National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 185 Research Studies DisplayedCrits-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
Vemulakonda VM, Sevick C, Juarez-Colunga E
Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network.
Studies based on administrative databases show that infant pyeloplasty is associated with minority race/ethnicity but lack clinical data that may influence treatment. The objective of this study was to identify clinical and demographic factors associated with pyeloplasty in infants from three large tertiary centers. The investigators found that infant pyeloplasty rates varied between sites. In addition, they found that prolonged T½ was associated with surgery despite prior studies suggesting this was a poor predictor of worsening dilation or function.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM, Sevick C, Juarez-Colunga E .
Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network.
Int Urol Nephrol 2021 Aug;53(8):1485-95. doi: 10.1007/s11255-021-02866-y..
Keywords: Newborns/Infants, Treatments, Practice Patterns
Ibrahim S, Lowe JR, Bramante CT
Metformin and Covid-19: focused review of mechanisms and current literature suggesting benefit.
In the current Covid-19 pandemic, four observational studies have been published showing reduced mortality among individuals with home metformin use. This article discusses these studies.
AHRQ-funded; HS026379.
Citation: Ibrahim S, Lowe JR, Bramante CT .
Metformin and Covid-19: focused review of mechanisms and current literature suggesting benefit.
Front Endocrinol 2021 Jul 22;12:587801. doi: 10.3389/fendo.2021.587801..
Keywords: COVID-19, Medication, Treatments
Wilkinson ST, Kitay BM, Harper A
Barriers to the implementation of electroconvulsive therapy (ECT): results from a nationwide survey of ECT practitioners.
Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder; yet, its use is confined to <1% of individuals with this disorder. In this study, the authors aimed to examine barriers to ECT from the perspective of the provider. The investigators concluded that coordinated efforts to overcome identified barriers may allow ECT to be more broadly implemented. Investments in education may increase the number of competent practitioners.
AHRQ-funded; HS023000.
Citation: Wilkinson ST, Kitay BM, Harper A .
Barriers to the implementation of electroconvulsive therapy (ECT): results from a nationwide survey of ECT practitioners.
Psychiatr Serv 2021 Jul;72(7):752-57. doi: 10.1176/appi.ps.202000387..
Keywords: Depression, Behavioral Health, Treatments
Caram MEV, Burns J, Kumbier K
Factors influencing treatment of veterans with advanced prostate cancer.
This study examined factors influencing treatment of veterans with metastatic castration-resistant prostate cancer (CRPC). Clinician and nonclinical factors associated with the first-line treatment for CPRC using data from the Veterans Health Administration was used. Almost 5000 patients who received abiraterone, enzalutamide, docetaxel, or ketoconazole from 2010 through 2017 were identified. Increasing age was associated with receipt of abiraterone or enzalutamide versus docetaxel. Greater preexisting comorbidity was associated with enzalutamide versus abiraterone. Patients with higher PSA values at the start of treatment were more likely to receive docetaxel than the other three treatments. African American men were more likely to receive ketoconazole.
AHRQ-funded; HS025707.
Citation: Caram MEV, Burns J, Kumbier K .
Factors influencing treatment of veterans with advanced prostate cancer.
Cancer 2021 Jul 1;127(13):2311-18. doi: 10.1002/cncr.33485..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Treatments
Bramante CT, Buse J, Tamaritz L
Outpatient metformin use is associated with reduced severity of COVID-19 disease in adults with overweight or obesity.
This study investigated whether outpatient metformin use is associated with reduced severity of COVID-19 in adults with overweight or obesity. Metformin can decrease interleukin-6 and tumor-necrosis factor- α, which appears to contribute to COVID-19 mortality. The authors conducted a retrospective cohort analysis of electronic health record (EHR) data that was pooled across multiple EHR systems from 12 hospitals and 60 primary care clinics in the Midwest between March and December 2020. Inclusion criteria included data for BMI > 25 kg/m(2); age range 30-85 years; and a positive SARS-CoV-2 polymerase chain reaction test. Metformin was associated with a decrease in mortality from COVID-19 and a nonsignificant decrease in hospital admission in the overall cohort.
AHRQ-funded; HS026379.
Citation: Bramante CT, Buse J, Tamaritz L .
Outpatient metformin use is associated with reduced severity of COVID-19 disease in adults with overweight or obesity.
