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Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches - Workshop Summary
by Leighanne Olsen J. Michael Mcginnis Roundtable On Value Science-Driven Health Care Institute of MedicineRecent scientific and technological advances have accelerated our understanding of the causes of disease development and progression,and resulted in innovative treatments and therapies. Ongoing work to elucidate the effects of individual genetic variation on patient outcomes suggests the rapid pace of discovery in the biomedical sciences will only accelerate. However,these advances belie an important and increasing shortfall between the expansion in therapy and treatment options and knowledge about how these interventions might be applied appropriately to individual patients. The impressive gains made in Americans' health over the past decades provide only a preview of what might be possible when data on treatment effects and patient outcomes are systematically captured and used to evaluate their effectiveness. Needed for progress are advances as dramatic as those experienced in biomedicine in our approach to assessing clinical effectiveness. In the emerging era of tailored treatments and rapidly evolving practice,ensuring the translation of scientific discovery into improved health outcomes requires a new approach to clinical evaluation. A paradigm that supports a continual learning process about what works best for individual patients will not only take advantage of the rigor of trials,but also incorporate other methods that might bring insights relevant to clinical care and endeavor to match the right method to the question at hand. The Institute of Medicine Roundtable on Value & Science-Driven Health Care's vision for a learning healthcare system,in which evidence is applied and generated as a natural course of care,is premised on the development of a research capacity that is structured to provide timely and accurate evidence relevant to the clinical decisions faced by patients and providers. As part of the Roundtable's Learning Healthcare System series of workshops,clinical researchers,academics,and policy makers gathered for the workshop Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches. Participants explored cutting-edge research designs and methods and discussed strategies for development of a research paradigm to better accommodate the diverse array of emerging data resources,study designs,tools,and techniques. Presentations and discussions are summarized in this volume.
Redesigning the Nursing and Human Resource Partnership: A Model for the New Normal Era
by Yupin Aungsuroch Joko Gunawan Mary L. FisherThis book focuses on the partnership between nursing and human resource management in hospital administration. In doing so, it addresses the barriers and challenges in the process of competence-based recruitment and selection, training and development, rewards and benefits, performance appraisal, career planning and development, and succession planning of nurses in the hospitals, specifically to face the new normal era. There is no doubt that the demand for nurses has been great during the COVID-19 pandemic. Nurses have become the heroes in the battle of the virus, and their hard work should be appreciated. Yet, burnout, stress, and depression among nurses have become the main issues during the pandemic. Some nurses leave their jobs and profession due to an excessive and stressful workload. This crisis puts a new focus on human resource management in hospital administration to retain their nurses, and also improve the quality of care. In addition to addressing the points above, the book also offers recommendations to resolve the barriers and challenges of competence-based human resource management by emphasizing the partnership between nursing and human recourses to influence nurse practice and human resource policy positively.
REDIRECTING INNOVATION IN U.S. HEALTH CARE: Options to Decrease Spending and Increase Value
by Steven Garber Susan M. Gates Emmett B. Keeler Mary E. Vaiana Andrew W. Mulcahy Christopher Lau Arthur L. KellermannNew 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.
