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Bass EB. Letter to the Editor re: SGIM Telehealth Position Statement. J Gen Intern Med 2024:10.1007/s11606-024-08772-0. [PMID: 38689121 DOI: 10.1007/s11606-024-08772-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Eric B Bass
- Society of General Internal Medicine, Alexandria, VA, USA.
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Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Healthcare organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024:djae048. [PMID: 38419574 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, healthcare organization characteristics including ownership, leadership, and culture can impact care access, communication, and patient outcomes. Healthcare organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming healthcare organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-, organization-, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in healthcare delivery-and their dynamics-is an important, yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. However, the field lacks conceptual grounding to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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Stephenson A, Bass EB, Bixler BR, Daneshmand S, Kirkby E, Marianes A, Pierorazio PM, Sharma R, Spiess PE. Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023. J Urol 2024; 211:20-25. [PMID: 37707243 DOI: 10.1097/ju.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE The purpose of this American Urological Association (AUA) guideline amendment is to provide a useful reference on the effective evidence-based treatment strategies for early-stage testicular cancer. METHODOLOGY/METHODS The original methodology protocol included searches of PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1980 through August 2018. The search strategy used medical subject heading (MeSH) terms and key words relevant to the diagnosis and treatment of early-stage testicular cancer. The searches conducted for the update presented herein utilized the same methodological protocol to capture literature published through March 2023. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS Updates were made to statements on imaging, seminoma management, non-seminoma management, surveillance for stage I testicular cancer, and additional survivorship. Further revisions were made to the methodology and reference sections as appropriate. CONCLUSIONS This guideline seeks to improve clinicians' ability to evaluate and treat patients with early-stage testicular cancer based on currently available evidence. Future studies will be essential to further support or refine these statements to improve patient care.
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Affiliation(s)
| | - Eric B Bass
- Johns Hopkins Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | | | - Ritu Sharma
- Johns Hopkins Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland
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Alkhatib HH, Beach MC, Gebo KA, Bass EB, Park JR, Atkinson MA, Kudchadkar SR, Sozio SM. The association of a scholarly concentrations program with medical students' matched residencies. Med Educ Online 2023; 28:2234651. [PMID: 37434383 DOI: 10.1080/10872981.2023.2234651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
PURPOSE Many medical school curricula include Scholarly Concentrations (SC) programs. While studies have examined how these programs affect students' future research involvement, the association of SC programs with students' specialty choices is uncertain. This study examines the SC program factors associated with congruence between the specialty focus of students' SC projects and the clinical specialty they matched into for residency. METHODS The authors conducted a retrospective cohort study of all students participating in the SC program at Johns Hopkins University School of Medicine for graduating classes 2013-2020. They used data from program questionnaires to categorize students' specialty interests (baseline) and SC program experiences (post-program). The authors categorized each student's project into specialties according to their faculty mentors' primary appointments, abstracted student publications from SCOPUS, and abstracted residency program rankings from Doximity Residency Navigator. The authors used multivariable logistic regression to calculate adjusted odds ratios (aOR) for specialty-congruent matching (same specialty as SC project) and for matching into a Doximity-ranked top 20 or top 10 program. RESULTS Overall, 35.3% of the 771 students matched into the same specialty as their SC projects. Increased odds of specialty-congruent matching occurred with 'definite' interest in the specialty at baseline [aOR (95% CI): 1.76 (0.98-3.15)] (P = 0.06) and with increasing publications with SC mentors [aOR (95% CI): 1.16 (1.03-1.30)] (P = 0.01). Congruence between SC specialty focus and matched specialty conferred no significant difference in odds of matching to a Doximity-ranked top 20 or top 10 program. CONCLUSIONS Baseline certainty of specialty interest and research productivity were associated with specialty congruence. However, as completing an SC project in a given specialty was not associated with increased odds of matching into that specialty nor into a higher Doximity-ranked program, SC program directors should advise students to pursue SC projects in any topic of personal interest.
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Affiliation(s)
- Hosam H Alkhatib
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy, Management, and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jenny R Park
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Meredith A Atkinson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Pediatrics, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen M Sozio
- Department of Medicine and Epidemiology, Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hsiao YL, Bass EB, Wu AW, Kelly D, Sylvester C, Berkowitz SA, Bellantoni M. Preventing Avoidable Rehospitalizations through Standardizing Management of Chronic Conditions in Skilled Nursing Facilities. J Am Med Dir Assoc 2023; 24:1910-1917.e3. [PMID: 37690461 DOI: 10.1016/j.jamda.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES This study evaluated the impact of standardized care protocols, as a part of a quality improvement initiative (J10ohns Hopkins Community Health Partnership, J-CHiP), on hospital readmission rates for patients with a diagnosis of congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD) after being discharged to skilled nursing facilities (SNFs). DESIGN A retrospective study comparing 30-day hospital readmission rates the year before and 2 years following the implementation of the care protocol interventions. SETTINGS AND PARTICIPANTS Patients discharged from Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center to the participating SNFs diagnosed with CHF and/or COPD. METHODS The standardized protocols included medical provider or nurse assessments on SNF admission, multidisciplinary care planning, and medication management to avoid unplanned readmissions to the hospital. Descriptive analyses were conducted to illustrate the 30-day readmission rates before and after protocol implementation. RESULTS There were 1128 patients in the pre-J-CHiP cohort and 2297 patients in the J-CHiP cohort. About half of the patients with a recorded diagnosis of CHF without COPD had the standardized protocol initiated, whereas 47% of the patients with a recorded diagnosis of COPD without CHF had the standardized protocol initiated. Of patients with recorded diagnoses of COPD and CHF, 49% had both protocols initiated. A reduction in the readmission rate was observed for patients with COPD protocols, from 23.5% in 2011 to 12.1% in 2015. However, fluctuations in the readmission rates were observed for patients who initiated the CHF protocols. CONCLUSIONS AND IMPLICATIONS There were improvements in the readmission rates in this study, especially for patients who had initiated standardized care protocols in the SNFs. Our findings demonstrate great value in standardizing care management and strengthening collaboration with chronic care settings to facilitate a smooth transition of medically complex patients discharged from large health care systems. Future interventions could consider assessing nonclinical factors that may impact preventable hospital readmissions.
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Affiliation(s)
- Ya Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Denise Kelly
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Carol Sylvester
- Office of Population Health, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Scott A Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michele Bellantoni
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
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6
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Jenkins JL, Hsu EB, Zhang A, Wilson LM, Russell A, Bass EB. Current Evidence for Infection Prevention and Control Interventions in Emergency Medical Services: A Scoping Review. Prehosp Disaster Med 2023:1-7. [PMID: 36987848 DOI: 10.1017/s1049023x23000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES The aim of this review was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. REPORT AND METHODS PubMed, Embase, CINAHL, and SCOPUS were searched from January 1, 2006 through March 15, 2022 for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven (11) observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing (survey-weight adjusted odds ratio [OR] 4.20; 95% confidence interval [CI], 1.02 to 17.27) and less frequent hand hygiene after glove use (survey-weight adjusted OR 10.51; 95% CI, 2.54 to 43.45) were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity (unadjusted risk ratio [RR] 4.2; 95% CI, 1.03 to 17.22). Workers were more likely to be vaccinated against influenza if their employer offered the vaccine (unadjusted OR 3.3; 95% CI, 1.3 to 8.3). Active, targeted education modules for H1N1 influenza were effective at increasing vaccination rates and the success of on-site vaccine clinics. CONCLUSIONS Evidence from the United States exists on the effectiveness of IPC practices in EMS clinicians, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. More research is needed on the effectiveness of PPE and vaccine acceptance.
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Affiliation(s)
- J Lee Jenkins
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edbert B Hsu
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allen Zhang
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa M Wilson
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Russell
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric B Bass
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Gross SM, Lerman JL, Hurley KM, Venkataramani M, Sharma R, Ogunwole SM, Zhang A, Bennett WL, Bass EB, Caulfield LE. Breastfeeding Outcomes Associated With the Special Supplemental Nutrition Program for Women, Infants, and Children: A Systematic Review. Acad Pediatr 2023; 23:244-260. [PMID: 36272723 DOI: 10.1016/j.acap.2022.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/06/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) promotes and supports breastfeeding for low-income women and children. A prior review reported negative associations of WIC with breastfeeding outcomes. WIC food package changes in 2009 increased breastfeeding support. OBJECTIVE The objectives of this systematic review were to 1) evaluate evidence on WIC participation and breastfeeding outcomes and 2) evaluate breastfeeding outcomes of WIC participants before versus after the 2009 food package. DATA SOURCES PubMed, Embase®, CINAHL, ERIC, SCOPUS, PsycINFO, and the Cochrane Central Register of Controlled Trials for papers published January 2009 to April 2022. ELIGIBILITY CRITERIA Included studies compared breastfeeding outcomes (initiation, duration, exclusivity, early introduction of solid foods) of WIC participants with WIC-eligible nonparticipants, or among WIC participants before versus after the 2009 package change. STUDY APPRAISAL METHODS Two independent reviewers evaluated each study and assessed risk of bias using EHPHP assessment. RESULTS From 13 observational studies we found: 1) moderate strength of evidence (SOE) of no difference in initiation associated with WIC participation; 2) insufficient evidence regarding WIC participation and breastfeeding duration or exclusivity; 3) low SOE that the 2009 food package change is associated with greater breastfeeding exclusivity; 4) low SOE that WIC breastfeeding support services are positively associated with initiation and duration. LIMITATIONS Only observational studies, with substantial risk of bias and heterogeneity in outcomes and exposures. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS WIC participation is not associated with a difference in breastfeeding initiation compared to WIC-eligible nonparticipants, but the 2009 food package change may have improved breastfeeding exclusivity among WIC participants and receipt of breastfeeding support services may have improved breastfeeding initiation and duration.
