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Eng, J., Krishnan, J.A., Segal, J.B., and others (2004, December). "Accuracy of CT in the diagnosis of pulmonary embolism: A systematic literature review." (AHRQ contract 290-97-0006). American Journal of Radiology 183, pp. 1819-1827.
With the advent of high-speed helical scanners in the early 1990s, it became possible to examine the pulmonary arteries for emboli using computerized tomography (CT). These authors reviewed the available evidence on this technology—including both systematic reviews and primary studies—and found a moderate amount of variation in the reported sensitivity of CT angiography for the diagnosis of pulmonary embolism. Sensitivity ranged from 45 percent to 100 percent, with only three of eight primary studies reporting a sensitivity above 90 percent. Reported specificity was generally greater than 90 percent with less variability. MDCT—a significant technical advance that involves use of four or more detectors—allows visualization of finer pulmonary vascular detail and provides potentially greater diagnostic accuracy, but systematic evaluations of this technology are not yet available.
Fouad, M.N., Mayo, C.P., Funkhouser, E.M., and others (2004). "Comorbidity independently predicted death in older prostate cancer patients, more of whom died with than from their disease." (AHRQ grant HS09446). Journal of Clinical Epidemiology 57, pp. 721-729.
This study involved 561 men with prostate cancer from one Alabama county who were older than 65 when they died during the period 1993-1995. About one-third (37 percent) of white men and 50 percent of black men died from prostate cancer, while the remainder died from other causes. Increasing age was associated with less likelihood of prostate cancer as the cause of death, as was white race and a greater number of coexisting medical conditions. Prostate cancer treatment did not independently affect the cause of death (that is, death with versus from prostate cancer). For the study, the researchers cross-linked death certificate, Medicare, and VA databases and reviewed medical records to rate the men's coexisting medical conditions and determine whether or not death was due to prostate cancer.
Gray, D.T. (2004, November). "Neonatal circumcision: Cost-effective preventive measure or "the unkindest cut of all'?" Medical Decision Making, 24, pp. 688-692.
Neither the American Academy of Pediatrics nor the Canadian Pediatric Society still recommends circumcision as a routine procedure. They recommend that if circumcision is performed, the procedure be accompanied by documented informed consent and adequate analgesia. Administrative data from AHRQ's Healthcare Cost and Utilization Project indicate that 1.2 million males (59 percent of all male newborns and 86 percent of those without a complicating diagnosis) were circumcised at birth in 2000. This author reviews several cost-effectiveness analyses of circumcision. He points out that such studies should explicitly consider the importance of various sociocultural and other issues that may not be fully captured in quantitative analyses. If cost-effectiveness analysis does not justify the procedure, then the next step may be to address the degree to which finite societal health care resources should be expended for a procedure performed primarily for sociocultural and religious reasons. Reprints (AHRQ Publication No. 05-R029) are available from the AHRQ Publications Clearinghouse.
Gurvitz, M., Chang, R.K., Drant, S., and Allada, V. (2004). "Frequency of aortic root dilation in children with a bicuspid aortic valve." (AHRQ grant HS13217). American Journal of Cardiology 94, pp. 1337-1340.
Bicuspid aortic valve (BAV) is associated with aortic root dilation and dissection in adults, but the age and conditions when dilation begins are unknown. Using echocardiographic data, these investigators compared the aortic root dimensions and valve hemodynamics of 76 children with BAV with those of 41 children without BAV. They found that children with an isolated BAV had aortic roots that were larger than normal at all of the measured anatomic levels, regardless of the presence of aortic stenosis or regurgitation. The dilation was most pronounced in the tubular portion of the ascending aorta.
Johnson-Masotti, A.P., Laud, P.W., Hoffmann, R.G., and others (2004, November). "A Bayesian approach to net health benefits: An illustration and application to modeling HIV prevention." (AHRQ grant HS11364). Medical Decision Making 24, pp. 634-653.
These authors used Bayesian analysis to estimate the incremental net health benefit (INHB) to seriously mentally ill men of advocacy training. The training group was compared with a control group in a randomized trial of HIV prevention. Advocacy training involved seven group sessions teaching effective communication strategies for disseminating HIV prevention messages to friends and acquaintances. Control conditions involved a one-on-one HIV/AIDS risk reduction education program. Using a Bernoulli model of HIV transmission, the authors converted changes in the participants' risk behaviors into the number of HIV infections averted. The authors obtained a positive mean INHB of 0.0008, indicating that advocacy training was just slightly favored over the control condition, assuming a $50,000 per quality-adjusted life year threshold.
Maslow, J.N., Lautenbach, E., Glaze, T., and others (2004, September). "Colonization with extraintestinal pathogenic Escherichia coli among nursing home residents and its relationship to fluoroquinolone resistance."(AHRQ grant HS10399). Antimicrobial Agents and Chemotherapy 48(9), pp. 3618-3620.