Rediscovering the Other America: The Continuing Crisis of Poverty and Inequality in the United States
by Elizabeth Segal Keith KiltyLearn why it is imperative to bring a progressive focus back to social welfare policy! This vital book explores recent research on poverty and inequality, identifies strategies for ensuring adequate services, and challenges many of the inaccurate beliefs that were used to justify welfare reform legislation in 1996. You'll find up-to-date information on various marginalized groups and their social problems, including lack of health coverage for women with mental health, substance abuse, and domestic violence problems. In addition, you'll find data on the health coverage situation for the poor, for Appalachians, and for women in general. Finally, Rediscovering the Other America: The Continuing Crisis of Poverty and Inequality in the United States suggests strategies for changing public perceptions about the nature of poverty and the poor. From the editors: "In 1962, Michael Harrington published The Other America, which documented how deeply entrenched poverty and inequality were in one of the wealthiest countries in the world. Four decades later, we find it necessary once again to rediscover this profound social condition. The purpose of this book is to awaken policymakers and the public to this situation once again, in order to affect the nature of public policies dealing with these issues." Rediscovering the Other America: The Continuing Crisis of Poverty and Inequality in the United States covers a wide range of issues, some similar to what Harrington described in 1962 and some reflecting recent social, political, and economic developments. Specifically, the book addresses: providing health care coverage for the poor why poverty persisted during the economic boom of the Clinton presidency politicians' views and beliefs regarding poverty, welfare, and welfare recipients the impact of the 1996 welfare reform legislation on the nonprofit sector economic differences between women and men poverty in Appalachia the impact of welfare reform on those who receive public assistance
Redo Cardiac Surgery in Adults
by Lars G. Svensson Hartzell V. Schaff V. R. MachirajuRedo cardiac surgeries are challenging cases with a myriad of influential factors, ranging from the patient's pathology to the whimsy of the previous surgeon. Redo Cardiac Surgery in Adults, 2nd Edition clearly outlines practical approaches, surgical techniques, and management of associated conditions such as perioperative stroke and acute kidney function. It covers the spectrum of redo cardiac operations, including coronary artery bypass, mitral valve repair, reoperation for prosthetic mitral valve endocarditis, aortic arch reoperation, descending and thoracoabdominal aortic reoperation, and reoperations following endovascular aortic repair. All redo cardiac surgeries present a complex array of challenges beyond what the original procedure demands. This book, written by an outstanding group of prominent physicians, will give the reader the knowledge and tools to approach these cases with confidence.
Redox Biology in Plasma Medicine (Oxidative Stress and Disease)
by Thomas Von Woedtke Sander BekeschusPlasma medicine uses non-equilibrium plasmas generated under atmospheric-pressure conditions. Therapeutical plasmas can stimulate tissue regeneration or inactivate cancer cells. This book reviews the interrelation between plasma chemistry and biochemistry complemented by discussion of the ways plasmas inactivate various pathogens. Focus is on the plasma effects on mammalian cells, subsequent consequences for cell-biological processes, and plasma applicability specific medical therapies. Contributions illustrate the ways cold atmospheric-pressure plasma can be used as a controllable source of redox-active species and as a useful tool for research in redox biology.Key Features Summarizes plasma chemistry, biochemistry, and microbiology Documents the ways plasmas interact with lipids, membranes, and cells Reviews therapeutic uses of plasmas in medicine Focuses on uses of plasmas as cancer treatment
Redox-Genome Interactions in Health and Disease (Oxidative Stress and Disease #Vol. 10)
by Jürgen Fuchs Maurizio PoddaAt the nexus of advances in molecular genetics and findings in redox biology, this volume elaborates on the dynamics governing cellular redox states and aggregates the body of evidence linking oxidative stress and redox modulation with a host of monogenetic and polygenetic diseases.
Redox Proteins in Supercomplexes and Signalosomes
by Ricardo O. Louro Irene Díaz-MorenoGet Insight on the Function of Supercomplexes in Biological SystemsRedox Proteins in Supercomplexes and Signalosomes is one of the first books to explore the key role played by redox proteins and their interaction network in a wide range of essential cellular processes in all domains of life. The book explains how the mitochondrial respiratory chai
Redox Regulation and Therapeutic Approaches in Cancer
by Mohinder Pal BansalThis book aims to provide an association of the major redox-sensitive pathways and networks involved in cancer. The initial chapter of the book discusses basic information about oxidative stress, its generation, and regulation (redox regulation or redox homeostasis) via cell signaling in normal and cancer cells. The book also explores antioxidants and metabolic events in cancer cells compared to normal cells. It further covers the application of nanoparticles in redox regulation in cancer cells. The role of redox regulation in cancer therapy, its influence, and its involvement in programmed cell death (PCD), metastasis, immune system, p53, and cell cycle/DNA damage repair pathways have been discussed in separate chapters. It further reviews the importance of dietary phytochemicals in redox regulation in normal and cancer pathophysiology. Towards the end, the book focuses on the role of redox balance, especially in ROS-dependent cellular processes in cancer stem cells.
