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Four new evidence reports were released recently by the Agency for Healthcare Research and Quality. They present the results of systematic reviews of the evidence on weaning from mechanical ventilation, disability in patients with chronic renal failure, management of acute otitis media, and management of new onset atrial fibrillation. The reports were prepared by Evidence-based Practice Centers (EPCs) supported by the Agency for Healthcare Research and Quality. They provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies.
There are 12 AHRQ-supported EPCs; they systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. The goal is to inform health plans, providers, purchasers, and the health care system as a whole by providing essential information to improve health care quality.
Copies of the evidence report summaries are now available from the AHRQ Publications Clearinghouse. Copies of the full evidence reports will be available in the near future.
Criteria for Weaning from Mechanical Ventilation
Mechanical ventilation refers to the use of life-support technology to perform the work of breathing for patients who are unable to do so on their own. The majority of critically ill patients in most modern intensive care units require a period of this treatment. The use of prolonged mechanical ventilation is associated with hospital-acquired pneumonia, cardiac-associated morbidity, and death. On the other hand, premature discontinuation of mechanical ventilation also incurs a substantial risk of reintubation and other complications.
This evidence report, which was developed for AHRQ by the McMaster University Evidence-based Practice Center (contract 290-97-0017), focuses on issues related to weaning patients from mechanical ventilation. In preparing the report, the EPC addressed the following questions:
- When should weaning be initiated?
- What criteria should be used to initiate the weaning process?
- What are the most effective methods of weaning from mechanical ventilation?
- What are the optimal roles of non-physician health care professionals in facilitating safe and expeditious weaning?
- What is the value of clinical practice algorithms and computers in expediting weaning?
In addition to answering these questions, the report also presents background information, describes the methodology used by the EPC, and identifies a number of priorities for future research on mechanical ventilation.
Copies of the summary (AHRQ Publication No. 00-E028) are available from the AHRQ Publications Clearinghouse. The full evidence report (AHRQ Publication No. 00-E029) is expected to be available by late summer 2000.
Determinants of Disability in Patients with Chronic Renal Failure
The purpose of this report, which was prepared for AHRQ by ECRI of Plymouth Meeting, PA (contract 290-97-0020), is to evaluate the Social Security Administration's current Listing of Impairments for determining disability in individuals with chronic renal failure. Renal failure occurs when the kidneys lose their ability to filter wastes from the blood. It can occur as a result of chronic conditions such as primary kidney disease, diabetes, hypertension, and heart disease. Renal failure can also be acute, occurring from a sudden injury or illness, such as a blow to the abdomen, bacterial infection, or a drug overdose.
This report is concerned with chronic renal failure, which is much more common than acute renal failure, and focuses solely on patients who are undergoing dialysis. It presents background information, the methodology and parameters used in collecting evidence, the results of the review, and a discussion of future research needs.
Copies of the report summary (AHRQ Publication No. 00-E012) are available from the AHRQ Publications Clearinghouse. Copies of the full report (AHRQ Publication No. 00-E013) are expected to be available by late summer 2000.
Management of Acute Otitis Media
This report presents an analysis of the available scientific evidence on the initial management of uncomplicated acute otitis media (AOM) in children ages 4 weeks to 18 years. For the purposes of this report, AOM is defined as the presence of middle-ear effusion in conjunction with the rapid onset of one or more signs or symptoms of inflammation of the middle ear. Uncomplicated AOM is defined as AOM that is limited to the middle ear cleft. The scope of the evidence report is limited to three key clinical questions:
- What is the natural history of AOM without antibiotic treatment?
- Are antibiotics effective in preventing clinical failure?
- What is the relative effectiveness of specific antibiotic regimens?
The EPC presents background information about AOM, discusses the methodology used in developing the report, discusses the effects of antibiotics on AOM, compares the relative effects of different antibiotic regimens, and discusses the limitations of the literature. This evidence report was developed for AHRQ by the Southern California Evidence-based Practice Center (contract 290-97-0001).
Copies of the report summary (AHRQ Publication No. 00-E008) are available from the AHRQ Publications Clearinghouse. Copies of the full report are expected to be available by late summer 2000.
Management of New Onset Atrial Fibrillation
Atrial fibrillation (AF) is the most common arrhythmia physicians face in clinical practice, accounting for about one-third of hospitalizations for arrhythmia. This evidence report, which was developed for AHRQ by the Johns Hopkins University Evidence-based Practice Center (contract 290-97-0006), was prepared to synthesize the available scientific evidence that should be used to guide clinicians in their management of patients with new onset atrial fibrillation. It is limited to first-line strategies for use in patients with this condition. It identifies a set of key questions used to guide the review, describes the methodology used by the EPC, presents the results of the review and the meta-analysis and decision analysis, and presents a set of research topics to guide future studies.
Copies of the report summary (AHRQ Publication No. 00-E006) are available from AHRQ Publications Clearinghouse. Copies of the full report (AHRQ Publication No. 00-E007) are expected to be ready by winter 2000.
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