Nursing home residents are at greater risk than others for developing urinary tract and bloodstream infections. These infections are often caused by a type of gram-negative bacteria (GNB), extraintestinal pathogenic Escherichia coli (ExPEC). GNB resistance to antibiotics is a growing problem among nursing home residents. Resistance to the fluroquinolone (FQ) class of antibiotics, commonly prescribed for E. coli, is also a growing problem. This study found that 59 percent of fecal samples of 49 residents of a Veterans Affairs nursing home were colonized with ExPEC, 22 percent were colonized with adhesin-positive E. coli, and 51 percent were colonized with FQ-resistant E. coli.
Mayer, M.L., and Skinner, A.C. (2004, December). "Too many, too few, too concentrated? A review of the pediatric subspecialty workforce literature." (AHRQ grant HS13309). Archives of Pediatric and Adolescent Medicine 158, pp. 1158-1165.
Improved survival rates among very premature infants and children with previously fatal childhood illnesses, such as cystic fibrosis, may lead to increased need for pediatric subspecialists. Yet, little is known about the distribution of the pediatric subspecialty workforce relative to the demand for their services, according to this review of literature on the topic. Of 41 studies, only 8 attempted to make future workforce projections, and only 1 explicitly accounted for non-clinical activities in its projections. While some studies suggested that additional pediatric subspecialists are not needed, these studies did not include objective assessments of demand in geographic areas where pediatric subspecialty physicians are not available.
Ondategui-Parra, S., Bhagwat, J.G., Zou, K.H., and others (2004). "Practice management performance indicators in academic radiology departments." (AHRQ grant HS13234). Radiology 233, pp. 716-722.
Assessing departmental performance with a wide range of management indicators is not yet an established and standardized practice in academic radiology departments in the United States, according to this study. The researchers sent a survey to members of the Society of Chairmen of Academic Radiology Departments. The survey examined six categories of practice management performance indicators ranging from general organization to radiology reporting and customer satisfaction. The most frequently used performance indicators were: productivity (78 percent), report turnaround (82 percent) and transcription time (71 percent), appointment access to magnetic resonance imaging (80 percent), patient satisfaction (84 percent), and expenses (67 percent).
Radwin, L.E., Washko, M., Suchy, K.A., and Tyman, K. (2005). "Development and testing of four desired health outcomes scales." (AHRQ grant HS11625). Oncology Nursing Forum 32(1), pp. 92-96.
This study provides preliminary evidence of acceptable psychometric properties for four scales designed to measure desired outcomes of cancer nursing care. The four scales include: Fortitude Scale, Trust in Nurses Scale, Cancer Patient Optimism Scale, and Authentic Self-Representation Scale. Sixty-six recently treated cancer patients who attended a cancer support organization workshop responded to the four scales. Responses showed reliability for each scale: 0.81 for the Fortitude Scale; 0.81 for the Trust in Nurses Scale; 0.75 for the Cancer Patient Optimism Scale, and 0.71 for Authentic Self-Representation Scale. The authors recommend further psychometric testing of the scales with large samples.
Ramos, B.M. (2004, December). "Culture, ethnicity, and caregiver stress among Puerto Ricans." (AHRQ grant HS08641). Journal of Applied Gerontology 23(4), pp. 469-486.
The author conducted focus groups in Spanish with 68 Puerto Rican female caregivers who were providing care for older relatives in community settings. Subjects talked about caregiving stressors and how they viewed and coped with the stressors. Most of the women lived in poverty and constantly struggled to make ends meet. They found caregiving difficult because of their limited English and unfamiliar environment. Many were caring for highly dependent elderly relatives, whose debilitating conditions required intense day-to-day care. As a result, some women could hold only part-time jobs or could not work at all. Since in the Puerto Rican culture, women are counted on to keep smooth family relations, the caregivers invariably identified interpersonal relationships as a major source of stress. Despite these problems, the caregivers unanimously viewed caregiving as rewarding and positive, which may have lessened their stress. Many appeared to cope with resignation. Religion and spiritual practices were the most commonly reported coping strategies, and the church was viewed as crucial for social support.
Wataganara, T., Peter, I., Messerlian, G.M., and others (2004, September). "Inverse correlation between maternal weight and second trimester circulating cell-free fetal DNA levels." (AHRQ grant T32 HS00060). Obstetrics & Gynecology 104(3), pp. 545-550.
Clinical applications of the analysis of cell-free fetal DNA in maternal plasma and serum are expanding. However, use of fetal DNA during prenatal screening requires knowledge of variables that might affect its levels in the maternal circulation. This study found, for example, that fetal DNA levels are affected by maternal weight in the second trimester. The investigators developed a database that included previously measured fetal DNA levels and newly acquired clinical information on women in their second and third trimesters, such as maternal age, weight, and smoking history. They observed no significant associations between maternal factors studied and plasma fetal DNA levels in the first trimester group. However, they found a significant inverse correlation between maternal weight and serum fetal DNA level in the second trimester group.
Current as of March 2005
AHRQ Publication No. 05-0062