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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.
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1 to 25 of 183 Research Studies DisplayedCarroll CE, Landrum MB, Wright AA
Adoption of innovative therapies across oncology practices-evidence from immunotherapy.
Immunotherapy has emerged as a crucial development in cancer care, significantly enhancing patient outcomes for various cancer forms, yet limited information exists regarding the adoption of this innovative treatment by different practices or the speed of uptake. The purpose of this study was to evaluate the adoption of immunotherapy across oncology practices in the United States and examine variations in adoption based on practice characteristics. This cohort investigation utilized Medicare fee-for-service data from beneficiaries undergoing six-month chemotherapy cycles between 2010 and 2017. Data analysis was conducted from January 19, 2021, to September 28, 2022, for patients diagnosed with cancers for which the US Food and Drug Administration (FDA) approved immunotherapy during the study period: melanoma, kidney cancer, lung cancer, and head and neck cancer. The primary outcome assessed whether a practice adopted immunotherapy. The data included 71,659 episodes from 1,732 oncology practices. The study found that among these, 264 practices (15%) were rural, 900 (52%) were independent, and 492 (28%) had 1 to 5 physicians. The study also found that the majority of practices adopted immunotherapy within two years of FDA approval, but considerable variations in adoption rates existed across practice types. Following FDA approval, immunotherapy adoption was 11 percentage points lower in rural practices compared to urban practices and 27 percentage points lower in practices with 1 to 5 physicians than those with six or more physicians. Adoption rates were comparable between independent practices and nonacademic institutions; however, both practice types exhibited lower adoption than academic institutions (independent practice difference, -6 percentage points; nonacademic systems difference, -9 percentage points).
AHRQ-funded; HS024072
Citation: Carroll CE, Landrum MB, Wright AA .
Adoption of innovative therapies across oncology practices-evidence from immunotherapy.
JAMA Oncol 2023 Mar;9(3):324-33. doi: 10.1001/jamaoncol.2022.6296.
Keywords: Cancer, Treatments
Treadwell JR, Kessler SK, Wu M
Pharmacologic and dietary treatments for epilepsies in children aged 1-36 months: a systematic review.
The purpose of this systematic review study was to assess the effectiveness and harms of pharmacologic and dietary treatments for epilepsy in children aged 1-36 months without infantile spasms. The researchers searched EMBASE, MEDLINE, PubMed, and the Cochrane Library for studies published from 1/1/1999 to 8/19/21 to identify studies reporting data on children aged 1-36 months receiving pharmacologic or dietary treatments for epilepsy. Twenty-three studies met the inclusion criteria. The study found that Levetiracetam leads to seizure freedom in some infants but the data on 6 other medications (lamotrigine, phenytoin, rufinamide, stiripentol, topiramate, and vigabatrin) were too limited to allow conclusions about their effectiveness. Three medications (lamotrigine, levetiracetam, and topiramate) were rarely discontinued due to adverse effects, and severe events were also rare. In the category of diets, the ketogenic diet lead to seizure freedom in some infants and both the ketogenic diet and modified Atkins diet reduced average seizure frequency.
AHRQ-funded; 75Q80120D00002.
Citation: Treadwell JR, Kessler SK, Wu M .
Pharmacologic and dietary treatments for epilepsies in children aged 1-36 months: a systematic review.
Neurology 2023 Jan 3;100(1):e16-e27. doi: 10.1212/wnl.0000000000201026..
Keywords: Children/Adolescents, Neurological Disorders, Newborns/Infants, Medication, Nutrition, Treatments, Evidence-Based Practice
Tsou AY, Kessler SK, Wu M
Surgical treatments for epilepsies in children aged 1-36 months: a systematic review.