J Med Virol 2021 Jul;93(7):4273-79. doi: 10.1002/jmv.26873..
Keywords: COVID-19, Infectious Diseases, Obesity, Medication, Treatments, Outcomes
VanderPluym JH, Halker Singh RB, Urtecho M
Acute treatments for episodic migraine in adults: a systematic review and meta-analysis.
Migraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy. The objective of this study was to evaluate the benefits and harms associated with acute treatments for episodic migraine in adults. The investigators concluded that there are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments were associated with improved pain and function.
AHRQ-funded; 290201500013I.
Citation: VanderPluym JH, Halker Singh RB, Urtecho M .
Acute treatments for episodic migraine in adults: a systematic review and meta-analysis.
JAMA 2021 Jun 15;325(23):2357-69. doi: 10.1001/jama.2021.7939..
Keywords: Neurological Disorders, Pain, Chronic Conditions, Treatments
Pasalic D, Barocas DA, Huang LC
Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.
This retrospective cohort study’s objective was to determine if there were differences in treatment-related regret or survival between prostate cancer patients who received external-beam radiation therapy (EBRT) with or without a brachytherapy boost (EBRT-LDR), over a 5-year period. The cohort included 695 men who met inclusion criteria and received either EBRT (n=583) or EBRT-LDR (n=112). Men who received either treatment reported clinically worse urinary irritation and bowel function through 3 years but resolved after 5 years. Men who received EBRT-LDR continued to report moderate- to-big problems with urinary function bother and frequent urination at 5 years. There was no difference in treatment-related regret or survival between patients who received either treatment.
AHRQ-funded; HS019356; HS022640.
Citation: Pasalic D, Barocas DA, Huang LC .
Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.
Cancer 2021 Jun 1;127(11):1912-25. doi: 10.1002/cncr.33388..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Outcomes, Patient-Centered Outcomes Research, Treatments
Campbell JI, Sandora TJ, Haberer JE
A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking.
This literature review looked at current studies on the diagnosis and treatment of pediatric latent tuberculosis infection (TB infection), commonly known as the TB infection care cascade. The authors conducted a systematic search of several medical databases and included articles and meeting abstracts that studied children and adolescents 21 years or younger who were screened for or diagnosed with TB infection. They identified 146 studies examining steps in the pediatric TB infection care cascade, including 31 in children living in low- and middle-income countries. Most literature described the final cascade step, which is treatment initiation to completion. Strengths and gaps were identified and future research in examining cascade steps upstream of treatment initiation was recommended.
AHRQ-funded; HS000063.
Citation: Campbell JI, Sandora TJ, Haberer JE .
A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking.
BMJ Glob Health 2021 May;6(5). doi: 10.1136/bmjgh-2020-004836..
Keywords: Children/Adolescents, Respiratory Conditions, Diagnostic Safety and Quality, Treatments, Care Management, Evidence-Based Practice
Maduekwe UN, Herb JN, Esther RJ
Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities.
This study looked at the need for pathological nodal staging in patients with extremity synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid (SCARE) soft tissue sarcoma. Patients included were without clinical nodal involvement undergoing surgical resection in the National Cancer Database (2004-2017). The cohort included 4158 patients, with 669 patients (16%) undergoing regional lymph node surgery (RLNS). Patients with epithelioid and clear cell sarcomas were most likely to undergo RLNS. Forty-five (7%) had positive nodes with clear cell sarcoma (14%) and angiosarcoma (13%) having the highest rates of nodal positivity. Five-year survival was reduced in patients with positive nodes.
AHRQ-funded; HS000032.
Citation: Maduekwe UN, Herb JN, Esther RJ .
Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities.
J Surg Oncol 2021 May;123(8):1792-800. doi: 10.1002/jso.26465..
Keywords: Cancer, Diagnostic Safety and Quality, Treatments
Heneghan MB, Hussain T, Barrera L
Access to technology and preferences for an mHealth intervention to promote medication adherence in pediatric acute lymphoblastic leukemia: approach leveraging behavior change techniques.
This study’s objectives were to examine access to mobile technology and preferences for an mHealth intervention to improve medication adherence in pediatric acute lymphoblastic leukemia (ALL). Parents of children with ALL as well as adolescents and young adults (AYAs) with ALL who received maintenance chemotherapy were given a cross-sectional survey. Findings showed that parents, adolescents, and AYAs reported ubiquitous access to mobile technology and strong interest in multiple adherence-specific mHealth app features. Parents and AYAs provided valuable insight into preferred features for a multifunctional behavioral intervention to promote medication adherence in pediatric ALL.
