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AHRQ Research Studies
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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 41 Research Studies Displayed
Holcomb CN, Graham LA, Richman JS
The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting.
The investigators sought to determine the incremental risk of noncardiac surgery on myocardial infarction (MI) and coronary revascularization following coronary stenting. They found that the incremental risk of noncardiac surgery on adverse cardiac events among post-stent patients is highest in the initial 6 months following stent implantation and stabilizes at 1.0% after 6 months.
Citation: Holcomb CN, Graham LA, Richman JS . The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting. J Am Coll Cardiol 2014 Dec 30;64(25):2730-9. doi: 10.1016/j.jacc.2014.09.072.
Keywords: Adverse Events, Cardiovascular Conditions, Patient-Centered Healthcare, Risk, Surgery
Bobb JF, Obermeyer Z, Wang Y
Cause-specific risk of hospital admission related to extreme heat in older adults.
The purpose of this study was to identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data. The investigators found that among older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. They noted however, that the absolute risk increase was small and of uncertain clinical importance.
Citation: Bobb JF, Obermeyer Z, Wang Y . Cause-specific risk of hospital admission related to extreme heat in older adults. JAMA 2014 Dec 24-31;312(24):2659-67. doi: 10.1001/jama.2014.15715..
Keywords: Elderly, Hospitalization, Risk
Singh JA, Lewallen DG
Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: a 13-year study of time trends.
The researchers examined the time-trends in key demographic and clinical characteristics of patients undergoing primary total hip arthroplasty (THA). They found that obesity, medical and psychological comorbidity increased and the underlying diagnosis of RA/inflammatory arthritis decreased rapidly in primary THA patients over 13-years.
Citation: Singh JA, Lewallen DG . Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: a 13-year study of time trends. BMC Musculoskelet Disord 2014 Dec 17;15:441. doi: 10.1186/1471-2474-15-441..
Keywords: Surgery, Obesity, Risk, Registries, Arthritis
Bhavsar NA, Bream JH, Meeker AK
A peripheral circulating TH1 cytokine profile is inversely associated with prostate cancer risk in CLUE II.
The authors evaluated the association between peripheral-cytokine concentrations and prostate cancer. They found that men with a prediagnostic circulating TH1 profile and higher IL6 may have a lower risk of prostate cancer, including aggressive disease. They concluded that identifying specific inflammatory cytokines associated with prostate cancer may lead to improved prevention and treatment strategies.
Citation: Bhavsar NA, Bream JH, Meeker AK . A peripheral circulating TH1 cytokine profile is inversely associated with prostate cancer risk in CLUE II. Cancer Epidemiol Biomarkers Prev 2014 Nov;23(11):2561-7. doi: 10.1158/1055-9965.epi-14-0010.
Keywords: Patient-Centered Outcomes Research, Cancer: Prostate Cancer, Risk
Segal CG, Waller DK, Tilley B
An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery.
The authors developed four independent, multivariate, predictive models to assess the unique associations between risk factors and each surgical site infection (SSI) group: superficial, deep, organ space, and an aggregate of all 3 types of SSIs. They found that unique risks for superficial SSIs include diabetes, chronic obstructive pulmonary disease, and dyspnea; deep SSIs had the greatest magnitude of association with BMI and the greatest incidence of wound disruption; and organ space SSIs were often owing to anastomotic leaks and were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, and a bleeding disorder. They concluded that more effective prevention strategies may be developed by reporting and examining each type of SSI separately.
Citation: Segal CG, Waller DK, Tilley B . An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Surgery 2014 Nov;156(5):1253-60. doi: 10.1016/j.surg.2014.05.010.
Keywords: Risk, Healthcare-Associated Infections (HAIs), Adverse Events, Surgery, Patient Safety
Spangler EL, Goodney PP, Schanzer A
Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients.
The purpose of this study was to compare risk-stratified outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Included in the study group were 11,336 patients who underwent isolated primary CEA and 544 who underwent primary CAS. The researchers found that asymptomatic normal- and high-risk patients do equally well after CEA or CAS. However, normal- and high-risk symptomatic patients have substantially worse outcomes with CAS compared with CEA.
Citation: Spangler EL, Goodney PP, Schanzer A . Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients. J Vasc Surg 2014 Nov;60(5):1227-31, 31.e1. doi: 10.1016/j.jvs.2014.05.044..
Keywords: Outcomes, Comparative Effectiveness, Risk, Cardiovascular Conditions, Heart Disease and Health
Shear TC, Balachandran JS, Mokhlesi B
Risk of sleep apnea in hospitalized older patients.