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Affiliation(s)
- Susan M Gross
- Department of Population, Family and Reproductive Health (SM Gross), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jennifer L Lerman
- Center for Human Nutrition (JL Lerman, KM Hurley, and LE Caulfield), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Kristen M Hurley
- Center for Human Nutrition (JL Lerman, KM Hurley, and LE Caulfield), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Maya Venkataramani
- Division of General Internal Medicine (M Venkataramani, SM Ogunwole, WL Bennett, and EB Bass), The Johns Hopkins University, Baltimore, Md
| | - Ritu Sharma
- The Johns Hopkins University Evidence-based Practice Center (R Sharma, A Zhang, and EB Bass), Baltimore, Md
| | - S Michelle Ogunwole
- Division of General Internal Medicine (M Venkataramani, SM Ogunwole, WL Bennett, and EB Bass), The Johns Hopkins University, Baltimore, Md
| | - Allen Zhang
- The Johns Hopkins University Evidence-based Practice Center (R Sharma, A Zhang, and EB Bass), Baltimore, Md
| | - Wendy L Bennett
- Division of General Internal Medicine (M Venkataramani, SM Ogunwole, WL Bennett, and EB Bass), The Johns Hopkins University, Baltimore, Md
| | - Eric B Bass
- Division of General Internal Medicine (M Venkataramani, SM Ogunwole, WL Bennett, and EB Bass), The Johns Hopkins University, Baltimore, Md; The Johns Hopkins University Evidence-based Practice Center (R Sharma, A Zhang, and EB Bass), Baltimore, Md
| | - Laura E Caulfield
- Center for Human Nutrition (JL Lerman, KM Hurley, and LE Caulfield), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
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Russell A, Jenkins JL, Zhang A, Wilson LM, Bass EB, Hsu EB. A review of infectious disease epidemiology in emergency medical service clinicians. Am J Infect Control 2022:S0196-6553(22)00846-X. [PMID: 36509183 DOI: 10.1016/j.ajic.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The emergency medical service (EMS) workforce is at high risk of occupationally-acquired infections. This review synthesized existing literature on the prevalence, incidence, and severity of infections in the EMS workforce. METHODS We searched PubMed, Embase, CINAHL, and SCOPUS from January 1, 2006 to March 15, 2022 for studies in the US that involved EMS clinician or firefighter populations and reported 1 or more health outcomes related to occupationally-acquired infections. RESULTS Of the 25 studies that met the inclusion criteria, most focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with prevalence rates ranging from 1.1% to 36.2% (median 6.7%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in 4 studies ranged from 1.9% to 6.4%, and the prevalence of Hepatitis C in 1 study was 1.3%. Few studies reported incidence rates. The prevalence or incidence of these infections generally did not differ by age or gender, but 4 studies reported differences by race or ethnicity. In the 4 studies that compared infection rates between EMS clinicians and firefighters, EMS clinicians had a higher chance of hospitalization or death from SAR-CoV-2 (odds ratio 4.23), a higher prevalence of Hepatitis C in another study (odds ratio 1.74), and no significant difference in MRSA colonization in a separate study. CONCLUSIONS More research is needed to better characterize the incidence and severity of occupationally-acquired infections in the EMS workforce.
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Affiliation(s)
- Anna Russell
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - J Lee Jenkins
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allen Zhang
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Lisa M Wilson
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
| | - Eric B Bass
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edbert B Hsu
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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Saldanha IJ, Adam GP, Bañez LL, Bass EB, Berliner E, Devine B, Hammarlund N, Jain A, Norris SL, Skelly AC, Vander Ley K, Wang Z, Wilt TJ, Viswanathan M. Inclusion of nonrandomized studies of interventions in systematic reviews of interventions: updated guidance from the Agency for Health Care Research and Quality Effective Health Care program. J Clin Epidemiol 2022; 152:300-306. [PMID: 36245131 PMCID: PMC10777810 DOI: 10.1016/j.jclinepi.2022.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES We developed guidance to inform decisions regarding the inclusion of nonrandomized studies of interventions (NRSIs) in systematic reviews (SRs) of the effects of interventions. STUDY DESIGN AND SETTING The guidance workgroup comprised SR experts and used an informal consensus generation method. RESULTS Instead of recommending NRSI inclusion only if randomized controlled trials (RCTs) are insufficient to address the SR key question, different topics may require different decisions regarding NRSI inclusion. We identified important considerations to inform such decisions from topic refinement through protocol development. During topic scoping and refinement, considerations were related to the clinical decisional dilemma, adequacy of RCTs to address the key questions, risk of bias in NRSIs, and the extent to which NRSIs are likely to complement RCTs. When NRSIs are included, during SR team formation, familiarity with topic-specific data sources and advanced analytic methods for NRSIs should be considered. During protocol development, the decision regarding NRSI inclusion or exclusion should be justified, and potential implications explained. When NRSIs are included, the protocol should describe the processes for synthesizing evidence from RCTs and NRSIs and determining the overall strength of evidence. CONCLUSION We identified specific considerations for decisions regarding NRSI inclusion in SRs and highlight the importance of flexibility and transparency.
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Affiliation(s)
- Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Gaelen P Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Lionel L Bañez
- Evidence-Based Practice Center Program, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Eric B Bass
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Beth Devine
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Noah Hammarlund
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL, USA
| | - Anjali Jain
- Evidence-Based Practice Center Program, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Andrea C Skelly
- Pacific Northwest Evidence-Based Practice Center, Portland, OR, USA; Aggregate Analytics, Inc., Fircrest, WA, USA
| | - Kelly Vander Ley
- Department of Medical and Clinical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Timothy J Wilt
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota Schools of Medicine and Public Health, Minneapolis, MN, USA
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10
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Venkataramani M, Ogunwole SM, Caulfield LE, Sharma R, Zhang A, Gross SM, Hurley KM, Lerman JL, Bass EB, Bennett WL. Maternal, Infant, and Child Health Outcomes Associated With the Special Supplemental Nutrition Program for Women, Infants, and Children : A Systematic Review. Ann Intern Med 2022; 175:1411-1422. [PMID: 36063550 DOI: 10.7326/m22-0604] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve maternal and child health outcomes. In 2009, the WIC food package changed to better align with national nutrition recommendations. PURPOSE To determine whether WIC participation was associated with improved maternal, neonatal-birth, and infant-child health outcomes or differences in outcomes by subgroups and WIC enrollment duration. DATA SOURCES Search (January 2009 to April 2022) included PubMed, Embase, CINAHL, ERIC, Scopus, PsycInfo, and the Cochrane Central Register of Controlled Trials. STUDY SELECTION Included studies had a comparator of WIC-eligible nonparticipants or comparison before and after the 2009 food package change. DATA EXTRACTION Paired team members independently screened articles for inclusion and evaluated risk of bias. DATA SYNTHESIS We identified 20 observational studies. We found: moderate strength of evidence (SOE) that maternal WIC participation during pregnancy is likely associated with lower risk for preterm birth, low birthweight infants, and infant mortality; low SOE that maternal WIC participation may be associated with a lower likelihood of inadequate gestational weight gain, as well as increased well-child visits and childhood immunizations; and low SOE that child WIC participation may be associated with increased childhood immunizations. We found low SOE for differences in some outcomes by race and ethnicity but insufficient evidence for differences by WIC enrollment duration. We found insufficient evidence related to maternal morbidity and mortality outcomes. LIMITATION Data are from observational studies with high potential for selection bias related to the choice to participate in WIC, and participation status was self-reported in most studies. CONCLUSION Participation in WIC was likely associated with improved birth outcomes and lower infant mortality, and also may be associated with increased child preventive service receipt. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERO: CRD42020222452).
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Affiliation(s)
- Maya Venkataramani
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (M.V., S.M.O.)
| | - S Michelle Ogunwole
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (M.V., S.M.O.)
| | - Laura E Caulfield
- Center for Human Nutrition, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (L.E.C., K.M.H., J.L.L.)
| | - Ritu Sharma
- Center for Evidence-Based Practice, Johns Hopkins University School of Medicine, Baltimore, Maryland (R.S., A.Z.)
| | - Allen Zhang
- Center for Evidence-Based Practice, Johns Hopkins University School of Medicine, Baltimore, Maryland (R.S., A.Z.)
| | - Susan M Gross
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (S.M.G.)
| | - Kristen M Hurley
- Center for Human Nutrition, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (L.E.C., K.M.H., J.L.L.)
| | - Jennifer L Lerman
- Center for Human Nutrition, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (L.E.C., K.M.H., J.L.L.)
| | - Eric B Bass
- Division of General Internal Medicine and Center for Evidence-Based Practice, Johns Hopkins University School of Medicine, Baltimore, Maryland (E.B.B.)
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, and Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (W.L.B.)
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11
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Aboumatar H, Pitts S, Sharma R, Das A, Smith BM, Day J, Holzhauer K, Yang S, Bass EB, Bennett WL. Patient engagement strategies for adults with chronic conditions: an evidence map. Syst Rev 2022; 11:39. [PMID: 35248149 PMCID: PMC8898416 DOI: 10.1186/s13643-021-01873-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient and family engagement (PFE) has been defined as a partnership between patients, families, and health care providers to achieve positive health care outcomes. There is evidence that PFE is critical to improving outcomes. We sought to systematically identify and map the evidence on PFE strategies for adults with chronic conditions and identify areas needing more research. METHODS We searched PubMed, CINAHL, EMBASE, and Cochrane, January 2015 to September 2021 for systematic reviews on strategies for engaging patients with chronic conditions and their caregivers. From each review, we abstracted search dates, number and type of studies, populations, interventions, and outcomes. PFE strategies were categorized into direct patient care, health system, and community-policy level strategies. We found few systematic reviews on strategies at the health system, and none at the community-policy level. In view of this, we also searched for original studies that focused on PFE strategies at those two levels and reviewed the PFE strategies used and study findings. RESULTS We found 131 reviews of direct patient care strategies, 5 reviews of health system strategies, and no reviews of community-policy strategies. Four original studies addressed PFE at the health system or community-policy levels. Most direct patient care reviews focused on self-management support (SMS) (n = 85) and shared decision-making (SDM) (n = 43). Forty-nine reviews reported positive effects, 35 reported potential benefits, 37 reported unclear benefits, and 4 reported no benefits. Health system level strategies mainly involved patients and caregivers serving on advisory councils. PFE strategies with the strongest evidence focused on SMS particularly for patients with diabetes. Many SDM reviews reported potential benefits especially for patients with cancer. DISCUSSION Much more evidence exists on the effects of direct patient care strategies on PFE than on the effects of health system or community-policy strategies. Most reviews indicated that direct patient care strategies had positive effects or potential benefits. A limitation of this evidence map is that due to its focus on reviews, which were plentiful, it did not capture details of individual interventions. Nevertheless, this evidence map should help to focus attention on gaps that require more research in efforts to improve PFE.
