Introduction
Evidence-based medicine is the use of systematically reviewed cases to make the best decisions concerning the health of a patient. It involves integrating personal expertise with available best clinical evidence from systematic research in treatment. This practice aims at improving the quality of healthcare and reducing the gap between research or information known and real-life situations. In addition, it reduces variations in interventions. The best evidence-based practice integrates patients’ values and circumstances, clinical expertise, and research evidence. This paper analyzes evidence-based medicine and the policies governing it.
The Process of Evidence-Based Medicine Analysis
The process of evidence-based analysis involves five major steps. The first step involves formulating of question to be used in finding relevant research. The second step is gathering –new practical knowledge needed is identified in this period. The third phase is appraising articles to ascertain their clinical usefulness and validity. The fourth is summarizing the evidence by tabling the results of evidence applications in a clinic. Lastly, the evidence is graded by evaluating clinical performance, and a conclusion statement is developed in the analysis final part.
The Major Players and their Roles in Evidence-Based Medicine Policy
The major key players in the Evidence-Based Medicine (EBM) policy are the government, hospitals, patients, and researchers. The hospital’s critical role is to guide patients and provide quality health care based on EBM. Researchers play a significant role in generating new ideas that solve medical issues and challenges. They are also required to improve the health of the population as well as the cost of care. The mandate of the government is to aid in strengthening and planning quality care. It also ensures health care facilities conform to the rules and policies guiding them. Patients are major EBM players because they have to cooperate with medics to achieve maximum benefits from evidence concerning their illness.
The Evidence-Based Levels
The levels of evidence are hierarchical, and they are classified according to their methodological designs and credibility in clinical practice. The first level is systemic review; it involves meta-analysis of relevant evidence from randomized controlled trials. Level two evidence is based on a systemic review of homogeneous cohort studies (Shah et al., 2019). Level three evidence is the results obtained from the systemic review of case-control studies. The fourth level of evidence is derived from case series, case-control studies, and low-quality cohort studies. Level five evidence is based on opinions of health experts, which are not based on mechanistic studies or systemic review results.
The hierarchy of evidence levels is also represented by a pyramid. The bottom part denotes findings from animal research and lab testing. The middle segments are evidence from case-control trials that summarize the treatment of patients without correlation. It is followed by randomized controlled trials, which are experiment designs conducted to reduce bias. Thereafter, the systematic review part of the pyramid follows, which connotes the assessment of high-evidence articles in evidence-based medicine. The highest level is meta-analysis where statistical and quantitative analyses of various randomized controlled trials are critically compared.
Review of the Case Constraints on Evidence-Based Medicine
Evidence-based medicine was emphasized and expanded by the Affordable Care Act (ACA) in the 2009 stimulus rule. It was then established by the Patient-Centered Outcomes Research Institute (PCORI) within the Centers for Medicare & Medicaid Services. However, this legislation restricted the use of the institute’s research in the Department of Health and Human Services (Cairney & Oliver, 2017). Federal lawmakers were concerned about controversies that may arise from the research findings in Medicare Advisory Payment Commission. For this reason, they placed constraints on how ACA can utilize evidence-based medicine.
Medicare currently covers the cost of care deemed necessary and reasonable. It does not consider evidence on the charges and effectiveness of treatment relative to others. In addition, Medicare does not compare effectiveness information when determining payment rates for services (Shah et al., 2016). This is because it links the cost of medication to reimbursement. In other countries, comparative effectiveness research is utilized in regulatory stages such as the approval of procedures and new drugs. However, the US restrictions on the use of comparative effectiveness research have been affected. One of the limitations is that secretaries can only use results from research conducted through a transparent and iterative process when approving Medicaid cover (Cairney & Oliver, 2017). In addition, it requires that the evidence gathering procedure should include opinions from the public.
The second restriction is based on the payment for services in Medicaid. Secretaries have been prohibited from approving claims which are solely centered on comparative clinical effectiveness research. The third constraint specifies that evidence from comparative clinical effectiveness research should not be used to determine reimbursement, coverage, or incentive under the title XVIII act (Tolan, 2019). This implies that a life of a terminally ill old person should not be prolonged at the expense of a young person who has no comorbid disorders. Lastly, the law restricts the use of comparative clinical effectiveness research in discouraging patients from choosing a treatment based on their values.
Case Constraint Analysis on Evidenced-Based Medicine
The constraints state that “The Secretary may only use evidence and findings from research conducted under section 1181 to determine coverage” (McLaughlin & McLaughlin, 2014, p. ). This shows that top-level evidence is used to justify the practice. In this case, evidence from the meta-analysis of systematic studies is appropriate. The constraint stating that “The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted” is supported by controlled trials (McLaughlin & McLaughlin, 2014, p. ). Thus, it belongs to the middle level of the evidence pyramid where case-control experiments are utilized.