This study assessed the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. It found that two of every 5 inpatients older than 50 years screened at high risk for OSA. Those screening at high risk have worse in-hospital sleep quantity and quality.
Citation: Shear TC, Balachandran JS, Mokhlesi B . Risk of sleep apnea in hospitalized older patients. J Clin Sleep Med 2014 Oct 15;10(10):1061-6. doi: 10.5664/jcsm.4098..
Keywords: Elderly, Sleep Problems, Risk, Respiratory Conditions
Bish EK, El-Amine H, Steighner LA
A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.
The researchers sought to identify the risk factors associated with surgical site infections (SSIs) resulting from procedures performed at ambulatory surgery centers (ASCs) and to design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the socio-technical probabilistic risk assessment (ST-PRA) tool for a particular surgical procedure. They found that failure to protect the patient effectively accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. They determined that, assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased.
Citation: Bish EK, El-Amine H, Steighner LA . A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers. Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S133-41. doi: 10.1086/677824.
Keywords: Ambulatory Care and Surgery, Risk, Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Injuries and Wounds, Adverse Events
Patel M, Phillips-Caesar E, Boutin-Foster C
Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US.
The researchers conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying cardiovascular disease related behaviors among a Bangladeshi cohort. Bangladeshi individuals in this study cited a combination of internal and external factors as barriers to lifestyle modification. The authors recommended interventions to address these barriers that simultaneously address self-efficacy and work-life balance.
Citation: Patel M, Phillips-Caesar E, Boutin-Foster C . Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US. J Immigr Minor Health 2014 Oct;16(5):994-1000. doi: 10.1007/s10903-013-9868-7.
Keywords: Cardiovascular Conditions, Lifestyle Changes, Racial and Ethnic Minorities, Risk
Safford MM, Barasch A, Curtis JR
Bisphosphonates and hip and nontraumatic subtrochanteric femoral fractures in the Veterans Health Administration.
This study examined associations between bisphosphonate use and nontraumatic subtrochanteric (NTST) femoral fractures and hip fractures in the Veterans Health Administration. It found that nontraumatic subtrochanteric femoral fractures were uncommon, and longer bisphosphonate use was associated with lower (not higher) risk. In men, risks of NTST femoral fractures associated with bisphosphonate treatment may be low in contrast to substantial protective benefits for hip fracture.
AHRQ-funded; HS016956; HS018517.
Citation: Safford MM, Barasch A, Curtis JR . Bisphosphonates and hip and nontraumatic subtrochanteric femoral fractures in the Veterans Health Administration. J Clin Rheumatol 2014 Oct;20(7):357-62. doi: 10.1097/rhu.0000000000000170..
Keywords: Elderly, Injuries and Wounds, Risk, Medication, Adverse Events
Chaudhry SI, Khan RF, Chen J
National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010.
The investigators evaluated changes in the incidence of 1-year recurrent acute myocardial infarction (AMI) hospitalization and mortality. In a national sample of Medicare beneficiaries hospitalized for AMI from 1999 to 2010, they found that hospitalization for recurrent AMI decreased, as did subsequent mortality, albeit to a lesser extent. The risk of recurrent AMI hospitalization declined less in black patients than in whites, increasing observed racial disparities by the end of the study period.
Citation: Chaudhry SI, Khan RF, Chen J . National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010. J Am Heart Assoc 2014 Oct;3(5):e001197. doi: 10.1161/jaha.114.001197.
Keywords: Hospitalization, Medicare, Mortality, Heart Disease and Health, Risk
Holzer J, Canavan M, Bradley E
County-level correlation between adult obesity rates and prevalence of dentists.
The researchers conducted a study to examine the association between the prevalence of dentists and the rates of adult obesity. They found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity. This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population.
Citation: Holzer J, Canavan M, Bradley E . County-level correlation between adult obesity rates and prevalence of dentists. J Am Dent Assoc 2014 Sep;145(9):932-9. doi: 10.14219/jada.2014.48.
Keywords: Dental and Oral Health, Obesity, Risk, Social Determinants of Health, Value
Boehme AK, Rawal PV, Lyerly MJ
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
The researchers compared several scoring systems among patients receiving systemic and endovascular treatments. They concluded that their study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.
Citation: Boehme AK, Rawal PV, Lyerly MJ . Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt. J Stroke Cerebrovasc Dis 2014 Sep;23(8):2001-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.003.
Keywords: Decision Making, Diagnostic Safety and Quality, Risk, Stroke
Petrov ME, Kim Y, Lauderdale DS
Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study.
