Research Activities, January 2014
Berkman, N.D., Lohr, K.N., Morgan, L.C., and others (2013). "Interrater reliability of grading strength of evidence varies with the complexity of the evidence in systematic reviews." (AHRQ Contract No. 290-07-11056). Journal of Clinical Epidemiology 66, pp. 1105-1117.
The researchers examined the consistency (interrater reliability) of applying guidance for grading strength of evidence in systematic reviews for the AHRQ Evidence-based Practice Center Program. They found that current instructions may be sufficient for straightforward quantitative evaluations that use meta-analysis for summarizing findings of randomized controlled trials. In contrast, agreement suffered when evaluations did not lend themselves to meta-analysis and reviewers needed to rely on their own qualitative judgment.
Brooks, J.M., and Ohsfeldt, R.L. (2013, August). "Squeezing the balloon: Propensity scores and unmeasured covariate balance." (AHRQ grants HS16094, HS18381). HSR: Health Services Research 48(4), pp. 1487-1495.
This study assessed the covariate balancing properties of propensity score-based algorithms in which covariates affecting treatment choice are both measured and unmeasured. It found that if the unmeasured covariates affecting treatment choice are confounders, propensity score methods can exacerbate the bias in treatment effect estimates.
Brown, J.S., Kahn, M., and Toh, S. (2013, August). "Data quality assessment for comparative effectiveness research in distributed data networks." (AHRQ grants HS19912, HS19908). Medical Care 51(8) Suppl 3, S22-S29.
Distributed data networks that combine information from multiple sources are needed to generate evidence about the real-world effectiveness, safety, and quality of medical care. The authors provide a set of field-tested best practices and a set of recommendations for data quality checking for comparative effectiveness research in distributed data networks.
Budge, P.J., Lazensky, B., Elliott, K.E., and others (2013, April). "Primary amebic meningoencephalitis in Florida: A case report and epidemiological review of Florida cases." (AHRQ grant T32 HS13833). Journal of Environmental Health 75(8), pp. 26-31.
The researchers describe a fatal case of primary amebic meningoencephalitis in a resident of northeast Florida and the ensuing public health investigation. They highlight the positive collaborations that developed in this joint investigation among State and local environmental health specialists and epidemiologists and the CDC.
Devine, E.B., Alfonso-Cristancho, R., Devlin, A., and others (2013). "A model for incorporating patient and stakeholder voices in a learning health care network: Washington State's Comparative Effectiveness Research Translation Network." (AHRQ grant HS20025). Journal of Clinical Epidemiology 66, pp. S122-S129.
The authors describe a multisite, longitudinal, prospective, observational cohort study grounded in patient-centered outcomes research and conducted by Washington State's Comparative Effectiveness Research Translation Network. They outline the ways in which patients and other stakeholders are being incorporated into all aspects of research to compare invasive and noninvasive treatments for peripheral arterial disease, and describe how results are being incorporated into practice.
Doshi, P. (2013). "Influenza vaccines. Time for a rethink." (2013). (AHRQ grant T32 HS19488). JAMA Internal Medicine 173(11), pp. 1014-1016.
The author challenges basic assumptions behind the treatment of influenza as a major public health threat. He argues that the evidence that influenza represents a threat of public health proportions is questionable, the evidence that influenza vaccines reduce important outcomes such as mortality is unreliable, and the assumption that past influenza vaccine safety is predictive of future experience is unsound.
Haukoos, J.S., and Hopkins, E. (2013, March). "Understanding HIV screening in the emergency department: Is perception reality?" (AHRQ grant HS17260). Academic Emergency Medicine 20(3), pp. 309-312.
Understanding how to best integrate routine HIV screening into emergency care remains a critical next step for emergency medicine. The author discusses two articles appearing in the same issue that use qualitative methodology to better understand clinician and patient understanding of routine HIV screening in the emergency department. He believes that additional research is required to better understand how opt-out consent mechanisms are interpreted. For now, clinicians and program administrators must be careful in how they incorporate opt-out consent into screening programs.
Hernandez, A.F. (2013, July 3). "Preventing heart failure." (AHRQ grant HS16964). Journal of the American Medical Association 310(1), pp. 44-45.
The author discusses an article in the same issue on St. Vincent's Screening To Prevent Heart Failure (STOP-HF) trial. The STOP-HF trial focused on measuring B-type natriuretic peptide in a population with cardiovascular risk factors. The trial also compared collaborative care with usual care. Finally, there is a discussion of the issues raised by the trial, as well as its limitations and the lessons to be learned from improving heart failure prevention strategies.
Hollingworth, J.M., Rogers, M.A.M., Krein, S.L., and others (2013). "Determining the noninfectious complications of indwelling urethral catheters." (AHRQ grant HS20927). Annals of Internal Medicine 159, pp. 401-410.