AHRQ-funded; HS023011.
Citation: Heneghan MB, Hussain T, Barrera L .
Access to technology and preferences for an mHealth intervention to promote medication adherence in pediatric acute lymphoblastic leukemia: approach leveraging behavior change techniques.
J Med Internet Res 2021 Feb 18;23(2):e24893. doi: 10.2196/24893..
Keywords: Children/Adolescents, Young Adults, Caregiving, Cancer, Medication, Patient Adherence/Compliance, Health Information Technology (HIT), Treatments
Gupta A, Sedhom R, Sharma R
Nonpharmacological interventions for managing breathlessness in patients with advanced cancer: a systematic review.
The purpose of this review was to evaluate the advantages and harms of nonpharmacological interventions for managing breathlessness in adults with advanced cancer. PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched for English-language studies about randomized and nonrandomized clinical trials, controlled trials, and observational studies. Findings included the safety and association with improved breathlessness of several nonpharmacological interventions for adults with advanced cancer. Recommendations included incorporating nonpharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness.
AHRQ-funded; 290201500006I.
Citation: Gupta A, Sedhom R, Sharma R .
Nonpharmacological interventions for managing breathlessness in patients with advanced cancer: a systematic review.
JAMA Oncol 2021 Feb;7(2):290-98. doi: 10.1001/jamaoncol.2020.5184..
Keywords: Cancer, Respiratory Conditions, Treatments, Evidence-Based Practice, Comparative Effectiveness, Quality of Life, Outcomes, Patient-Centered Outcomes Research
Feliciano JL, Waldfogel JM, Sharma R
Pharmacologic interventions for breathlessness in patients with advanced cancer: a systematic review and meta-analysis.
This systematic review and meta-analysis examined the use of pharmacological interventions for breathlessness in patients with advanced cancer. Studies were identified from database inception to May 2020 using predefined eligibility criteria. Pharmacologic intervention benefits and harms were compared, focusing on breathlessness, anxiety, exercise capacity and health-related quality of life. Out of 7729 unique citations, 19 studies with a total of 1424 patients were included. Opioids were not associated with more effectiveness than placebo for improving breathlessness or exercise capacity. Anxiolytics were also not associated with more effectiveness than placebo for breathlessness or anxiety. There was limited evidence for other pharmacologic interventions. There was some harm, but it was minimal in those short-term studies.
AHRQ-funded; 290201500006I.
Citation: Feliciano JL, Waldfogel JM, Sharma R .
Pharmacologic interventions for breathlessness in patients with advanced cancer: a systematic review and meta-analysis.
JAMA Netw Open 2021 Feb;4(2):e2037632. doi: 10.1001/jamanetworkopen.2020.37632..
Keywords: Cancer: Lung Cancer, Cancer, Respiratory Conditions, Medication, Treatments, Opioids, Evidence-Based Practice, Comparative Effectiveness, Quality of Life, Outcomes, Patient-Centered Outcomes Research
Dinan MA, Wilson LE, Reed SD
Association of 21-gene assay (OncotypeDX) testing and receipt of chemotherapy in the Medicare breast cancer patient population following initial adoption.
This study looked at trends in the association of 21-gene assay testing and receipt of chemotherapy in the Medicare breast cancer patient population following initial adoption from 2001 to 2011. The investigators looked at updated SEER-Medicare data from 2004 and 2011. The cohort included 26,009 patients who met inclusion criteria. Assay use was associated with a decrease in absolute percentage use of chemotherapy by 4.5%, which became even more pronounced from 2008-2011 with a decrease of 6.8%.
AHRQ-funded; HS022189.
Citation: Dinan MA, Wilson LE, Reed SD .
Association of 21-gene assay (OncotypeDX) testing and receipt of chemotherapy in the Medicare breast cancer patient population following initial adoption.
Clin Breast Cancer 2020 Dec;20(6):487-94.e1. doi: 10.1016/j.clbc.2020.05.010..
Keywords: Cancer: Breast Cancer, Cancer, Treatments, Genetics, Medicare, Women, Healthcare Utilization
Friese CR, Fauer AJ, Kuisell C
Patient-reported outcomes collected in ambulatory oncology practices: feasibility, patterns, and correlates.
