EHC Program Inside Track Newsletter

Issue 16, July 2013

EHC Inside Track is a newsletter highlighting important news and developments from AHRQ's Effective Health Care Program.

In this issue:

 

AHRQ Report: For Preventing Childhood Obesity, Combining Strategies Works Best

A new evidence review from AHRQ’s Effective Health Care (EHC) Program has broadened understanding of obesity prevention in children, underscoring the need for a combination of school- and community-based programs to help kids maintain a healthy weight.

The report, Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis, concluded that the most effective prevention programs focus on both diet and exercise in communities where children live and go to school.

Overweight children and adolescents are at greater risk for health problems than their normal weight counterparts and are more likely to become obese adults. This is a growing concern for health care providers and for parents of children and adolescents due to the increased likelihood of developing serious health conditions.

The AHRQ report analyzed childhood obesity interventional studies that aimed to improve diet, physical activity, or both in many settings including schools, homes, primary care clinics, child care settings, the community, and combinations of these settings in high-income countries. More than 80 percent of the studies were conducted in school-based settings.

One of the report authors, Nakiya N. Showell, M.D., MPH, of the AHRQ-funded Johns Hopkins University Evidence-Based Practice Center, said the obesity prevention research project combined with her other ongoing research and clinical experience have broadened her perspective and changed the way she counsels her patients and their families.

Said Showell: "I’m not just saying to my patients that you need to limit your screen time, play outdoors, and eat fresh fruits and vegetables every day without asking questions like—‘Where do you buy food? Are you able to get healthy foods where you live? Can your child get a healthy meal at school? Are you able to pack a lunch for your child?’ I’m starting to ask the questions first before I give the guidance and tailoring my counseling because I have a better understanding of what could affect one’s obesity risk."

The report concluded that combining diet and physical activity programs may help reduce the occurrence of overweight and obesity in children in several scenarios – when interventions were used in the school with a home or community component, in the school with a home and community component, and in the community with a school component.

Programs directed at the environment to improve food intake (i.e., healthier diet) or increase physical activity are generally positive, the report found. However, the effectiveness of interventions primarily implemented at home, in primary care medical settings, and child-care settings or those using consumer health informatics approaches is largely unknown.

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Nurses Go Online to Discuss Comparative Effectiveness Research

A new online discussion forum on the allnurses.com Web site provides an overview of the Effective Health Care (EHC) Program while offering a chance for nurse practitioners, nurses, and others to highlight topics and share views on issues related to nursing and clinical care.

Current posts include an introduction to the EHC Program, patient education in nursing care, and a continuing education activity on understanding comparative effectiveness research and its applicability to practice. Future discussion topics will include continuing education, health literacy, and clinical effectiveness in priority conditions. All posts include links to EHC Program resources.

The forum’s goals are to engage the nursing community at-large, foster dialogue, and provide updates on evidence-based resources designed to support continuing education and patient care.

"Nurses have a long history of providing patient-centered and evidence-based care. The forum is a great place to discuss, learn from, and provide input into the EHC Program resources," said Beth A. Collins Sharp, PhD, RN, senior advisor, Women's Health and Gender Research, and senior advisor for nursing at AHRQ. "With the forum, we now have a modern – and fun – tool to engage with nurses and promote our mutual goals of high-quality, evidence-based health care."

Clinicians or professional groups seeking to spread the word about the allnurses.com forum should contact EHC_Outreach@ahrq.hhs.gov for sample newsletter articles and social media posts.

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More New, Free Effective Health Care Program Resources

The following evidence reviews compared available evidence from numerous research studies

Current Evidence Is Inconclusive to Recommend for or Against the Use of Oral Contraceptives for the Prevention of Ovarian Cancer; Future Research is Needed

More evidence is needed to recommend for or against the use of oral contraceptives solely for the prevention of ovarian cancer. This new report from AHRQ, in partnership with the Centers for Disease Control and Prevention (CDC), included a systematic review and simulation modeling. It finds that the use of oral contraceptives may increase life expectancy by one month when noncontraceptive benefits are included (e.g., reduced deaths from ovarian, colorectal, and endometrial cancers). However, the harm-benefit ratio of oral contraceptives for ovarian cancer prevention alone is uncertain when the increased risk of breast cancer, cervical cancer, and cardiovascular events associated with oral contraceptive use are taken into consideration. More well-designed research studies are needed to determine whether the use of oral contraceptives solely to prevent ovarian cancer can be recommended when considering their demonstrated risks. Read the full research review here: Oral Contraceptive Use for the Primary Prevention of Ovarian Cancer.