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Affiliation(s)
- Hanan Aboumatar
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA.
| | - Samantha Pitts
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA
| | - Ritu Sharma
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Asar Das
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine Holzhauer
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA
| | - Sejean Yang
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA
| | - Eric B Bass
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA
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12
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Huang MM, Cheaib JG, Su ZT, Biles MJ, Sharma R, Zhang A, Singla N, Bass EB, Pierorazio PM. Assessing quality of care in the diagnosis and treatment of early-stage testicular cancer: A critical review and summary. Urol Oncol 2021; 39:400-408. [PMID: 33642227 DOI: 10.1016/j.urolonc.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the current literature on quality of care in the diagnosis and management of early-stage testicular cancer. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies on quality of care in testicular cancer diagnosis and management from January 1980 to August 2018. Major overlapping themes related to quality of care in the diagnosis and management of TGCT were identified and evidence related to these themes were abstracted. EVIDENCE 62 studies were included in the review. A number of themes were identified including (1) trends in survival and outcomes, (2) management patterns, (3) adherence to evidence-based clinical guidelines, (4) delays in care, (5) treatment complications and toxicities, (6) sociodemographic factors, (7) volume of patients treated, (8) gaps in provider knowledge and medical errors, and (9) multidisciplinary approaches to care. EVIDENCE SUMMARY As survival for patients with testicular cancer improves, there has been a greater emphasis on other components of quality of care, such as reducing treatment toxicity and minimizing delays in diagnosis. Efforts to meet these goals include encouragement of adherence to evidence-based guidelines, greater utilization of surveillance, and promotion of multidisciplinary team-based care. Although outcomes have improved, social determinants of health, such as insurance status, race, and geographical residence all may influence survival and cancer-related outcomes. Additionally, qualitative review indicates patients who receive care at high-volume institutions appear to experience better outcomes than those treated at smaller centers. CONCLUSIONS As outcomes and survival improve for patients with testicular cancer, quality of care has become an important consideration. Future avenues of research on this topic include identifying an appropriate balance between centralization of care and expanding access to underserved areas, minimizing delays in care, ensuring greater adherence to clinical guidelines, and addressing sociodemographic and racial disparities in outcomes.
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Affiliation(s)
- Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritu Sharma
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allen Zhang
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric B Bass
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
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13
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Feliciano JL, Waldfogel JM, Sharma R, Zhang A, Gupta A, Sedhom R, Day J, Bass EB, Dy SM. Pharmacologic Interventions for Breathlessness in Patients With Advanced Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2037632. [PMID: 33630086 PMCID: PMC7907959 DOI: 10.1001/jamanetworkopen.2020.37632] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE Improved survival in patients with advanced cancer has increased the need for better understanding of how to manage common symptoms that they may experience, such as breathlessness. OBJECTIVE To assess the benefits and harms associated with pharmacologic interventions for breathlessness in adults with advanced cancer. DATA SOURCES PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published from database inception through May 31, 2020, using predefined eligibility criteria within a PICOTS (population, intervention, comparator, outcome, timing, setting) format. STUDY SELECTION Randomized clinical trials (RCTs), non-RCTs, and observational studies with a comparison group that evaluated benefits and/or harms and cohort studies that reported harms were selected. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened studies for eligibility, serially abstracted data, independently assessed risk of bias, and graded strength of evidence (SOE). MAIN OUTCOMES AND MEASURES Benefits and harms of pharmacologic interventions were compared, focusing on breathlessness, anxiety, exercise capacity, and health-related quality of life. When possible, meta-analyses were conducted and standardized mean differences (SMDs) calculated. RESULTS In this systematic review and meta-analysis, a total of 7729 unique citations were identified, of which 19 studies (17 RCTs and 2 retrospective studies) that included a total of 1424 patients assessed the benefits of medications for management of breathlessness in advanced cancer or reported harms. The most commonly reported type of cancer was lung cancer. Opioids were not associated with more effectiveness than placebo for improving breathlessness (SMD, -0.14; 95% CI, -0.47 to 0.18) or exercise capacity ( SMD, 0.06; 95% CI, -0.43 to 0.55) (SOE, moderate); most studies examined exertional breathlessness. Specific dose and/or route of administration of opioids did not differ in effectiveness for breathlessness (SMD, 0.15; 95% CI, -0.22 to 0.52) (SOE, low). Anxiolytics were not associated with more effectiveness than placebo for breathlessness or anxiety (reported mean between-group difference, -0.52; 95% CI, -1.045 to 0.005) (SOE, low). Evidence for other pharmacologic interventions was limited. Pharmacologic interventions demonstrated some harms compared with usual care, but dropout attributable to adverse events was minimal in these short-term studies (range 3.2%-16%). CONCLUSIONS AND RELEVANCE Evidence did not support the association of opioids or other pharmacologic interventions with improved breathlessness. Given that studies had many limitations, pharmacologic interventions should be considered in selected patients but need to be considered in the context of potential harms and evidence of an association of nonpharmacologic interventions with improved breathlessness.
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Affiliation(s)
- Josephine L. Feliciano
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | | | - Ritu Sharma
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ramy Sedhom
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B. Bass
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sydney M. Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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14
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Gupta A, Sedhom R, Sharma R, Zhang A, Waldfogel JM, Feliciano JL, Day J, Gersten RA, Davidson PM, Bass EB, Dy SM. Nonpharmacological Interventions for Managing Breathlessness in Patients With Advanced Cancer: A Systematic Review. JAMA Oncol 2021; 7:290-298. [PMID: 33211072 DOI: 10.1001/jamaoncol.2020.5184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Breathlessness is a frequent and debilitating symptom in patients with advanced cancer. Often, in the context of breathlessness, aggressive cancer treatment is not beneficial, feasible, or aligned with goals of care. Targeted symptom-focused interventions may be helpful in this scenario. Objective To evaluate the advantages and harms of nonpharmacological interventions for managing breathlessness in adults with advanced cancer. Evidence Review PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception through May 2020 for published randomized clinical trials (RCTs), nonrandomized controlled trials, and observational studies of the advantages and/or harms of nonpharmacological interventions on alleviating breathlessness in adults with advanced cancer. Only English-language studies were screened for eligibility, titles, abstracts, and full text. Risk of bias and strength of evidence (SOE) were independently assessed. The key outcomes reported in studies were breathlessness, anxiety, exercise capacity, health-related quality of life, and harms. Data were analyzed from October 1, 2019, to June 30, 2020. Findings A total of 29 RCTs (2423 participants) were included. These RCTs evaluated various types of interventions, such as respiratory (9 RCTs), activity and rehabilitation (7 RCTs), behavioral and psychoeducational (3 RCTs), integrative medicine (4 RCTs), and multicomponent (6 RCTs). Several nonpharmacological interventions were associated with improved breathlessness, including fan therapy (standardized mean difference [SMD], -2.09; 95% CI, -3.81 to -0.37; I2 = 94.3%; P for heterogeneity = .02; moderate SOE) and bilevel ventilation (estimated slope difference, -0.58; 95% CI, -0.92 to -0.23; low SOE), lasting for a few minutes to hours, in the inpatient setting. In the outpatient setting, nonpharmacological interventions associated with improved breathlessness were acupressure and reflexology (integrative medicine) (low SOE) and multicomponent interventions (combined activity and rehabilitation, behavioral and psychoeducational, and integrative medicine) (low SOE) lasting for a few weeks to months. Five of the 29 RCTs (17%) reported adverse events, although adverse events and study dropouts were uncommon. Conclusions and Relevance Findings of this review include the safety and association with improved breathlessness of several nonpharmacological interventions for adults with advanced cancer. Guidelines and clinical practice should evolve to incorporate nonpharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness.
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Affiliation(s)
- Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ramy Sedhom
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ritu Sharma
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Allen Zhang
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Julie M Waldfogel
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Josephine L Feliciano
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca A Gersten
- Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Eric B Bass
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sydney M Dy
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Patel HD, Gupta M, Cheaib JG, Sharma R, Zhang A, Bass EB, Pierorazio PM. Testis-sparing surgery and scrotal violation for testicular masses suspicious for malignancy: A systematic review and meta-analysis. Urol Oncol 2020; 38:344-353. [PMID: 32192891 DOI: 10.1016/j.urolonc.2020.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 12/17/2022]
Abstract
Radical inguinal orchiectomy is the standard of care for men diagnosed with a testicular mass suspicious for germ cell tumor (TGCT). Nontraditional approaches to management, including testis-sparing surgery (TSS) and scrotal orchiectomy, occur in clinical practice. We systematically reviewed studies evaluating outcomes after TSS and scrotal violation for the management of a suspected TGCT. We used PubMed, Embase, and the Cochrane Central Register of Controlled Trials (January 1980-December 2018) to search for studies addressing morbidity and oncologic outcomes after TSS or scrotal violation for testicular masses concerning for TGCT. Paired reviewers independently screened abstracts for inclusion, sequentially extracted data, and assessed study quality. Twenty-one studies were included (10 TSS, 11 scrotal violation). Risk of local recurrence after TSS on meta-analysis was 7.5% after 3 to 5 years (absolute proportion reported in studies: 10.9%). Aggregated rates of positive margins (1.4%) and testicular atrophy (2.8%) across studies were low with 7.1% of patients requiring subsequent androgen therapy. Scrotal violation led to a higher aggregate risk of local recurrence compared to no scrotal violation (2.5% vs. 0.0%, P < 0.001) but did not appear to impact subsequent metastasis and survival in the short term (3-5 years). Most patients received adjuvant therapy after scrotal violation with 9.3% found to harbor residual primary tumor after scrotal scar excision. TSS carries a quantifiable risk of local recurrence after 3 to 5 years despite the majority receiving adjuvant radiation or chemotherapy. Scrotal violation carries a risk of local recurrence but does not appear to impact subsequent metastasis and survival in the short term.
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Affiliation(s)
- Hiten D Patel
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Mohit Gupta
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph G Cheaib
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritu Sharma
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, MD
| | - Allen Zhang
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, MD
| | - Eric B Bass
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, MD; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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16
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Knapp EA, Bennett WL, Wilson RF, Zhang A, Tseng E, Cheskin LJ, Bass EB, Kharrazi H, Stuart EA. Methods and Risks of Bias in Natural Experiments in Obesity: Opportunities for the Future Informed by a Systematic Review. Obesity (Silver Spring) 2019; 27:1950-1957. [PMID: 31693802 DOI: 10.1002/oby.22645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/19/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This paper promotes rigorous methods and designs currently underutilized in obesity research, informed by a recent systematic review of the methods and risks of bias in studies of policies, programs, and built environment changes for obesity prevention and control. METHODS To determine the current state of the field, relevant databases from 2000 to 2017 were searched to identify studies that fit the inclusion criteria. Study design, analytic approach, and other details of study methods were abstracted. These findings inform recommendations for obesity researchers and the field as a whole. RESULTS Previously identified were 156 natural experiment studies. Most were cross-sectional (35%), pre-post single group comparison (31%), or difference-in-differences designs (29%). Few used rigorous causal designs such as interrupted time series with more than two time points, propensity score methods, or instrumental variables. The potential relevance for obesity research is discussed, and recommendations for obesity researchers are provided. CONCLUSIONS To strengthen natural experiment study designs and enhance the validity of results, researchers should carefully consider and control for confounding and selection of comparison groups and consider study designs that address these biases.
