Agency For Healthcare Research And Quality Research Articles

The Effect of Prostaglandin Analogs on Central Corneal Thickness of Patients with Glaucoma or Ocular Hypertension: A Systematic Review

Background: Prostaglandin analogs (PGAs) are first-line antiglaucoma agents that appear to either decrease or increase central cornea thickness (CCT), creating controversy regarding the benefits of PGAs in treating CCT. Purpose: We performed the first meta-analysis of observational studies to evaluate the effects of PGAs on CCT in patients with glaucoma or ocular hypertension (OHT). Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A literature search was performed of the PubMed, Embase, Cochrane Library, System for Information on Grey Literature in Europe (Open Grey), and ClinicalTrials.gov databases and the references of retrieved studies. Only observational studies were included in the meta-analysis. The final CCT of patients and 95% confidence interval (CI) of each study were extracted. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ). A fixed-effects model was used to calculate the weighted mean difference (WMD) and 95% CI. Subgroup analyses based on several stratified factors such as public bias (Begg’s test) and sensitivity analyses were performed. Results: Five cohort, 5 case-control, and three cross-sectional studies including 2,722 subjects were included. The pooled effect of all thirteen studies showed that PGAs reduced the CCT of patients with glaucoma or OHT slightly but significantly (WMD = −9.37; 95% CI [−12.18, −6.57]; p = 0.00; I2 = 45.5%). Significant effects were also observed in all three study designs: cohort (WMD = −5.17; 95% CI [−9.52, −0.82]), case-control (WMD = -15.31; 95% CI [−22.66, −7.97]), and cross-sectional (WMD = −8.65; 95% CI [−17.30, −0.01]). In addition, subgroup analysis of exposure time showed the effect of PGAs to be more obvious in the first (WMD = −5.81; 95% CI [−9.49, −2.14]) and second (WMD = −13.73; 95% CI [−20.19, −7.28]) years. Conclusions: The pooled effects of previously reported studies suggest that PGA use can reduce the CCT of patients with glaucoma or OHT slightly but significantly, with this effect more pronounced in the first 2 years. These findings suggest that clinicians must closely monitor changes in CCT in the first 2 years of PGA use to identify cases of intraocular pressure misestimation and the efficacy of PGAs.

The Effect of a System-Level Tiered Huddle System on Reporting Patient Safety Events: An Interrupted Time Series Analysis.

The objective of this research was to evaluate the effect of implementing a system-level tiered huddle system (THS) on the reporting of patient safety events into the official event reporting system. A quasi-experimental study using interrupted time series was conducted to assess the impact and changes to trends in the reporting of patient safety events pre- (February-July 2020; six months) and post- (September 2020-February 2021; six months) THS implementation within one health care system (238 clinics and 4 hospitals). The severity of harm was analyzed in July 2021 using a modified Agency for Healthcare Research and Quality (AHRQ) harm score classification. The primary outcome measure was the number of patient safety events reported per month. Secondary outcomes included the number of patient safety events reported per month by each AHRQ harm score classification. The system-level THS implementation led to a significant and immediate increase in the total number of patient safety events reported per month (777.73, 95% confidence interval [CI] 310.78-1,244.68, p = 0.004). Similar significant increases were seen for reported numbers of unsafe conditions, near misses, no-harm events that reached patients, and temporary harm (p < 0.05 for each). Reporting of events with permanent harm and deaths also increased but was not statistically significant, likely due to the small number of reported events involving actual harm. These findings suggest that system-level THS implementation may increase reporting of patient safety events in the official event reporting system.

Home Health Unplanned Readmission Across Metro and Rural Areas following Stroke and Joint Replacement.