Summary of the Policy of Evidenced-Based Medicine
The idea of evidence-based medicine is based on reliable and solid gathered evidence that improves health care delivery. Scientific methods are utilized in collecting information to prove facts. Although the outcome of evidence-based medicine is commendable, the government rarely makes decisions based on this. For instance, limitations have been placed on the use of comparative effectiveness research by lawmakers in the United States. It has been observed that the improvement of medical practice is hindered by politicians. This is because they make laws according to their political ideology rather than evidence. Thus, policy decisions concerning health should be made in the presence of some healthcare providers and patients’ advocates.
Evidence-based medicine is a transparent process that informs decision-making procedures in the health care sector. Clinical decisions are no longer founded on lessons from medical schools and the experiences of patients. This is because the results of rigorous clinical studies have been incorporated in determining treatment plans for each patient. Adopting evidence-based medicine lowers the cost of treatment and improves the quality of care accorded to patients, and, therefore, it should be adopted in clinics.
References
Cairney, P., & Oliver, K. (2017). Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?. Health Research Policy and Systems, 15(1), 35.
McLaughlin, C. P., & McLaughlin, C. D. (2014). Health policy analysis (2nd ed.). Jones & Bartlett Publishers.
Shah, S. I., Brumberg, H. L., & Bearer, C. F. (2016). Toward development of evidenced-based quality parameters: What gets counted and who gets paid? Pediatric Research, 80(2), 170.
Shah, S., Brumberg, H. L., Kuo, A., Balasubramaniam, V., Wong, S., & Opipari, V. (2019). Academic advocacy and promotion: How to climb a ladder not yet built. The Journal of Pediatrics, 213, 4-7.
Tolan, P. H. (2019). Scaling up evidence-based interventions within the US public health market. Prevention Science, 20(8), 1169-1172.
The Racist Views On Community Integrity In Bruce Norris’s Clybourne Park
Bruce Norris’s play Clybourne Park touches upon the issues of racial discrimination, political correctness, prejudice, segregation, and gentrification illustrated by a story of two generations living in the same neighborhood. As the characters get into heated arguments to protect the integrity of their communities, Norris explores the development of racist and sexist attitudes throughout the decades. The author demonstrates that the concerns about community integrity are essentially based on racial prejudice, and public attitudes have not changed in decades despite changes in society.
The play is set in a house in the neighborhood of Clybourne Park located in central Chicago across two time periods. The first act is set in 1959, five years before the introduction of the Civil Rights Act of 1964 that prohibited discrimination based on race and color. It centers around an American middle-class family that sells their house at a knock-down price to move to another neighborhood in hopes of escaping the painful memories of their son’s death. The house is bought by a black family, which sparks a conflict between the neighbors on whether actions should be taken to protect their all-white neighborhood. The second act is set in 2009, when a white family moves into the same house, which is now in a poor state, in order to restore and rebuild it. The neighborhood is now populated by African Americans, and the arrival of a white family raises fears about the future of the community. In both acts, the conflicts escalate to a high degree of hostility, with the characters using harsh language to express their concerns.
In both acts, the main conflict centers around the neighbor’s concerns about people of another race moving into their neighborhood. In the first act, set in 1959, these concerns are discussed between neighbors with the deliberations on whether certain actions should be taken to prevent it. In 2009, the matter is addressed by the Neighborhood Association and the family themselves when renovation plans are discussed. Karl and Lena are the main advocates of these concerns in 1959 and 2009 respectively.
In both discussions, the nature of concerns is explained similarly based on financial interests and the integrity of the community. In 1959, Karl is worried that the value of their property will decline as more and more black families move in (Norris 43). In 2009, Lena is worried that the black community that has been living in the neighborhood for years is in danger of becoming priced out now that middle-class white people want to move in. She does not want big houses replacing the ones she grew up in, advocating for the preservation of the architectural heritage of the neighborhood (Norris 79). Both characters seem to be guided by the fear of losing the financial stability that the upcoming changes suggest.
However, financial matters seem to only be the tip of the iceberg, as becomes apparent throughout the discussions. As conversations become more intense, the integrity of the community and racial issues come to the foreground. In 1959, Karl claims that a black family would disturb the status quo in Clybourne Park, emphasizing the differences between black and white customs, traditions, and religion. He even brings in black servant Francine to prove his point of view, demanding her to say that she would feel uncomfortable living in Clybourne Park (Norris 38). In 2009, Lena is revealed to also be worried about the integrity of the community. She says, “Well when I was growing up I really don’t remember seeing a white face in the neighborhood for pretty much my entire…” (Norris 87). The discussion continues with one of the characters quoting an article claiming that the area declined with the arrival of African Americans in the 1970s (Norris 82). It becomes clear that the real reason for the rejection is racial differences, and both black and white characters have prejudices against people of a different race living next door to them.
With the nature of the conflict has remained the same throughout the decades, there are some differences in how it is addressed by the characters. Their language and arguments reflect the changes in society and the level of political correctness characteristic of that decade. Both discussions start with the characters being cautious about the sensitive matters they touch. However, as the conversation becomes more heated, they start to use harsher language, make discriminating comments, and accuse each other of racist views. It becomes apparent that although society has changed, people’s views on race and discrimination have remained practically the same.