Since little is known about noninfectious complications resulting from urethral catheter use, the researchers conducted a systematic review, identifying all published studies describing such complications. After performing their meta-analysis, they determined that many noninfectious catheter-associated complications are at least as common as clinically significant urinary tract infections.
Jiang, X., Sarwate, A.D., and Ohno-Machado, L. (2013, August). "Privacy technology to support data sharing for comparative effectiveness research: A systematic review." Medical Care 51(8), Suppl 3, pp. S58-S65.
The researchers reviewed existing and emerging techniques that may be appropriated for data sharing related to comparative effectiveness research (CER). Their systematic review, limited to methods that demonstrated practical impact and to data sharing for data tables, concluded that state-of-the-art privacy-preserving techniques can guide the development of practical tools that will scale up the CER studies of the future.
Johnson, T.J., and King, C. (2013, March). "An 11-year-old girl with right-sided weakness secondary to cerebral abscesses: A case report." (AHRQ grant T32 HS17587). Pediatric Emergency Care 29(3), pp. 360-363.
This report documents a case in which a previously healthy 11-year-old girl, who came to the emergency department with 8 days of headache and right-sided weakness, was found to have two cerebral abscesses. The authors review the clinical presentation, evaluation, and management of this unusual but potentially life-threatening condition.
Kim, K.K., McGraw, D., Mamo, L., and Ohno-Machado, L. (2013, August). "Development of a privacy and security policy framework for a multistate comparative effectiveness research network." (AHRQ grant HS19913). Medical Care 51(8), Suppl 3, pp. S66-S72.
This article describes the initial development of a flexible, ethical policy framework to govern the Scalable National Network for Effectiveness Research. The project's goal is to develop and demonstrate a scalable, flexible technical infrastructure for distributed research networks that enable real-time comparative effectiveness research.
Lyles, C.R., Lopez, A., Pasick, R., and Sarkar, U. (2013). "5 mins of uncomfyness is better than dealing with cancer 4 a lifetime: An exploratory qualitative analysis of cervical and breast cancer screening dialogue on Twitter." (AHRQ grant HS17594). Journal of Cancer Education 28, pp. 127-133.
Little is known about health behavior discussions on Twitter, a "micro-blogging" Web site. The authors retrieved publicly available Twitter messages during a 5-week period related to the terms "Pap smear" and "mammogram." Their analysis of 474 messages using one term or the other demonstrated that Twitter can be a rich source of information and could be used to design new health-related interventions.
Mathias, J.S., Agrawal, A., Feinglass, J., and others (2013). "Development of a 5 year life expectancy index in older adults using predictive mining of electronic health record data." (AHRQ grant T32 HS00078). Journal of American Medical Informatics Association 20, pp. e118-e124.
The authors used predictive data mining and high dimensional analytics of electronic health record (EHR) data to develop a highly accurate and clinically actionable 5-year life expectancy guide. Their EHR based index successfully distinguished adults age 50 and over with life expectancy of 5 years or greater from those with a life expectancy of 5 years or less. This information could be used clinically to optimize preventive service use (e.g., cancer screening in the elderly).
Ogunyemi, O.I., Meeker, D., Kim, H-E. (2013). "Identifying appropriate reference data models for comparative effectiveness research (CER) studies based on data from clinical information systems." (AHRQ grant HS19913). Medical Care 51(8), Suppl 3, pp. S45-S52.
The authors examine the challenges associated with representing and mapping data for analyses in CER studies that use data taken from multiple electronic health records and associated data warehouses. They further assess the impact of having a common data model on the approach to data collection and exchange. They also present an evaluation of the modeling challenges and data or information loss that can occur when using different existing data models.
Palson, O.S., and Whitehead, W.E. (2013). "Psychological treatments in functional gastrointestinal disorders: A primer for the gastroenterologist." (AHRQ grant HS18695). Clinical Gastroenterology and Hepatology 11, pp. 208-216.
This article aims to identify and describe the forms of psychological treatment that show evidence of effectiveness in functional gastrointestinal disorders (FGIDs). In addition, it summarizes the empirical evidence for their effectiveness, explains how to find a suitable local provider, characterizes which FGID patients should be considered for referral, and describes how to make an effective referral.
Puskarich, M.A., Trzeciak, S., Shapiro, N.I., and others (2013, June). "Whole blood lactate kinetics in patients undergoing quantitative resuscitation for severe sepsis and septic shock." (AHRQ grant HS18519). Chest 143(6), pp. 1548-1553.
The researchers compared the association of whole-blood lactate kinetics with survival in patients with septic shock undergoing early quantitative resuscitation. They concluded that in patients in the emergency department with a sepsis diagnosis, early lactate normalization during the first 6 hours of resuscitation was the strongest independent predictor of survival and was superior to other measures of lactate kinetics.
Reed, M., Huang, J., Brand, R., and others (2013). "Implementation of an outpatient electronic health record and emergency department visits, hospitalizations, and office visits among patients with diabetes." (AHRQ grant HS15280). Journal of the American Medical Association 310(10), pp. 1060-1065.