The purpose of this article was to summarize the findings of a systematic review commissioned by the American Epilepsy Society to evaluate evidence and describe evidence gaps for surgical treatments for epilepsy in children aged 1 to 36 months without infantile spasms. The researchers searched EMBASE, MEDLINE, PubMed, and the Cochrane Library for studies published from 1/1/1999 to 8/19/21 and included studies reporting data on children aged 1 month to 36 months or less enrolled in surgical interventions or neurostimulation for epilepsy. Eighteen studies met inclusion criteria. The review found that seizure freedom for infants undergoing hemispherectomy/hemispherotomy ranged from 7% to 76% at 1 year after surgery. For non-hemispheric surgeries seizure freedom ranged from 40% to 70%. Over half of infants undergoing hemispherectomy/hemispherotomy achieved a favorable outcome (Engel I or II, ILAE I to IV, or >50% seizure reduction) at follow-up of over 1 year. The researchers note that the studies had important limitations. The researchers concluded that while evidence remains sparse and low quality, some infants achieve seizure freedom after surgery and 50% or greater achieve favorable outcomes.
AHRQ-funded; 75Q80120D00002.
Citation: Tsou AY, Kessler SK, Wu M .
Surgical treatments for epilepsies in children aged 1-36 months: a systematic review.
Neurology 2023 Jan 3;100(1):e1-e15. doi: 10.1212/wnl.0000000000201012..
Keywords: Children/Adolescents, Newborns/Infants, Surgery, Treatments, Evidence-Based Practice
Nguyen NH, Luo J, Paul P
Effectiveness and safety of biologic therapy in Hispanic vs non-Hispanic patients with inflammatory bowel diseases: a CA-IBD cohort study.
Researchers compared risk of hospitalization, surgery, and serious infection in Hispanic versus non-Hispanic adult patients with inflammatory bowel diseases (IBDs) who were new recipients of biologic therapy. Their findings indicate that Hispanic patients experienced higher hospitalization, surgery, and serious infection rates. The researchers concluded that future studies should investigate the biological, social, and environmental drivers of these differences.
AHRQ-funded; HS019913.
Citation: Nguyen NH, Luo J, Paul P .
Effectiveness and safety of biologic therapy in Hispanic vs non-Hispanic patients with inflammatory bowel diseases: a CA-IBD cohort study.
Clin Gastroenterol Hepatol 2023 Jan;21(1):173-81.e5. doi: 10.1016/j.cgh.2022.05.008..
Keywords: Digestive Disease and Health, Racial and Ethnic Minorities, Treatments
Rastogi V, Marcaccio CL, Kim NH
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
The purpose of this study was to assess perioperative outcomes in patients in the Vascular Quality Initiative who underwent juxta-/pararenal FEVAR with supraceliac vs infraceliac sealing. 1,486 Patients who received an elective FEVAR for juxta-/pararenal aortic aneurysms in the Vascular Quality Initiative between 2014 and 2021were identified and included.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
AHRQ-funded; HS027285.
Citation: Rastogi V, Marcaccio CL, Kim NH .
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
J Vasc Surg 2023 Jan;77(1):9-19.e2. doi: 10.1016/j.jvs.2022.08.007..
Keywords: Cardiovascular Conditions, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Treatments
Campbell JI, Tabatneck M, Sun M
Increasing use of interferon gamma release assays among children ≥2 years of age in a setting with low tuberculosis prevalence.
This article describes a retrospective cohort study that examined interferon gamma release assays (IGRAs) use to diagnose tuberculosis (TB) infection in children aged 2–17. The objectives of the study were to evaluate whether testing approaches for TB has changed since 2015. Electronic health records were used to identify IGRAs and tuberculin skin tests (TSTs) completed by children in two Boston-area academic health systems. The researchers observed that the proportion of IGRA tests increased between 2015 and 2021 in this low TB-prevalence setting. Testing in public versus private insurance, inpatient/subspecialty settings, lower age, and non-English preferred language were associated with an increased chance of receiving an IGRA. Findings suggest that the TST is being “retired,” and that education and support for primary care clinicians could improve equitable access to IGRA testing for children.
AHRQ-funded; HS000063.
Citation: Campbell JI, Tabatneck M, Sun M .
Increasing use of interferon gamma release assays among children ≥2 years of age in a setting with low tuberculosis prevalence.
Pediatr Infect Dis J 2022 Dec;41(12):e534-e37. doi: 10.1097/inf.0000000000003685..
Keywords: Children/Adolescents, Treatments, Respiratory Conditions, Infectious Diseases
De B, Pasalic D, Barocas DA
Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study.