<h3>Research Objectives</h3> Explore national geographic differences in unplanned readmission after accounting for patient-level admission factors and area-level post-acute care availability for individuals receiving home health services following stroke or lower-extremity joint replacement (JR). <h3>Design</h3> Retrospective cross-sectional analysis of Centers for Medicare & Medicaid Services (CMS) home health claims records and the Outcome and Assessment Information Set (OASIS). Using Rural-Urban Continuum Codes (RUCC) we classified all US counties into metro, metro-adjacent rural, and non-metro-adjacent rural areas and examined the availability of other post-acute care (PAC) provider types (long-term care hospitals, skilled nursing (SNF), and inpatient rehabilitation facilities) in each. We conducted multilevel logistic regressions to show the association between county classification and the odds of an unplanned readmission. <h3>Setting</h3> We examined acute care discharges to home health agencies. <h3>Participants</h3> The population included 100% Medicare records from 2013–2015 fee-for-service beneficiaries >65 years. The cohort included 21,395 stroke records and 160,287 JR records. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Odds of an unplanned readmission for individuals who received home health services following stroke or JR. <h3>Results</h3> Overall, 11.0% of stroke and 3.4% of JR had an unplanned readmission. For those >65 with JR, unplanned readmissions increased as age (range 2.6–5.4%) and length of stay (2.9–13%) increased. PAC availability other than home health varied across county groups. For metro counties, >50% were SNF-only; only 20% had all PAC provider types, whereas 80% of metro-adjacent rural counties were SNF-only with < 2% with all PAC provider types. Compared to metro areas, residing in a rural area was protective of readmission for those with stroke (metro-adjacent rural OR=0.887 (95CI 0.751–1.047), metro non-adjacent rural OR=0.789 (0.634–0.982). There was no significant effect of rural area on JR unplanned readmission. <h3>Conclusions</h3> Residing in rural counties is protective against unplanned readmission following home health services for stroke care. Further research should characterize social and contextual factors in rural areas that contribute to community-dwelling individuals' health. <h3>Author(s) Disclosures</h3> This work was supported by the Agency for Healthcare Research and Quality (AHRQ) R01-HS024711. Authors declare no conflicts.

Association of Social Determinants of Health Measures and Successful Community Discharge Across Rehabilitation Service Areas

<h3>Research Objectives</h3> Evaluate: 1) variation in successful community discharge across Rehabilitation Service Areas (RSAs) nationally, and 2) the relationship between social determinants of health (SDH) variables/indices and successful community discharge across RSAs. <h3>Design</h3> Retrospective cross-sectional analysis of Centers for Medicare & Medicaid Services (CMS) and AHRQ SDH dataset. We performed maximum likelihood factor analysis with varimax rotation and principled mean analysis to identify how many factors to extract from the AHRQ-SDH dataset and calculated a rehabilitation-specific SDH measure (SDH-R) based on these factors and variables. Next, we calculated the Social Deprivation Index (SDI) and the SDH-R for a random sample of 800 RSAs and examined the association between SDI and SDH-R and successful community discharge. <h3>Setting</h3> We examined discharges following post-acute care from long-term care hospitals, home health agencies, and skilled nursing and inpatient rehabilitation facilities. <h3>Participants</h3> The population included 2013–2015 Medicare records from fee-for-service beneficiaries >65 years. The cohort included 2,287,210 records across all diagnostic groups. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Successful community discharge across the 1711 RSAs nationally using CMS quality measure specifications. <h3>Results</h3> The national average for successful community discharge across RSAs was 55.1%. The pattern of successful community discharge indicates the majority of RSAs(1239, 72.4%) perform at the national average for successful community discharge with 253 RSAs (14.8%) significantly below and 219(12.8%) significantly above the national average. Factor analysis with AHRQ-SDH variables identified five factors with eigenvalues >1.0. The resultant model explained 23.1% of the variation in successful community discharge. The SDH-R model performed significantly better than the SDI (RMSE:SDH-R=0.88 vs SDI=0.99). <h3>Conclusions</h3> Successful community discharge varied across RSAs nationally. We identified SDH variables related to successful community discharge following rehabilitation. More research is needed to understand how SDH impacts community discharge across high- and low-performing RSAs and explore disparities and equity issues related to successful community discharge following post-acute care rehabilitation. <h3>Author(s) Disclosures</h3> This work was supported by the Agency for Healthcare Research and Quality (AHRQ) R01-HS024711 (TR,JP,AH,YK,KE), T32-HS026133 (YK,JD). All authors declare no conflicts.

Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample.

COVID-19 has brought the disparities in health outcomes for patients to the forefront. Racial and gender identity are associated with prevalent healthcare disparities. In this study, we examine the health disparities in COVID-19 hospitalization outcome from the intersectional lens of racial and gender identity. The Agency for Healthcare Research and Quality (AHRQ) 2020 NIS dataset for hospitalizations from 1 January 2020 to 31 December 2020 was analyzed for primary outcome of in-patient mortality and secondary outcomes of intubation, acute kidney injury (AKI), AKI requiring hemodialysis (HD), cardiac arrest, stroke, and vasopressor use. A multivariate regression model was used to identify associations. A p value of &lt;0.05 was considered significant. Men had higher rates of adverse outcomes. Native American men had the highest risk of in-hospital mortality (aOR 2.0, CI 1.7-2.4) and intubation (aOR 1.8, CI 1.5-2.1), Black men had highest risk of AKI (aOR 2.0, CI 1.9-2.0). Stroke risk was highest in Asian/Pacific Islander women (aOR 1.5, p = 0.001). We note that the intersection of gender and racial identities has a significant impact on outcomes of patients hospitalized for COVID-19 in the United States with Black, Indigenous, and people of color (BIPOC) men have higher risks of adverse outcomes.

