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"clinical questions"

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Nonstandard Interventions to Treat CDI or Reduce the Risk of Recurrence

Presentation: Clostridium difficile Infections: Diagnosis, Treatment, and Prevention

Keywords: antibodies | C. difficile Infection (CDI) | fecal transplant | immune whey | prebiotic | probiotics | nonstandard interventions

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Clinical Questions Addressed by the CER (1 of 2)

Presentation: Analgesics for Osteoarthritis—An Update

Keywords: comparative effectiveness | systematic review | key question

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Clinical Questions Addressed by the CER (2 of 2)

Presentation: Analgesics for Osteoarthritis—An Update

Keywords: key question | comparative effectiveness | systematic review

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Outline of Material

Presentation: Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations

Keywords: comparative effectiveness review

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Clinical Questions Addressed by the CER (1 of 3)

Presentation: Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations

Keywords: key questions | clinical questions | prevalence | incidence | natural history | musculoskeletal pain | children | adolescents

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Clinical Questions Addressed by the CER (2 of 3)

Presentation: Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations

Keywords: key questions | clinical questions | clinical diagnosis | musculoskeletal pain | children | adolescents | antinuclear antibody | cyclic-citrullinated peptide | rheumatoid factor | juvenile idiopathic arthritis | pediatric systemic lupus erythematosus | test performance | test sensitivity | test specificity | positive predictive value | negative predictive value

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Clinical Questions Addressed by the CER (3 of 3)

Presentation: Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations

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The Comparative Effectiveness Review Development Process

Presentation: Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer

Keywords: comparative effectiveness review

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Clinical Questions Addressed by the Comparative Effectiveness Review of Radiotherapy for Head and Neck Cancer

Presentation: Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer

Keywords: | 2DRT | 3DCRT | adverse events | experience | head and neck cancer | IMRT | outcomes | proton beam therapy | quality of life | radiotherapy | survival | tumor control | comparative effectiveness

The comparative effectiveness review topic, Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II-Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease, was nominated in a public process. Sufficient research into the current literature determined that there was a need for the available evidence on the addition of ACEIs and ARBs to standard medical therapy for patients with stable ischemic heart disease and preserved left ventricular systolic function (LVSF) and that there was an adequate number of clinical trials to be included in a comparative effectiveness review (CER). Based on this research, the Agency for Healthcare Research and Quality (AHRQ) commissioned the University of Connecticut/Hartford Hospital Evidence-Based Practice Center to prepare the CER with input from a Technical Expert Panel. This advisory panel was comprised of experts in different specialties, including cardiologists, a cardiovascular pharmacist/pharmacologist, and a health policy pharmacist. The panel identified important issues, reviewed proposed methods, defined parameters for the review of evidence, and helped to refine the key clinical questions that the research would subsequently address. Once formulated, the key clinical questions were published online and were made available for public commentary in order to refine the scope and focus of the research questions. A comprehensive systematic review of the literature was then conducted using several well-known databases, including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. All methods used in the review followed version 1.0 of AHRQ’s Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews (available at: http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf) and the trial end points were determined a priori. Based on the findings of the review, a draft CER was prepared and published online for public comment, and the draft underwent rigorous peer review to improve the final product. After the CER was finalized, the complete report was published on the Internet (available at: http://effectivehealthcare.ahrq.gov/ehc/products/57/335/bodyfinal.pdf) and a condensed version was published in the Annals of Internal Medicine (available at: http://www.annals.org/content/early/2009/10/19/0003-4819-151-12-200912150-00162.full).

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The CER Development Process

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

Keywords: effective health care | peer-review process | systematic review | comparative effectiveness

$This CER focused on a population of patients with stable ischemic heart disease (IHD) and preserved left ventricular systolic function (LVSF). The clinical trials evaluated in this CER included ischemic heart disease patients without left ventricular systolic dysfunction, which was defined as having a left ventricular ejection fractions greater than 40%. The key questions centered around the comparative effectiveness of 1) adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to standard medical therapy versus standard medical therapy alone, 2) combining an ACEI with an ARB and adding them to standard medical therapy versus adding an ACEI alone to standard medical therapy, or 3) adding an ACEI or an ARB to standard medical therapy versus standard medical therapy alone in patients with stable IHD and preserved LVSF who are in close proximity to a revascularization procedure. The comparative effectiveness of ACEIs versus ARBs was not a focus of the CER. This CER focused on a population of patients with stable IHD who also have preserved LVSF. The key questions centered around the comparative effectiveness of ACEIs or ARBs added to standard medical therapy versus standard medical therapy alone; or centered around the combined use of ACEIs and ARBs added to standard medical therapy versus an ACEI added to standard medical therapy. Among the clinical trials included in this general category, some were conducted where recent coronary revascularization procedures were a prerequisite for enrollment. These clinical trials were evaluated separately from those in which this was not a prerequisite.$

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Clinical Questions Addressed by the CER for Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

Keywords: benefits | clinical questions | harms | treatment modalities | comparative effectiveness

The CER Development Process (1)The comparative effectiveness review (CER) topic, Comparative Effectiveness of Recombinant Factor VIIa for Off-Label Uses vs. Usual Care in the Hospital Setting, was nominated in a public process. The nominated topic was reviewed and selected based on need, importance, and feasibility. Sufficient research into the current literature by experts in the field and stakeholders determined that a CER on the off-label usage trends and benefits and harms for select patient populations was needed and would not duplicate existing work. Based on this research, key clinical questions that the report would address were developed and made available for public comment. The Agency for Healthcare Research and Quality (AHRQ) then commissioned the Stanford-UCSF Evidence-Based Practice Center to prepare the CER with input from a Technical Expert Panel. This advisory panel was comprised of experts in different specialties, including anesthesiology, pediatric hematology/oncology, transplantation, pathology, hematology, pharmacology, trauma surgery, and drug risk management. The panel identified important issues, reviewed proposed methods, defined parameters for the review of evidence, and helped develop the draft report.

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The CER Development Process (1)

Presentation: Comparative Effectiveness of In-Hospital Use of Recombinant Factor VIIa for Off-Label Indications vs. Usual Care

Keywords: comparative effectiveness | recombinant factor VIIa | off-label | topic nomination | stakeholder | technical expert panel | research process

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