The investigators determined the association between objectively measured sleep and 10-year changes in estimated glomerular filtration rate. They found that, in this community-based sample, shorter sleep and poorer sleep quality were related to higher kidney filtration rates over 10 years.
Citation: Petrov ME, Kim Y, Lauderdale DS . Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study. Sleep Med 2014 Sep;15(9):1140-6. doi: 10.1016/j.sleep.2014.05.021.
Keywords: Risk, Sleep Problems, Kidney Disease and Health
Petrov ME, Howard VJ, Kleindorfer D
Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study.
The authors investigated the relation between sleep medication use and incident stroke. At the sleep assessment, 9.6% of the participants used prescription sleep medication and 11.1% used over-the-counter sleep aids. Over an average follow-up of 3.3 ± 1.0 years, 297 stroke events occurred. The authors found that over-the-counter sleep medication use was associated with increased risk of incident stroke; however, there was no significant association with prescription sleep medications. They concluded that over-the-counter sleep medication use may independently increase the risk of stroke beyond other risk factors in middle-aged to older individuals with no history of stroke.
Citation: Petrov ME, Howard VJ, Kleindorfer D . Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study. J Stroke Cerebrovasc Dis 2014 Sep;23(8):2110-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.03.025.
Keywords: Medication: Safety, Medication, Risk, Sleep Problems, Stroke, Cardiovascular Conditions, Racial and Ethnic Minorities
Schelleman H, Han X, Brensinger CM
Pharmacoepidemiologic and in vitro evaluation of potential drug-drug interactions of sulfonylureas with fibrates and statins.
This study examined whether initiation of fibrates or statins in sulfonylurea users is associated with hypoglycemia and in vitro inhibition of cytochrome P450 (CYP) enzymes by statins, fenofibrate and glipizide. It found that use of fenofibrate or gemfibrozil together with glyburide was associated with
elevated overall risks of serious hypoglycemia.
elevated overall risks of serious hypoglycemia.
Citation: Schelleman H, Han X, Brensinger CM . Pharmacoepidemiologic and in vitro evaluation of potential drug-drug interactions of sulfonylureas with fibrates and statins. Br J Clin Pharmacol 2014 Sep;78(3):639-48. doi: 10.1111/bcp.12353..
Keywords: Comparative Effectiveness, Medication, Risk
Baillargeon J, Urban RJ, Kuo YF
Risk of myocardial infarction in older men receiving testosterone therapy.
The purpose of this paper was to examine the risk of myocardial infarction (MI) in a population-based cohort of older men receiving intramuscular testosterone. The investigators found that older men who were treated with intramuscular testosterone did not appear to have an increased risk of MI. For men with high MI risk, testosterone use was modestly protective against MI.
Citation: Baillargeon J, Urban RJ, Kuo YF . Risk of myocardial infarction in older men receiving testosterone therapy. Ann Pharmacother 2014 Sep;48(9):1138-44. doi: 10.1177/1060028014539918..
Keywords: Cardiovascular Conditions, Elderly, Men's Health, Heart Disease and Health, Risk
The impact of short breaks from cardiac surgery on mortality and stay length in California.
In this small, exploratory study, the researchers sought to investigate potential surgical “forgetting” among cardiac surgeons taking a break from performing isolated coronary artery bypass graft (CABG) surgery in a large state-wide study in California. Patients operated on by surgeons who had not performed isolated CABG in the prior calendar month stayed in hospital 0.5 day longer.
Citation: Huesch MD . The impact of short breaks from cardiac surgery on mortality and stay length in California. J Healthc Qual 2014 Sep-Oct;36(5):42-9. doi: 10.1111/jhq.12018..
Keywords: Surgery, Outcomes, Mortality, Risk
Wu AC, Li L, Fung V
Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.
The researchers compared the effectiveness of different controller medication regimens under real-life conditions. They found that the risk of emergency department visits, hospitalizations, and oral corticosteroids did not differ between children who initiated leukotriene antagonist and those who initiated inhaled corticosteroid. These findings may be explainable by leukotriene antagonist having similar effectiveness as inhaled corticosteroid in real-life usage.
Citation: Wu AC, Li L, Fung V . Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids. J Allergy Clin Immunol Pract 2014 Sep-Oct;2(5):607-13. doi: 10.1016/j.jaip.2014.05.009..
Keywords: Comparative Effectiveness, Medication, Children/Adolescents, Asthma, Risk
Goldsweig AM, Reid KJ, Gosch K
Contemporary use of dual antiplatelet therapy for preventing cardiovascular events.