The Use of Physical Screening Tools to Identify Injury Risk Within Pre-Professional Ballet Dancers: An Integrative Review

Objective. To conduct an integrative review of all relevant research investigating the physical risk factors for injury within pre-professional ballet dancers, to provide insight that may benefit practitioners within these institutions and highlight areas for future research within this specialised population. Design. Studies were identified from the following electronic databases: MEDLINE via PubMed, SPORTDiscus via EBSCOhost, and Web of Science Core Collection via Web of Science. 8,415 titles were identified during the electronic search process. Five studies satisfied the inclusion criteria and were included in the review. The modified Agency for Healthcare Research and Quality (AHRQ) scale for observational studies was used to assess study quality. Results. The review identified that the following physical characteristics may influence prospective injury risk in pre-professional ballet dancers: age and maturation status, anthropometrics and body composition, strength and power, joint mobility and range of motion, specific dance function, and cardiorespiratory fitness. Limitations. The research identified lacked methodological quality. This, combined with the low number of studies identified, makes the design of screening protocols challenging for practitioners. Originality. Despite the number of pre-professional balletic institutions worldwide, previous reviews have not used a systematic search strategy or investigated both sexes in this cohort. Due to the unique demands of ballet, an understanding of the interaction between injury and physical characteristics is a critical step in order to reduce injury burden. Conclusions. This review succeeded in determining risk factors for injury within this population, but, due to insufficient evidence, could not provide robust screening recommendations.

Pediatric Age at Hematopoietic Stem Cell Transplant: Associations with Non-Malignant Genetic Disease and Race

Introduction: Increasingly, hematopoietic stem cell transplant (HSCT) is used in pediatrics to treat both malignant and nonmalignant conditions. Many of the nonmalignant disorders for which HSCT is curative are genetic, and it has long been recognized that the diagnostic odyssey for patients with genetic disorders is frequently quite long. Notably, the diagnostic odyssey is longer for non-white patients with genetic diseases than for white patients with genetic diseases. We hypothesized that this disparity would also manifest as older age at time of HSCT, which could be associated with greater co-morbidities and worse outcomes. While previous studies have analyzed the association between race and pediatric HSCT access and survival, (PMID:32497418; 35071585; 34900869)we sought to determine if the diagnostic odyssey is longer for racial minorities compared to Caucasians. Methods: To test this hypothesis, we utilized the 2019 version of the Kids’ Inpatient Database (KID), developed by the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ). The HSCT sample was identified using ICD-10-PCS Procedure Codes for transfusion of hematopoietic/cord blood stem cells: Allogenic: 30243X3, 30243Y3, 30243X4, 30233X4, 30243Y2; Autologous: 30243Y0. A variable for pediatric genetic disease (PGD) was generated using 348 ICD-10-CM diagnostic codes corresponding to 283 pediatric genetic diseases for which the carrier frequency is greater than 1 in 500 in the general population or in an at-risk subpopulation (e.g., sickle cell anemia in AA). We controlled for malignant disease leading to HSCT using ICD-10-CM diagnostic codes to identify lymphomas, leukemias, myelodysplastic syndrome, myeloproliferative neoplasms, neuroblastomas, and brain tumors. Multiple linear regression was used to test if age of HSCT procedure was significantly associated with race, known non-malignant PGD, malignant disease, payer status, and location (rural vs. urban). Results: We identified 1,178 pediatric aged patients (age 20 and younger) who received HSCT in 2019 (Allogenic N=618; autologous N=560). The clinical characteristics of these patients are described in Table 1. The average age for Caucasian pediatric patients treated with HSCT is 6.8 years (82 months). Comparing PGD vs. all other diagnoses related to HSCT, patients with known PGD are transplanted on average 1.9 years (22 months) earlier than matched controls (P<0.001). This difference persists after controlling for race, disease severity, transplant type, Medicaid status, and rural health system location. African American and Asian pediatric patients are treated with HSCT on average 1.6 years (18 months) older than matched Caucasian controls (P=0.003 and 0.032, respectively). The effect of race persists even after controlling for thalassemias and sickle cell disease, associated with non-European ancestry. Conclusions: Age at transplant may be a useful surrogate for ongoing health disparities and to inform real-world research. African American and Asian ancestries are associated with HSCT at an older age, suggesting a prolonged diagnostic or therapeutic odyssey. This effect persists after controlling for factors such as non-malignant and malignant conditions, payer status, rural location, and genetic diseases that are over-represented in racial groups. More work is required to determine if this delay in treatment is due to differences in the spectrum of genetic diseases treated by HSCT in children of different ancestries, and if these delays in therapy may be associated with increased comorbidities and worse HSCT outcomes. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 9912: Cardiac Events Among Amyotrophic Lateral Sclerosis Patients in the United States; a Fresh Perspective From the 2019 National Inpatient Sample