MRSA: Screening Strategies in Health Care Settings

According to a research review funded by AHRQ, there is not enough evidence in the available literature to compare the effectiveness of screening strategies for methicillin-resistant Staphylococcus aureus (MRSA) in select patient populations. The review finds that there is low strength of evidence that screening all hospitalized patients (universal screening) for MRSA bacteria decreases hospital-acquired MRSA infections compared with no screening. However, there is not enough evidence to draw conclusions on the effectiveness of universal MRSA screening strategies on other outcomes, including the risk of death and other potential harms. Ultimately, the review underscores the need for additional well-designed studies that take into account factors that may complicate results.

After the completion of this EHC Program report, an AHRQ-funded project on different approaches to reduce MRSA infection was published in the May 30, 2013, online issue of the New England Journal of Medicine. In that study, researchers achieved a 44 percent reduction in all-cause bloodstream infections and significantly reduced the presence of MRSA when they decolonized every patient who entered the ICU, regardless of MRSA status. AHRQ funds numerous research projects to identify the best approaches for reducing MRSA and other health care-associated infections. The findings are available in the research review, Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA).

Nonsurgical Therapies for Lung Cancer

A new research review from the AHRQ finds that there is not enough evidence in the available literature to determine the comparative effectiveness of local, nonsurgical therapies to treat patients with stage I non-small cell lung cancer (NSCLC) or patients with airway obstruction from advanced lung tumors. Ultimately, more research is needed, especially considering that NSCLC is the leading cause of cancer-related mortality in the United States and worldwide. Read the full research review here: Local Nonsurgical Therapies for the Treatment of Stage I Non-Small Cell Lung Cancer and Endobronchial Obstruction Due to Advanced Lung Tumors.

Heart Conditions: Rate-Control and Rhythm-Control Treatment Strategies for Atrial Fibrillation

According to the latest research review from AHRQ, strategies to slow the heart rate to a normal range (rate control) are similar to strategies to revert the heart rhythm back to normal (rhythm control) when looking at all-cause mortality, cardiovascular mortality, and stroke in older patients with mild symptoms from atrial fibrillation. However, the review shows that rate-control strategies are superior to rhythm-control strategies in reducing hospitalizations from cardiovascular events in these patients. There is a high strength of evidence showing the benefit of calcium channel blockers (verapamil or diltiazem) compared with digoxin for ventricular rate control. The review also finds a high strength of evidence that use of a single biphasic waveform is more effective than use of a single monophasic waveform for electrical cardioversion for conversion to sinus rhythm. There is also a high strength of evidence supporting pulmonary vein isolation versus antiarrhythmic drugs for maintaining sinus rhythm in a select subset of patients. Because of the wide range of options within each strategic treatment approach for atrial fibrillation, additional studies are needed to evaluate the comparative safety and effectiveness of individual antiarrhythmic medications and procedures. These findings and others can be found in the full review, Treatment of Atrial Fibrillation.

Migraine in Children: Beta Blocker Propranolol May Help, But More Research is Still Needed

New AHRQ research finds limited evidence on the benefits and harms of migraine preventive drugs in children, as reporting quality of migraine studies involving children is poor with few trials providing detailed information. However, low strength evidence suggests that the beta blocker propranolol is more effective than a placebo for preventing migraine in children, with no bothersome negative effects that could lead to treatment discontinuation. The review finds non-drug treatments such as stress management, demonstrated better benefit-to-harm ratios than drugs treatments in head-to-head randomly controlled trials. These findings can be found in the full review, Migraine in Children: Preventive Pharmacologic Treatments.

Other New Research

Radiation Treatments Show Similar Results in Prostate Cancer Patients After Surgery

According to new research from AHRQ’s DEcIDE Network published in JAMA Internal Medicine on May 20, 2013, for prostate cancer patients who require radiotherapy following prostatectomy, the prostate cancer therapies intensity-modulated radiotherapy (IMRT) and conformal radiotherapy (CRT) achieved similar morbidity and cancer control results. Men who received IMRT versus CRT showed no significant difference in rates of long-term gastrointestinal morbidity, urinary nonincontinent morbidity, urinary incontinence, or erectile dysfunction. There was also no significant difference in subsequent treatment for recurrent disease. IMRT is a newer and more costly treatment option for post-prostatectomy patients with adverse pathology results or recurrent disease. It remains unclear whether the potential benefits of a more focused radiation technique will be realized in terms of improving outcomes of men with localized prostate cancer after prostatectomy.

To learn more, access the report here: Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy.

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Current as of July 2013
Internet Citation: EHC Program Inside Track Newsletter: Issue 16, July 2013. July 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/insidetrack/16/index.html