The purpose of this study was to compare patient reported outcomes through 5 years following radical prostatectomy or external beam radiation therapy with low dose rate brachytherapy boost for localized prostate cancer. The researchers enrolled men 80 years of age or under who had localized prostate adenocarcinoma and followed them longitudinally from 2011 to 2012. The study found that when compared with radical prostatectomy, external beam radiation therapy with low dose rate brachytherapy boost was related with clinically meaningful worse urinary irritative/obstructive and better urinary incontinence function through 5 years. Urinary function bother was similar between groups. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with worse bowel function through 5 years compared to radical prostatectomy. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with better sexual function at 1 year compared to radical prostatectomy, but there was insufficient evidence to reject the supposition that no difference was seen at 3 or 5 years. The researcher concluded that external beam radiation therapy with low dose rate brachytherapy boost was related with clinically meaningful worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment compared to radical prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: De B, Pasalic D, Barocas DA .
Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study.
J Urol 2022 Dec;208(6):1226-39. doi: 10.1097/ju.0000000000002902..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Treatments
Pritchard KT, Baillargeon J, Lee WC
Trends in the use of opioids vs nonpharmacologic treatments in adults with pain, 2011-2019.
This serial cross-sectional analysis on trends in the use of prescription opioids and nonpharmacologic alternatives in treating pain used MEPS to estimate the use of outpatient services by cancer-free adults with chronic or surgical pain from 2011 to 2019. A total of unweighted 46,420 respondents, 9643 (20.4% weighted) received surgery and 36,777 (79.6% weighted) did not. The prevalence of nonpharmacologic treatments increased in 2019 for both chronic and surgical pain cohorts, especially with exclusive use compared with 2011. Chiropractors and physical therapists were the most common licensed healthcare professionals used among the cohort who used nonpharmacologic treatment.
AHRQ-funded; T32HS026133.
Citation: Pritchard KT, Baillargeon J, Lee WC .
Trends in the use of opioids vs nonpharmacologic treatments in adults with pain, 2011-2019.
JAMA Netw Open 2022 Nov;5(11):e2240612. doi: 10.1001/jamanetworkopen.2022.40612..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Medication, Pain, Chronic Conditions, Treatments
McDonagh MS, Morasco BJ, Wagner J
Cannabis-based products for chronic pain : a systematic review.
Researchers sought to evaluate the benefits and harms of cannabinoids for chronic pain. They found that oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation.
AHRQ-funded; 75Q80120D00006.
Citation: McDonagh MS, Morasco BJ, Wagner J .
Cannabis-based products for chronic pain : a systematic review.
Ann Intern Med 2022 Aug;175(8):1143-53. doi: 10.7326/m21-4520.
AHRQ-funded; 75Q80120D00006..
AHRQ-funded; 75Q80120D00006..
Keywords: Pain, Chronic Conditions, Complementary and Alternative Medicine, Treatments, Evidence-Based Practice
Curatolo M, Rundell SD, Gold LS
Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults.
The purpose of this prospective study was to compare older adults undergoing epidural steroid injections (ESI) with patients not receiving ESI to test the hypotheses that those on ESI: 1) have worse outcomes before ESI, 2) have improved outcomes after ESI, and 3) have improved outcomes due to a specific ESI effect. The researchers evaluated patients 65 years of age or older from 3 United States health care systems who presented to primary care with new episodes of back pain. The three outcomes assessed were back and leg pain intensity, disability, and quality of life, all of which were evaluated at baseline, and then with 3-, 6-, 12- and 24- month follow-ups. The study found that in ESI patients, pain intensity, disability, and quality of life at baseline were significantly worse than in non-ESI patients. The study concluded that adults 65 and older who were treated with ESI have long-term improvement, but the improvement is not likely to be related to a specific effect of ESI, making epidural steroid injections unlikely to provide long-term benefits.
AHRQ-funded; HS019222; HS022972.
Citation: Curatolo M, Rundell SD, Gold LS .
Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults.
Eur J Pain 2022 Aug;26(7):1469-80. doi: 10.1002/ejp.1975..