Introduction: Respiratory distress and complications are the leading causes of death among Amyotrophic Lateral Sclerosis (ALS) patients. However, several studies have reported multiple cardiovascular complications linked with heart rate and rhythm. We, therefore, aim to investigate cardiovascular involvement among ALS patients further. Methods: Data from the 2019 National Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), and partners were analyzed to estimate the presence of multiple cardiovascular events in patients with a diagnosis of Amyotrophic Lateral Sclerosis in the United States via their respective ICD-10 codes. The risk of cardiopulmonary resuscitations and mortality rates were also estimated via multivariate regression models, accounting for different variables. Results: We identified 12,865 cases of ALS in the United States. Different cardiac arrhythmias were recorded, such as supraventricular tachycardia (2.1%), ventricular tachycardia (1.7%), ventricular fibrillation (0.2%), and paroxysmal atrial fibrillation (3.8%), and long QT syndrome (0.6%). Several cases of heart blocks were also observed as 0.4% had a first degree, 0.3% had a second degree, and 0.3% had third-degree atrioventricular blocks. 10.7% also had a diagnosis of heart failure, and 565 (4.4%) patients had an old myocardial infarct. Finally, we found 160 (1.2%) cases of cardiopulmonary resuscitation, which had a higher risk of occurring among diabetics (aOR 1.922, 95%CI 1.383-2.670, p&lt;0.01) and patients with hypertension (aOR 1.516, 95% CI 1.007-2.134, p=0.017), while it was less common among Females (aOR 0.527,95% CI 0.368-0.755, p&lt;0.01). The adjusted odds ratio of death in ALS patients with cardiopulmonary resuscitation was 14.910 (95% CI 9.760-22.78, p&lt;0.01). Conclusions: Several cardiac arrhythmias can be observed among ALS patients. Cardiopulmonary resuscitation has a poorer outcome, and physicians treating ALS patients should be advised to watch for early changes, which may help reduce the need for CPR.

Using PSI-90 Scores to Improve Patient Safety and Quality Ratings

The Agency for Healthcare Research and Quality (AHRQ) developed patient safety indicators (PSIs) to help hospitals identify potentially preventable complications after surgeries and procedures.1 Despite their use by federal programs to assess quality of care, there is no consensus on their accuracy as a marker of quality.2 This article examines how a midsize community hospital used PSI-90 scores to develop targeted interventions that resulted in improved patient safety and quality ratings.

Abstract 15236: A Systematic Review of the Quality of Life (QOL) Assessment Tools Used in Aortic Dissection in the Context of Survivorship

Introduction: The term 'survivorship' describes the therapeutic, functional, psychosocial, and financial experience of living with a chronic condition.This term acknowledges the fact that a patient’s life can be radically altered overnight because of their disease and treatment, but also designates patients as ‘survivors’, having overcome the acute phase (‘acute survivorship’) and now needing to live with, through and beyond their condition (‘extended survivorship’ and ‘permanent survivorship’). The aim of this systematic review was to identify the most frequently used quality of life (QOL) assessment tools and to determine how closely these align to the concept of 'survivorship'. Methods: A systematic literature review was conducted according to PRISMA guidelines. Embase, Medline and the Cochrane Library were electronically searched till January 2022 for studies reporting on QOL in aortic dissection patients. Observational studies and case series studies were included. Due to the degree of heterogeneity existing between the studies, a meta-analysis was not conduced. Study quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist. Results: A total of 27 studies were included, encompassing 32 QOL tools. The most common QOL tool utilised was the SF-36, across 11 studies. Only one qualitative study investigated patient perspectives of living with aortic dissection. Overall, QOL was found to be poor in aortic dissection survivors. All identified QOL tools demonstrated a poor alignment with the survivorship domains. Included studies displayed a moderate to high risk of bias, having small sample sizes and an insufficient follow-up period. Conclusion: This review highlights the absence of an aortic dissection specific QOL tool. All QOL tools identified failed to encompass the breadth of survivorship domains, with a lack of studies focusing on the patients’ perspective. Further research is urgently required to gain an insight into the quality of life of patients who have survived an aortic dissection, and to develop an aortic dissection specific QOL tool, underpinned by the survivorship domains.