The researchers examined the association between implementing a commercially available outpatient electronic health record (EHR) and emergency department (ED) visits, hospitalizations, and office visits for patients with diabetes mellitus. They found that use of an outpatient EHR in an integrated delivery system was associated with modest reductions in ED visits and hospitalizations, but not office visits.
Ryan, G.J., Cuadle, J.M., Rhee, M.K., and others (2013, September). "Medication reconciliation: Comparing a customized medication history form to a standard medication form in a specialty clinic (CAMPII 2)." (AHRQ grant HS18230). Journal of Patient Safety 9(3), pp. 160-168.
In a crossover prospective study, researchers compared the accuracy and acceptability of a "fill-in-the-blank" medication history form (USUAL) to a customized form that contained a checklist of the 44 most frequently prescribed diabetes clinic medications. They found that medication self-report is very poor, and few subjects created an accurate list on either form. There were no differences in overall accuracy between the customized form and USUAL.
Sarfaty, M., Stello, B., Johnson, M., and others (2013). "Colorectal cancer screening in the framework of the medical home model: Findings from focus groups and interviews." (AHRQ Contract No. 290-06-00014). American Journal of Medical Quality 28(5), pp. 422-428.
This article summarizes the qualitative data that bear on the survey findings presented in an earlier paper on colorectal cancer screening in 15 primary care practices. Key points in the earlier article were the underuse of evidence-based systems such as reminders, test tracking, and rescheduling. The qualitative data reinforce those findings by showing the lack of office policies or systems.
Toh, S., Gagne, J.J., Rassen, J.A., and others (2013, August). "Confounding adjustment in comparative effectiveness research conducted within distributed research networks." (AHRQ grants HS19912, HS18088). Medical Care 51(8), Suppl 3, S4-S10.
The researchers describe the strengths and limitations of different confounding adjustment approaches that can be considered in observational comparative effectiveness research studies conducted within distributed research networks. The use of appropriate methods that incorporate confounder summary scores allows investigators to perform many analyses traditionally conducted through a centralized dataset with detailed patient-level information.
Wang, J.J., Sebek, K.M., McCullough, C.M., and others (2013, August). "Sustained improvement in clinical preventive service delivery among independent primary care practices after implementing electronic health record systems." (AHRQ grants HS17059, HS17294). Preventing Chronic Disease. Public Health Research, Practice, and Policy 10, pp. E130.
This study examines the continued improvement in clinical quality measures for a group of independent primary care practices using electronic health records and receiving technical support from a local public health agency. It found that during 2 years practices showed significant improvement in the delivery of antithrombotic therapy, blood pressure control, smoking cessation intervention, and hemoglobin A1c testing.
Wu, H-Y., Karnik, S., Subhadarshini, A., and others (2013). "An integrated pharmacokinetics ontology and corpus for text mining." (AHRQ grant HS19818). BMC Bioinformatics 14, p. 35.
From either database construction or literature mining, the main challenge of pharmacokinetics (PK) data integration is the lack of PK ontology. This paper develops a PK ontology that can annotate all aspects of in vitro PK experiments and in vivo PK studies. It then constructs a PK corpus to present four classes of PK abstracts.
Yoon, S., Elhadad, N., and Bakken, S. (2013). "A practical approach for content mining of tweets." (AHRQ grant HS18953). American Journal of Preventive Medicine 45(1), pp. 122-129.
This paper describes a practical approach to analyzing Tweet contents and illustrates an application of the approach to the topic of physical activity. The approach includes five steps: (1) selecting keywords to gather an initial set of Tweets to analyze; (2) importing data; (3) preparing data; (4) analyzing data topic, sentiment, and ecologic context; and (5) interpreting data.
Yu, Z., Liu, L., Bravata, D.M., and others (2013). "A semiparametric recurrent events model with time-varying coefficients." (AHRQ HS20263). Statistics in Medicine 32, pp. 1016-1026.
The authors consider a recurrent events model with time-varying coefficients motivated by two clinical applications. They use a random effects model to describe the intensity of recurrent events and a penalized spline method to estimate the time-varying coefficients. Next, they use Laplace approximation to evaluate the penalized likelihood without a closed form. After further steps, they apply their method to analyze two data sets: a stroke study and a child wheeze study.
Yudkowsky, R., Luciano, C., Banerjee, P., and others (2013). "Practice on an augmented reality/haptic simulator and library of virtual brains improves residents' ability to perform a ventriculostomy." (AHRQ grant HS17361). Simulation in Healthcare 8(1), pp. 25-31.
The researchers, using computed tomographic scans of actual patients and developed a library of 15 virtual brains for a ventriculostomy simulator. They used this library to permit repeated deliberate practice on cases that exhibit a range of normal and abnormal anatomies, and studied the impact of simulator practice on both simulated and live surgical performance.