Keywords: Elderly, Back Health and Pain, Pain, Treatments
Marks MR, Dux MC, Rao V
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
Investigators examined psychotropic medication use and psychotherapy patterns among individuals diagnosed with anxiety disorders and PTSD post-traumatic brain injury (TBI). They found that receipt of pharmacotherapy pre- and post-TBI was considerably more common than receipt of psychotherapy. Individuals diagnosed with anxiety were 66% less likely to receive psychotherapy compared with individuals diagnosed with PTSD. Overall, psychotropic medication use and rates of antidepressant prescription use in the anxiety group were higher compared to those in the PTSD group.
AHRQ-funded; HS024560.
Citation: Marks MR, Dux MC, Rao V .
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
J Neuropsychiatry Clin Neurosci 2022 Summer;34(3):247-53. doi: 10.1176/appi.neuropsych.21040104..
Keywords: Anxiety, Behavioral Health, Brain Injury, Treatments, Practice Patterns, Medication
Korthuis PT, Cook RR, Lum PJ
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Opioid Use Disorder (OUD) treatment medications can improve outcomes for human immunodeficiency virus (HIV) and also reduce opioid use. The purpose of the study was to determine if outpatient naltrexone treatment could also reduce opioid use and improve outcomes for HIV. The researchers reported that enrollment was stopped early because of slower than expected recruitment, resulting in 114 final participants with untreated OUD and HIV, with 62% positive for fentanyl, 60% positive for cocaine, and 47% positive for other opioids at the baseline. The intervention compared treatment as usual (TAU) of methadone or buprenorphine with extended-release naltrexone (XR-NTX) on group differences in viral suppression at 24 weeks and past 30-day use of opioids at 24 weeks. The study reported that at 24 weeks the outcome of viral suppression was similar for TAU and XR-NTX, and that fewer XR-NTX participants initiated medication than TAU participants. The outcome of previous 30-day use of opioids was similar for TAU as compared to XR-NTX. Of those participants who did initiate medication, those administered XR-NTX experienced less days of opioid use when compared with TAU in the prior 30 days. The researchers reported that the study evidence was not conclusive but did support that XR-NTX is not inferior to TAU for HIV viral suppression, and that study participants who started XR-NTX used less opioids at 24 weeks than participants who were administered TAU.
AHRQ-funded; HS026370.
Citation: Korthuis PT, Cook RR, Lum PJ .
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Addiction 2022 Jul;117(7):1961-71. doi: 10.1111/add.15836..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Behavioral Health, Medication, Treatments, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Uhl S, Siddique SM, Bloschichak A
Interventions for malnutrition in hospitalized adults: a systematic review and meta-analysis.
The purpose of this review of existing research was to evaluate the effectiveness of hospital-initiated interventions for patients with malnutrition. The study found 11 randomized controlled trials (RCTs) that evaluated 2 types of interventions: 1) specialized nutrition care, and 2) increased protein provision, with moderate evidence in pooled findings that specialized nutrition care and increased protein provision reduced mortality by 21%. Decrease in length of stay was not significant. The researchers concluded that in patients at risk for or diagnosed with malnutrition, specialized nutrition care and increased protein provision reduced mortality.
AHRQ-funded; 75Q80120D00002.
Citation: Uhl S, Siddique SM, Bloschichak A .
Interventions for malnutrition in hospitalized adults: a systematic review and meta-analysis.
J Hosp Med 2022 Jul;17(7):556-64. doi: 10.1002/jhm.12891..
Keywords: Nutrition, Inpatient Care, Treatments
Drewry AM, Mohr NM, Ablordeppey EA
Therapeutic hyperthermia is associated with improved survival in afebrile critically ill patients with sepsis: a pilot randomized trial.