Redox Regulation of Cell Signaling and Its Clinical Application (Oxidative Stress and Disease)
by Lester Packer Junji YodoiPresents recent developments in the rapidly expanding field of redox regulation research. The book examines insights into intracellular communication and new techniques for diagnosing and treating diseases associated with oxidation and reduction. It focuses on important cellular mechanisms, such as redox reactions related to thioredoxin (TRX)/adult
Redox Regulation of Differentiation and De-differentiation (Oxidative Stress and Disease #48)
by Carsten Berndt Christopher Horst LilligCell differentiation and the development of multicellular organisms are processes of self-assembly, controlled and driven by signaling molecules and cascades including redox regulation. These reactions may have provided the energy for the first metabolic steps in the evolution of life. Today, redox modifications are established as important regulatory events in cellular functions including differentiation and development. Redox modifications of single cysteines regulate differentiation of stem cells, formation of functioning organs, and de-differentiation such as formation of cancer cells. Current cancer therapy is based on redox events as well and regeneration often reactivates developmental pathways. Understanding differentiation and de-differentiation on a molecular level is therefore a prerequisite for the continuing development of new medical therapies. This book summarizes the roles of redox regulation in development by bringing together different concepts and comparing similarities and differences between various cell types and species. An international team of contributors presents several new aspects of redox-regulated differentiation and de-differentiation, including aspects of redox medicine. Key Features Provides the first summary on this important topic Reviews redox-dependent development of model organisms and single organs Highlights the redox-regulated pathways important for differentiation processes Illustrates the potential of redox medicine Combines state-of-the-art knowledge in differentiation/development, aging/longevity, and repair/regeneration Written by leading experts in the field Related Titles Ayyanathan, K., ed. Cancer Cell Signaling: Targeting Signaling Pathways Toward Therapeutic Approaches to Cancer (ISBN 978-1-77188-067-1) Clarke, M. & J. Frampton. Stem Cells: Biology and Application (ISBN 9780-8153-4511-4) Lim, W. & B. Mayer. Cell Signaling: Principles and Mechanisms (ISBN 978-0-8153-4244-1) Wong, E., ed. Autophagy and Signaling (ISBN 978-0-367-65772-7)
Redox Signaling and Biomarkers in Ageing (Healthy Ageing and Longevity #15)
by Ufuk ÇakatayThis book aims to present the age-related alterations in redox signaling networks and their diagnostic biomarkers in aging cells using multidisciplinary approach. Establishing sensitive and specific biomarkers of dynamic redox homeostasis is crucially important in the development of effective antiaging and senolytic interventions. Recent years have seen tremendous advances in the understanding of redox signaling events which highlight the process of aging and age-related pathologies. A major challenge in biological aging research is developing reliable biomarkers to determine the consequences of disrupted redox signaling networks long before the clinical diagnosis of age-related diseases is made. Therefore, we have chosen to concentrate on aging-induced aberrant redox signaling networks, their biomarkers, and pathological consequences in this book. Although oxidation is a natural metabolic process, the imbalance in the level of oxidants and antioxidants causes oxidative stress and eventually leads to inflammatory conditions, diabetes, neurodegenerative diseases, and cancer. Novel redox-sensitive biomarkers for the evaluation of aging-induced proteinopathies such as amyloid ß and tau proteins in Alzheimer's disease, α-synuclein in Parkinson's disease, and islet amyloid polypeptides in type 2 diabetes mellitus recently drew the attention of researchers. Inside this textbook, readers will find comprehensive perspectives on the association between redox homeostasis and the aging process both at the molecular and clinical levels. Due to the inherent relationship between impaired metabolic activities and oxidative stress, the temporal interaction between intermediary metabolism and disturbed redox status can lead to greater susceptibility to aging-induced diseases and disorders, such as cardiovascular diseases, hypertension, and diabetes. This knowledge could be a key to continued research toward improving medication regimens such as in cancer and cardiovascular therapies, and procedural outcomes for patients. This book brings together current research evidence and knowledge on redox signaling and biomarkers in aging in chapters written by leading global experts in this rapidly evolving field. We hope that this textbook is of interest to a wide group of researchers, advanced students, scientifically curious non-specialist readers and clinicians alike.
Reduced Port Laparoscopic Surgery
by Toshiyuki Mori Giovanni DapriReduced port laparoscopic surgery is a fast-developing topic for the laparoscopic surgeon, with the emergence of a number of new techniques as well as new instruments. Edited by surgeons who have pioneered the single-incision approach, this volume provides extensive information for the beginning surgeon, examining different operation techniques and covering the advantages and pitfalls of reduced port laparoscopic surgery. In addition, the text provides the foundation for new ideas to further develop skills for the advanced laparoscopic surgeon.
