viernes, 20 de julio de 2018

EHC Update: Breastfeeding and Rheumatoid Arthritis Final Reports

EHC Update: Breastfeeding and Rheumatoid Arthritis Final Reports

effective health care program - helping you make better treatment choices

Systematic Reviews Now Available

Selected Key Messages:
  • Baby-Friendly Hospital Initiative (BFHI) is associated with improved rates ofbreastfeeding initiation and duration.
  • Health care staff education combined with postpartum home visits may be effective for increasing breastfeeding duration.
  • Health care staff education alone (with no additional breastfeeding support services) may not be effective for increasing breastfeeding initiation rates.
  • For women enrolled in the Women, Infants, and Children (WIC) program, peer-support interventions offered by WIC agencies may improve rates of breastfeeding initiation and duration.
  • Breastfeeding is associated with reduced maternal risk of breast and ovarian cancer,hypertension, and type 2 diabetes.
  • Workplace, school-based, and community-based interventions and underlying socioeconomic factors need further research.
    Selected Key Messages:
    • Conclusions are based on studies that enrolled patients with moderate to high disease activity at baseline as measured with Disease Activity 28 Scores and may not apply to the general rheumatoid arthritis (RA) population.
    • Corticosteroids in combination with methotrexate (MTX) may improve remission rates more than MTX alone (difference range, 2.1% to 42.8%), but they did not differ significantly in disease activity in the long term (up to 5 years).
    • Two-agent treatments with MTX and tumor necrosis factor (TNF) biologics or non-TNF biologics most likely yield higher treatment response rates than treatment with MTX monotherapy or any biologic monotherapy (range of American College of Rheumatology response differences, 1.2% to 25.6%).
    • Rates of serious adverse events and discontinuations because of adverse events may not differ between any disease-modifying antirheumatic drugs (DMARDs).
    • Insufficient information was available about treatment options for patient subgroups, such as disease activity, prior therapy, demographics, and the presence of other serious conditions.
    • Future research should address the (1) assessment of long-term comparative benefits and harms of DMARDs, (2) determination of treatment decisions based on disease activity severity in early RA, and (3) timing of initiation of biologic medications.

    About us: AHRQ’s Effective Health Care Program is committed to providing the best available evidence on the outcomes, benefits and harms, and appropriateness of drugs, devices, and health care services and by helping health care professionals, patients, policymakers, and health care systems make informed health care decisions. The program partners with research centers, academic institutions, health professional societies, consumer organizations, and other stakeholders to conduct research, evidence synthesis, evidence translation, dissemination, and implementation of research findings.
    Contact us at: 

    What’s New for Biologics

    What’s New for Biologics

    AHRQ Toolkit Helped Madonna Rehabilitation Hospital Reduce Patient Falls by 21 Percent | Agency for Healthcare Research & Quality

    AHRQ Toolkit Helped Madonna Rehabilitation Hospital Reduce Patient Falls by 21 Percent | Agency for Healthcare Research & Quality

    AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

    AHRQ Toolkit Helped Madonna Rehabilitation Hospital Reduce Patient Falls by 21 Percent

