EHC Program Inside Track Newsletter
Issue 27, September 2014
Highlighting important news and developments from AHRQ’s Effective Health Care Program
Dear Subscribers:
This is our final issue of AHRQ’s EHC Inside Track newsletter. It has been our pleasure for the last two and half years to share research findings and other updates from our Effective Health Care (EHC) Program. We hope these resources have been valuable in addressing the health care decisions you and your patients face. Although the newsletter’s run is ending, AHRQ will continue to be a vital source of evidence on health care treatments and other issues as we translate and disseminate research findings for use by providers, patients, health system leaders, policy makers, and others. Our mission remains producing evidence and working with individuals and partners to make health care safer, higher quality, and more accessible, equitable, and affordable.
There are ways to stay informed about AHRQ’s latest research and evidence-based resources to support your practice.
Thanks again for your ongoing interest in AHRQ.
Sincerely,
Howard E. Holland
Director, Office of Communications and Knowledge Transfer, AHRQ
In this issue:
“Few things are more important than putting evidence-based information into the hands of physicians and patients,” said James L. Madara, M.D., chief executive officer and executive vice president of the AMA (shown right).
Dr. Madara’s support echoes AHRQ’s commitment to help patients, their caregivers, and clinicians work together to make informed treatment decisions. As more patients gain access to medical care, AHRQ will continue to provide easy-to-read materials they can use. With the help of partners like the AMA, AHRQ has placed treatment options materials in the hands of patients and clinicians.
Other leaders who have supported the EHC Program include David L. Bronson, M.D., M.A.C.P., immediate past president of the American College of Physicians; Deidre Walton, J.D., M.S.N., R.N., president of the National Black Nurses Association; Elena V. Rios, M.D., M.S.P.H., president of the National Hispanic Medical Association; Nicole Lamoureux Busby, executive director of the National Association of Free and Charitable Clinics; and Reid B. Blackwelder, M.D., FAAFP, president of the American Academy of Family Physicians.
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According to the latest systematic review from AHRQ and in agreement with findings from a previous 2009 study, vitamin D and calcium benefit both bone mineral density and bone mineral content, but evidence of the value of these nutrients for other health outcomes is inconsistent. These outcomes include cancers of the breast, colon, and prostate; heart disease; pregnancy; immune function; falls and fractures; and all-cause mortality. Although new evidence was identified—particularly for heart outcomes, all-cause death, several types of cancer, and intermediate outcomes for bone health—no firm conclusions can be drawn. Beyond these observations, it is difficult to make any substantive statements on the basis of the available evidence concerning the link of either vitamin D levels in the body, vitamin D and calcium intake, or both with the various health outcomes.
These and other findings are available in the research report Vitamin D and Calcium: A Systematic Review of Heath Outcomes (Update). The report was requested and funded by the Office of Dietary Supplements, National Institutes of Health.
Research Finds Core Needle Biopsy is Similar to Open Surgical Biopsy When Diagnosing Breast Lesions
A research review from AHRQ finds a large body of evidence suggesting that ultrasound and stereotactically guided core needle biopsy procedures used to diagnose suspicious breast lesions have sensitivity and specificity (accuracy of diagnosis) close to that of open biopsy procedures and are associated with fewer harms. Evidence also shows that freehand procedures have lower sensitivity than imaging-guided methods. There is moderate strength evidence that women diagnosed with breast cancer by core needle biopsy were more likely to have their cancer treated with a single surgical procedure, compared with women diagnosed by open surgical biopsy. More research is needed in key areas, including test performance, to evaluate MRI-guided methods and other core needle biopsy methods and studies explicitly reporting on groups of patients at high baseline risk of breast cancer on the basis of factors such as genetic testing or family history of disease, among others. These research findings are available in the research review Core Needle and Open Surgical Biopsy for Diagnosis of Breast Lesions: An Update to the 2009 Report.
New Study Assesses Accuracy of Imaging Tests for the Staging of Colorectal Cancer
A research review from AHRQ finds that current evidence permits some tentative conclusions about the comparative accuracy and effectiveness of imaging tests for staging colorectal cancer, but many research gaps remain. Low-strength evidence suggests endoscopic rectal ultrasound (ERUS) is more accurate than computed tomography (CT) for preoperative rectal cancer T (tumor) staging. ERUS is less likely to incorrectly stage, under-stage or over-stage rectal cancer than CT in the preoperative T staging setting. Magnetic resonance imaging (MRI) is similar in accuracy to ERUS in the same setting. Moderate-strength evidence suggests MRI is more likely to detect colorectal liver metastases (spreading) than CT. Low strength evidence suggests that CT, MRI, and ERUS are comparable for rectal cancer N (nodal) staging, where all have limited sensitivity, and for interim rectal cancer T restaging, but both sensitivity and specificity are poor. More research is needed to better assess the interim restaging of both colon and rectal cancer, the impact of combining different imaging modalities on pretreatment and interim staging assessments, and the accuracy and clinical usefulness of PET/CT, among other issues. These findings are available in the research review Imaging Tests for the Staging of Colorectal Cancer: Comparative Effectiveness.
