'Organisation des Nations Unies à l'épreuve des conflits de l'après-guerre froide$fMichel Liegeois$gpreface de Jean Cot 210 $aBruxelles$cBruylant$d2003 215 $a236 p.$d24 cm 410 0$12001 454 1 $12001 461 1$1001------$12001 606 0 $aNazioni Unite$xForze Armate$xDifesa della pace 676 $a327.0634 700 1$aLIEGEOIS,$bMichel$0562707 702 1$aCOT,$bJean 801 0$aIT$bsalbc$gISBD 912 $a990001734550203316 951 $a327.063 LIE 1 (ISP IV 1316)$b42175 G.$cISP IV$d00084906 959 $aBK 969 $aGIU 979 $aMARIA$b10$c20040608$lUSA01$h1203 979 $aIANNONE$b90$c20050512$lUSA01$h1637 979 $aRSIAV2$b90$c20090325$lUSA01$h1350 996 $aMaintien de la paix et diplomatie coercitive$9945677 997 $aUNISA LEADER 00734nam0 2200265 450 001 9910327559803321 005 20190708144134.0 100 $a20190708d1968----km y0itay50 ba 101 1 $aita$cfre 102 $aIT 105 $a 001yy 200 1 $aElementi di semiologia$fRoland Barthes 205 $a4. ed. 210 $aTorino$cEinaudi$dstampa 1968 215 $a96 p.$d18 cm 225 1 $aNuovo politecnico$v7 454 0$12001$aÉléments de sémiologie$916671 700 1$aBarthes,$bRoland$f<1915-1980>$036036 801 0$aIT$bUNINA$gREICAT$2UNIMARC 901 $aBK 912 $a9910327559803321 952 $aMTD 649$b903/36$fDARPU 959 $aDARPU 996 $aEléments de sémiologie$916671 997 $aUNINA LEADER 05225nam 2200649 450 001 9910220091803321 005 20231108003917.0 010 $a0-8330-8549-2 010 $a0-8330-8547-6 035 $a(CKB)3710000000108683 035 $a(EBL)1684540 035 $a(SSID)ssj0001216878 035 $a(PQKBManifestationID)11836996 035 $a(PQKBTitleCode)TC0001216878 035 $a(PQKBWorkID)11197744 035 $a(PQKB)10803063 035 $a(Au-PeEL)EBL1684540 035 $a(CaPaEBR)ebr10867874 035 $a(OCoLC)879551018 035 $a(MiAaPQ)EBC1684540 035 $a(EXLCZ)993710000000108683 100 $a20140517h20142014 uy 0 101 0 $aeng 135 $aur|n|---||||| 181 $ctxt 182 $cc 183 $acr 200 00$aRedirecting innovation in U.S. health care $eoptions to decrease spending and increase value /$fSteven Garber [and six others] 210 1$aSanta Monica, California :$cRAND Corporation,$d2014. 210 4$d©2014 215 $a1 online resource (135 p.) 300 $aDescription based upon print version of record. 311 $a0-8330-8546-8 320 $aIncludes bibliographical references. 327 $aCover; Title Page; Copyright; Preface; Contents; Figures; Summary; Acknowledgments; Abbreviations; Chapter One: Introduction; Project Goals; What Determines Value for Health Care Products?; Chapter Two: The Context for Medical Product Innovation; Three Stages of Innovation; Primary Actors in Inventing Medical Products; Drug and Device Companies; HIT Companies; Goals of Medical Product Inventors; Private Investors; Financial Incentives of Medical Product Inventors; Influencers of Medical Product Invention; National Institutes of Health; U.S. Food and Drug Administration 327 $aU.S. Patent and Trademark Office Office of the National Coordinator for Health Information Technology; Primary Actor and Influencers in Approval of Medical Technologies; Primary Actors in Adoption of Medical Products; Physicians; Hospitals; Influencers of Providers; Summary: Context for Medical Product Innovation; Chapter Three: Methods; Literature Reviews; Technical Expert Panel; Expert Interviews; Case Studies; Policy Options; Chapter Four: Analysis; Lack of Basic Scientific Knowledge; Lack of an Adequate Knowledge Base Can Hinder Product Inventors 327 $aSources of Financial Support for Increasing Basic Scientific Knowledge Federal Funding Is Critical to Expanding the Basic Scientific Base; Case Study Summary: Haemophilus influenzae Type b (Hib) Vaccine; How Scientific Uncertainty Affects Medical Product Invention; Costs and Risks of FDA Approval; Could the FDA Ensure Safety with Quicker and Less Costly Processes?; Delays Entail Both Health and Financial Costs; Case Study Summary: A Cardiovascular Polypill; Unpredictability and Ineffective Communication Complicate the Approval Process; FDA Caution May Be a Root Cause of Regulatory Delay 327 $aCase Study Summary: Avastin for Metastatic Breast Cancer Regulatory Risk Figures Prominently in Investment and Invention Decisions; How Regulatory Uncertainty Affects Investment and Invention; Limited Rewards for Medical Products That Could Lower Spending; Many Patients and Providers Are Fairly Insensitive to Prices; Generous Health Insurance Tends to Reduce Consumers' Sensitivity to Price; Fee-for-Service Payment Also Tends to Reduce Price Sensitivity; Lack of Price Transparency Also Reduces Price Sensitivity; Medicare Is Not Allowed to Consider Costs in Coverage and Reimbursement Decisions 