This study’s objective was to test the hypothesis that forced-air warming of critically ill afebrile sepsis patients improves immune function compared to standard temperature management. Patients were considered eligible patients if they were mechanically ventilated septic adults with: 1) a diagnosis of sepsis within 48 hours of enrollment; 2) anticipated need for mechanical ventilation of greater than 48 hours; and 3) a maximum temperature less than 38.3°C within the 24 hours prior to enrollment. Intervention treatment was external warming using a forced-air warming blanket for 48 hours, with a goal temperature 1.5°C above the lowest temperature documented in the previous 24 hours. The authors enrolled 56 patients in this randomized, controlled trial. Participants allocated to external warming had lower 28-day mortality (18% vs 43%) and more 28-day hospital-free days. No differences were observed between the groups in HLA-DR expression or IFN-γ production.
AHRQ-funded; HS025753.
Citation: Drewry AM, Mohr NM, Ablordeppey EA .
Therapeutic hyperthermia is associated with improved survival in afebrile critically ill patients with sepsis: a pilot randomized trial.
Crit Care Med 2022 Jun;50(6):924-34. doi: 10.1097/ccm.0000000000005470..
Keywords: COVID-19, Sepsis, Treatments, Comparative Effectiveness, Evidence-Based Practice, Outcomes
Petragallo R, Bardach N, Ramirez E
Barriers and facilitators to clinical implementation of radiotherapy treatment planning automation: a survey study of medical dosimetrists.
Researchers examined the barriers and facilitators to adoption of commercially available automated planning tools into the clinical workflow using a survey of medical dosimetrists. Through surveys, three categories of barriers to use of automation were identified. This investigation highlighted several concrete approaches that could potentially increase the translation of automation into the clinic, along with areas of needed research.
AHRQ-funded; HS026486.
Citation: Petragallo R, Bardach N, Ramirez E .
Barriers and facilitators to clinical implementation of radiotherapy treatment planning automation: a survey study of medical dosimetrists.
J Appl Clin Med Phys 2022 May;23(5):e13568. doi: 10.1002/acm2.13568..
Keywords: Treatments, Implementation
Douin DJ, Krause M, Williams C
Corticosteroid administration and impaired glycemic control in mechanically ventilated COVID-19 patients.
This study’s objective was to determine the association between corticosteroid administration and impaired glycemic control among COVID-19 patients requiring mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation. This multicenter retrospective cohort study was conducted between March 9 and May 17, 2020 at 12 US hospitals. The primary outcome measured was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission. The authors included 292 mechanically ventilated patients. Sixty-six patients (22.6%) died within 28 days of ICU admission. Seventy-one patients (24.3%) received a cumulative dose of at least an equivalent of 320 mg methylprednisolone. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL.
AHRQ-funded; HS027795.
Citation: Douin DJ, Krause M, Williams C .
Corticosteroid administration and impaired glycemic control in mechanically ventilated COVID-19 patients.
Semin Cardiothorac Vasc Anesth 2022 Mar;26(1):32-40. doi: 10.1177/10892532211043313..
Keywords: COVID-19, Treatments, Medication
Sun D, Heimall JR, Greenhawt MJ
Cost utility of lifelong immunoglobulin replacement therapy vs hematopoietic stem cell transplant to treat agammaglobulinemia.
This study evaluated the cost utility of lifelong immunoglobulin replacement therapy (IRT) versus hematopoietic stem cell transplant (HSCT) to treat agammaglobulinemia. This economic evaluation used Markov analysis to model the base-case scenario of a patient aged 12 months to receive lifelong IRT vs matched sibling donor (MSD) or matched unrelated donor (MUD) HSCT. In this evaluation, lifelong IRT cost more than HSCT ($1,512,946 compared with $563,776 [MSD] and $637,036 [MUD]) and generated similar quality-adjusted life-years (QALYs) (20.61 vs 17.25 [MSD] and 17.18 [MUD]). While choosing IRT over HSCT generated higher incremental cost-effectiveness ratios (ICERs), it exceeded US willing-to-pay threshold of $100,000/QALY. However, IRT prevented at least 2488 premature deaths per 10,000 microsimulations compared with HSCT treatment. But when the annual IRT price was reduced from $60,145 to below $29,469, IRT became the cost-effective strategy.
AHRQ-funded; HS024599.
Citation: Sun D, Heimall JR, Greenhawt MJ .
Cost utility of lifelong immunoglobulin replacement therapy vs hematopoietic stem cell transplant to treat agammaglobulinemia.