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Affiliation(s)
- Emily A Knapp
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Renee F Wilson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allen Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eva Tseng
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lawrence J Cheskin
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Eric B Bass
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hadi Kharrazi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth A Stuart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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17
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Bramante CT, Thornton RLJ, Bennett WL, Zhang A, Wilson RF, Bass EB, Tseng E. Systematic Review of Natural Experiments for Childhood Obesity Prevention and Control. Am J Prev Med 2019; 56:147-158. [PMID: 30573143 PMCID: PMC7397557 DOI: 10.1016/j.amepre.2018.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
Abstract
CONTEXT The National Academy of Medicine recommends childhood obesity prevention efforts making healthier options the passive choice. This review evaluated the effectiveness of population-level policies and programs from natural experiments for childhood obesity prevention. EVIDENCE ACQUISTION The search included PubMed, CINAHL, PsycINFO, and EconLit from 2000 to 2017 for policies evaluated by natural experiments reporting childhood BMI outcomes. The studies were analyzed in 2017-2018. Interventions were classified by environmental focus (food/beverage, physical activity, or both) and stratified by setting (school, community, both). Risk of bias was evaluated for each study. EVIDENCE SYNTHESIS Of 33 natural experiments, most (73%) took place in the school setting only. The most common environmental focus in any setting was food/beverage (48%). All four studies that focused on both food/beverage and physical activity in schools demonstrated decreased prevalence of overweight/obesity or BMI z-score by 0.04-0.17. BMI decreased in all four studies in both school and community settings. The largest effect size was a decrease in BMI z-score of 0.5, but most were <0.25. The risk of bias was high for most (76%) studies. Most (63%) of the eight studies with low/medium risk of bias took place in the school setting focused on the food/beverage environment; effects on BMI were mixed. CONCLUSIONS Natural experiments evaluating school-based policies focusing on both the food/beverage and physical activity environments (versus targeting only one) consistently showed improvement in BMI. However, most studies had high risk of bias, highlighting the need for improved methods for evaluation of natural experiments for childhood obesity prevention.
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Affiliation(s)
- Carolyn T Bramante
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Rachel L J Thornton
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wendy L Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Allen Zhang
- Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Renee F Wilson
- Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric B Bass
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eva Tseng
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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18
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Berkowitz SA, Parashuram S, Rowan K, Andon L, Bass EB, Bellantoni M, Brotman DJ, Deutschendorf A, Dunbar L, Durso SC, Everett A, Giuriceo KD, Hebert L, Hickman D, Hough DE, Howell EE, Huang X, Lepley D, Leung C, Lu Y, Lyketsos CG, Murphy SME, Novak T, Purnell L, Sylvester C, Wu AW, Zollinger R, Koenig K, Ahn R, Rothman PB, Brown PMC. Association of a Care Coordination Model With Health Care Costs and Utilization: The Johns Hopkins Community Health Partnership (J-CHiP). JAMA Netw Open 2018; 1:e184273. [PMID: 30646347 PMCID: PMC6324376 DOI: 10.1001/jamanetworkopen.2018.4273] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Johns Hopkins Community Health Partnership was created to improve care coordination across the continuum in East Baltimore, Maryland. OBJECTIVE To determine whether the Johns Hopkins Community Health Partnership (J-CHiP) was associated with improved outcomes and lower spending. DESIGN, SETTING, AND PARTICIPANTS Nonrandomized acute care intervention (ACI) and community intervention (CI) Medicare and Medicaid participants were analyzed in a quality improvement study using difference-in-differences designs with propensity score-weighted and matched comparison groups. The study spanned 2012 to 2016 and took place in acute care hospitals, primary care clinics, skilled nursing facilities, and community-based organizations. The ACI analysis compared outcomes of participants in Medicare and Medicaid during their 90-day postacute episode with those of a propensity score-weighted preintervention group at Johns Hopkins Community Health Partnership hospitals and a concurrent comparison group drawn from similar Maryland hospitals. The CI analysis compared changes in outcomes of Medicare and Medicaid participants with those of a propensity score-matched comparison group of local residents. INTERVENTIONS The ACI bundle aimed to improve transition planning following discharge. The CI included enhanced care coordination and integrated behavioral support from local primary care sites in collaboration with community-based organizations. MAIN OUTCOMES AND MEASURES Utilization measures of hospital admissions, 30-day readmissions, and emergency department visits; quality of care measures of potentially avoidable hospitalizations, practitioner follow-up visits; and total cost of care (TCOC) for Medicare and Medicaid participants. RESULTS The CI group had 2154 Medicare beneficiaries (1320 [61.3%] female; mean age, 69.3 years) and 2532 Medicaid beneficiaries (1483 [67.3%] female; mean age, 55.1 years). For the CI group's Medicaid participants, aggregate TCOC reduction was $24.4 million, and reductions of hospitalizations, emergency department visits, 30-day readmissions, and avoidable hospitalizations were 33, 51, 36, and 7 per 1000 beneficiaries, respectively. The ACI group had 26 144 beneficiary-episodes for Medicare (13 726 [52.5%] female patients; mean patient age, 68.4 years) and 13 921 beneficiary-episodes for Medicaid (7392 [53.1%] female patients; mean patient age, 52.2 years). For the ACI group's Medicare participants, there was a significant reduction in aggregate TCOC of $29.2 million with increases in 90-day hospitalizations and 30-day readmissions of 11 and 14 per 1000 beneficiary-episodes, respectively, and reduction in practitioner follow-up visits of 41 and 29 per 1000 beneficiary-episodes for 7-day and 30-day visits, respectively. For the ACI group's Medicaid participants, there was a significant reduction in aggregate TCOC of $59.8 million and the 90-day emergency department visit rate decreased by 133 per 1000 episodes, but hospitalizations increased by 49 per 1000 episodes and practitioner follow-up visits decreased by 70 and 182 per 1000 episodes for 7-day and 30-day visits, respectively. In total, the CI and ACI were associated with $113.3 million in cost savings. CONCLUSIONS AND RELEVANCE A care coordination model consisting of complementary bundled interventions in an urban academic environment was associated with lower spending and improved health outcomes.
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Affiliation(s)
- Scott A. Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kathy Rowan
- NORC at the University of Chicago, Bethesda, Maryland
| | | | - Eric B. Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michele Bellantoni
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel J. Brotman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Samuel C. Durso
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anita Everett
- Substance Abuse Mental Health Services Administration, Department of Health and Human Services, Washington, DC
| | | | | | | | - Douglas E. Hough
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric E. Howell
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xuan Huang
- Johns Hopkins HealthCare, Glen Burnie, Maryland
| | - Diane Lepley
- Johns Hopkins Health System, Baltimore, Maryland
| | - Curtis Leung
- Johns Hopkins Health System, Baltimore, Maryland
| | - Yanyan Lu
- Johns Hopkins HealthCare, Glen Burnie, Maryland
| | | | | | - Tracy Novak
- Johns Hopkins Health System, Baltimore, Maryland
| | | | | | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ray Zollinger
- Johns Hopkins Community Physicians, Baltimore, Maryland
| | - Kevin Koenig
- NORC at the University of Chicago, Bethesda, Maryland
| | - Roy Ahn
- NORC at the University of Chicago, Bethesda, Maryland
| | - Paul B. Rothman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Tseng E, Zhang A, Shogbesan O, Gudzune KA, Wilson RF, Kharrazi H, Cheskin LJ, Bass EB, Bennett WL. Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review. J Gen Intern Med 2018; 33:1990-2001. [PMID: 30206789 PMCID: PMC6206360 DOI: 10.1007/s11606-018-4619-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/30/2018] [Accepted: 07/31/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND This systematic review identifies programs, policies, and built-environment changes targeting prevention and control of adult obesity and evaluates their effectiveness. METHODS We searched PubMed, CINAHL, PsycINFO, and EconLit from January 2000 to March 2018. We included natural experiment studies evaluating a program, policy, or built-environment change targeting adult obesity and reporting weight/body mass index (BMI). Studies were categorized by primary intervention target: physical activity/built environment, food/beverage, messaging, or multiple. Two reviewers independently assessed the risk of bias for each study using the Effective Public Health Practice Project tool. RESULTS Of 158 natural experiments targeting obesity, 17 reported adult weight/BMI outcomes. Four of 9 studies reporting on physical activity/built environment demonstrated reduced weight/BMI, although effect sizes were small with low strength of evidence and high risk of bias. None of the 5 studies targeting the food/beverage environment decreased weight/BMI; strength of evidence was low, and 2 studies were rated high risk of bias. DISCUSSION We identified few natural experiments reporting on the effectiveness of programs, policies, and built-environment changes on adult obesity. Overall, we found no evidence that policies intending to promote physical activity and healthy eating had beneficial effects on weight/BMI and most studies had a high risk of bias. Limitations include few studies met our inclusion criteria; excluded studies in children and those not reporting on weight/BMI outcomes; weight/BMI reporting was very heterogeneous. More high-quality research, including natural experiments studies, is critical for informing the population-level effectiveness of obesity prevention and control initiatives in adults.
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Affiliation(s)
- Eva Tseng
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA.
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Renee F Wilson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Cheskin
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
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20
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Hsiao YL, Bass EB, Wu AW, Richardson MB, Deutschendorf A, Brotman DJ, Bellantoni M, Howell EE, Everett A, Hickman D, Purnell L, Zollinger R, Sylvester C, Lyketsos CG, Dunbar L, Berkowitz SA. Implementation of a comprehensive program to improve coordination of care in an urban academic health care system. J Health Organ Manag 2018; 32:638-657. [PMID: 30175678 DOI: 10.1108/jhom-09-2017-0228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose Academic healthcare systems face great challenges in coordinating services across a continuum of care that spans hospital, community providers, home and chronic care facilities. The Johns Hopkins Community Health Partnership (J-CHiP) was created to improve coordination of acute, sub-acute and ambulatory care for patients, and improve the health of high-risk patients in surrounding neighborhoods. The paper aims to discuss this issue. Design/methodology/approach J-CHiP targeted adults admitted to the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, patients discharged to participating skilled nursing facilities (SNFs), and high-risk Medicare and Medicaid patients receiving primary care in eight nearby outpatient sites. The primary drivers of the program were redesigned acute care delivery, seamless transitions of care and deployment of community care teams. Findings Acute care interventions included risk screening, multidisciplinary care planning, pharmacist-driven medication management, patient/family education, communication with next provider and care coordination protocols for common conditions. Transition interventions included post-discharge health plans, hand-offs and follow-up with primary care providers, Transition Guides, a patient access line and collaboration with SNFs. Community interventions involved forming multidisciplinary care coordination teams, integrated behavioral care and new partnerships with community-based organizations. Originality/value This paper offers a detailed description of the design and implementation of a complex program to improve care coordination for high-risk patients in an urban setting. The case studies feature findings from each intervention that promoted patient engagement, strengthened collaboration with community-based organizations and improved coordination of care.
