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Press Release Date: March 20, 2000
The Agency for Healthcare Research and Quality (AHRQ) works to improve the quality of health care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHRQ's Research Activities.
Simple Resuscitation Method Is Best for Children in Out-of-Hospital Emergency Settings
Researchers at the Harbor-UCLA Medical Center in Los Angeles urge paramedics to use simple resuscitation instead of the riskier intubation method for children who have stopped breathing. If pediatric intubation is necessary, say researchers, it should be performed in a controlled hospital setting. The recommendations come after a three-year study of 830 children in Southern California; the longest and largest controlled trial to date of treatments for children in a pre-hospital setting. During intubation, tubes can be dislodged or misplaced, blocking oxygen to the lungs and potentially causing death. In the Harbor-UCLA study, researchers compared how bag-valve-mask ventilation (BVM) and BVM followed by intubation affected survival and neurological outcomes, such as coma or mild to severe disability. Their comparison found no significant difference in survival or in achieving a good neurological outcome among children receiving either procedure. The study—which was jointly funded by AHRQ and the Health
Resources and Services Administration's Bureau of Maternal and Child Health—involved children younger than twelve or weighing less than 80 pounds.
["Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: A controlled clinical trial," by Marianne Gausche, M.D., Roger J. Lewis, M.D., Ph.D., Samuel J. Stratton, M.D., M.P.H., and others, in the January 9 JAMA 283 (6), pp. 783-790.]
Competing Basic Needs Prompt One-Third of HIV-Infected Individuals to Delay or Forgo Medical Care
One-third of those infected with the human immunodeficiency virus (HIV) that causes AIDS say that competing priorities cause them to postpone or go without medical care, according to an AHRQ-supported study. As a result, many did not receive life-extending antiretroviral or other therapies. These individuals either could not get time off from work, had no way of getting to a doctor, or were too sick to obtain medical care. Eight percent reported they went without food, clothing or housing because their medical care costs were so high. For HIV-infected patients to stay healthy, says lead study author William E. Cunningham, M.D., M.P.H., more resources must be devoted to providing basic necessities like home care, transportation, and employment support. Cunningham and his colleagues at the University of California, Los Angeles (UCLA) surveyed a nationally representative sample of 2,864 adults receiving HIV care. These patients were part of the national HIV Cost and Services Utilization Study co-directed by Martin F. Shapiro and Samuel A. Bozzette of RAND.
["The impact of competing subsistence needs and barriers on access to medical care for persons with human
immunodeficiency virus receiving care in the United States," by Dr. Cunningham, Ronald M. Andersen, Ph.D., Mitchell H. Katz, M.D., and others in the December 1999 Medical Care 37 (12), pp. 1270-1281.]
Vaginal Delivery After Prior C-Section Remains Relatively Safe
Risk of uterine rupture from vaginal birth after cesarean (VBAC) is relatively low, according to a recent study supported in part by AHRQ's Childbirth Patient Outcomes Research Team (PORT). Because of uterine scarring in c-section deliveries, a woman attempting vaginal delivery with the next baby is at increased risk of uterine rupture. However, in studying 1995 hospital discharge data for over 500,000 California women, researchers found this risk to be low (.5 percent). The study's findings support recommendations by the National Institutes of Health and the Department of Health and Human Services to reduce cesarean rates by widespread VBAC.
["Vaginal birth after cesarean and uterine rupture rates in California," by Kimberly D. Gregory, M.D., M.P.H., Lisa M. Korst, M.D., Patricia Cane, Ph.D., and others, in the December 1999 Obstetrics & Gynecology 94(6), pp. 985-989.]
Other articles in Research Activities include findings on:
- Influence of childhood ear infections on behavior and family stress.
- Posttraumatic stress disorder following childhood traffic injuries.
- Racial disparities in receipt of hormone replacement therapy.
- Improved sexual functioning after hysterectomy.
- Improving women's health care.
- Safety of lipid-lowering medications.
- Benefits of surgery for peripheral vascular disease.
- Outcome of elderly patients hospitalized for fainting.
- Using hospital data to track state CHIP efforts.
- Costly turnover of primary care physicians.
- TQM efforts to improve CABG surgery outcomes.
- Improving quality of care in emergency departments.
- Influence of patient education in evaluating physician performance.
- Middle-aged children caring for elderly parents.
- Nursing home quality of care.
- Predicting length of survival in women with HIV.
For additional information, contact AHRQ Public Affairs, (301) 427-1364: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).