ECRI Institute Research Articles

Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023)

The purpose of this guideline is to provide a clinical structure with which to approach the diagnosis, counseling, and treatment of female patients with stress urinary incontinence (SUI). The primary source of evidence for the 2017 version of the SUI guideline was the systematic literature review conducted by the ECRI Institute. The initial search spanned literature from January 2005 to December 2015, with an additional updated abstract search through September 2016. The current amendment represents the first update to the 2017 iteration and includes updated literature published through February 2022. This guideline has been amended to reflect changes in and additions to the literature since 2017. The Panel maintained that the differentiation between index and non-index patients remained important. The index patient is a healthy female with minimal or no prolapse who desires surgical therapy for treatment of pure SUI or stress-predominant mixed urinary incontinence. Non-index patients have factors that may affect their treatment options and outcomes, such as high grade prolapse (grade 3 or 4), urgency-predominant mixed incontinence, neurogenic lower urinary tract dysfunction, incomplete bladder emptying, dysfunctional voiding, SUI following anti-incontinence treatment, mesh complications, high body mass index, or advanced age. While gains have been made in the field to support new methods for the diagnosis, treatment, and follow-up of patients with SUI, the field continues to expand. As such, future reviews of this guideline will take place to stay in keeping with the highest levels of patient care.

Is Electronic Health Record Safety a Paradox?

Is Electronic Health Record Safety a Paradox?

Standards of Nutritional Care for Patients with Cystic Fibrosis: A Methodological Primer and AGREE II Analysis of Guidelines.

Although many Clinical Practice Guidelines (CPGs) have been published for the care of patients with Cystic Fibrosis (CF), including a variety of nutrition recommendations, the quality of these CPGs has never been evaluated. The aim of this study was to compare, review, and critically appraise CPGs for the nutritional management of CF, throughout the lifespan. We searched PubMed, Guidelines International Network (GIN), ECRI Institute, and Guidelines Central for CPGs, with information on the nutritional management of CF. Retrieved CPGs were appraised by three independent reviewers, using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument and checklist. A total of 22 CPGs (seven solely nutrition oriented), by 14 different publishers, were retrieved. The Thoracic Society of Australia and New Zealand CPGs scored the highest overall quality (94.4%), while the Paediatric Gastroenterology Society/Dietitians Association of Australia CPGs had the lowest score (27.8%). Great variation in AGREE II domain-specific scores was observed in all CPGs, suggesting the existence of different strengths and weaknesses. Despite the availability of several CPGs, many appear outdated, lacking rigor, transparency, applicability, and efficiency, while incorporating bias. Considering that CPGs adherence is associated with better outcomes and the need for improving life expectancy in patients with CF, the development of CPGs of better quality is deemed necessary.

Extension of Intravenous Tubing and Pumps Outside Rooms for Safety and Efficiency.

Extension of Intravenous Tubing and Pumps Outside Rooms for Safety and Efficiency.

How do cancer screening guidelines trade off benefits versus harms and burdens of screening? A systematic survey

ObjectivesCancer screening guidelines differ in their recommendations for or against screening. To be able to provide explicit recommendations, guidelines need to specify thresholds for the magnitude of benefits of screening,...

Synopsis of the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: The Diagnosis and Management of Hypertension in the Primary Care Setting.

In January 2020, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the diagnosis and management of hypertension in the primary care setting. The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature from 15 December 2013 to 25 March 2019 and developed and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis summarizes key features of the guideline in several key areas: the measurement of blood pressure, the definition of hypertension, target treatment goals, and nonpharmacologic and pharmacologic treatment of essential and resistant hypertension.

AORN Position Statement on the Role of the Health Care Industry Representative in Perioperative Settings

<scp>AORN</scp> Position Statement on the Role of the Health Care Industry Representative in Perioperative Settings

Machine learning for screening prioritization in systematic reviews: comparative performance of Abstrackr and EPPI-Reviewer