Standardizing Malnutrition Benchmarking Programs to Support Effective Quality Improvement Efforts.

Health care facilities and providers strive to provide the best care possible in the most efficient and economic manner.1 External benchmarking programs help them determine how they compare with what is considered “best in class,” while providing guidance for continuous quality improvement (CQI) to achieve desired results. The US Agency for Healthcare Research and Quality (AHRQ) develops quality indicators to measure the quality, safety, effectiveness, and efficiency of services provided both within and outside hospitals.

Trải nghiệm của người nhà bệnh nhi điều trị nội trú tại Bệnh viện Sản Nhi tỉnh Ninh Bình năm 2021

Objective: Describe the experience of inpatient pediatric patients’ relatives at Ninh Binh Obstetrics and Gynecology Hospital in 2021. Methods: A cross-sectional descriptive study carried out on 245 inpatient pediatric patients’ relatives at Ninh Binh Obstetrics and Gynecology Hospital from July 2021 to April 2022. In this study, we used a set of questionnaires to assess service users' experience of medical facilities and health care systems (Consumer Assessment of Healthcare Providers and Systems – CAHPS) developed by the US Agency for Healthcare Research and Quality (AHRQ). Results: Overall assessment of the hospital, the rate of positive experiences of the patients’ relatives at the hospital reached 54.7%. In which, positive experience on hospital discharge accounted for the highest rate (over 64%). The aspect of doctor and nursing care accounted for over 40% of positive experiences. The subsection on experience in this treatment of the patients’ relatives had the highest positive experience rate with 43.8%. Besides, the hospital environment were positively experienced by relatives of pediatric patients, from 30 to 35%. The understanding of care after leaving the hospital had the lowest positive rate &lt;30%. Conclusion: The overall positive experience rate of patients’ relatives were above 50%. Further studies are needed to understand the causes and processes by which the patient's family members have negative experiences at the hospital. Keywords: Experience, CAHPS, Family members of pediatric patient, Inpatient treatment, Ninh Binh Obstetrics and Gynecology Hospital.

Bone-Regenerative Ability of Platelet-Rich Plasma Following Sinus Augmentation with Anorganic Bovine Bone: A Systematic Review with Meta-Analysis.

Background: The objective of this systematic review is to assess the effect of the adjuvant use of platelet-rich plasma (PRP) and its type on new bone formation by anorganic bovine bone during maxillary sinus floor augmentation procedure. Methods: PubMed, Cochrane Central Register of Controlled Trials, and Ovid databases were searched for relevant studies published up to 16 September 2021. Randomized clinical trials (RCTs) and non-randomized controlled clinical trials (CCTs) that reported data on the new bone formation (measured by histomorphometric analysis) were considered. Risk of bias and quality assessment of included studies were evaluated following the Cochrane Handbook for Systematic Reviews of Interventions and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Strength of evidence was assessed following the approach of the Agency for Healthcare Research and Quality (AHRQ) through its evidence-based practice center (AHRQ EPC). The meta-analysis was based on the primary outcome of newly formed bone, for which the standard mean difference was calculated. Results: After the application of eligibility criteria, six clinical trials (three RCTs and three CCTs) covering 85 maxillary sinus floor elevation procedures were included. The pooled new bone formation value for PRP was 1.67 (95% CI: −0.15 to 3.49; I2: 86%), indicating the absence of significant effect. Plasma rich in growth factors (PRGF) was the pure PRP tested in five of the included studies. When sub-group (type of PRP) meta-analysis was performed, significantly higher new bone formation was observed in the PRGF group [2.85 (95% CI: 0.07 to 5.64; I2: 88%)] in comparison to the control group. Conclusions: A beneficial effect on new bone formation after maxillary sinus floor elevation can be obtained when anorganic bovine bone is mixed with PRGF.

Sexual Development in Perinatally HIV-Infected Young People: A Systematic Review and Explorative Study.