    Patient Safety
    July 2018
    Patient falls resulting in injury were reduced by 21 percent at Madonna Rehabilitation Hospital after the Lincoln, NE, facility implemented AHRQ’s Preventing Falls in Hospitals Toolkit in 2015.
    Madonna Rehabilitation Hospital, a 48-bed post-acute care facility, prevented eight patient falls during a nearly 2-year period, saving an estimated $107,000 in medical costs, according to Jackie Krason, R.N., M.S.N., the hospital’s quality and risk management supervisor.
    AHRQ’s toolkit helps hospitals overcome the challenges associated with developing, implementing, and sustaining a fall prevention program. Fall prevention involves managing a patient's underlying fall risk factors and optimizing a hospital's physical design and environment.
    Using the toolkit, the hospital updated its fall risk assessment system to use more specific risk factors, which enabled the registered nurses to better identify patients at greatest risk of a fall. Krason said this is where the AHRQ toolkit really made a difference.
    “We developed and tested a new system that could accurately assess the impact that cognition, history of falls, gait, and balance had on a post-acute care patient’s risk of falling,” Krason said. “We previously had a falls prevention program in place, but it was definition-driven instead of risk-driven.”
    The AHRQ toolkit also includes guidance on ways to build internal support for a fall prevention program, which Krason called “quite invaluable in establishing buy-in among our hospital’s leadership.” Staff education is also emphasized in the toolkit, which led the hospital to provide annual, mandatory training for all employees. The in-person training includes an online component with a followup test as well as hands-on competency and is tied to an employee’s annual performance evaluation.
    Surveillance of the physical environment is also important, noted Terasa Farlin, R.N., the hospital’s nurse manager. “With our facility’s increased focus on preventing falls, nursing staff and therapists now conduct an assessment of the condition of each patient’s room during their hourly rounds. This presents the opportunity to relocate unneeded equipment or electrical cords that could pose a hazard.”
    Given that a patient’s length of stay can range from 2 weeks to 4 months in the rehab facility, “we need to keep their living space as organized as possible to prevent a possible fall,” Farlin added.
    Madonna Rehabilitation Hospital was one of several facilities recruited to participate in a project that evaluated the effectiveness of AHRQ’s Preventing Falls in Hospitals Toolkit. “We benefitted greatly from the project in helping us improve measures for fall prevention,” Krason said.
    Impact Case Study Identifier: 
    AHRQ Product(s): Preventing Falls in Hospitals Toolkit
    Topics(s): Health Care Costs, Health Care Quality, Medical Errors, Outcomes, Patient Experience, Patient Safety
    Geographic Location: Nebraska
    Implementer: Madonna Rehabilitation Hospital
    Date: 07/18/2018

    A Tip of the Cap to Researchers' Outstanding Use of AHRQ Data | Agency for Healthcare Research & Quality

    A Tip of the Cap to Researchers' Outstanding Use of AHRQ Data | Agency for Healthcare Research & Quality

    AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

    AHRQ Views

    Blog posts from AHRQ leaders

    Herbert WongAHRQ researchers really know data. They collect them. They analyze them. They help get them into the hands of policymakers, health system leaders, purchasers, clinicians, researchers, and others who use these data for many purposes—not only to keep pace with health care trends, but also to improve the care that patients receive.
    Once a year, AHRQ and AcademyHealth are pleased to recognize the researchers whose peer-reviewed journal articles make the best use of data from one of AHRQ's primary data sources—the Healthcare Cost and Utilization Project (HCUP).
    This year, two research teams received AHRQ–AcademyHealth HCUP Outstanding Article of the Year awards. I had the honor to present the awards at AcademyHealth's recent Annual Research Meeting, and both efforts were exceptional:
    • For clinical research: A team led by investigators at the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, and the Saint Luke's Mid-America Heart Institute examined nationwide 30-day readmission rates for peripheral arterial disease revascularization in 2014 and whether risk of readmission varied among hospitals. The team looked at more than 60,000 discharges at more than 1,000 acute care hospitals that are included in the HCUP's Nationwide Readmission Database. The researchers found the overall 30-day readmission rate to be nearly 18 percent, with procedural complications (28 percent) and sepsis (8 percent) being the most common causes for readmission. After accounting for the case mix of patients, the risk of 30-day readmission rate moderately varied across hospitals. The researchers suggested that hospital quality may only partially account for risk of readmissions, and that other factors such as post-discharge care should be examined. The article, "Readmissions After Revascularization Procedures for Peripheral Arterial Disease: A Nationwide Cohort Study," was published in the Annals of Internal Medicine.
    • For health policy research: Researchers from several institutions—the David Geffen School of Medicine, University of California Los Angeles; the Ross School of Business, University of Michigan; the University of Illinois; the University of Chicago; and the National Bureau of Economic Research—investigated how Medicaid eligibility among children may impact their likelihood of adult hospitalizations. Drawing on data from HCUP's State Inpatient Databases and State Emergency Discharge Databases, the team found that more years of childhood eligibility are associated with fewer adult hospitalizations. Notably, black children who were eligible for Medicaid had a 7 to 15 percent decrease in adult hospitalizations. A similar effect was not found among non-blacks. The article, "Childhood Medicaid Coverage and Later-Life Health Care Utilization Link to Exit Disclaimer," was published in The Review of Economics and Statistics.
    Choosing the most outstanding articles of the year is never easy. To date, over 6,000 peer-reviewed articles cite HCUP data. With data beginning in 1988, HCUP offers the Nation's largest collection of longitudinal hospital care data, including information on inpatient care, ambulatory care, and emergency department visits.
    We’re also mindful that HCUP is just one of many AHRQ data sources that help experts keep abreast of health care trends and improve care. The Agency's Medical Expenditure Panel Survey is the only national data source measuring how Americans use and pay for medical care, health insurance, and out-of-pocket spending. Our National Quality & Disparities Report, along with our State Snapshots, each year provide updated measures on trends related to the access, timeliness, and effectiveness of care; patient safety; and patient centeredness. And AHRQ's Consumer Assessment of Healthcare Providers and Systems (CAHPS®) collects voluntarily submitted survey results on patients' experience with health, which are stored in the CAHPS Database.
    We applaud the many skilled, devoted health services researchers who consistently use AHRQ's data platforms to examine the rapid changes in health care, as well as their commitment to making a difference in patients' lives. Again, congratulations to the winners of this year's HCUP Articles of the Year award. We look forward to seeing the submissions next year!
    Herbert Wong is the Director of the Division of Markets and Systems Research in AHRQ's Center for Delivery, Organizations, and Markets.
    Get more AHRQ news, sign up for AHRQ news via email, and follow AHRQ on Twitter  Link to Exit DisclaimerLinkedIn Link to Exit DisclaimerFacebook Link to Exit Disclaimer, and YouTube Link to Exit Disclaimer.
    Page last reviewed July 2018
    Page originally created July 2018
    Internet Citation: A Tip of the Cap to Researchers' Outstanding Use of AHRQ Data. Content last reviewed July 2018. Agency for Healthcare Research and Quality, Rockville, MD.

    Press Announcements > Statement from FDA Commissioner Scott Gottlieb, M.D., on agency’s efforts to encourage the development of and broaden access to generic versions of opioid analgesics that are formulated to deter abuse

    Press Announcements > Statement from FDA Commissioner Scott Gottlieb, M.D., on agency’s efforts to encourage the development of and broaden access to generic versions of opioid analgesics that are formulated to deter abuse

    One of the ways that the U.S. Food and Drug Administration is working to address the opioid epidemic is by encouraging the development of opioid analgesic products that are harder to manipulate and abuse. Opioids with abuse-deterrent formulations (ADFs) are intended to make certain types of abuse, such as crushing a tablet to snort or dissolving a capsule to inject, more difficult or less rewarding. 

    These innovative formulations are designed to make it harder for people to manipulate the opioid product so they can’t be as easily abused to deliver an immediate “high.” But it’s important that prescribers and patients understand that these drugs are not “abuse-proof,” and they do not prevent addiction, overdose or death.

    New Guidances: Use of Electronic Health Record Data in Clinical Investigations / E17 General Principles for Planning and Design of Multiregional Clinical Trials

    1. Use of Electronic Health Record Data in Clinical Investigations: Final Guidance for Industry:

    FDA has published a  guidance for industry entitled “Use of Electronic Health Record Data in Clinical Investigations; Guidance for Industry.” This guidance is intended to assist sponsors, clinical investigators, contract research organizations, institutional review boards, and other interested parties on the use of electronic health record (EHR) data in FDA-regulated clinical investigations.  The guidance’s goals are to modernize and streamline clinical investigations through inclusion of real world data in clinical investigations and facilitate integration of clinical trials that occur in routine care settings.  In addition, we hope that the guidance will encourage sponsors and health care organizations to work with EHR and electronic data capture (EDC) system vendors to further advance the interoperability and integration of EHR and EDC systems.