BackgroundImproving the speed of systematic review (SR) development is key to supporting evidence-based medicine. Machine learning tools which semi-automate citation screening might improve efficiency. Few studies have assessed use of screening prioritization functionality or compared two tools head to head. In this project, we compared performance of two machine-learning tools for potential use in citation screening.MethodsUsing 9 evidence reports previously completed by the ECRI Institute Evidence-based Practice Center team, we compared performance of Abstrackr and EPPI-Reviewer, two off-the-shelf citations screening tools, for identifying relevant citations. Screening prioritization functionality was tested for 3 large reports and 6 small reports on a range of clinical topics. Large report topics were imaging for pancreatic cancer, indoor allergen reduction, and inguinal hernia repair. We trained Abstrackr and EPPI-Reviewer and screened all citations in 10% increments. In Task 1, we inputted whether an abstract was ordered for full-text screening; in Task 2, we inputted whether an abstract was included in the final report. For both tasks, screening continued until all studies ordered and included for the actual reports were identified. We assessed potential reductions in hypothetical screening burden (proportion of citations screened to identify all included studies) offered by each tool for all 9 reports.ResultsFor the 3 large reports, both EPPI-Reviewer and Abstrackr performed well with potential reductions in screening burden of 4 to 49% (Abstrackr) and 9 to 60% (EPPI-Reviewer). Both tools had markedly poorer performance for 1 large report (inguinal hernia), possibly due to its heterogeneous key questions. Based on McNemar’s test for paired proportions in the 3 large reports, EPPI-Reviewer outperformed Abstrackr for identifying articles ordered for full-text review, but Abstrackr performed better in 2 of 3 reports for identifying articles included in the final report. For small reports, both tools provided benefits but EPPI-Reviewer generally outperformed Abstrackr in both tasks, although these results were often not statistically significant.ConclusionsAbstrackr and EPPI-Reviewer performed well, but prioritization accuracy varied greatly across reports. Our work suggests screening prioritization functionality is a promising modality offering efficiency gains without giving up human involvement in the screening process.

Update on the NAEPPCC Asthma Guidelines: The wait is over, or is it?

As an asthma specialist, one is often asked to discuss the asthma guidelines. The challenge that one faces is deciding which guidelines to use as a resource for discussion or presentation. It often comes down to the following questions: What is the question? What message does one want to deliver? Where is the most current information? and Who is the target audience? This commentary will help answer those questions as it guides the reader through the new update of the National Heart, Lung and Blood Institute/National Asthma Education and Prevention Program guidelines and then outlines differences between 2 widely used strategies for the management of asthma: the Global Initiative for Asthma and the National Heart, Lung and Blood Institute/National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma.

Clinician Burnout and the Meaningful Connection of the ACU Community.

Clinician Burnout and the Meaningful Connection of the ACU Community Douglas Olson, MD (bio), Craig Kennedy, MPH (bio), and Felix Nunez, MD, MPH (bio) Much has been said recently regarding clinician burnout in health care. Whether it be the disengagement of front-line care givers, mental health status of care teams, or potentially the worst—suicide, which is higher among health care professions that most all others—burnout is a serious part of health care delivery today. While the topic of burnout is a nuanced and complex one, there are three key tenets that require all those caring for the underserved to focus on at present. The Association of Clinicians for the Underserved continues to address all of these! 1. The concept of the triple aim in health care has shifted to the quadruple aim, which continues to encompass high quality care, low cost care and increased patient satisfaction, but now also the fourth element—increased care team satisfaction.1 2. The ECRI Institute, which works closely with the United States Health Research and Services Administration (HRSA), through which almost all community health centers receive malpractice insurance (Federal Tort Claims Act, or FTCA) has noted that burnout is one of 10 top patient safety concerns for 2019.2 3. While burnout can affect anyone, at any age, in any industry, it is important to note that there are certain sectors and roles that are at increased risk, and purpose-driven work—that is work (such as health care) which people love and about which they feel passionately—is one of them.3 Working in systems that support high-quality, patient-centered work—surrounded by a network of colleagues with shared ideals and goals—has defined the Association of Clinicians for the Underserved since its inception. From the many years of advocacy for the National Health Service Corps (NHSC), by many NHSC members and alumni, ACU has continued to be a leader in workforce retention and recruitment (most notably, through its recent work on the HRSA-funded STAR2 Center for Workforce). Burnout is not a new idea to ACU, nor is the concept of shared community, nor the data showing that being surrounded by a true community of peers helps to decrease (or, "treat") burnout. Now a bona fide syndrome with ICD-11 classification, the World Health Organization noted that the syndrome of burnout is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one's [End Page 1] job, or feelings of negativity or cynicism related to one's job; and 3) reduced professional efficacy.3 According to Dike Drummond, MD—known to some as The HappyMD—"[R]esearchers are beginning to notice differences in the way physician burnout presents in men and women." For women it often begins with exhaustion and a feeling of not being able to recharge your batteries, followed by early signs of blaming your patients or clients. For men, it often begins with cynicism and blaming your patients or clients, followed by exhaustion and falling energy and engagement.4 Whether the sufferer is male or female, though, burnout has an impact on patient care: it not only produces less engaged employees, but also leads to reduced patient engagement, reduced patient satisfaction, reduced quality and value of care that is delivered, and increased risk for a health care error or mistake. Whether these impacts are recognized by a chief executive, medical or compliance officer, the chief financial officer will also be keen to note that burnout leads to increased staff turnover—costing organizations thousands or millions of dollars, well beyond the loss of organizational knowledge that results from employee change. Organizational risk management plans for 2020 are something ECRI strongly endorses, including efforts to measure (and perhaps mitigate) burnout. Patients are beginning to demand the same, and with good reason: they simply want more engaged care, delivered by more empathetic care teams, that is safer. Paul Huschilt, CSP (Canadian Speaker Hall of Fame) spoke with the ACU community at this year's 2019 annual ACU meeting in Washington D.C. As health care professionals, we face urgent demands, responsibilities and pressures. His talk, replete with laughter and concluded with...