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Affiliation(s)
- Ya Luan Hsiao
- Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Albert W Wu
- Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | | | | | - Daniel J Brotman
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | | | - Eric E Howell
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Anita Everett
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Debra Hickman
- Sisters Together and Reaching, Baltimore, Maryland, USA
| | - Leon Purnell
- Men and Families Center, Baltimore, Maryland, USA
| | | | | | | | - Linda Dunbar
- Johns Hopkins HealthCare LLC, Baltimore, Maryland, USA
| | - Scott A Berkowitz
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
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21
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Bennett WL, Wilson RF, Zhang A, Tseng E, Knapp EA, Kharrazi H, Stuart EA, Shogbesan O, Bass EB, Cheskin LJ. Methods for Evaluating Natural Experiments in Obesity: A Systematic Review. Ann Intern Med 2018; 168:791-800. [PMID: 29710087 DOI: 10.7326/m18-0309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Given the obesity pandemic, rigorous methodological approaches, including natural experiments, are needed. PURPOSE To identify studies that report effects of programs, policies, or built environment changes on obesity prevention and control and to describe their methods. DATA SOURCES PubMed, CINAHL, PsycINFO, and EconLit (January 2000 to August 2017). STUDY SELECTION Natural experiments and experimental studies evaluating a program, policy, or built environment change in U.S. or non-U.S. populations by using measures of obesity or obesity-related health behaviors. DATA EXTRACTION 2 reviewers serially extracted data on study design, population characteristics, data sources and linkages, measures, and analytic methods and independently evaluated risk of bias. DATA SYNTHESIS 294 studies (188 U.S., 106 non-U.S.) were identified, including 156 natural experiments (53%), 118 experimental studies (40%), and 20 (7%) with unclear study design. Studies used 106 (71 U.S., 35 non-U.S.) data systems; 37% of the U.S. data systems were linked to another data source. For outcomes, 112 studies reported childhood weight and 32 adult weight; 152 had physical activity and 148 had dietary measures. For analysis, natural experiments most commonly used cross-sectional comparisons of exposed and unexposed groups (n = 55 [35%]). Most natural experiments had a high risk of bias, and 63% had weak handling of withdrawals and dropouts. LIMITATION Outcomes restricted to obesity measures and health behaviors; inconsistent or unclear descriptions of natural experiment designs; and imperfect methods for assessing risk of bias in natural experiments. CONCLUSION Many methodologically diverse natural experiments and experimental studies were identified that reported effects of U.S. and non-U.S. programs, policies, or built environment changes on obesity prevention and control. The findings reinforce the need for methodological and analytic advances that would strengthen evaluations of obesity prevention and control initiatives. PRIMARY FUNDING SOURCE National Institutes of Health, Office of Disease Prevention, and Agency for Healthcare Research and Quality. (PROSPERO: CRD42017055750).
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Affiliation(s)
- Wendy L Bennett
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Renee F Wilson
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Allen Zhang
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eva Tseng
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Emily A Knapp
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Hadi Kharrazi
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Elizabeth A Stuart
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Oluwaseun Shogbesan
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eric B Bass
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Lawrence J Cheskin
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
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Riggs KR, Berger ZD, Makary MA, Bass EB, Chander G. Surgeons' views on preoperative medical evaluation: a qualitative study. Perioper Med (Lond) 2017; 6:16. [PMID: 29090090 PMCID: PMC5655808 DOI: 10.1186/s13741-017-0072-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background There is substantial variation in the practice of preoperative medical evaluation (PME) and limited evidence for its benefit, which raises concerns about overuse. Surgeons have a unique role in this multidisciplinary practice. The objective of this qualitative study was to explore surgeons’ practices and their beliefs about PME. Methods We conducted of semi-structured interviews with 18 surgeons in Baltimore, Maryland. Surgeons were purposively sampled to maximize diversity in terms of practice type (academic vs. private practice), surgical specialty, gender, and experience level. General topics included surgeons’ current PME practices, perceived benefits and harms of PME, the surgical risk assessment, and potential improvements and barriers to change. Interviews were audio-recorded and transcribed. Transcripts were analyzed using content analysis to identify themes, which are presented as assertions. Transcripts were re-analyzed to identify supporting and opposing instances of each assertion. Results A total of 15 themes emerged. There was wide variation in surgeons’ described PME practices. Surgeons believed that PME improves surgical outcomes, but not all patients benefit. Surgeons were cognizant of the financial cost of the current system and the potential inconvenience that additional tests and office visits pose to patients. Surgeons believed that PME has minimal to no risk and that a normal PME is reassuring to them and patients. Surgeons were confident in their ability to assess surgical risk, and risk assessment by non-surgeons rarely affected their surgical decision-making. Hospital and anesthesiology requirements were a major driver of surgeons’ PME practices. Surgeons did not receive much training on PME but perceived their practices to be similar to their colleagues. Surgeons believed that PME provides malpractice protection, welcomed standardization, and perceived there to be inadequate evidence to significantly change their current practice. Conclusions Views of surgeons should be considered in future research on and reforms to the PME process.
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Affiliation(s)
- Kevin R Riggs
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Zackary D Berger
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Room 8060, Baltimore, MD 21287 USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Eric B Bass
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Room 8060, Baltimore, MD 21287 USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Room 8060, Baltimore, MD 21287 USA
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23
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Weston CM, Yune S, Bass EB, Berkowitz SA, Brotman DJ, Deutschendorf A, Howell EE, Richardson MB, Sylvester C, Wu AW. A Concise Tool for Measuring Care Coordination from the Provider's Perspective in the Hospital Setting. J Hosp Med 2017; 12:811-817. [PMID: 28991946 DOI: 10.12788/jhm.2795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND To support hospital efforts to improve coordination of care, a tool is needed to evaluate care coordination from the perspective of inpatient healthcare professionals. OBJECTIVES To develop a concise tool for assessing care coordination in hospital units from the perspective of healthcare professionals, and to assess the performance of the tool in measuring dimensions of care coordination in 2 hospitals after implementation of a care coordination initiative. METHODS We developed a survey consisting of 12 specific items and 1 global item to measure provider perceptions of care coordination across a variety of domains, including teamwork and communication, handoffs, transitions, and patient engagement. The questionnaire was distributed online between October 2015 and January 2016 to nurses, physicians, social workers, case managers, and other professionals in 2 tertiary care hospitals. RESULTS A total of 841 inpatient care professionals completed the survey (response rate = 56.6%). Among respondents, 590 (75%) were nurses and 37 (4.7%) were physicians. Exploratory factor analysis revealed 4 subscales: (1) Teamwork, (2) Patient Engagement, (3) Handoffs, and (4) Transitions (Cronbach's alpha 0.84-0.90). Scores were fairly consistent for 3 subscales but were lower for patient engagement. There were minor differences in scores by profession, department, and hospital. CONCLUSIONS The new tool measures 4 important aspects of inpatient care coordination with evidence for internal consistency and construct validity, indicating that the tool can be used in monitoring, evaluating, and planning care coordination activities in hospital settings.
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Affiliation(s)
- Christine M Weston
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sehyo Yune
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eric B Bass
- Evidence-Based Practice Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Scott A Berkowitz
- Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel J Brotman
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amy Deutschendorf
- Care Coordination and Clinical Resource Management, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Eric E Howell
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Melissa B Richardson
- Care Coordination and Clinical Resource Management, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Carol Sylvester
- Care Management Services, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Albert W Wu
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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24
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Patel HD, Pierorazio PM, Johnson MH, Sharma R, Iyoha E, Allaf ME, Bass EB, Sozio SM. Renal Functional Outcomes after Surgery, Ablation, and Active Surveillance of Localized Renal Tumors: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2017; 12:1057-1069. [PMID: 28483780 PMCID: PMC5498358 DOI: 10.2215/cjn.11941116] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/06/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Management strategies for localized renal masses suspicious for renal cell carcinoma include radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance. Given favorable survival outcomes across strategies, renal preservation is often of paramount concern. To inform clinical decision making, we performed a systematic review and meta-analysis of studies comparing renal functional outcomes for radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1997 to May 1, 2015 to identify comparative studies reporting renal functional outcomes. Meta-analyses were performed for change in eGFR, incidence of CKD, and AKI. RESULTS We found 58 articles reporting on relevant renal functional outcomes. Meta-analyses showed that final eGFR fell 10.5 ml/min per 1.73 m2 lower for radical nephrectomy compared with partial nephrectomy and indicated higher risk of CKD stage 3 or worse (relative risk, 2.56; 95% confidence interval, 1.97 to 3.32) and ESRD for radical nephrectomy compared with partial nephrectomy. Overall risk of AKI was similar for radical nephrectomy and partial nephrectomy, but studies suggested higher risk for radical nephrectomy among T1a tumors (relative risk, 1.37; 95% confidence interval, 1.13 to 1.66). In general, similar findings of worse renal function for radical nephrectomy compared with thermal ablation and active surveillance were observed. No differences in renal functional outcomes were observed for partial nephrectomy versus thermal ablation. The overall rate of ESRD was low among all management strategies (0.4%-2.8%). CONCLUSIONS Renal functional implications varied across management strategies for localized renal masses, with worse postoperative renal function for patients undergoing radical nephrectomy compared with other strategies and similar outcomes for partial nephrectomy and thermal ablation. Further attention is needed to quantify the changes in renal function associated with active surveillance and nephron-sparing approaches for patients with preexisting CKD.