Reducing Birth Defects: Meeting The Challenge In The Developing World
by Committee on Improving Birth OutcomesEach year more than 4 million children are born with birth defects. This book highlights the unprecedented opportunity to improve the lives of children and families in developing countries by preventing some birth defects and reducing the consequences of others. A number of developing countries with more comprehensive health care systems are making significant progress in the prevention and care of birth defects. In many other developing countries, however, policymakers have limited knowledge of the negative impact of birth defects and are largely unaware of the affordable and effective interventions available to reduce the impact of certain conditions. Reducing Birth Defects: Meeting the Challenge in the Developing World includes descriptions of successful programs and presents a plan of action to address critical gaps in the understanding, prevention, and treatment of birth defects in developing countries. This study also recommends capacity building, priority research, and institutional and global efforts to reduce the incidence and impact of birth defects in developing countries.
Reducing Drug Attrition
by James R. Empfield Michael P ClarkMedicinal chemistry is both science and art. The science of medicinal chemistry offers mankind one of its best hopes for improving the quality of life. The art of medicinal chemistry continues to challenge its practitioners with the need for both intuition and experience to discover new drugs. Hence sharing the experience of drug research is uniquely beneficial to the field of medicinal chemistry. Drug research requires interdisciplinary team-work at the interface between chemistry, biology and medicine. Therefore, the topic-related series Topics in Medicinal Chemistry covers all relevant aspects of drug research, e. g. pathobiochemistry of diseases, identification and validation of (emerging) drug targets, structural biology, drugability of targets, drug design approaches, chemogenomics, synthetic chemistry including combinatorial methods, bioorganic chemistry, natural compounds, high-throughput screening, pharmacological in vitro and in vivo investigations, drug-receptor interactions on the molecular level, structure-activity relationships, drug absorption, distribution, metabolism, elimination, toxicology and pharmacogenomics. In general, special volumes are edited by well known guest editors.
Reducing Environmental Cancer Risk: 2008-2009 Annual Report President's Cancer Panel
by LaSalle D. Leffall Margaret L. KripkeThe statistics are staggering: this year, 1.5 million Americans will be diagnosed with cancer—and more than 550,000 will die from the disease. One underlying cause of these high numbers may be the failure of the US government to regulate toxic substances. The President’s Cancer Panel Report examines the risks posed by the chemicals in our environment, and offers suggestions on what we can do to improve public health and safety. In the strongest words, it urges the President to “use the power of your office to remove the carcinogens and other toxins from our food, water, and air that needlessly increase health care costs, cripple our Nation’s productivity, and devastate American lives.”
Reducing Geographical Imbalances of Health Workers in Sub-Saharan Africa: A Labor Market Perspective on What Works, What Does Not, and Why
by Agnes Soucat Christophe Lemiere Negda Jahanshahi Ellen Smith Christopher HerbstThe human resources crisis in the health sector has been gathering attention on the global stage. To date, however, most of this attention has focused on shortages of health human resources (HRH) at the national level. At least as important are problems at the sub-national level. Massive geographic and skill mix imbalances are reflected in the perilous undersupply of HRH in most rural areas. Virtually all Sub-Saharan African countries suffer from significant geographic imbalances. Very little substantive information or documentation exists on the problem. Even less is known about the lessons from policies aimed at addressing urban-rural human resource imbalances, let alone experiences of Sub-Saharan Africa countries, with such policies. There also appears to be a disconnect between the objectives and efforts of policymakers on the one hand and the functioning of national health labor markets and labor market behavior on the other hand. This disconnect hinders policy effectiveness and the efficient utilization of resources intended to narrow urban-rural inequities. In Sub-Saharan Africa government policies, often limited to the management of public sector vacancies, appear to be elaborated, prescribed, and implemented independently of labor market considerations. Partly as a result, they are unable to effectively address urban-rural imbalances, which are an outcome of labor market dynamics. This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective. It then use insights from this perspective as a basis for elaborating policy options that incorporate the underlying labor market forces. The goal of the study is to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. The book is thus suitable for researchers, policy analysts and policy makers with an interest in understanding and improving the allocation of human resources for health in the developing world.