    2. E17 General Principles for Planning and Design of Multiregional Clinical Trials Guidance for Industry

    The purpose of this guidance is to describe general principles for the planning and design of multiregional clinical trials (MRCTs) with the aim of increasing the acceptability of MRCTs in global regulatory submissions. The guidance addresses strategic program issues and issues that are specific to the planning and design of confirmatory MRCTs, and it should be used together with other ICH guidances for industry, including E5 Ethnic Factors in the Acceptability of Foreign Clinical Data, E6 Good Clinical Practice, E8 General Considerations for Clinical Trials, E9 Statistical Principles for Clinical Trials, E10 Choice of Control Group and Related Issues in Clinical Trials, and E18 Genomic Sampling and Management of Genomic Data. 

    Air Force, NASA seek potential medical collaboration |

    Air Force, NASA seek potential medical collaboration |

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    Air Force, NASA seek potential medical collaboration

    David Loftus M.D., PH.D, medical officer and principal investigator space biometrics research branch, NASA Ames Research Center, meets with members of the 60th Medical Group at Travis Air Force Base, California. NASA and David Grant Medical Center are meeting for a potential collaboration between the two organizations to help in future space exploration. (U.S. Air Force photo by Louis Briscese)

    David Loftus M.D., PH.D, medical officer and principal investigator space biometrics research branch, NASA Ames Research Center, meets with members of the 60th Medical Group at Travis Air Force Base, California. NASA and David Grant Medical Center are meeting for a potential collaboration between the two organizations to help in future space exploration. (U.S. Air Force photo by Louis Briscese)

    TRAVIS AIR FORCE BASE, Calif. – Representatives from NASA visited David Grant Medical Center here, recently, in hopes of establishing research collaboration leading to advances in medical support for deep space missions as well as warfighters. The space agency provided a presentation on manned deep space exploration missions and how Travis fits into their long-term vision.
    The Clinical Investigation Facility inside DGMC provided valuable research data to NASA. They arranged demonstrations of their capabilities during the visit which was led by Air Force Lt. Col. Leonardo Tato, director of the Clinical Investigation Facility, 60th Medical Support Squadron.
    “NASA is being chartered to come up with medical capabilities for long-term exploration,” said Tato. “Currently, their medical capacities are based on their mission to 230 miles low orbit.”
    Dr. David Loftus, medical officer and principal investigator of the Space Biosciences Research Branch, NASA Ames Research Center, Moffett Field, California, is excited about the potential collaboration between NASA and Travis.
    “We see a partnership with Travis as a terrific opportunity,” said Loftus. “With our medical technologies and their abilities to test them with real-world application through research, the partnership will be vital to our success.”
    Although manned space travel isn’t new, the distances for the next phase of deep space missions are much greater than ever before for human exploration.
    “Traveling to Mars and beyond are such tremendous distances from earth,” said Loftus. “That type of travel requires a whole new medical capability, which is why we are here at Travis.”
    NASA’s vision is to begin long-distance travel within the next 15 to 20 years.
    “The maximum distance we travel now is 230 miles to the International Space Station,” said Loftus. “Ultimately, we’ll explore unmanned and then manned missions around the moon, then to Mars and beyond.”
    Research at the CIF is conducted with the purpose of advancing military science and developing advanced military technologies to improve healthcare of patients on and off the battlefield. The research aims to address unique military medical requirements that civilian institutions and industry may not have economic incentive to pursue.
    “We have to leverage our civilian partnerships and other government agencies to solve our unique military health capability gaps,” said Tato. “Our military mission and unique operational environment generates special medical needs, whereas civilian institutions and businesses don’t have the monetary incentive to tackle these issues as they are not in their scope of practice.”
    NASA is working in conjunction with Livermore National Laboratory, Livermore, California, to develop instruments that analyze patients through breath and fluids.
    “Our technologies are a combined effort between NASA and Livermore National Laboratory,” said Loftus. “The advancements of microfluidic and breath analysis technologies combined together to form a very powerful diagnostic instrument.”
    One of the devices NASA is utilizing was created by Dr. Jing Li, NASA Ames Research Center, Li has been developing this device for 10 years.
    “The E-Nose breathalyzer allows you to understand the different volatile compounds in exhaled breath,” said Loftus. “This correlates with the various compounds and the health of the patient or warfighter.”
    There is also optimism that the collaboration will improve military applications on the battlefield.
    “We feel this technology will be perfect for deep space missions as well as military applications,” said Loftus. “We’re very interested in the effects of injuries from pulmonary and traumatic brain injury from improvised explosive devices.”
    The collaboration between NASA and Travis is a perfect fit because of the similarities they share said Air Force Lt. Col. Ian Stewart, 60th Medical Support Squadron, nephrologist, which is a doctor that specializes in kidney care.
    “It’s very exciting because NASA and the military share a lot of similar problems,” said Stewart. “The ability to evacuate a casualty from an austere environment is similar to providing emergency medical care to an astronaut in space.”
    Disclaimer: Re-published content may have been edited for length and clarity. Read original post.