ECRI Institute and ISMP enter formal affiliation agreement

ECRI Institute and ISMP enter formal affiliation agreement

Institute for Safe Medication Practices joins ECRI Institute

Institute for Safe Medication Practices joins ECRI Institute

VA/DoD Clinical Practice Guideline: Diagnosis and Treatment of Low Back Pain.

In September 2017, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved the joint Clinical Practice Guideline (CPG) for Diagnosis and Management of Low Back Pain. This CPG was intended to provide healthcare providers a framework by which to evaluate, treat, and manage patients with low back pain (LBP). The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through September 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. A patient focus group was also convened to ensure patient values and perspectives were considered when formulating preferences and shared decision making in the guideline. The VA/DOD LBP CPG provides evidence-based recommendations for the diagnostic approach, education and self-care, non-pharmacologic and non-invasive therapy, pharmacologic therapy, dietary supplements, non-surgical invasive therapy, and team approach to treatment of low back pain.

Occipital nerve stimulation for non-migrainous chronic headaches: a systematic review protocol

BackgroundDefined as a headache lasting at least 15 days per month, chronic headache is reported by 3% of the general population, and a substantial proportion of them are refractory to current therapies. Occipital nerve stimulation (ONS) is a treatment option, but is still considered as a last resort treatment especially because of its invasive nature and the cost associated. Some reviews reported a limited efficacy of ONS for the treatment of migraines, with a high risk of complications. However, results reporting its efficacy and safety on other headache disorders are unclear. The aim of this review is to assess the efficacy and safety of ONS in regards to non-migrainous chronic headaches.MethodsWe will conduct a systematic review and meta-analysis of studies evaluating the use of ONS in comparison to sham stimulation or the best available treatment in patients with chronic headache. MEDLINE, CINHAL, EMBASE, PsycINFO, ECRI Institute Library, WIKISTIM, the Cochrane Library databases, and clinical trial registries will be searched for eligible studies. The review will include adult patients diagnosed with chronic headache excluding migraine. Two independent reviewers will process to the screening of studies according to titles, abstracts, and then full texts. The primary outcome is the overall reduction of head pain severity. The secondary outcomes are rates of reduction in the severity of head pain, headache frequency, and duration, use of medication, impairment, quality of life, healthcare utilization, return to work, and adverse events. Extracted data will include patients’ and procedure characteristics, details on comparative treatment or sham, and clinical outcomes. The risk of bias of the studies will be also independently assessed using the Cochrane risk of bias tools.DiscussionThis systematic review will allow us to better evaluate the potential role of ONS for the treatment of patients with chronic headache that are refractory to less invasive therapies. It will help to determine the degree of safety of ONS. Moreover, it will help to design and conduct future randomized controlled trials focused on patients who may better respond to such treatment.Systematic review registrationPROSPERO CRD42019121623

Testing the temperature of patient safety in the NHS.

John Tingle, Global Patient Safety Specialist, ECRI Institute, discusses several recent NHS reports which show the current state of patient safety in the NHS.