Reducing Gun Violence in America: Informing Policy with Evidence and Analysis
by Daniel W. Webster and Jon S. VernickOutstanding Academic Title, Choice MagazineThe staggering toll of gun violence—which claims 31,000 U.S. lives each year—is an urgent public health issue that demands an effective evidence-based policy response.The Johns Hopkins University convened more than 20 of the world's leading experts on gun violence and policy to summarize relevant research and recommend policies that are both constitutional and have broad public support. Collected for the first time in one volume, this reliable, empirical research and legal analysis will help lawmakers, opinion leaders, and concerned citizens identify policy changes to address mass shootings, along with the less-publicized gun violence that takes an average of 80 lives every day.Selected recommendations include:• Background checks: Establish a universal background check system for all persons purchasing a firearm from any seller. • High-risk individuals: Expand the set of conditions that disqualify an individual from legally purchasing a firearm. • Mental health: Focus federal restrictions on gun purchases by persons with serious mental illness on the dangerousness of the individual.• Trafficking and dealer licensing: Appoint a permanent director to ATF and provide the agency with the authority to develop a range of sanctions for gun dealers who violate gun sales or other laws. • Personalized guns: Provide financial incentives to states to mandate childproof or personalized guns. • Assault weapons and high-capacity magazines: Ban the future sale of assault weapons and the future sale and possession of large-capacity ammunition magazines.• Research funds: Provide adequate federal funds to the Centers for Disease Control and Prevention, National Institutes of Health, and National Institute of Justice for research into the causes and solutions of gun violence.The book includes an analysis of the constitutionality of many recommended policies and data from a national public opinion poll that reflects support among the majority of Americans—including gun owners—for stronger gun policies.
Reducing Inequalities in Health: A European Perspective
by Johan Mackenbach Martijntje BakkerSocio-economic inequalities in health are present to a greater or lesser extent in all European countries and the available data suggests that the health gap is increasing. Many studies have been conducted to explain inequalities in health and from them much has been learnt about the different contributory factors. However, in practice it seems hard to translate the knowledge of causes into effective interventions and policies. Reducing Inequalities in Health: a European Perspective:* brings together an unrivalled collection of contemporary data on successful policies and interventions* compares differences in approach in several European countries* includes recent evaluation studies* discusses conceptual issues for research* provides examples of good and bad practice in Europe* draws out the policy and research implications for the futureWith contributions from leading researchers in 14 different European countries, this book provides a comprehensive source of reference for the reader interested in what really works in the field of health promotion and what sort of policies reduce the health gap.
Reducing Lightning Injuries Worldwide (Springer Natural Hazards)
by Mary Ann Cooper Ronald L. HolleThis book is a resource for understanding why Lightning continues to be a major health hazard, especially in the developing world, and equips researchers, governments, and public health advocates with the knowledge and techniques needed to reduce lightning casualties worldwide.
Reducing Mortality in Acute Kidney Injury
by Giovanni Landoni Antonio Pisano Alberto Zangrillo Rinaldo BellomoThis book describes the techniques, strategies, and drugs that have been demonstrated by at least one paper published in a peer-reviewed journal to significantly influence survival in patients with or at risk for acute kidney injury. Each chapter focuses on a specific intervention. The scope is accordingly wide, with coverage of topics as diverse as the type, timing, and dose of renal replacement therapy (RRT), anticoagulation and specific indications for RRT, perioperative hemodynamic optimization, fluid balance, diuretics, colloids, fenoldopam, terlipressin, N-acetylcysteine, and vasopressin. A variety of settings are considered, including critically ill patients, cardiac surgery, and hepatic and hematologic disorders. The topic selection was made using a democracy-based approach in which hundreds of specialists from dozens of countries expressed, via the web, whether they agreed with these topics and whether they used the techniques in their daily clinical practice. The clear text is supported by "how to do" sections and "key point" boxes that provide easily accessible practical information. The book will be of interest for a wide variety of specialists, including intensivists, nephrologists, emergency doctors, and anesthesiologists.
