Recently Published Projects

Objectives: The ultimate reason for accurately diagnosing clinical Alzheimer’s-type dementia (CATD) and whether Alzheimer’s disease (AD) is the underlying neuropathological etiology is to inform decision making about drug and nondrug treatments to improve patient and caregiver outcomes. In individuals with suspected cognitive impairment, comprehensive neuropsychological testing may help clinically diagnose dementia and distinguish between dementia subtypes. However, such testing is time consuming and access is limited in some clinical settings. Therefore, we need better understanding in this population with suspected cognitive impairment (case finding) which brief cognitive tests and test combinations most accurately distinguish patients with CATD from those with normal cognition or mild cognitive impairment (MCI), and whether patient characteristics affect test classification accuracy. Additionally, many individuals clinically diagnosed with CATD do not meet neuropathologic (gold standard) criteria for AD on post-mortem brain autopsy. Therefore, we also need better understanding of how accurate pre-mortem brain imaging and cerebrospinal fluid (CSF) biomarkers are for distinguishing patients whose dementia is due to AD from those with non-AD dementia, and whether classification accuracy varies depending on patient characteristics. Finally, although only a few prescription drugs are approved by the U.S. Food and Drug Administration (FDA) for CATD, many supplements are promoted for cognition and function. In addition, many prescription drugs are used off-label for CATD-associated behavioral and psychological symptoms of dementia (BPSD), including antipsychotics despite FDA black box warnings about their increased mortality risk in this population. Less is understood about the beneficial and harmful effects of supplements for CATD-associated BPSD. To guide CATD treatment decisions for cognition, function, BPSD and other outcomes, we need to clarify the benefits and harms of prescription drugs and supplements in this population.

Objectives: Structured Abstract Objective. To understand the evidence base for care interventions, implementation strategies, and between-provider communication tools among children with special healthcare needs (CSHCN) transitioning from pediatric to adult medical care services. Data Sources. We searched Ovid Medline, Ovid Embase, the Cochrane Central trials (CENTRAL) registry, and CINAHL to identify studies through September 10, 2021. We conducted grey literature searches to identify additional resources relevant to contextual questions. Review Methods. Using a mixed-studies review approach, we searched for interventions or implementation strategies for transitioning CSHCN from pediatric to adult services. Two investigators screened abstracts and full-text articles of identified references for eligibility. Eligible studies included randomized controlled trials, quasi-experimental observational, and mixed method studies of CSHCN, their families, caregivers, or healthcare providers. We extracted basic study information from all eligible studies and grouped interventions into categories based on disease conditions. We summarized basic study characteristics for included studies and outcomes for studies assessed as low to medium risk of bias using ROB-2. Results. We identified 9,549 unique references, 440 of which represented empirical research; of these, 154 (16 major disease categories) described or examined a care transition intervention with enough detail to be potentially eligible for inclusion in any of the Key Questions. Of these, 96 studies met comparator criteria to undergo risk of bias assessment; however only nine studies were assessed as low or medium risk of bias and included in our analytic set. Low-strength evidence shows transition clinics may not improve hemoglobin A1C levels either at 12 or 24 months in youth with type 1 diabetes mellitus compared with youth who received usual care. For all other interventions and outcomes, the evidence was insufficient to draw meaningful conclusions because the uncertainty of evidence was too high. Some approaches to address barriers include dedicating time and resources to support transition planning, developing a workforce trained to care for the needs of this population, and creating structured processes and tools to facilitate the transition process. No globally accepted definition for effective transition of care from pediatric to adult services for CSHCN exists; definitions are often drawn from principles for transitions, encompassing a broad set of clinical aspects and other factors that influence care outcomes or promote continuity of care. There is also no single measure or set of measures consistently used to evaluate effectiveness of transitions of care. The literature identifies a limited number of available training and other implementation strategies focused on specific clinical specialties in targeted settings. No eligible studies measured the effectiveness of providing linguistic and culturally competent healthcare care for CSHCN. Identified transition care training, and care interventions to prepare pediatric patients and their families for transitioning CSHCN to adult care, varied considerably. 10 Conclusions. Little rigorous evidence exists to inform care interventions and implementation strategies. Significant barriers impede implementation of interventions, tools, and trainings to transition CSHCN that may be reduced in future intervention development. This review highlights the need for more rigorous studies across the diverse populations of CSHCN in order to provide clearer answers for CSHCN, their families, caregivers, providers, funders, and policymakers.

Objectives: Systematic review of diagnostic accuracy and clinical impact of PET and PET-CT used for surveillance in several cancer types

Objectives: Systematic review of diagnostic accuracy and clinical impact of PET and PET-CT used for surveillance in several cancer types

Objectives: Objectives. To identify new evidence published after the 2020 AHRQ review, Opioid Treatments for Chronic Pain (available: https://effectivehealthcare.ahrq.gov/products/opioids-chronic-pain/research). Data sources. Ovid® MEDLINE®, : Ovid MEDLINE® In-Process & In-Data-Review Citations, Ovid MEDLINE® Epub Ahead of PrintPsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases, reference lists of included studies were searched to March 16, 2022. Review methods. As in the original review, one investigator screened citations identified through searches for eligibility for full-text review. In addition, a second investigator utilized a machine learning classifier to assist in the screening. The machine learning classifier screened all citations; the second investigator reviewed all studies that the machine learning classifier did not classify as very low probability of inclusion. The machine learning classifier was previously shown to have 100 percent recall for identifying eligible studies in update searches for this review. Any citation identified as potentially eligible by either of the two investigators underwent full-text review to determine final eligibility. We utilized the same methods for data abstraction and quality assessment as for the original report. Results. (See Update Reports) Conclusions. Two placebo-controlled trials identified for Surveillance Report 3 were consistent with the findings of the original report with regard to an association between opioids and small improvements in short-term pain and function and increased risk of harms. Updated meta-analyses based on placebo-controlled trials provided estimates very similar to the original report. One new trial provided low strength of evidence that TENS may be associated with improved short-term pain and function and decreased adverse events versus placebo; no studies evaluating this comparison were in the original report. One observational study identified for Surveillance Report 3 found no differences between involuntary or voluntary tapering versus no tapering in pain or function, but was rated poor quality and provided insufficient evidence to inform new conclusions on the effects of tapering on these outcomes, which had no prior studies. Surveillance Report 3 builds on Surveillance Reports 1 and 2, which identified new studies on short-term benefits and harms, long-term benefits and harms, risk mitigation strategies, dose-dependent risks of opioids, and management of opioid use disorder; for all of these areas, findings with the addition of studies identified in this surveillance report were consistent with the original report.