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Affiliation(s)
- Hiten D. Patel
- James Buchanan Brady Urological Institute, Department of Urology, and
| | | | | | | | | | - Mohamad E. Allaf
- James Buchanan Brady Urological Institute, Department of Urology, and
| | - Eric B. Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of
- Health Policy and Management and
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and
| | - Stephen M. Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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25
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Affiliation(s)
- Eric B Bass
- From Evidence-based Practice Center, Johns Hopkins University, and Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rathan M Subramaniam
- From Evidence-based Practice Center, Johns Hopkins University, and Johns Hopkins School of Medicine, Baltimore, Maryland
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26
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Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, Bass EB, Allaf ME. Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. J Urol 2016; 196:989-99. [PMID: 27157369 PMCID: PMC5593254 DOI: 10.1016/j.juro.2016.04.081] [Citation(s) in RCA: 229] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Several options exist for management of clinically localized renal masses suspicious for cancer, including active surveillance, thermal ablation and radical or partial nephrectomy. We summarize evidence on effectiveness and comparative effectiveness of these treatment approaches for patients with a renal mass suspicious for localized renal cell carcinoma. MATERIALS AND METHODS We searched MEDLINE®, Embase® and the Cochrane Central Register of Controlled Trials from January 1, 1997 through May 1, 2015. Paired investigators independently screened articles to identify controlled studies of management options or cohort studies of active surveillance, abstracted data sequentially and assessed risk of bias independently. Strength of evidence was graded by comparisons. RESULTS The search identified 107 studies (majority T1, no active surveillance or thermal ablation stratified outcomes of T2 tumors). Cancer specific survival was excellent among all management strategies (median 5-year survival 95%). Local recurrence-free survival was inferior for thermal ablation with 1 treatment but reached equivalence to other modalities after multiple treatments. Overall survival rates were similar among management strategies and varied with age and comorbidity. End-stage renal disease rates were low for all strategies (0.4% to 2.8%). Radical nephrectomy was associated with the largest decrease in estimated glomerular filtration rate and highest incidence of chronic kidney disease. Thermal ablation offered the most favorable perioperative outcomes. Partial nephrectomy showed the highest rates of urological complications but overall rates of minor/major complications were similar among interventions. Strength of evidence was moderate, low and insufficient for 11, 22 and 30 domains, respectively. CONCLUSIONS Comparative studies demonstrated similar cancer specific survival across management strategies, with some differences in renal functional outcomes, perioperative outcomes and postoperative harms that should be considered when choosing a management strategy.
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Affiliation(s)
- Phillip M Pierorazio
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael H Johnson
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Hiten D Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ritu Sharma
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Emmanuel Iyoha
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Eric B Bass
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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27
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Lai GY, Gary TL, Tilburt J, Bolen S, Baffi C, Wilson RF, Howerton MW, Gibbons MC, Tanpitukpongse TP, Powe NR, Bass EB, Ford JG. Effectiveness of strategies to recruit underrepresented populations into cancer clinical trials. Clin Trials 2016; 3:133-41. [PMID: 16773955 DOI: 10.1191/1740774506cn143oa] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Certain populations, including racial and ethnic minorities and older persons, have had a history of low participation in cancer-related trials, yet there has been little information reported on recruitment strategies tailored to improve their enrollment. Methods We conducted a systematic literature review to examine the methods used to study recruitment of underrepresented populations into cancer prevention and treatment trials and examined the studies that compared the efficacy and/or effectiveness of different recruitment strategies. We performed an electronic search through multiple databases including PubMed and a hand search of 34 journals. Potential studies were pulled and underwent title, abstract, and article review by at least two investigators. Results Fourteen articles examined recruitment of underrepresented populations into cancer trials and, of these, five compared efficacy or effectiveness of different strategies for recruitment of underrepresented populations into randomized or concurrent controlled trials. These five studies used various strategies but only three reported that specific recruitment strategies, such as media campaigns and churchbased project sessions, resulted in improvement in accrual to cancer trials. Conclusion There is limited evidence for efficacious or effective strategies to recruit underrepresented populations in cancer-related trials. The available evidence cannot be generalized to these heterogeneous groups. Further study is needed on efficacious strategies for recruitment of underrepresented populations into cancerrelated trials.
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Affiliation(s)
- Gabriel Y Lai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch 615 N. Wolfe St. E6531, Baltimore, MD 21205, USA
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Patel HD, Iyoha E, Pierorazio PM, Sozio SM, Johnson MH, Sharma R, Bass EB, Allaf ME. A Systematic Review of Research Gaps in the Evaluation and Management of Localized Renal Masses. Urology 2016; 98:14-20. [PMID: 27542860 DOI: 10.1016/j.urology.2016.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/01/2016] [Accepted: 08/09/2016] [Indexed: 12/28/2022]
Abstract
The management of clinically localized renal masses suspicious for renal cell carcinoma varies, partially because of gaps in the evidence base. We conducted a systematic review to summarize research gaps for the evaluation of composite models for predicting malignancy; use of percutaneous renal sampling for diagnosis; and comparative effectiveness of surgery, thermal ablation, and active surveillance. A total of 147 studies, published in 150 articles, were identified. To promote improved patient care and health outcomes, we recommend incorporation of emerging biomarkers into validated composite models, standardization of biopsy protocols, standard reporting of clinical stage, and performance of prospective studies with objective selection criteria.
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Affiliation(s)
- Hiten D Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Emmanuel Iyoha
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, MD
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Michael H Johnson
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ritu Sharma
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, MD
| | - Eric B Bass
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
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Pierorazio PM, Patel HD, Johnson MH, Sozio SM, Sharma R, Iyoha E, Bass EB, Allaf ME. Distinguishing malignant and benign renal masses with composite models and nomograms: A systematic review and meta-analysis of clinically localized renal masses suspicious for malignancy. Cancer 2016; 122:3267-3276. [DOI: 10.1002/cncr.30268] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Phillip M. Pierorazio
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Hiten D. Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Michael H. Johnson
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Stephen M. Sozio
- Department of Medicine; Johns Hopkins Medical Institutions; Baltimore Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Ritu Sharma
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health; Baltimore Maryland
| | - Emmanuel Iyoha
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health; Baltimore Maryland
| | - Eric B. Bass
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health; Baltimore Maryland
| | - Mohamad E. Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions; Baltimore Maryland
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Tilburt J, Ford JG, Howerton MW, Gary TL, Lai GY, Bolen S, Baffi C, Wilson RF, Tanpitukpongse TP, Powe NR, Bass EB, Sugarman J. Applying justice in clinical trials for diverse populations. Clin Trials 2016; 4:264-9. [PMID: 17715253 DOI: 10.1177/1740774507079440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Considerable attention has focused on increasing clinical trial participation for members of “underrepresented groups”. However, doing so involves clarifying how to meet the demands of justice, or fairness, which provides the ethical mandate to enhance broad trial representation. Purpose To examine the ethical principle of justice as it applies to recruiting diverse populations to clinical trials representation. Methods In this paper, we analyse the conceptual and practical challenges in applying the principle of justice to clinical trials representation. Results Different facets of justice include demands for both fair outcomes and fair processes. Including both of these facets in clinical trials policy should not only promote access to trials, but also help to provide a framework to improve fairness in representation in clinical trials. Efforts to evaluate recruitment of representation should include outcome and process measures. Limitations The suggestions offered based on this conceptual analysis need to be tested empirically. Conclusions Those involved in the design, conduct and oversight of clinical trials should consider all of the facets of justice when assessing representation in clinical trials and attempt to balance fair access to trials with a fair process that may require protection from being unduly pressured to participate. Clinical Trials 2007; 4: 264—269; http://ctj.sagepub.com
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Affiliation(s)
- Jon Tilburt
- Department of Clinical Bioethics, National Institutes of Health, Bethesda, MD, USA.
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Tilburt J, Ford JG, Howerton MW, Gary TL, Lai GY, Bolen S, Baffi C, Wilson RF, Tanpitukpongse TP, Powe NR, Bass EB, Sugarman J. Authors' response to J Kahn. Clin Trials 2016. [DOI: 10.1177/1740774507079656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bass EB. Prevention Strategies for Contrast-Induced Nephropathy. Ann Intern Med 2016; 164:511-2. [PMID: 27043989 DOI: 10.7326/l16-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Subramaniam RM, Suarez-Cuervo C, Wilson RF, Turban S, Zhang A, Sherrod C, Aboagye J, Eng J, Choi MJ, Hutfless S, Bass EB. Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis. Ann Intern Med 2016; 164:406-16. [PMID: 26830221 DOI: 10.7326/m15-1456] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND N-acetylcysteine, sodium bicarbonate, statins, and ascorbic acid have been studied for reducing contrast-induced nephropathy (CIN). PURPOSE To evaluate the comparative effectiveness of interventions to reduce CIN in adults receiving contrast media. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, and Scopus databases through June 2015. Risk of bias and overall strength of evidence (SOE) of studies were assessed. STUDY SELECTION Randomized, controlled trials of N-acetylcysteine, sodium bicarbonate, statins, or ascorbic acid that used intravenous (IV) or intra-arterial contrast media and defined CIN with enough data for meta-analysis. DATA EXTRACTION Two reviewers independently extracted data and assessed study quality. DATA SYNTHESIS Low-dose N-acetylcysteine plus IV saline compared with IV saline (risk ratio [RR], 0.75 [95% CI, 0.63 to 0.89]; low SOE), N-acetylcysteine plus IV saline compared with IV saline in patients receiving low-osmolar contrast media (RR, 0.69 [CI, 0.58 to 0.84]; moderate SOE), and statins plus N-acetylcysteine plus IV saline versus N-acetylcysteine plus IV saline (RR, 0.52 [CI, 0.29 to 0.93]; low SOE) had clinically important and statistically significant benefits. The following 3 comparisons suggested a clinically important difference that was not statistically significant: sodium bicarbonate versus IV saline in patients receiving low-osmolar contrast media (RR, 0.65 [CI, 0.33 to 1.25]; low SOE), statins plus IV saline versus IV saline (RR, 0.68 [CI, 0.39 to 1.20]; low SOE), and ascorbic acid versus IV saline (RR, 0.72 [CI, 0.48 to 1.01]; low SOE). Strength of evidence was generally insufficient for comparisons of the need for renal replacement, cardiac events, and mortality. LIMITATION Too few studies were done in patients receiving IV contrast media. CONCLUSION The greatest reduction in CIN was seen with N-acetylcysteine plus IV saline in patients receiving LOCM and with statins plus N-acetylcysteine plus IV saline. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Eng J, Wilson RF, Subramaniam RM, Zhang A, Suarez-Cuervo C, Turban S, Choi MJ, Sherrod C, Hutfless S, Iyoha EE, Bass EB. Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis. Ann Intern Med 2016; 164:417-24. [PMID: 26830055 DOI: 10.7326/m15-1402] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). PURPOSE To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. DATA SOURCES PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. STUDY SELECTION Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. DATA EXTRACTION Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. DATA SYNTHESIS None of the 5 studies that compared types of LOCM reported a statistically significant or clinically important difference among study groups, but the strength of evidence was low. Twenty-five randomized, controlled trials found a slight reduction in CIN risk with the iso-osmolar contrast media agent iodixanol compared with a diverse group of LOCM that just reached statistical significance in a meta-analysis (pooled relative risk, 0.80 [95% CI, 0.65 to 0.99]; P = 0.045). This comparison's strength of evidence was moderate. In a meta regression of randomized, controlled trials of iodixanol, no relationship was found between route of administration and comparative CIN risk. LIMITATIONS Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. CONCLUSION No differences were found in CIN risk among types of LOCM. Iodixanol had a slightly lower risk for CIN than LOCM, but the lower risk did not exceed a criterion for clinical importance. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Patel HD, Johnson MH, Pierorazio PM, Sozio SM, Sharma R, Iyoha E, Bass EB, Allaf ME. Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature. J Urol 2016; 195:1340-1347. [PMID: 26901507 DOI: 10.1016/j.juro.2015.11.029] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. MATERIALS AND METHODS MEDLINE®, Embase® and the Cochrane databases were searched (January 1997 to May 2015) for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. RESULTS A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1% with 90.4% of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80% of patients. The false-positive rate was low (4.0%), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16%) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5%, CI 96.5-98.5) and specific (96.2%, CI 90.7-100) when a diagnostic result was obtained, but most patients (∼80%) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7% with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3%, CI 52.4-74.2). Direct complications included hematoma (4.9%), clinically significant pain (1.2%), gross hematuria (1.0%), pneumothorax (0.6%) and hemorrhage (0.4%). CONCLUSIONS Diagnostic accuracy was generally high for biopsy of localized renal masses with a low complication rate, but the nondiagnostic rate and negative predictive value were concerning. Renal mass sampling should be used judiciously as further research will determine its true clinical utility.
