Recently Published Projects

Published on June 23, 2021
Interventions to Reduce Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections [Entered Retrospectively]
133 Citations • 6 Key Questions • 133 Extraction Forms
Project created on June 23, 2021
Last updated on June 23, 2021
Objectives: Objectives. To assess the comparative effectiveness of interventions for reducing antibiotic use for acute respiratory tract infections (RTIs) in adults and children. Data Sources. Electronic databases (MEDLINE® from 1990 and the Cochrane Library databases from 2005 to February 2015), reference lists of included systematic reviews, and scientific information packets from of point-of-care test manufacturers and experts. Review Methods. Using predefined criteria, we selected studies of any intervention designed to reduce antibiotic prescribing for acute RTIs. Interventions were organized into educational, communication, clinical, system level, and multifaceted categories. The key outcome was change in prescribing; secondary outcomes were undesirable consequences such as medical complications and satisfaction. The quality of included studies was rated and the strength of the evidence was assessed. Clinical and methodological heterogeneity limited quantitative analysis. Our synthesis focused on interventions that had evidence of net benefit: at least moderate strength of evidence for decreasing overall prescribing of antibiotics for acute RTI and at least low strength evidence for other outcomes. Results. Based on 132 studies, including 88 randomized controlled trials, several interventions had net benefit. Compared with usual care, reductions in overall prescribing were 21 percent for clinic-based educational programs for parents, 7 percent for public education campaigns combined with clinician education, 9 to 26 percent for communication training, 5 to 9 percent for electronic decision support, 2 to 34 percent for C-reactive protein (CRP), 12 to 72 percent for procalcitonin in adults, and >25 percent for clinician communication training plus CRP testing. Delayed prescribing reduced use by 34 to 76 percent compared with immediate prescribing. Additionally, public education campaigns combined with clinician education and electronic decision support possibly improved appropriate prescribing. Interventions varied in their effects on other outcomes. Few studies assessed impact on the most serious undesirable outcomes, but in those that did, there were no increases in medical complications for public education campaigns combined with clinician education or electronic decision support and, for hospitalizations, no increases for CRP or procalcitonin and only a slight increase for communication+CRP. Negative impacts on less serious outcomes were few and small: more return visits with CRP testing, slightly longer symptom duration with communication training plus CRP testing, and decreased patient satisfaction and slightly longer symptom duration with delayed prescribing. Direct comparisons of interventions were few; only clinician communication training plus CRP testing showed net benefit over CRP testing alone. Interventions with no or negative impact on antibiotic prescribing were procalcitonin in children, clinic-based education for parents of children ≤24 months with acute otitis media, and point-of-care testing for influenza in children. Conclusions. Interventions from all categories had evidence of net benefit and no serious adverse consequences. Magnitude of benefit varied widely and current evidence is inadequate to determine key modifying factors. Future studies need to better evaluate potential effect modifiers, and directly compare the effective interventions individually and combined, on net benefit, sustainability, and resource use.
Published on June 23, 2021
Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer [Retrospectively Entered]
17 Citations • 11 Key Questions • 17 Extraction Forms
Project created on June 23, 2021
Last updated on June 23, 2021
Objectives: The purpose of this technical brief is to understand current utilization of metastatic breast imaging modalities for treatment evaluation in the United States, both in order to summarize the current state of the science and to inform future research on this topic.
Published on June 16, 2021
Breast Reconstruction After Mastectomy
324 Citations • 6 Key Questions • 162 Extraction Forms
Project created on May 04, 2020
Last updated on November 08, 2022
Objectives: This systematic review will assess the surgical breast reconstruction options for women who are undergoing (or have undergone) mastectomy for breast cancer. Specifically, the review will address: (1) the (comparative) benefits and harms of IBR and AR (Key Question [KQ] 1) (2) the (comparative) benefits and harms of timing of IBR and AR in relation to chemotherapy and radiation therapy (KQ 2) (3) the (comparative) benefits and harms of various options for IBR (KQs 3, 4, and 5) (4) the (comparative) benefits and harms of various flap types for AR (KQ 6).
Published on May 28, 2021
A Descriptive Analysis of the Scientific Literature on Meteorological and Air Quality Factors and COVID-19
61 Citations • 9 Key Questions • 61 Extraction Forms
Project created on October 15, 2020
Last updated on August 06, 2021
Objectives: Descriptive systematic literature review from epidemiologic perspective of studies assessing influence of environmental and meteorological factors on COVID-19 transmission and severity.
Published on March 03, 2021
Catheter Ablation for Treatment of Atrial Fibrillation [Prospectively Entered]
50 Citations • 7 Key Questions • 50 Extraction Forms
Project created on March 03, 2021
Last updated on March 03, 2021
Objectives: Because catheter ablation is increasingly being used to treat AF patients in the Medicare population, and there is uncertainty regarding the efficacy and harms of this procedure in this population in particular, a systematic review to re-evaluate the current state of evidence, identify and evaluate inconsistencies in the evidence, and identify important research gaps is warranted to help inform clinical practice and policy.