    Soldiers test Army's newest transport telemedicine technology

    Soldiers test MEDHUB during an exercise at Camp Atterbury, Indianapolis. (U.S. Army photo by Greg Pugh)
    MEDHUB is really about life-saving situational awareness
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    Navy Care app enables medical appointments from work, home

    A Sailor uses the Navy Care app on her cell phone for a virtual health visit with a Naval Hospital Jacksonville provider. Navy Care enables patients to have a live video visit with a clinician on a smartphone, tablet, or computer. It’s private, secure, and free. (U.S. Navy photo by Petty Officer 1st Class Jacob Sippel)
    The app delivers convenient care with the quality of a face-to-face visit
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    From an award ceremony to panel talks, senior leaders will have presence at HIMSS

    Vice Adm. Raquel Bono, director of Defense Health Agency, will be honored as a recipient of the HIMSS Most Influential Women in Health IT Awards on March 8 in Las Vegas.
    Federal health, IT experts come together for discussion on hot topics
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    Air Force robotic surgery training program aims at improving patient outcomes

    Air Force Col. Debra Lovette (left), 81st Training Wing commander, receives a briefing from Air Force 2nd Lt. Nina Hoskins, 81st Surgical Operations squadron room nurse, on robotics surgery capabilities inside the robotics surgery clinic at Keesler Medical Center, Mississippi. The training program stood up in March 2017 and has trained surgical teams within the Air Force and across the Department of the Defense. (U.S. Air Force photo by Kemberly Groue).
    Robotic surgery is becoming the standard of care for many specialties and procedures
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    2017 Year in Review: Places where Military Health System leaders, experts gathered

    Navy Vice Adm. Raquel Bono, director, Defense Health Agency, speaks at the Defense Health Information Technology Symposium, July 25, in Orlando, Florida. Conferences like this one help MHS and other health care personnel to exchange ideas and information to help improve care to beneficiaries. (Courtesy photo)
    Conferences offer opportunities to focus on the best health care for beneficiaries
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    First cold storage platelet unit collected in Southwest Asia

    Air Force Staff Sgt. Jonathan Flannigan, NCO in charge of the apheresis element with the 379th Expeditionary Medical Group, monitors the Trima Accel Automated Blood Collection System machine used to obtain blood platelets from donors at Al Udeid Air Base, Qatar. Apheresis element Airmen are tasked with collecting and storing platelet products and providing them for distribution throughout the U.S. Central Command area of responsibility. (U.S. Air Force photo by Senior Airman Cynthia A. Innocenti)
    It is likely that cold storage platelets, a method developed by the military, will eventually be the standard practice around the world for handling and shipping platelets
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    Combat medic students train using hologram technology