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Affiliation(s)
- Hiten D Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Michael H Johnson
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ritu Sharma
- Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland
| | - Emmanuel Iyoha
- Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland
| | - Eric B Bass
- Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Affiliation(s)
- Eric B Bass
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Ranasinghe PD, Maruthur NM, Nicholson WK, Yeh HC, Brown T, Suh Y, Wilson LM, Nannes EB, Berger Z, Bass EB, Golden SH. Comparative effectiveness of continuous subcutaneous insulin infusion using insulin analogs and multiple daily injections in pregnant women with diabetes mellitus: a systematic review and meta-analysis. J Womens Health (Larchmt) 2015; 24:237-49. [PMID: 25713996 DOI: 10.1089/jwh.2014.4939] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We systematically reviewed the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) with insulin analogs compared with multiple daily injections (MDI) in pregnant women with diabetes mellitus. We searched Medline®, Embase®, and the Cochrane Central Register of Controlled Trials through May 2013. Studies comparing CSII with MDI in pregnant women with diabetes mellitus were included. Studies using regular insulin CSII were excluded. We conducted meta-analyses where there were two or more comparable studies based on the type of insulin used in the MDI arm. Seven cohort studies of pregnant women with type 1 diabetes reported improvement in hemoglobin A1c (HbA1c) in both groups. Meta-analysis showed no difference in maternal and fetal outcomes for CSII versus MDI. Results were similar when CSII was compared with MDI with insulin analogs or regular insulin. Studies had moderate to high risk bias with incomplete descriptions of study methodology, populations, treatments, follow up, and outcomes. We conclude that observational studies reported similar improvements in HbA1c with CSII and MDI during pregnancy, but evidence was insufficient to rule out possible important differences between CSII and MDI for maternal and fetal outcomes. This highlights the need for future studies to examine the effectiveness and safety of CSII with insulin analogs and MDI in pregnant women with diabetes mellitus.
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Bertram A, Yeh HC, Bass EB, Brancati F, Levine D, Cofrancesco J. How we developed the GIM clinician-educator mentoring and scholarship program to assist faculty with promotion and scholarly work. Med Teach 2015; 37:131-5. [PMID: 24819726 DOI: 10.3109/0142159x.2014.911269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Clinician Educators' (CEs) focus on patient care and teaching, yet many academic institutions require dissemination of scholarly work for advancement. This can be difficult for CEs. Our division developed the Clinician-Educator Mentoring and Scholarship Program (CEMSP) in an effort to assist CEs with scholarship, national reputation, recognition, promotion and job satisfaction. The key components are salary-supported director and co-director who coordinate the program and serve as overall mentors and link CEs and senior faculty, and a full-time Senior Research Coordinator to assist with all aspects of scholarship, a close relationship with the General Internal Medicine (GIM) Methods Core provides advanced statistical support. Funding for the program comes from GIM divisional resources. Perceived value was evaluated by assessing the number of manuscripts published, survey of faculty regarding usage and opinion of CEMSP, and a review of faculty promotions. Although impossible to attribute the contributions of an individual component, a program specifically aimed at helping GIM CE faculty publish scholarly projects, increase participation in national organizations and focus on career progression can have a positive impact.
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Berkman ND, Lohr KN, Ansari MT, Balk EM, Kane R, McDonagh M, Morton SC, Viswanathan M, Bass EB, Butler M, Gartlehner G, Hartling L, McPheeters M, Morgan LC, Reston J, Sista P, Whitlock E, Chang S. Grading the strength of a body of evidence when assessing health care interventions: an EPC update. J Clin Epidemiol 2014; 68:1312-24. [PMID: 25721570 DOI: 10.1016/j.jclinepi.2014.11.023] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/12/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To revise 2010 guidance on grading the strength of evidence (SOE) of the effectiveness of drugs, devices, and other preventive and therapeutic interventions in systematic reviews produced by the Evidence-based Practice Center (EPC) program, established by the US Agency for Healthcare Research and Quality (AHRQ). STUDY DESIGN AND SETTING A cross-EPC working group reviewed authoritative systems for grading SOE [primarily the approach from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group] and conducted extensive discussions with GRADE and other experts. RESULTS Updated guidance continues to be conceptually similar to GRADE. Reviewers are to evaluate SOE separately for each major treatment comparison for each major outcome. We added reporting bias as a required domain and retained study limitations (risk of bias), consistency, directness, and precision (and three optional domains). Additional guidance covers scoring consistency, precision, and reporting bias, grading bodies of evidence with randomized controlled trials and observational studies, evaluating single study bodies of evidence, using studies with high risk of bias, and presenting findings with greater clarity and transparency. SOE is graded high, moderate, low, or insufficient, reflecting reviewers' confidence in the findings for a specific treatment comparison and outcome. CONCLUSION No single approach for grading SOE suits all reviews, but a more consistent and transparent approach to reporting summary information will make reviews more useful to the broad range of audiences that AHRQ's work aims to reach. EPC working groups will consider ongoing challenges and modify guidance as needed, on issues such as combining trials and observational studies in bodies of evidence, weighting domains, and combining qualitative and quantitative syntheses.
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Affiliation(s)
- Nancy D Berkman
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Kathleen N Lohr
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Mohammed T Ansari
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Box 201B, Ottawa Hospital - General campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Ethan M Balk
- Center for Evidence-Based Medicine, Brown University, School of Public Health, Box G-S121-8, Providence, RI 02912, USA
| | - Robert Kane
- University of Minnesota, School of Public Health, 420 Delaware St SE, MMC 197, Minneapolis, MN 55455, USA
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Oregon Health Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Sally C Morton
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburg, PA 15261, USA
| | - Meera Viswanathan
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Eric B Bass
- Department of Medicine, and Department of Health Policy and Management, Johns Hopkins University, 624 North Broadway, Room 680A, Baltimore, MD, 21205, USA
| | - Mary Butler
- University of Minnesota, School of Public Health, 420 Delaware St SE, MMC 197, Minneapolis, MN 55455, USA
| | - Gerald Gartlehner
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA; Department for Clinical Epidemiology and Evidence-based Medicine, Danube University, Dr. Karl Dorrek Strasse 30, 3500 Krems, Austria
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Melissa McPheeters
- Department of Health Policy, Vanderbilt University, Medical Center, 6th Floor, 2525 West End Avenue, Nashville, TN 37203, USA
| | - Laura C Morgan
- Division of Social Policy, Health & Economics Research, RTI International (Research Triangle Institute), PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - James Reston
- Evidence-Based Practice Center and Health Technology Assessment Group, ECRI Institute Headquarters, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA
| | - Priyanka Sista
- University of North Carolina School of Medicine, 1001 Bondurant Hall, CB# 9535, Chapel Hill, NC 27599, USA
| | - Evelyn Whitlock
- Center for Health Research, Kaiser Permanente, Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA
| | - Stephanie Chang
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA
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Michos ED, Wilson LM, Yeh HC, Berger Z, Suarez-Cuervo C, Stacy SR, Bass EB. Prognostic value of cardiac troponin in patients with chronic kidney disease without suspected acute coronary syndrome: a systematic review and meta-analysis. Ann Intern Med 2014; 161:491-501. [PMID: 25111499 DOI: 10.7326/m14-0743] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS). PURPOSE To systematically review the literature on troponin testing in patients with CKD without ACS. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. STUDY SELECTION Studies examining elevated versus normal troponin levels in patients with CKD without ACS. DATA EXTRACTION Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). Meta-analyses were conducted when studies had sufficient homogeneity of key variables. DATA SYNTHESIS Ninety-eight studies met inclusion criteria. Elevated troponin levels were associated with all-cause and cardiovascular mortality among patients receiving dialysis (moderate SOE). Pooled hazard ratios (HRs) for all-cause mortality from studies that adjusted for age and coronary artery disease or a risk equivalent were 3.0 (95% CI, 2.4 to 4.3) for troponin T and 2.7 (CI, 1.9 to 4.6) for troponin I. The pooled adjusted HRs for cardiovascular mortality were 3.3 (CI, 1.8 to 5.4) for troponin T and 4.2 (CI, 2.0 to 9.2) for troponin I. Findings were similar for patients with CKD who were not receiving dialysis, but there were fewer studies. No study tested treatment strategies by troponin cut points. LIMITATION Studies were heterogeneous regarding assays, troponin cut points, covariate adjustment, and follow-up. CONCLUSION In patients with CKD without suspected ACS, elevated troponin levels were associated with worse prognosis. Future studies should focus on whether this biomarker is more appropriate than clinical models for reclassifying risk of patients with CKD and whether such classification can help guide treatment in those at highest risk for death. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Stacy SR, Suarez-Cuervo C, Berger Z, Wilson LM, Yeh HC, Bass EB, Michos ED. Role of troponin in patients with chronic kidney disease and suspected acute coronary syndrome: a systematic review. Ann Intern Med 2014; 161:502-12. [PMID: 25111593 DOI: 10.7326/m14-0746] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging. PURPOSE To evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. STUDY SELECTION Studies examining elevated versus normal troponin levels in terms of their diagnostic performance in detection of ACS, effect on ACS management strategies, and prognostic value for mortality or cardiovascular events after ACS among patients with CKD. DATA EXTRACTION Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). DATA SYNTHESIS Twenty-three studies met inclusion criteria. The sensitivity of troponin T for ACS diagnosis ranged from 71% to 100%, and specificity ranged from 31% to 86% (6 studies; low SOE). The sensitivity and specificity of troponin I ranged from 43% to 94% and from 48% to 100%, respectively (8 studies; low SOE). No studies examined how troponin levels affect management strategies. Twelve studies analyzed prognostic value. Elevated levels of troponin I or troponin T were associated with higher risk for short-term death and cardiac events (low SOE). A similar trend was observed for long-term mortality with troponin I (low SOE), but less evidence was found for long-term cardiac events for troponin I and long-term outcomes for troponin T (insufficient SOE). Patients with advanced CKD tended to have worse prognoses with elevated troponin I levels than those without them (moderate SOE). LIMITATION Studies were heterogeneous in design and in ACS definitions and adjudication methods. CONCLUSION In patients with CKD and suspected ACS, troponin levels can aid in identifying those with a poor prognosis, but the diagnostic utility is limited by varying estimates of sensitivity and specificity. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Madhav Goyal
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Eric B Bass
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland2Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
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Valle MF, Maruthur NM, Wilson LM, Malas M, Qazi U, Haberl E, Bass EB, Zenilman J, Lazarus G. Comparative effectiveness of advanced wound dressings for patients with chronic venous leg ulcers: A systematic review. Wound Repair Regen 2014; 22:193-204. [DOI: 10.1111/wrr.12151] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/10/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Nisa M. Maruthur
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Epidemiology; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
| | - Lisa M. Wilson
- Department of Health Policy and Management; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
| | - Mahmoud Malas
- Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Umair Qazi
- Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Elisabeth Haberl
- Department of Health Policy and Management; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
| | - Eric B. Bass
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Health Policy and Management; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
- Department of Health Systems and Outcomes; Johns Hopkins University School of Nursing; Baltimore Maryland
| | - Jonathan Zenilman
- Department of Epidemiology; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
- Division of Infectious Diseases; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Gerald Lazarus
- Department of Dermatology; Johns Hopkins University School of Medicine; Baltimore Maryland
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Goyal M, Singh S, Sibinga EMS, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med 2014; 174:357-68. [PMID: 24395196 PMCID: PMC4142584 DOI: 10.1001/jamainternmed.2013.13018] [Citation(s) in RCA: 1022] [Impact Index Per Article: 102.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. OBJECTIVE To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health-related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. EVIDENCE REVIEW We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. FINDINGS After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). CONCLUSIONS AND RELEVANCE Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.
