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AHRQ issues new evidence reports on responding to bioterrorism and use of fish oil supplements to fight heart disease

The Agency for Healthcare Research and Quality has published new evidence reports that focus on bioterrorism preparedness and response, training of hospital staff to respond to a mass casualty incident, and use of fish oil to help fight heart disease. The reports were developed by AHRQ-supported Evidence-based Practice Centers (EPCs). There are 13 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.

EPC reports and summaries are published by AHRQ and are available online and through the AHRQ Publications Clearinghouse.

Bioterrorism preparedness and response. Coordinating resources across local and State lines—also known as regionalization—may benefit some bioterrorism preparedness and response capabilities, but more research is needed to find the best ways of coordinating those resources, according to this new evidence report. The report, Regionalization of Bioterrorism Preparedness and Response, identifies three key ways regionalization can make a difference in communities' response.

First, regionalization may help communities with surge capacity—a health care system's ability to rapidly expand beyond normal services—to provide critical response services such as medical care, distribution and dispensing of preventive drugs, outbreak investigation, and emergency management.

Second, regionalization may be the best way for State and local governments to use scarce resources by joining with other communities to develop teams of trained response personnel and maintain supplies of response equipment.

Third, pre-existing agreements and written plans that specify roles, payment, and chain of command may help in coordinating the numerous response organizations likely to be involved. The researchers also found that:

  • Most Federal, State, and local organizations that are likely to be part of a regional response were designed independently or for purposes other than responding to bioterrorism. Efforts to coordinate these organizations for bioterrorism preparedness have only just begun.
  • Supply chain management concepts used in manufacturing are directly relevant to those parts of a bioterrorism response that require the purchasing, inventorying, distributing, and rapid dispensing of needed supplies.
  • Pre-event hospital designation (such as limiting high-cost specialty care to specifically designated hospitals with increased experience in treating severely injured patients) and formalized protocols for pre-hospital and hospital trauma care (such as first responders knowing where and how to rapidly transport exposed patients) contribute to improved patient outcomes.

The report was prepared by a team of researchers led by Dena Bravata, M.D., at AHRQ's Evidence-based Practice Center at Stanford University-University of California, San Francisco. In reviewing the available literature on this topic, the researchers found few evaluations of systems relevant to preparedness and even fewer evaluations of the regionalization of systems relevant to bioterrorism preparedness. They recommend that future research focus on the costs and benefits of regionalization of surveillance, inventory management and distribution systems, and information management.

The report, Regionalization of Bioterrorism Preparedness and Response, Evidence Report/Technology Assessment No. 96 (AHRQ Publication No. 04-E016-1, summary; 04-E016-2, full report) is available from the AHRQ Publications Clearinghouse.

Editor's Note: This report is one of more than 50 studies, workshops, conferences, and other activities funded under the Agency's bioterrorism research portfolio. For more information, select Public Health Preparedness. AHRQ sponsors research that provides the evidence base for tools and resources needed in bioterrorism planning and response.

Training of hospital staff to respond to a mass casualty incident. Disaster scenarios that once seemed merely theoretical have become a disturbing reality and represent a growing threat for a mass casualty incident. There is a clear need to determine the best ways to mitigate the potential impact of a mass casualty incident that could result in multiple casualties that may overwhelm local resources and potentially could involve natural, biological, chemical, nuclear, or other agents.

The Johns Hopkins University EPC reviewed published evidence regarding the usefulness of the following approaches in training staff to respond to a mass casualty incident: hospital disaster drills, computer simulations, and tabletop or other exercises, as well as the methods and tools that have been used in evaluating these approaches.

Their review revealed that the evidence is limited. However, enough studies were available to suggest that hospital disaster drills can help to identify problems with incident command, communications, triage, patient flow, security, and other issues. The evidence also indicated that computer simulations and tabletop and other exercises may help to train key decisionmakers in disaster response. They conclude, however, that the evidence was insufficient to support firm conclusions about specific training methods or the usefulness of reported evaluation methods. They note that future disaster preparedness efforts would benefit from increased reporting of hospitals' experiences in disaster response training.

Training of Hospital Staff to Respond to a Mass Casualty Incident, Evidence Report/Technology Assessment No. 95, is available from the AHRQ Publications Clearinghouse (AHRQ Publication No. 04-E015-1, summary; 04-E015-2, full report).

Use of fish oil to fight heart disease. Fish oil can help reduce deaths from heart disease, according to this new series of evidence reports. The systematic reviews of the available literature found evidence that long chain omega-3 fatty acids, the beneficial component in fish and fish oil supplements, reduce heart attack and other problems related to heart and blood vessel disease in people who already have these conditions, as well as reduce their overall risk of death. Although omega-3 fatty acids do not alter total cholesterol, HDL cholesterol, or LDL cholesterol, evidence suggests that they can reduce levels of triglycerides—a fat in the blood that may contribute to heart disease.

The review also found other evidence indicating that fish oil can help lower high blood pressure slightly, may reduce risk of coronary artery reblockage after angioplasty, may increase exercise capability among patients with clogged arteries, and may possibly reduce the risk of irregular heartbeat—particularly in individuals with a recent heart attack.

The evidence reports on the health effects of omega-3 fatty acids are part of a series conducted by AHRQ-supported Evidence-based Practice Centers at the request of the National Institutes of Health's Office of Dietary Supplements, which plans to use the findings to develop research agendas on the issues. Five reports have been issued so far, and an additional six reports will be issued next year.

Other findings from the AHRQ evidence reviews include:

  • Omega-3 fatty acids do not affect fasting blood sugar or glycosylated hemoglobin in people with type II diabetes, nor do they appear to affect plasma insulin levels or insulin resistance.
  • Alpha-linolenic acid—a type of omega-3 fatty acid from plants such as flaxseed, soybeans, and walnuts—may help reduce deaths from heart disease but to a much lesser extent than fish oil.
  • Based on the evidence to date, it is not possible to conclude whether omega-3 fatty acids help improve respiratory outcomes in children and adults who have asthma.
  • Omega-3 fatty acids appear to have mixed effects on people with inflammatory bowel disease, kidney disease, or osteoporosis and no discernible effect on people who have rheumatoid arthritis.

The evidence reports and EPCs that produced them are as follows:

Tufts-New England Medical Center EPC, Boston

University of Ottawa EPC, Ottawa, Ontario

Southern California EPC, Santa Monica, CA

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