JAMA Pediatr 2022 Feb; 176(2):176-84. doi: 10.1001/jamapediatrics.2021.4583..
Keywords: Medication, Healthcare Costs, Treatments, Evidence-Based Practice
Wright JH, Owen J, Eells TD
Effect of computer-assisted cognitive behavior therapy vs usual care on depression among adults in primary care: a randomized clinical trial.
Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. The purpose of this study was to evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment.
AHRQ-funded; HS024047.
Citation: Wright JH, Owen J, Eells TD .
Effect of computer-assisted cognitive behavior therapy vs usual care on depression among adults in primary care: a randomized clinical trial.
JAMA Netw Open 2022 Feb;5(2):e2146716. doi: 10.1001/jamanetworkopen.2021.46716..
Keywords: Depression, Behavioral Health, Primary Care, Treatments, Comparative Effectiveness
Kang MM, Hasan Y, Waller J
Has hypofractionated whole-breast radiation therapy become the standard of care in the United States? An updated report from National Cancer Database.
This study examined trends in the use of hypofractionated whole-breast irradiation (HF-WBI) over time in the United States and factors related to its adoption for patients undergoing a lumpectomy from 2004 to 2016. Lumpectomy patients in the National Cancer Database were identified, with 688,079 early-stage invasive breast cancer patients, and 248,218 patients diagnosed with ductal carcinoma in situ. Among invasive cancer patients, HB-WBI use increased from 0.7% in 2004 to 38.1% in 2016. Among ductal carcinoma in situ patients, HB-WBI use increased significantly from 0.42% in 2004 to 34.3% in 2016. Factors associated with HB-WBI use included age, geographic location, race/ethnicity, tumor stage, grade, treating facility type, and volume.
AHRQ-funded; HS025806.
Citation: Kang MM, Hasan Y, Waller J .
Has hypofractionated whole-breast radiation therapy become the standard of care in the United States? An updated report from National Cancer Database.
Clin Breast Cancer 2022 Jan;22(1):e8-e20. doi: 10.1016/j.clbc.2021.05.016..
Keywords: Cancer: Breast Cancer, Cancer, Treatments, Practice Patterns
Rhee TG, Sint K, Olfson M
Association of ECT with risks of all-cause mortality and suicide in older Medicare patients.
This observational study examined the effects of electroconvulsive therapy (ECT) on suicide and all-cause mortality risk in Medicare psychiatric patients age 65 or older. Patients receiving ECT were exact matched to control subjects in a 1-to-3 ratio on age, gender, principal hospital diagnosis, past-year psychiatric hospitalizations, past-year suicide attempts, and Elixhauser comorbidity index. A total of 10,46 patients were in the ECT group and 31,160 in the control group. Compared with the control group, patients receiving ECT had lower all-cause mortality for up to 1 year following hospital discharge. For death by suicide, ECT was associated with short-lived effects which waned over time.
AHRQ-funded; HS023000.
Citation: Rhee TG, Sint K, Olfson M .
Association of ECT with risks of all-cause mortality and suicide in older Medicare patients.
Am J Psychiatry 2021 Dec;178(12):1089-97. doi: 10.1176/appi.ajp.2021.21040351..
Keywords: Elderly, Behavioral Health, Mortality, Treatments
Andreae SJ, Andreae LJ, Richman JS
Peer-delivered cognitive behavioral therapy-based intervention reduced depression and stress in community dwelling adults with diabetes and chronic pain: a cluster randomized trial.
Researchers examined whether a cognitive behavioral therapy (CBT)-based program intended to increase physical activity despite chronic pain in patients with diabetes delivered by community members trained as peer coaches also improved depressive symptoms and perceived stress. They found that this peer-delivered CBT-based program improved depressive symptoms and stress in individuals with diabetes and chronic pain. They recommended training community members as a feasible strategy for offering CBT-based interventions in rural and under-resourced communities.
AHRQ-funded; HS019239.
Citation: Andreae SJ, Andreae LJ, Richman JS .
Peer-delivered cognitive behavioral therapy-based intervention reduced depression and stress in community dwelling adults with diabetes and chronic pain: a cluster randomized trial.