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Affiliation(s)
- Madhav Goyal
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Sonal Singh
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Erica M S Sibinga
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Neda F Gould
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
| | | | - Ritu Sharma
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Zackary Berger
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Dana Sleicher
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
| | - David D Maron
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Hasan M Shihab
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Shauna Linn
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Shonali Saha
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Eric B Bass
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland4Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
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Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA, Cramer H. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. Deutsche Zeitschrift für Akupunktur 2014. [DOI: 10.1016/j.dza.2014.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Malas MB, Qazi U, Lazarus G, Valle MF, Wilson LM, Haberl EB, Bass EB, Zenilman J. Comparative effectiveness of surgical interventions aimed at treating underlying venous pathology in patients with chronic venous ulcer. J Vasc Surg Venous Lymphat Disord 2013; 2:212-25. [PMID: 26993193 DOI: 10.1016/j.jvsv.2013.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/30/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Chronic venous ulcers (CVUs) remain the leading causes for nonhealing wounds in the lower extremities. Although multilayer compression dressing remains the treatment gold standard, there are various surgical procedures aimed at healing CVUs with little or no evidence on the efficacy of these treatment methods. We conducted a systematic review of the effects of various surgical treatments for CVUs, in terms of ulcer healing rates, complete time to heal, recurrence rates, mortality, pain, and quality of life. METHODS We searched MEDLINE, EMBASE, the Cochrane Central Register for Controlled Trials, and the Cumulative Index for Nursing and Allied Health Literature databases from January 1980 through July 2012. We included studies that compared a surgical procedure with multilayer compression therapy or another surgical procedure among patients with CVUs. We also included studies without a comparison group if they were of sufficient quality. Two independent reviewers screened titles, abstracts, and articles for eligibility. Two reviewers extracted data on study design, applicability, results, and quality. RESULTS We identified 10,676 citations, of which 22 studies (23 publications) were included. Eight studies (six randomized controlled trials, two cohorts) compared a surgical procedure with compression. Fourteen studies evaluated different surgical interventions. Adding superficial vein ligation and stripping to compression did not improve wound-healing rate. However, the recurrence rate was 50% reduced when surgery corrected the underlying superficial venous pathology (moderate to high strength of evidence [SOE]). Adding subfascial endoscopic perforator surgery with superficial vein surgery to compression does not improve the healing rate of venous ulcers or reduce the recurrence rate except for medial and large ulcers (high SOE). The SOE was insufficient to support a conclusion about the effects of sclerotherapy when added to compression in healing CVUs. There was insufficient evidence on the surgical treatment of CVUs secondary to deep venous reflux and venous obstruction. We are unable to draw conclusions about the effects of surgical procedures on mortality, pain, and quality of life. CONCLUSIONS Our ability to draw conclusions on most surgical techniques is limited due to poorly designed and executed studies, with no uniformity of treatment methods, follow-up or reporting, and lack of randomization. We found some evidence to suggest superficial vein ligation and stripping may reduce the risk of wound recurrence, but these surgical techniques are infrequently performed. The newer minimally invasive techniques lack evidence. Randomized controlled trials for the endovenous procedures used today for treating CVUs are needed.
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Affiliation(s)
- Mahmoud B Malas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Umair Qazi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Gerald Lazarus
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - M Fran Valle
- School of Nursing, University of Maryland, Baltimore, Md
| | - Lisa M Wilson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Elisabeth B Haberl
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Eric B Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Jonathan Zenilman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Md
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Yeh HC, Lau BD, Golden SH, Donner T, Brown TT, Bass EB. High-priority research needs for insulin delivery and glucose monitoring methods. J Diabetes Sci Technol 2013; 7:1650-1. [PMID: 24351194 PMCID: PMC3876346 DOI: 10.1177/193229681300700628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hsin-Chieh Yeh
- Johns Hopkins University, 2024 E. Monument St., Suite 2-500, Baltimore, MD 21287.
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Lazarus G, Valle MF, Malas M, Qazi U, Maruthur NM, Doggett D, Fawole OA, Bass EB, Zenilman J. Chronic venous leg ulcer treatment: future research needs. Wound Repair Regen 2013; 22:34-42. [PMID: 24134795 DOI: 10.1111/wrr.12102] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/31/2013] [Indexed: 11/30/2022]
Abstract
The prevalence and costs of chronic venous ulcer care in the US are increasing. The Johns Hopkins University Evidence-Based Practice Center recently completed a systematic review of the comparative effectiveness of advanced wound dressings, antibiotics, and surgical management of chronic venous ulcers. Of 10,066 citations identified in the literature search, only 66 (0.06%) met our liberal inclusion criteria for providing evidence on the effectiveness of interventions for chronic venous ulcers. Based on review of those studies, members of our team and a panel of informed stakeholders identified important research gaps and methodological deficiencies and prioritized specific future research needs. Based on that review, we provide the results of our assessment of future research needs for chronic venous ulcer care. Advanced wound dressings were considered to have the highest priority for future research, followed by venous surgery and antibiotics. An imperative from our assessment is that future research evaluating interventions for chronic venous ulcers meet quality standards. In a time of increasing cost pressure, the wound care community needs to develop high-quality evidence to justify the use of present and future therapeutic modalities.
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Affiliation(s)
- Gerald Lazarus
- Departments of Dermatology, Medicine and Surgery, School of Medicine, Johns Hopkins University, Queenstown, Maryland
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Abstract
To deliver high-quality clinical care to patients with diabetes and other chronic conditions, clinicians must understand the evidence available from studies that have been performed to address important clinical management questions. In an evidence-based approach to clinical care, the evidence from clinical research should be integrated with clinical expertise, pathophysiological knowledge, and an understanding of patient values. As such, in an effort to provide information from many studies, the publication of diabetes meta-analyses has increased markedly in the recent past, using either observational or clinical trial data. In this regard, guidelines have been developed to direct the performance of meta-analysis to provide consistency among contributions. Thus, when done appropriately, meta-analysis can provide estimates from clinically and statistically homogeneous but underpowered studies and is useful in supporting clinical decisions, guidelines, and cost-effectiveness analysis. However, often these conditions are not met, the data considered are unreliable, and the results should not be assumed to be any more valid than the data underlying the included studies. To provide an understanding of both sides of the argument, we provide a discussion of this topic as part of this two-part point-counterpoint narrative. In the point narrative preceding the counterpoint narrative below, Dr. Home provides his opinion and review of the data to date showing that we need to carefully evaluate meta-analysis, and we need to learn what results are reliable. In the counterpoint narrative here, Drs. Golden and Bass emphasize that an effective system exists to guide meta-analysis and that rigorously conducted, high-quality systematic reviews and meta-analyses using established guidelines are an indispensable tool in evidence synthesis despite their limitations. —William T. Cefalu, MD Editor in Chief, Diabetes Care
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Chang SM, Bass EB, Berkman N, Carey TS, Kane RL, Lau J, Ratichek S. Challenges in implementing The Institute of Medicine systematic review standards. Syst Rev 2013; 2:69. [PMID: 23981546 PMCID: PMC3765784 DOI: 10.1186/2046-4053-2-69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/05/2013] [Indexed: 11/30/2022] Open
Abstract
In 2011, The Institute of Medicine (IOM) identified a set of methodological standards to improve the validity, trustworthiness, and usefulness of systematic reviews. These standards, based on a mix of theoretical principles, empiric evidence, and commonly considered best practices, set a high bar for authors of systematic reviews.Based on over 15 years of experience conducting systematic reviews, the Agency for Healthcare Research and Quality Evidence-based Practice Center (EPC) program has examined the EPC's adherence and agreement with the IOM standards. Even such a large program, with infrastructure and resource support, found challenges in implementing all of the IOM standards. We summarize some of the challenges in implementing the IOM standards as a whole and suggest some considerations for individual or smaller research groups needing to prioritize which standards to adhere to, yet still achieve the highest quality and utility possible for their systematic reviews.
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Affiliation(s)
- Stephanie M Chang
- Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA
| | - Eric B Bass
- Johns Hopkins University, Hampton House 680A, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Nancy Berkman
- RTI International, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194, USA
| | - Timothy S Carey
- University of North Carolina at Chapel Hill, 5039 Old Clinic Building, CB #7110, Chapel Hill, NC 27599-7110, USA
| | - Robert L Kane
- University of Minnesota School of Public Health, MMC 179, Minneapolis, MN 55455, USA
| | - Joseph Lau
- Brown University, 121 S. Main Street, 8th floor, Providence, RI 02912, USA
| | - Sara Ratichek
- University of Utah, School of Nursing, Salt Lake City, USA
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