The purpose of this study was to examine the feasibility of soliciting outcomes from adults who received chemotherapy treatment for cancer and to describe the patterns and correlates of patient-reported toxicities. Results determined that querying patients on chemotherapy treatment experiences and toxicities was feasible. Toxicity rates varied across practices, informing quality improvement. Toxicity severity and service use incidence exceed previously published trial data, particularly for pain, fatigue, and gastrointestinal issues. Open-text questions enabled exploration with newer treatment regimens.
AHRQ-funded; HS024914.
Citation: Friese CR, Fauer AJ, Kuisell C .
Patient-reported outcomes collected in ambulatory oncology practices: feasibility, patterns, and correlates.
Health Serv Res 2020 Dec;55(6):966-72. doi: 10.1111/1475-6773.13574..
Keywords: Ambulatory Care and Surgery, Cancer, Treatments, Quality of Care, Patient-Centered Outcomes Research, Outcomes
Steele DW, Becker SJ, Danko KJ
Brief behavioral interventions for substance use in adolescents: a meta-analysis.
Adolescents with problematic substance use (SU) are at risk for far-reaching adverse outcomes. The objective of this study was to synthesize the evidence regarding the effects of brief behavioral interventions for adolescents (12-20 years) with problematic SU. The investigators concluded that the use of a behavioral intervention called motivational interviewing reduced heavy alcohol use, alcohol use days, and SU-related problems in adolescents but did not reduce cannabis use days.
AHRQ-funded; 290201500002I.
Citation: Steele DW, Becker SJ, Danko KJ .
Brief behavioral interventions for substance use in adolescents: a meta-analysis.
Pediatrics 2020 Oct;146(4):e2020351. doi: 10.1542/peds.2020-0351..
Keywords: Children/Adolescents, Substance Abuse, Alcohol Use, Treatments
Nguyen JT, Cole AL, Leech AA
Cost-effectiveness of first-line tyrosine kinase inhibitor therapy initiation strategies for chronic myeloid leukemia.
AHRQ-funded; HS000032.
Citation: Nguyen JT, Cole AL, Leech AA .
Cost-effectiveness of first-line tyrosine kinase inhibitor therapy initiation strategies for chronic myeloid leukemia.
Value Health 2020 Oct;23(10):1292-99. doi: 10.1016/j.jval.2020.05.019..
Keywords: Chronic Conditions, Medication, Healthcare Costs, Treatments
Greenhawt M, Kim EH, Campbell DE
Improvements in eliciting dose across baseline sensitivities following 12 months of epicutaneous immunotherapy (EPIT) in peanut-allergic children aged 4 to 11 years.
The post hoc analyses presented in this article evaluated eliciting dose changes after epicutaneous immunotherapy treatment in peanut-allergic children in clinical trials in a more insightful way than a binomial endpoint approach allows. Findings showed that, for each entry eliciting dose (ED), patients treated daily for 12 months were able to achieve 2- to 6-fold greater ED increases versus placebo. The raw proportion of patients in the treatment group who were able to achieve an ED 1000 mg after 12 months was higher compared with placebo for every entry ED of 3 mg or greater.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Kim EH, Campbell DE .
Improvements in eliciting dose across baseline sensitivities following 12 months of epicutaneous immunotherapy (EPIT) in peanut-allergic children aged 4 to 11 years.
J Allergy Clin Immunol Pract 2020 Oct;8(9):3219-21. doi: 10.1016/j.jaip.2020.05.030..
Keywords: Children/Adolescents, Treatments
Santosa KB, Keane AM, Keller M
Inpatient versus outpatient management of negative pressure wound therapy in pediatric patients.
Negative pressure wound therapy (NPWT) is commonly used to manage complex wounds in the pediatric population. With recently developed portable NPWT devices, providers have the opportunity to transition NPWT to the outpatient setting. However, there are no studies describing outpatient NPWT in pediatric patients. Therefore, the purpose of this study was to leverage a population-level analysis to advance current knowledge about outpatient NPWT use in pediatric patients.
AHRQ-funded; HS019455.
Citation: Santosa KB, Keane AM, Keller M .
Inpatient versus outpatient management of negative pressure wound therapy in pediatric patients.
J Surg Res 2020 Oct;254:197-205. doi: 10.1016/j.jss.2020.04.025..