The authors examined dual antiplatelet therapy (DAPT) use in contemporary clinical practice after publication of the results of the landmark randomized clinical trial CHARISMA. They found that use of DAPT is modest in patients with established cardiovascular disease, for whom the CHARISMA trial suggested decreased major adverse cardiovascular events (MACEs), and prescription rates have remained stable over time; use of DAPT in patients with multiple risk factors only, for whom CHARISMA suggested that DAPT may lead to increased MACEs, was low and decreased over time.
Citation: Goldsweig AM, Reid KJ, Gosch K . Contemporary use of dual antiplatelet therapy for preventing cardiovascular events. Am J Manag Care 2014 Aug;20(8):659-65.
Keywords: Cardiovascular Conditions, Medication, Prevention, Practice Patterns, Risk
Majid A, McAninch J, Morgan DJ
Predictors of early treatment discontinuation in a cohort of patients treated with boceprevir-based therapy for hepatitis C infection.
This study aimed to assess early treatment discontinuation rates and identify underlying risk factors for discontinuation in a real-world boceprevir-based treatment cohort. Nearly half of patients started on boceprevir-based hepatitis C triple therapy stopped treatment by 24 weeks, with more discontinuing because of treatment intolerance than virologic failure. Early discontinuation was significantly more common in patients with comorbidities.
Citation: Majid A, McAninch J, Morgan DJ . Predictors of early treatment discontinuation in a cohort of patients treated with boceprevir-based therapy for hepatitis C infection. J Viral Hepat 2014 Aug;21(8):585-9. doi: 10.1111/jvh.12201.
Keywords: Hepatitis, Adverse Events, Medication, Risk
Santos CA, Brennan DC, Fraser VJ
Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation.
The researchers sought to expand understanding of the scope, risk factors and outcomes associated with delayed-onset cytomegalovirus (CMV) disease among kidney transplant reci
Citation: Santos CA, Brennan DC, Fraser VJ . Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation. Transplantation. 2014 Jul 27;98(2):187-94. doi: 10.1097/TP.0000000000000030..
Keywords: Transplantation, Hospital Readmissions, Risk, Outcomes
Dahlke AR, Merkow RP, Chung JW
Comparison of postoperative complication risk prediction approaches based on factors known preoperatively to surgeons versus patients.
The objective of this paper was to compare three estimation models: (1) the All Information Model; (2) the Surgeon Assessment Model; and (3) the Patient-Entered Model. The investigators observed a small decline in model performance that they suggest may not be clinically meaningful. They concluded that the Surgeon Assessment and Patient-Entered models with fewer predictors can be used with relative confidence to predict a patient's risk.
Citation: Dahlke AR, Merkow RP, Chung JW . Comparison of postoperative complication risk prediction approaches based on factors known preoperatively to surgeons versus patients. Surgery 2014 Jul;156(1):39-45. doi: 10.1016/j.surg.2014.03.002.
Keywords: Adverse Events, Decision Making, Risk, Surgery
Chambers C, Chiu S, Scott AN
Factors associated with poor mental health status among homeless women with and without dependent children.
The researchers estimated the prevalence of mental health problems among homeless women as well as the effects of risk factors on those problems. They found that, in a group of 522 homeless women in Toronto, Canada, poor mental health was associated with low perceived access to social support, physical/sexual assault in the past 12 months, presence of a chronic health condition, and presence of a drug use problem.
Citation: Chambers C, Chiu S, Scott AN . Factors associated with poor mental health status among homeless women with and without dependent children. Community Ment Health J. 2014 Jul;50(5):553-9. doi: 10.1007/s10597-013-9605-7..
Keywords: Behavioral Health, Chronic Conditions, Social Determinants of Health, Risk
Strom Williams JL, Lynch CP, Winchester R
Gender differences in composite control of cardiovascular risk factors among patients with type 2 diabetes.
This study examined the gender differences in multiple cardiovascular disease (CVD) risk factor control in adults with type 2 diabetes seen in diverse clinical settings. It found that women had significantly poorer composite control of CVD risk outcomes compared with men, adjusting for relevant confounding factors. In unadjusted analyses, women had higher mean systolic blood pressure and LDL cholesterol levels compared with men.
Citation: Strom Williams JL, Lynch CP, Winchester R . Gender differences in composite control of cardiovascular risk factors among patients with type 2 diabetes. Diabetes Technol Ther 2014 Jul;16(7):421-7. doi: 10.1089/dia.2013.0329..
Keywords: Cardiovascular Conditions, Risk, Diabetes, Outcomes, Sex Factors