Clinical Rounds

In Brief Burnout is among ECRI Institute's top safety concerns for 2019...common dehydration signs are unreliable in older adults...using blindfolds in simulation training improves leadership skills...and more

Be Aware of Health Technology Hazards

PATIENT SAFETY IS PARAMOUNT in health care. Various agencies provide guidance to providers on alerts for patient safety hazards in the health care arena. One of those groups is the ECRI Institute, whose mission is to protect patients from unsafe and ineffective medical technologies and practices. The ECRI Institute makes recommendations based on patient safety events. To advise health care facilities, the ECRI Institute provided a top 10 list of 2019 health technology hazards that include important safety issues. These topics were derived after nominations from ECRI Institute engineers, scientists, clinicians, and other patient safety analysts based on their own expertise and insight gained through investigating patient safety events, testing medical devices, watching hospital practices, reviewing the literature, and discussing with people working in the health care systems and with the actual devices. 1 The ECRI Institute2019 Top 10 Health Technology Hazards: Executive Brief. 2018https://assets.ecri.org/PDF/White-Papers-and-Reports/2019-Top-10-Hazards.pdfDate accessed: January 15, 2019 Google Scholar The team at the ECRI Institute also considered the following factors when determining the top 10 topics: •Severity: What is the likelihood that the hazard could cause serious injury or death? •Frequency: How likely is the hazard? Does it occur often? •Breadth: If the hazard occurs, are the consequences likely to spread to affect a great number of people, either within one facility or across many facilities? •Insidiousness: Is the problem difficult to recognize? Could the problem lead to a cascade of downstream errors before it is identified or corrected? •Profile: Is the hazard likely to receive significant publicity? Has it been reported in the media, and is an affected hospital likely to receive negative attention? Has the hazard become a focus of regulatory bodies or accrediting agencies? •Preventability: Can actions be taken now to prevent the problem or at least minimize the risks? Would raising awareness of the hazard help reduce future occurrences? 1 The ECRI Institute2019 Top 10 Health Technology Hazards: Executive Brief. 2018https://assets.ecri.org/PDF/White-Papers-and-Reports/2019-Top-10-Hazards.pdfDate accessed: January 15, 2019 Google Scholar Jacqueline Ross, PhD, RN, CPAN, Department of Patient Safety, The Doctors Company, Napa, CA

Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus.

In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis summarizes key features of the guideline in 7 areas: patient-centered care and shared decision making, glycemic biomarkers, hemoglobin A1c target ranges, individualized treatment plans, outpatient pharmacologic treatment, glucose targets for critically ill patients, and treatment of hospitalized patients.

Systematic Review of Calcineurin Inhibitor Monitoring and Dosing Strategies in Renal Transplantation: Notice of a New Report Funded by the Agency for Healthcare Research and Quality.

The calcineurin inhibitors (CNIs)6 tacrolimus (TAC) and cyclosporine A (CsA) are effective immunosuppressive agents for renal transplantation but require careful management to avoid toxicity. Routine therapeutic monitoring guides dosing, but uncertainty surrounds different monitoring methods and time points. Additionally, the effectiveness of strategies to reduce CNI exposure is unclear. A recent report commissioned by the Agency for Healthcare Research and Quality (AHRQ) based on research conducted by the ECRI Institute–Penn Medicine Evidence-based Practice Center to address these questions is now available (https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports). The systematic review evaluates the evidence for 3 questions. The first question compared immunoassay analysis with liquid chromatographic or mass spectrometric analytical techniques for therapeutic monitoring of CNIs. The second question examined CsA monitoring time points, and the third question evaluated alternatives to full-dose CNI regimens. The review included 105 studies. Eleven studies addressing the analytic validity of monitoring …

Understanding Clinical Alarm Safety.

Patient safety organizations and health care accreditation agencies recognize the significance of clinical alarm hazards. The Association for the Advancement of Medical Instrumentation, a nonprofit organization focused on development and use of safe and effective medical equipment, identifies alarm management as a major issue for health care organizations. ECRI Institute, a nonprofit organization that researches approaches for improving patient safety and quality of care, identifies alarm hazards as the most significant of the "Top Ten Health Technology Hazards" for 2014. A new Joint Commission National Patient Safety Goal focusing on clinical alarm safety contains new requirements for accredited hospitals to be fully implemented by 2016. Through a fictional unfolding case study, this article reviews selected contributing factors to clinical alarm hazards present in inpatient, high-acuity settings. Understanding these factors improves contributions by nurses to clinical alarm safety practice.