Similar to other young people with a chronic health condition, perinatally HIV-infected (PHIV) adolescents may have an impacted sexual development. This paper aims to compare sexual milestones of PHIV to HIV uninfected peers, through a systematic review (SR) and explorative study. We performed a systematic search in 4 electronic databases (Medline, Embase, Web of Science, and Scopus), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Last search in all databases was performed in May 2021. We included studies that reported on quantitative data of any of the main outcomes and compared PHIV to HIV uninfected control groups. Main outcomes were defined as the occurrence and/or debut age of sexual milestones (falling in love, having been in a romantic relationship, masturbation, kissing, non-genital caressing (feeling or petting, touching), genital caressing (fingering, handjob), giving or receiving oral sex, and penetrative sex (vaginal or anal). We excluded case reports, audits, guidelines, editorials, abstracts, studies that reported on behaviorally infected HIV patients, studies that did not include an HIV uninfected control group and studies that could not be translated to English or Dutch. We used the Agency for Health Care Research and Quality (AHRQ) Checklist for quality assessment. We performed qualitative synthesis of the data. In the explorative study, we compared sexual milestones of PHIV and HIV uninfected controls matched for age, sex, ethnicity and educational level, using a subset of questions of a validated questionnaire. We included eighteen studies in the SR, describing outcomes of an estimated 1,963 participants. Seventeen studies compared the occurrence and/or debut age of intercourse in PHIV and HIV uninfected controls and 4 studies reported on any of the other sexual milestones. The majority of studies found no difference in occurrence (12 of 16 studies) or debut age (6 of 8 studies) of intercourse in PHIV compared to controls. Two of 4 studies reporting on any of the other milestones found no significant differences between PHIV and HIV uninfected controls. In the explorative study, we included ten PHIV participants and 16 HIV uninfected, matched controls. PHIV tended to report a later debut age of sexual milestones than controls (not significant). The SR includes only a small number of studies and few studies report on non-penetrative milestones. The explorative study adds to this review by including non-penetrative milestones and comparing PHIV to HIV-uninfected, well-matched controls. However, the sample size was small. PHIV seem to engage in sexual activities and achieve sexual milestones at a similar rate as their HIV uninfected peers, with a tendency of a later start in well treated PHIV. The review was registered in the PROSPERO database (CRD42021252103) and funded by AIDSfonds. AIDSfonds had no role in the study design or interpretations of this study. ter Haar AM, Fieten A, Van den Hof M, et al. Sexual Development in Perinatally HIV-Infected Young People: A Systematic Review and Explorative Study. Sex Med 2022;10:100578.

Influence of type 2 diabetes microangiopathy on bone mineral density and bone metabolism: A meta-analysis

BackgroundDiabetic microangiopathy is a type of vascular dysfunction. The effect of type 2 diabetes microangiopathy (DMA) on bone mineral density (BMD) and bone metabolism is still unclear. ObjectiveA meta-analysis was performed to investigate the effects of microangiopathy on BMD and bone metabolism in type 2 diabetic patients. MethodsWe searched the PubMed, Embase, Cochrane Library and CNKI databases to identify observational studies investigating the effects of type 2 diabetes microangiopathy on BMD or bone metabolism. The time limit for the literature retrieval was from the establishment of the database to September 25, 2021. The Newcastle–Ottawa scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) scale were used to evaluate the quality of the studies. RevMan 5.3 software was used for the data analysis. Stata 14.0 was used to quantitatively evaluate the publication bias of the outcome indicators. ResultsIn total, 12 observational studies were included, including 7 cohort studies, 4 case–control studies and 1 cross-sectional study. In total, 2,500 patients with type 2 diabetes were included. Among them, 1,249 patients had microangiopathy (DMA group), and 1,251 patients did not have microangiopathy (control group). The results of the meta-analysis showed that the BMDs of the femoral neck (SMD = −1.34, 95% CI = −2.22 to −0.45, P = 0.003), lumbar spine (SMD = −0.69, 95% CI = −1.31 to −0.08, P = 0.03) and Ward's triangle (SMD = −2.84, 95% CI = −4.84 to −0.83, P = 0.006) in the DMA group were lower than those in the control group. In the comparison of the bone metabolism indexes, the contents of N-terminal propeptide of type I procollagen (P1NP) (SMD = 0.18, 95% CI = 0.03 to 0.32, P = 0.02), osteocalcin (SMD = 6.97, 95% CI = 3.46 to 10.48, P < 0. 0001), parathyroid hormone (PTH) (SMD = 0.38, 95% CI = 0.03 to 0.73, P = 0.03) and C-telopeptide of type 1 collagen (CTX) (SMD = 0.39, 95% CI = 0.03 to 0.75, P = 0.03) in serum from the DMA group were higher than those in serum from the control group. The serum content of 25-hydroxyvitamin D3 (25(OH)D3) (SMD = −0.63, 95% CI = −1.19 to −0.07, P = 0.03) in the DMA group was lower than that in the control group. There was no significant difference in serum alkaline phosphatase (ALP), calcium or phosphorus between the two groups (P > 0.05). ConclusionsType 2 diabetes microangiopathy can reduce the lumbar spine, femoral neck and Ward's triangle BMD and has a higher risk of osteoporosis or osteoporosis fractures. The levels of P1NP, PTH, CTX and OC in the serum of patients with type 2 diabetes microangiopathy are higher, and the lower 25(OH)D3 content may be a mechanism by which DMA destroys bone metabolism balance.