327 $aLimited Time Horizons and Fragmented Decision making Case Study Summary: Electronic Health Records; Inadequate Rewards for Products That Decrease Spending; Implications for Inventors and Investors; Treatment Creep; Case Study Summary: Implantable Cardioverter-Defibrillator; Manufacturers Can Promote Low-Value Use; Case Study Summary: Prostate-Specific Antigen; Defensive Medicine Is a Form of Treatment Creep; Off-Label Use of Medical Products Is Widespread, but Health Effects Are Unknown; It Is Difficult to Control Undesirable Instances of Off-Label Use 327 $aTreatment Creep Can Substantially Affect Incentives for Innovators 330 $aNew medical technologies are a leading driver of U.S. health care spending. This report identifies promising policy options to change which medical technologies are created, with two related policy goals: (1) Reduce total health care spending with the smallest possible loss of health benefits, and (2) ensure that new medical products that increase spending are accompanied by health benefits that are worth the spending increases. 606 $aMedical care$zUnited States 606 $aMedical care, Cost of$zUnited States 606 $aMedical innovations 615 0$aMedical care 615 0$aMedical care, Cost of 615 0$aMedical innovations. 676 $a362.10973 700 $aGarber$b Steven$f1950-$0910138 702 $aGarber$b Steven 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910220091803321 996 $aRedirecting innovation in U.S. health care$92885267 997 $aUNINA LEADER 04061nam 2200637Ia 450 001 9910958513803321 005 20251017110100.0 010 $a0-309-15037-X 010 $a1-282-55453-0 010 $a9786612554537 010 $a0-309-12667-3 035 $a(CKB)2550000000010451 035 $a(EBL)3378578 035 $a(SSID)ssj0000415142 035 $a(PQKBManifestationID)11311504 035 $a(PQKBTitleCode)TC0000415142 035 $a(PQKBWorkID)10409385 035 $a(PQKB)10144545 035 $a(MiAaPQ)EBC3378578 035 $a(Au-PeEL)EBL3378578 035 $a(CaPaEBR)ebr10367627 035 $a(CaONFJC)MIL255453 035 $a(OCoLC)923281330 035 $a(DNLM)1554049 035 $a(EXLCZ)992550000000010451 100 $a20091211d2010 uy 0 101 0 $aeng 135 $aurcn||||||||| 181 $ctxt 182 $cc 183 $acr 200 00$aCrisis standards of care $esummary of a workshop series /$fClare Stroud ... [et al.], rapporteurs; Forum on Medical and Public Health Preparedness for Catastrophic Events, Board on Health Sciences Policy, Institute of Medicine of the National Academies 205 $a1st ed. 210 $aWashington, D.C. $cNational Academies Press$dc2010 215 $a1 online resource (175 p.) 300 $aDescription based upon print version of record. 311 08$a0-309-12666-5 320 $aIncludes bibliographical references (p. 65-68). 327 $a""Front Matter""; ""Reviewers""; ""Contents""; ""Workshop Summary""; ""Appendix A: References""; ""Appendix B: Summary of *Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report*""; ""Appendix C: Workshop Agendas""; ""Appendix D: Participant Feedback Survey Responses""; ""Appendix E: Biographical Sketches of Workshop Planning Committee Members, Invited Speakers, and Panelists"" 330 $a"During a wide-reaching catastrophic public health emergency or disaster, existing surge capacity plans may not be sufficient to enable healthcare providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Although recent efforts to address these concerns have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. This workshop summary highlights the extensive work that is already occurring across the nation. Specifically, the book draws attention to existing federal, state, and local policies and protocols for crisis standards of care; discusses current barriers to increased provider and community engagement; relays examples of existing interstate collaborations; and presents workshop participants' ideas, comments, concerns, and potential solutions to some of the most difficult challenges."--Publisher's description. 606 $aDisaster medicine$xStandards$zUnited States$vCongresses 606 $aEmergency medical services$xStandards$zUnited States$vCongresses 606 $aIntegrated delivery of health care$xStandards$zUnited States$vCongresses 615 0$aDisaster medicine$xStandards 615 0$aEmergency medical services$xStandards 615 0$aIntegrated delivery of health care$xStandards 676 $a362.18 701 $aStroud$b Clare$01601279 712 02$aInstitute of Medicine (U.S.).$bForum on Medical and Public Health Preparedness for Catastrophic Events. 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910958513803321 996 $aCrisis standards of care$94446894 997 $aUNINA