Ann Behav Med 2021 Oct 4;55(10):970-80. doi: 10.1093/abm/kaab034..
Keywords: Depression, Behavioral Health, Diabetes, Chronic Conditions, Treatments, Pain, Lifestyle Changes
Moazzezi M, Rose B, Kisling K
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
This study’s objective was to assess the new online adaptive radiation therapy technology called Ethos for treating prostate cancer. Twenty-five prostate patients previously treated at the author’s clinic were re-planed using an Ethos emulator. Clinical margins of 3 mm posterior, 5 mm left/right/anterior, and 7 mm superior/inferior were used. Dose metrics were compared to unadapted plans to evaluate clinical target volumes (CTV) and online adaptive radiation (OAR) dose changes. Overall, 96% of fractions required auto-segmentation edits, although they were mostly minor. Adaptation improved CTV 98% for the 24 patients with minor auto-segmentation corrections. However, for one in 25 patients, large contour edits were required.
AHRQ-funded; HS025440.
Citation: Moazzezi M, Rose B, Kisling K .
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
J Appl Clin Med Phys 2021 Oct;22(10):82-93. doi: 10.1002/acm2.13399..
Keywords: Cancer: Prostate Cancer, Cancer, Treatments, Imaging
Garsa A, Jang JK, Baxi S
Radiation therapy for brain metastases: a systematic review.
This systematic review synthesizes the available evidence on radiation therapy for brain metastases. A literature search was conducted using the major medical databases and included randomized controlled trials and large observational studies which evaluated whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to lung cancer, breast cancer, or melanoma. No statistically significant difference in overall survival was found with a combination of SRS plus WBRT compared with SRS alone or WBRT alone. Radiation therapy after surgery did not improve overall survival compared with surgery alone. WBRT plus systemic therapy was associated with increased risks for vomiting compared with WBRT alone. There was not enough data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.
AHRQ-funded; 290201500010I.
Citation: Garsa A, Jang JK, Baxi S .
Radiation therapy for brain metastases: a systematic review.
Pract Radiat Oncol 2021 Sep-Oct;11(5):354-65. doi: 10.1016/j.prro.2021.04.002..
Keywords: Cancer, Surgery, Treatments, Patient-Centered Outcomes Research, Evidence-Based Practice
Crits-Christoph P, King C, Goldstein E
Use of cognitive techniques is associated with change in positive compensatory skills in the treatment of major depressive disorder in a community mental health setting.
Investigators sought to examine the association between adherence and competence in cognitive therapy (CT) techniques and change in positive compensatory skills and depressive symptoms within a community mental health setting. They found that adherence and competence were both significantly associated with linear change in positive compensatory skills from baseline to month 5. They concluded that their results support the hypothesis that use of CT techniques is associated with change in compensatory skills in a community mental health setting.
AHRQ-funded; HS018440.
Citation: Crits-Christoph P, King C, Goldstein E .
Use of cognitive techniques is associated with change in positive compensatory skills in the treatment of major depressive disorder in a community mental health setting.
Psychother Res 2021 Sep;31(7):909-20. doi: 10.1080/10503307.2020.1866785..
Keywords: Depression, Behavioral Health, Treatments
Xu L, Xie D, Griffin KS
Objective adherence to dental device versus positive airway pressure treatment in adults with obstructive sleep apnea.
Although mandibular advancement device (MAD) treatment of adults with obstructive sleep apnea (OSA) is generally less efficacious than positive airway pressure (PAP), the two treatments are associated, with similar clinical outcomes. As a sub-analysis of a randomized trial comparing the effect of MAD versus PAP on blood pressure, this study compared objectively measured adherence to MAD versus PAP treatment in adults with OSA.
AHRQ-funded; HS019738.
Citation: Xu L, Xie D, Griffin KS .
Objective adherence to dental device versus positive airway pressure treatment in adults with obstructive sleep apnea.
J Sleep Res 2021 Aug;30(4):e13240. doi: 10.1111/jsr.13240..
Keywords: Sleep Problems, Patient Adherence/Compliance, Treatments, Dental and Oral Health, Respiratory Conditions