Oral health-related quality of life in patients with osteoarthritis of the temporomandibular joint-Results of a systematic review.

The aim of this systematic review was to assess the oral health-related quality of life (OHRQoL) of patients with osteoarthritis (OA) of the temporomandibular joint (TMJ). This systematic literature search applied the search terms "oral health-related quality of life AND osteoarthritis of jaw OR arthritis of temporomandibular joint AND oral health-related quality of life" in PubMed, Medline, Web of Science and Scopus. Eligibility criteria were publication until 31 August 2021, examination of children or adults with OA of TMJ, reporting of any OHRQoL measurement and a full text in English language. Two different, independent and experienced reviewers performed this systematic literature search. The analysis of respective data was qualitative. For quality appraisal, the available checklist from the Agency for Healthcare Research and Quality (AHRQ) was applied. Out of 102 findings, eight studies were included in qualitative analysis. Seven clinical investigations were performed in adults aged between 34 and 43 years. The other included study was performed on children. The quality of two studies was moderate, and six studies were evaluated as of high quality. Most studies applied the 14-item short form of the oral health impact profile (OHIP 14) for assessment of OHRQoL. OHIP 14 ranged between 9.24 and 38.86 points in means of sum score. Comparison with healthy individuals revealed worse OHRQoL of OA patients in two studies. Associations between OHRQoL with either oral health, general quality of life or disease-related parameters were rarely reported and heterogeneous. Five of the included studies reported subscales of OHIP 14, showing an impairment in all subscales. There are hints that patients with OA of the TMJ show a reduced OHRQoL. More studies are needed, especially regarding oral health, disease-related parameters and pain intensity and its potential influence on OHRQoL.

Comparing VA and Non-VA Medical Centers: Informing Veteran Health Care Choice at the MISSION Act Watershed

This study compared clinical quality and patient experience in US Department of Veterans Affairs (VA) and non-VA hospitals. One hospital was identified for each full-service VA hospital (<em>n</em> = 125 pairs). Hospitals were compared on four Agency for Healthcare Research and Quality (AHRQ) clinical indicators: Influenza immunization (IMM-2), Patient Safety Indicator 04 (PSI 04), Catheter-associated Urinary Tract Infection (CAUTI), Methicillin-resistant Staphylococcus aureus infection (MRSA); and three patient experience indicators: the three-item care transition measure (CTM-3) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) #18 and #19. In aggregate, VA hospitals fared significantly better than non-VA hospitals for PSI 04 and CTM-3. Non-VA hospitals fared significantly better for IMM-2 and HCAHPS #18. No differences were found for CAUTI, MRSA, and HCAHPS #19. At the pairwise level, VA hospitals performed the same as or better than the grand mean for each measure except for IMM-2. This study reinforces previous findings in that the data do not mirror public perception of a universally troubled VA system. This study will be helpful as it is one of the last studies published with the latest pre-MISSION Act data.

A systematic review and meta-analysis of the hyperuricemia risk from certain metals

The relationship between exposure to certain metals and the risk of hyperuricemia (HUA) has biological plausibility, yet prior studies have presented inconsistent findings. We aim to clarify the relationship between exposure to certain metals and HUA using a systematic review and meta-analysis approach. We searched the Web of Science, Embase, MEDLINE, Pubmed, Corchrane and China National Knowledge Infrastructure databases from inception through December, 2021 in order to identify studies that assessed the relationships between metals and the risk of HUA. Data were pooled by random-effects models and expressed as pooled odds ratios (OR) and 95% confidence intervals (CIs). The risk of bias was assessed using a tool from Agency for Healthcare Research and Quality (AHRQ). Twenty eligible articles (nineteen cross-sectional studies and one cohort) were included in our analysis, involving 63,283 participants in total. The studies showed that arsenic (pooled OR = 1.702, 95% CI: 1.44, 2.011; n = 6, I2 = 29.5%), calcium (pooled OR = 1.765, 1.111, 2.804; 4, 82.3%), cadmium (pooled OR = 1.199,1.020, 1.410; 11, 38.5%) and lead (pooled OR = 1.564,1.205, 2.030; 11, 72.9%) exposure were, all linked to an increased risk of HUA. Exposure to molybdenum (pooled OR = 0.804, 0.724, 0.975, 3, 0%) was linked to a decreased risk of HUA, however. Exposure to arsenic, calcium, cadmium and lead is associated with an increased risk of HUA. Molybdenum exposure was associated with a decreased prevalence of HUA; however, aluminum, cobalt, copper, iron, magnesium, manganese, mercury, selenium, thallium and zinc are not associated with HUA risk. Further experimental studies are warranted to decipher the mechanisms by which exposure to the above metals affect HUA risk. The findings reinforced the importance of metals in the HUA risk, and provided a reference for legislation to prevent HUA and protect people's health.