Reducing Mortality in Critically Ill Patients
by Giovanni Landoni Martina Baiardo Redaelli Chiara Sartini Alberto Zangrillo Rinaldo BellomoThe 2nd edition of this book describes the recent techniques, strategies, and drugs that have been demonstrated by multicenter randomized trials to influence survival in critically ill, defined as those who have acute failure of at least one organ, due to either a pathological condition or a medical intervention, and require intensive care treatment. Each chapter focuses on a specific procedure, device, or drug. The scope is accordingly wide, with coverage of topics as diverse as noninvasive mechanical ventilation, protective ventilation, prone positioning, intravenous salbutamol in ARDS, high-frequency oscillatory ventilation, mild hypothermia after cardiac arrest, daily interruption of sedatives, tranexamic acid, diaspirin cross-linked hemoglobin, albumin, growth hormone, glutamine supplementation, tight glucose control, supranormal oxygen delivery, and hydroxyethyl starch in sepsis. The topics selection was performed with the help of hundreds of specialists from dozens of countries; they expressed via web if they agreed or not with these topics and if they used them in their daily clinical practice. The clear text is supported by "how to do" sections and "key point" boxes that provide easily accessible practical information. Written by acknowledged international experts, Reducing Mortality in Critically Ill Patients is of interest for a wide variety of specialists, including intensivists, emergency doctors, and anesthesiologists.
Reducing Mortality in the Perioperative Period
by Giovanni Landoni Laura Ruggeri Alberto ZangrilloThis book describes the techniques, strategies, and drugs that have been demonstrated by well-documented randomized trials to influence survival in the perioperative setting. It takes into consideration all types of adult surgery and will be relevant to the evaluation of any patient undergoing an operative procedure. Each chapter focuses on a specific procedure, device, or drug. The scope is accordingly wide, with coverage of topics as diverse as chlorhexidine oral rinse, clonidine therapy, insulin infusion, intra-aortic balloon pump support, leukodepletion, neuraxial anesthesia, and noninvasive respiratory support, to name but a few. In addition, the risks and benefits of using a web-based consensus process (as in this book) to identify effective means of reducing perioperative mortality are discussed. The clear text is supported by "how to do" sections and "key points" boxes that provide easily accessible practical information. Written by acknowledged international experts, Reducing Mortality in the Perioperative Period will be of interest for a wide variety of specialists, including surgeons, cardiologists, anesthesiologists, and intensivists.
Reducing Mortality in the Perioperative Period
by Giovanni Landoni Laura Ruggeri Alberto ZangrilloThis second edition presents the first update on a consensus process during which all evidence from the literature with a survival benefit in the perioperative period was gathered, and in which 500 physicians from 61 countries worked to confirm the findings. Perioperative morbidity and mortality currently represent a public health problem, as mortality alone is 1-4% in Western countries. Surprisingly, randomized evidence of survival benefit in the perioperative period is available for only 12 topics, while two drugs have been demonstrated to increase mortality. This book offers a complete description of each topic with updated evidence from the literature. Each chapter deals with a specific drug or technique and is structured into the following: background knowledge, main evidence from the literature, and a practical how-to section. Lastly, the book describes in detail the consensus process used, which served to reinforce the systematic review and which is currently being used and improved in other settings with growing success. Written by respected international experts, Reducing Mortality in the Perioperative Period, 2nd ed. will be of interest to a wide variety of specialists, including surgeons, anesthesiologists, intensivists and cardiologists.
Reducing Overuse (Elements of Improving Quality and Safety in Healthcare)
by Caroline Cupit Carolyn Tarrant Natalie ArmstrongOveruse has become a major issue of healthcare quality, safety, and sustainability around the world. In this Element, the authors discuss concepts, terminology, and the history of concerns. They show how interventions to address overuse target multiple drivers. They highlight successes and promising approaches, but also challenges in generating and using evidence about overuse. They emphasise that different stakeholder perceptions of value must be recognised. System-level efforts to restrict access to services have created tensions between stakeholder groups and stimulated politicised debates about rationing. They argue for clear articulation of priorities, problem definition, mechanisms for interventions, and areas of uncertainty. Policy-makers should prioritise transparency, be alert to inequalities as they seek to reduce overuse, and consider how to balance controlling use with enabling clinicians to respond to individual circumstances. The complexity of the drivers and possible solutions to overuse require the use of multiple research methods, including social science studies. This title is also available as Open Access on Cambridge Core.