More Research Needed to Inform Clinical Practice on Chronic Urinary Retention in Adults
A research review from AHRQ finds insufficient evidence to draw conclusions on the comparative benefits or harms of treatments for persistent partial retention of urine or chronic urinary retention (CUR) in adults. There is low-strength evidence suggesting that transurethral resection of the prostate (TURP) and microwave therapy achieved similar results in the rate at which men were catheter-free at six months post-treatment. In addition, no data was found to assess the impact of treating CUR independently of treating benign prostatic enlargement and other lower urinary tract symptoms. Consistent with a previous CUR review, low strength evidence suggests that sacral neuromodulation reduces the need for catheterization and post-void residual (PVR) urine for CUR not attributable to obstructive causes. Future research is necessary before information is useful in informing practice. Research should address conceptual issues in studying CUR such as defining standard clinical diagnostic criteria and strengthening the evidence base with adequately powered controlled trials or studies of populations and interventions common in practice. These research findings are available in the research review Chronic Urinary Retention: Comparative Effectiveness of Treatments and Harms.
Research Gaps Still Exist on Utility of Imaging Tests to Diagnose and Stage Pancreatic Cancer
A research review from AHRQ finds that current evidence permits some tentative conclusions about the comparative assessment of imaging tests for diagnosing and staging pancreatic adenocarcinoma, but research gaps remain. The evidence finds that multidetector computed tomography (MDCT) and endoscopic ultrasound with fine needle aspiration (EUS-FNA) have similar accuracy in assessing resectability in patients whose disease is un-staged. EUS-FNA has a slight advantage over MDCT with respect to T (tumor) staging (specifically, a lower chance of under sizing the tumor). However, MDCT and MRI are similarly accurate with respect to both diagnosing and assessing vessel involvement, and positron emission tomography–computed tomography (PET/CT) is more accurate than MDCT in assessing distant metastases. Prominent gaps in evidence continue to include minimal information on MDCT angiography; imprecise data on other imaging techniques; a lack of comparative data on patient-oriented outcomes and factors that could influence comparative accuracy; and lack of test-specific data on screening accuracy. These findings are available in the research review Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma.
Top of Page
This is our final issue of AHRQ’s EHC Inside Track newsletter. It has been our pleasure for the last two and half years to share research findings and other updates from our Effective Health Care (EHC) Program. We hope these resources have been valuable in addressing the health care decisions you and your patients face. Although the newsletter’s run is ending, AHRQ will continue to be a vital source of evidence on health care treatments and other issues as we translate and disseminate research findings for use by providers, patients, health system leaders, policy makers, and others. Our mission remains producing evidence and working with individuals and partners to make health care safer, higher quality, and more accessible, equitable, and affordable.
There are ways to stay informed about AHRQ’s latest research and evidence-based resources to support your practice.
- The AHRQ Electronic Newsletter provides weekly summaries of Agency developments, including new patient-centered outcomes research products from the EHC Program, as well as valuable information in the areas of patient safety, prevention and care management, health information technology, and practice improvement.
- AHRQ’s Twitter account and Facebook page provide links to the latest health care news.
Thanks again for your ongoing interest in AHRQ.
Sincerely,
Howard E. Holland
Director, Office of Communications and Knowledge Transfer, AHRQ
In this issue:
AMA Supports Effective Health Care Program
The American Medical Association (AMA) joined other health care professional organizations in support of AHRQ’s EHC Program. The AMA is the nation’s largest physician organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care for patients and communities.“Few things are more important than putting evidence-based information into the hands of physicians and patients,” said James L. Madara, M.D., chief executive officer and executive vice president of the AMA (shown right).
Dr. Madara’s support echoes AHRQ’s commitment to help patients, their caregivers, and clinicians work together to make informed treatment decisions. As more patients gain access to medical care, AHRQ will continue to provide easy-to-read materials they can use. With the help of partners like the AMA, AHRQ has placed treatment options materials in the hands of patients and clinicians.
Other leaders who have supported the EHC Program include David L. Bronson, M.D., M.A.C.P., immediate past president of the American College of Physicians; Deidre Walton, J.D., M.S.N., R.N., president of the National Black Nurses Association; Elena V. Rios, M.D., M.S.P.H., president of the National Hispanic Medical Association; Nicole Lamoureux Busby, executive director of the National Association of Free and Charitable Clinics; and Reid B. Blackwelder, M.D., FAAFP, president of the American Academy of Family Physicians.
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More Resources From the Effective Health Care Program
Link Between Vitamin D and Health Outcomes UnclearAccording to the latest systematic review from AHRQ and in agreement with findings from a previous 2009 study, vitamin D and calcium benefit both bone mineral density and bone mineral content, but evidence of the value of these nutrients for other health outcomes is inconsistent. These outcomes include cancers of the breast, colon, and prostate; heart disease; pregnancy; immune function; falls and fractures; and all-cause mortality. Although new evidence was identified—particularly for heart outcomes, all-cause death, several types of cancer, and intermediate outcomes for bone health—no firm conclusions can be drawn. Beyond these observations, it is difficult to make any substantive statements on the basis of the available evidence concerning the link of either vitamin D levels in the body, vitamin D and calcium intake, or both with the various health outcomes.