Development and Validation of the Summary Elixhauser Comorbidity Score for Use With ICD-10-CM-Coded Data Among Older Adults.

Older adults have many comorbidities contributing to mortality. To develop a summary Elixhauser (S-Elixhauser) comorbidity score to predict 30-day, in-hospital, and 1-year mortality in older adults using the 38 comorbidities operationalized by the Agency for Healthcare Research and Quality (AHRQ). Retrospective cohort study. Medicare beneficiaries from 2017 to 2019. Persons hospitalized in 2018 (n= 899844) and 3 disease-specific hospitalized cohorts. Weights were derived for 38 comorbidities to predict 30-day, in-hospital, and 1-year mortality. The S-Elixhauser score was internally validated and calibrated. Individual Elixhauser comorbidity indicators (38 comorbidities), the modified application of the AHRQ-derived Elixhauser summary score, the Charlson comorbidity indicators (17 comorbidities), and the Charlson summary score were externally validated. The c-statistic was used to evaluate discrimination of a comorbidity score model. The S-Elixhauser score was well calibrated and internally validated, with a c-statistic of 0.705 (95% CI, 0.703 to 0.707) in predicting 30-day mortality, 0.654 (CI, 0.651 to 0.657) for in-hospital mortality, and 0.743 (CI, 0.741 to 0.744) for 1-year mortality. In external validation of other comorbidity indices for 30-day mortality, the c-statistic was 0.711 (CI, 0.709 to 0.713) for the individual Elixhauser comorbidity indicators, 0.688 (CI, 0.686 to 0.690) for the AHRQ Elixhauser score, 0.696 (CI, 0.694 to 0.698) for the Charlson comorbidity indicators, and 0.690 (CI, 0.688 to 0.693) for the Charlson summary score. In 3 disease-specific populations, the discrimination of the S-Elixhauser score in predicting 30-day mortality ranged from 0.657 to 0.732. Validation of the S-Elixhauser comorbidity score and head-to-head comparison with other comorbidity scores in an external population are needed to evaluate comparative performance. The S-Elixhauser comorbidity score is well calibrated and internally validated but its advantage over the AHRQ Elixhauser and Charlson summary scores is unclear. National Institute on Aging.

Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting.

In many high-income settings policy consensus supports giving pregnant women who have had a previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or planning a vaginal birth after previous cesarean (VBAC), provided they have no contraindications to VBAC. To help women make an informed decision regarding this choice, clinical guidelines advise women should be counseled on the associated risks and benefits. The most recent and comprehensive review of the associated risks and benefits of planned VBAC compared to ERCS in high-income settings was published in 2010 by the US Agency for Healthcare Research and Quality (AHRQ). This paper describes a structured review of the evidence in high-income settings that has been published since the AHRQ review and the literature in high-income settings that has been published since 1980 on outcomes not included in the AHRQ review. Three databases (MEDLINE, EMBASE, and PsycINFO) were searched for relevant studies meeting pre-specified eligible criteria, supplemented by searching of reference lists. Forty-seven studies were identified as meeting the eligibility criteria and included in the structured review. The review suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the mother and her baby, the absolute risk of these complications is small for either birth approach. The review also found some evidence that planned VBAC compared to ERCS is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding. The limited evidence available also suggests that planned mode of birth after previous cesarean section is not associated with the child’s subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood. This information can be used to manage and counsel women with previous cesarean section about their subsequent birth choices. Collectively, the evidence supports existing consensus that there are risks and benefits associated with both planned VBAC and ERCS, and therefore women without contraindications to VBAC should be given an informed choice about planned mode of birth after previous cesarean section. However, further studies into the longer-term effects of planned mode of birth after previous cesarean section are needed along with more research to address the other key limitations and gaps that have been highlighted with the existing evidence.