    Alonzo Gonzales, a Combat Medic Program emergency medical technician course instructor, lectures students in Alpha Class 70-17 about different obstetrics complications  utilizing a specialized OB training manikin. The OB manikins resemble life-size pelvic cavities inside which the “fetus” can be positioned to replicate any number of complicated situations. (U.S. Army photo by Lisa Braun)
    The Combat Medic Training program is the first METC program to incorporate hologram technology to augment training
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    Possible cause for severe eczema has been found

    Some patients living with severe eczema – a possible disqualifying factor for military service – have been found to have mutations on a gene called CARD11. Identified as a possible cause for the condition, the discovery can lead to exciting possibilities for advancements, according to the researchers.
    Some patients living with severe eczema have been found to have mutations on a gene called CARD11 – Identified as a possible cause for the condition, the discovery can lead to exciting possibilities for advancements, according to the researchers
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    Health IT team working on creating an information ecosystem

    Health IT team working to create ecosystem of information for patients, providers.
    Highly interactive environment benefits patients, providers
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    Counter-hemorrhaging medical device saves service members' lives

    U.S. Army Spc. Courtney Natal provides aid to a simulated casualty. Born out of necessity on the battlefield, a new medical device is buying vital time for critically wounded patients in combat and in emergency care environments worldwide. (U.S. Army photo by Sgt. Harley Jelis)
    Born out of necessity on the battlefield, a new medical device is buying vital time for critically wounded patients
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    With success comes ‘great momentum’ in hearing center’s future

    Marine Staff Sgt. Charles Mitchell takes the annual audiogram test at Camp Pendleton, California. (U.S. Marine Corps photo by Cpl. Khoa Pelczar)
    DoD’s Hearing Center of Excellence works closely with other departments and organizations, including VA and NIH, to facilitate research focused on prevention, diagnosis, mitigation, treatment, and rehabilitation of hearing issues
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    Partnership improves care, prosthetics for wounded warriors

    Experts across the DoD and VA come together to collaborate on research and innovation through the Extremity Trauma and Amputation Center of Excellence. (U.S. Navy photo by Petty Officer 1st Class Anastasia McCarroll)
    The Extremity Trauma and Amputation Center of Excellence brings DoD and VA together to conduct research aimed at saving extremities and improving care for patients with amputations
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    Army scientists hope to unlock clues to bone healing in space experiment

    Bintu Sowe, an associate scientist at the U.S. Army U.S. Army Center for Environmental Health Research, processes samples from the bone healing experiment that was aboard the International Space Station. The samples were delivered back to Earth by SpaceX's Dragon cargo craft in March. (U.S. Army photo by Crystal Maynard)
    Scientists at the U.S. Army Center for Environmental Health Research are hoping to determine how bones heal in microgravity, based on an experiment that launched to the International Space Station aboard SpaceX in February and returned to earth aboard SpaceX's Dragon cargo craft in March
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    Health Innovation Month: Finding new ways to better health outcomes

    Sean Biggerstaff, Ph.D., acting director for the Research and Development directorate for the Defense Health Agency
    July is Health Innovation Month in the MHS. Sean Biggerstaff, acting director for Research and Development for the Defense Health Agency, shares his thoughts on what health care innovations are doing to save lives on and off the battlefield
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    Army supporting clinical trial testing hemorrhage control foam

    Exsanguination, or bleeding to death, remains the most common cause of potentially survivable death to wounded warfighters. The Army is looking at this device as a potential stop-gap for patients awaiting surgical care. It could be a 'bridge to surgery,' keeping the patient alive long enough to give them a fighting chance at survival. The device resembles a caulk gun that contains expandable foam designed to be injected into a patient by a trauma surgeon. (U.S. Navy phot by Lt. j.g. Haraz  Ghanbari)
    The Army is supporting a pivotal clinical trial to test the safety and effectiveness of a self-expanding foam device to stop massive intracavitary abdominal bleeding
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