These and other findings are available in the research report Vitamin D and Calcium: A Systematic Review of Heath Outcomes (Update). The report was requested and funded by the Office of Dietary Supplements, National Institutes of Health.
Research Finds Core Needle Biopsy is Similar to Open Surgical Biopsy When Diagnosing Breast Lesions
A research review from AHRQ finds a large body of evidence suggesting that ultrasound and stereotactically guided core needle biopsy procedures used to diagnose suspicious breast lesions have sensitivity and specificity (accuracy of diagnosis) close to that of open biopsy procedures and are associated with fewer harms. Evidence also shows that freehand procedures have lower sensitivity than imaging-guided methods. There is moderate strength evidence that women diagnosed with breast cancer by core needle biopsy were more likely to have their cancer treated with a single surgical procedure, compared with women diagnosed by open surgical biopsy. More research is needed in key areas, including test performance, to evaluate MRI-guided methods and other core needle biopsy methods and studies explicitly reporting on groups of patients at high baseline risk of breast cancer on the basis of factors such as genetic testing or family history of disease, among others. These research findings are available in the research review Core Needle and Open Surgical Biopsy for Diagnosis of Breast Lesions: An Update to the 2009 Report.
New Study Assesses Accuracy of Imaging Tests for the Staging of Colorectal Cancer
A research review from AHRQ finds that current evidence permits some tentative conclusions about the comparative accuracy and effectiveness of imaging tests for staging colorectal cancer, but many research gaps remain. Low-strength evidence suggests endoscopic rectal ultrasound (ERUS) is more accurate than computed tomography (CT) for preoperative rectal cancer T (tumor) staging. ERUS is less likely to incorrectly stage, under-stage or over-stage rectal cancer than CT in the preoperative T staging setting. Magnetic resonance imaging (MRI) is similar in accuracy to ERUS in the same setting. Moderate-strength evidence suggests MRI is more likely to detect colorectal liver metastases (spreading) than CT. Low strength evidence suggests that CT, MRI, and ERUS are comparable for rectal cancer N (nodal) staging, where all have limited sensitivity, and for interim rectal cancer T restaging, but both sensitivity and specificity are poor. More research is needed to better assess the interim restaging of both colon and rectal cancer, the impact of combining different imaging modalities on pretreatment and interim staging assessments, and the accuracy and clinical usefulness of PET/CT, among other issues. These findings are available in the research review Imaging Tests for the Staging of Colorectal Cancer: Comparative Effectiveness.
More Research Needed to Inform Clinical Practice on Chronic Urinary Retention in Adults
A research review from AHRQ finds insufficient evidence to draw conclusions on the comparative benefits or harms of treatments for persistent partial retention of urine or chronic urinary retention (CUR) in adults. There is low-strength evidence suggesting that transurethral resection of the prostate (TURP) and microwave therapy achieved similar results in the rate at which men were catheter-free at six months post-treatment. In addition, no data was found to assess the impact of treating CUR independently of treating benign prostatic enlargement and other lower urinary tract symptoms. Consistent with a previous CUR review, low strength evidence suggests that sacral neuromodulation reduces the need for catheterization and post-void residual (PVR) urine for CUR not attributable to obstructive causes. Future research is necessary before information is useful in informing practice. Research should address conceptual issues in studying CUR such as defining standard clinical diagnostic criteria and strengthening the evidence base with adequately powered controlled trials or studies of populations and interventions common in practice. These research findings are available in the research review Chronic Urinary Retention: Comparative Effectiveness of Treatments and Harms.
Research Gaps Still Exist on Utility of Imaging Tests to Diagnose and Stage Pancreatic Cancer
A research review from AHRQ finds that current evidence permits some tentative conclusions about the comparative assessment of imaging tests for diagnosing and staging pancreatic adenocarcinoma, but research gaps remain. The evidence finds that multidetector computed tomography (MDCT) and endoscopic ultrasound with fine needle aspiration (EUS-FNA) have similar accuracy in assessing resectability in patients whose disease is un-staged. EUS-FNA has a slight advantage over MDCT with respect to T (tumor) staging (specifically, a lower chance of under sizing the tumor). However, MDCT and MRI are similarly accurate with respect to both diagnosing and assessing vessel involvement, and positron emission tomography–computed tomography (PET/CT) is more accurate than MDCT in assessing distant metastases. Prominent gaps in evidence continue to include minimal information on MDCT angiography; imprecise data on other imaging techniques; a lack of comparative data on patient-oriented outcomes and factors that could influence comparative accuracy; and lack of test-specific data on screening accuracy. These findings are available in the research review Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma.
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Current as of September 2014
Internet Citation: EHC Program Inside Track Newsletter: Issue 27, September 2014. September 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/insidetrack/27/index.html
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