In 1959, Karl starts his argument by acknowledging the nature of the matter. He clearly states that the problem is in the black family moving to the house. However, when explaining the nature of his concerns, he softens it by referring to cultural differences, traditions, religion, and even food. When addressing Francine, he says nothing about the race: “So, with your children, might this be the sort of place, bearing in mind that they, too, would stand to be affected? (Norris 38). It can be said that also the core of the problem is the concerns that poor black people will not fit in, the characters are, nevertheless, afraid to express their opinions on race directly.
Bev is trying to resolve the conflict by expressing sympathy towards Francine and her husband. However, she is constantly condescending in her behavior. Although she defends the right of a black family to move into the neighborhood, it is clear that she does not regard them as equals. It becomes obvious in her conversation with Francine’s husband Albert when he once again rejects her gift of a chafing dish, claiming, “Ma’am we don’t want your things. Please. We got our own things” (Norris 52). Beth is offended, seeming not to have considered that her gifts might not have been accepted. For her, poverty and blackness are entwined, and she cannot presume that black people do not need her offerings.
In 2009, as the conflict progresses, the characters use harsher language, making racist jokes about women, homosexuals, and black people. As Bev in 1959, now Lindsey defends black people and says that she has a lot of black friends, also she cannot name a few when asked. The author stresses out that although the notion of politically correct language has changed, people’s attitudes have remained the same.
In Clybourne Park, Norris explores how racial prejudice influences attitudes within communities. In both acts of the play, when faced with an issue of a family of a different race moving into their neighborhood, the characters explain their concerns with financial and cultural matters. However, as the discussion becomes more heated, their real attitudes and racial prejudice come into the foreground. The play illustrates how public attitude on racial problems has not changed with time and still remains a topic of much controversy.
Work Cited
Norris, Bruce. Clybourne Park. Nick Hern Books, 2011.
Accounting Terminology In Modern Media
Accounting is one of the fields that are often discussed in media despite their complexity and abundance of terminology that only the specialist are capable of recognizing and placing in the context of the narration. In a recent article “Survey Finds Audit Flaws by the Big Accounting Firms” published by Reuters in the New York Times, a major accounting fraud is discussed with a mentioning of a range of terms and concepts, which, though used appropriately, still lack certain detailing that would have made the argument more convincing.
Though the author of the article uses the accounting terms properly, it is still obvious that more information could be mentioned in relation to these terms and that most of them are used for creating the impression of a professionally written article. Simple concepts such as “publicly traded banks” (Reuters para. 3) and “audit” (Reuters para. 2) are used correctly; however, as they became household names quite a while ago, it is reasonable to dismiss them as only partially related to specific terminology. More complicated notions, however, add a touch of vagueness to the report.
A further examination of the article shows that the author has a rather good grasp of the concept of an audit, as well as its key principles, purposes and ethics. Defined by Williams, Haka, Bettner and Carcello as the assumption of liability being transferred to the market participant in question, with the performance risks remaining the same before and after the transfer (Williams, Haka, Bettner and Carcello 13), the concept does relate to the topic discussed by the author and creates the premises for tying in the specifics of accounting and the accounting ethics.
When outlining the methods of addressing the threat of a financial and accounting fraud in a company, the author of the article mentions internal control testing as a method for preventing fraud in a company (Reuters para. 9). Indeed, the specified approach is deemed as rather worthwhile in the realm of accounting. In fact, it is traditionally preferred over other types of control, including financial reporting (Williams et al. 22). Therefore, it can be assumed that the author’s position regarding the issue and the prevention measures is quite legitimate.
The significance of a financial statement is also emphasized in the article as the key to successful supervision of the company’s key accounting processes and financial transactions: “procedures used to assess how financial statements are presented” (Reuters para. 9) are supposed to help identify a possible fraud. While even a close consideration of an organization’s financial statement is not enough to prove the fact of a fraud in most cases, one still has to admit that the specified process is a basic step in any audit, which helps spot the existing financial or accounting inconsistencies.
Finally, the necessity for conducting an audit of investment valuation deserves to be listed among the key accounting terms used by Reuters in the article (Reuters para. 10). Another doubtlessly efficient method of fighting financial frauds, the specified approach is a crucial part of a thorough inspection (Williams et al. 43).
Though the accounting terminology included in the article is used correctly and appropriately, it is still desirable that the author could have expanded on the solutions proposed. Without a more detailed explanation of the basic audit processes, the article looks rather empty. Nevertheless, one must give the author credit for addressing the corresponding financial issues in a proper manner.
Works Cited
Reuters. “Survey Finds Audit Flaws by the Big Accounting Firms.” New York Times. 2014. Web.
Williams, Jan, Sue Haka, Mark Bettner and Joseph Carcello. Financial & Managerial Accounting – With Access Code. 17th ed. New York City, NY: McGraw-Hill Irwin, 2014. Print.