Keywords: Children/Adolescents, Injuries and Wounds, Treatments, Care Management, Ambulatory Care and Surgery, Hospitalization
Feldman AG, Parsons JA, Dutmer CM
Subacute liver failure following gene replacement therapy for spinal muscular atrophy type 1.
This paper reports on two cases of transient, drug-induced liver failure after gene replacement therapy using an adeno-associated virus vector containing the survival motor neuron 1 gene.
AHRQ-funded; HS026510.
Citation: Feldman AG, Parsons JA, Dutmer CM .
Subacute liver failure following gene replacement therapy for spinal muscular atrophy type 1.
J Pediatr 2020 Oct;225:252-58.e1. doi: 10.1016/j.jpeds.2020.05.044..
Keywords: Newborns/Infants, Neurological Disorders, Genetics, Treatments, Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Patient Safety, Case Study
Schlick CJR, Merkow RP, Yang AD
Post-discharge venous thromboembolism after pancreatectomy for malignancy: predicting risk based on preoperative, intraoperative, and postoperative factors.
Extended chemoprophylaxis is recommended for high-risk patients following pancreatectomy for malignancy. However, quantifying risk remains difficult. In this study, the investigators sought to (a) identify factors associated with post-discharge venous thromboembolism (VTE) following pancreatectomy for malignancy and (b) develop a post-discharge VTE risk calculator to identify high-risk patients. The investigators concluded that preoperative, intraoperative, and postoperative factors were associated with post-discharge VTE following pancreatectomy for malignancy.
AHRQ-funded; HS026385.
Citation: Schlick CJR, Merkow RP, Yang AD .
Post-discharge venous thromboembolism after pancreatectomy for malignancy: predicting risk based on preoperative, intraoperative, and postoperative factors.
J Surg Oncol 2020 Sep 15;122(4):675-83. doi: 10.1002/jso.26046..
Keywords: Cancer, Surgery, Treatments, Blood Clots, Risk
Rhee TG, Olfson M, Sint K
Characterization of the quality of electroconvulsive therapy among older Medicare beneficiaries.
Electroconvulsive therapy (ECT) is an important therapy for treatment-resistant depression and is especially effective for elderly individuals with depression. This study provides the first US nationally representative description of ECT in the elderly. The investigators concluded that despite substantial evidence of efficacy, ECT use remained rare among elderly patients with depression.
AHRQ-funded; HS023000.
Citation: Rhee TG, Olfson M, Sint K .
Characterization of the quality of electroconvulsive therapy among older Medicare beneficiaries.
J Clin Psychiatry 2020 Jul 7;81(4). doi: 10.4088/JCP.19m13186.
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Keywords: Elderly, Medicare, Depression, Behavioral Health, Treatments, Patient-Centered Outcomes Research
Lafferty M, Fauer A, Wright N
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care. The authors identified four primary themes from the analysis that affect delays. They suggest future investigations to examine nurses' communication practices in the context of timely chemotherapy administration since communication and documentation technologies within healthcare settings continuously evolve.
AHRQ-funded; HS024914.
Citation: Lafferty M, Fauer A, Wright N .
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
Oncol Nurs Forum 2020 Jul 1;47(4):417-27. doi: 10.1188/20.Onf.417-427..
Keywords: Treatments, Cancer, Ambulatory Care and Surgery, Quality of Care, Clinician-Patient Communication, Communication, Provider: Nurse, Provider, Nursing, Chronic Conditions
Thomas MA, Fu Y, Yang D
Development and evaluation of machine learning models for voxel dose predictions in online adaptive magnetic resonance guided radiation therapy.
Daily online adaptive plan quality in magnetic resonance imaging guided radiation therapy (MRgRT) is difficult to assess in relation to the fully optimized, high quality plans traditionally established offline. In this paper, the authors discuss their machine learning prediction models capable of predicting 3D dose distributions and enabling the evaluation of online adaptive plan quality to better inform adaptive decision-making in MRgRT.
AHRQ-funded; HS022888.
Citation: Thomas MA, Fu Y, Yang D .
Development and evaluation of machine learning models for voxel dose predictions in online adaptive magnetic resonance guided radiation therapy.
J Appl Clin Med Phys 2020 Jul;21(7):60-69. doi: 10.1002/acm2.12884..
Keywords: Imaging, Treatments