Systematic reviews often assess the comparative effectiveness and safety of health care interventions. To be most useful to users, systematic reviews should include estimates of the potential benefits and harms that are important to decisionmakers. Quantitative approaches for the assessment of benefits and harms may enhance, support, and facilitate how decisionmakers use systematic reviews. Previously, we prepared a report on the challenges and principles of assessing benefits and harms of medical interventions, the influence of values and preference, and the key characteristics of...

The febrile infant is a common clinical problem that accounts for a large number of ambulatory care visits. Young febrile infants (ages 0-3 months) often present with nonspecific symptoms and it is difficult to distinguish between infants with a viral syndrome and those with early serious bacterial illness (e.g., meningitis, bacteremia, urinary tract infection (UTI), and pneumonia). The definitions of serious bacterial illness (SBI) vary across published literature. SBI typically includes the diagnoses of meningitis, bacteremia, and UTI. Some studies have also included pneumonia, bone and...

This future research needs (FRN) report is a follow-up to the 2012 comparative effectiveness review (CER) "Long-Term Care for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care." The review was intended to support policy and research decisionmaking. FRN projects identify gaps in the current research that limit the conclusions in CERs and inform researchers and research funders about these gaps. They aim to encourage research likely to fill the gaps and make the body of evidence more useful to decisionmakers. The CER addressed the following two Key Questions...

Meta-analyses of proportions or rates (e.g., incidence rates) are very often included in reports generated by the Effective Health Care Program, and in systematic reviews in general. For example, one would use a meta-analysis of proportions to calculate the summary frequency of adverse or harmful events. Depending on the clinical context, adverse events can be rare (e.g., the incidence rate of rhabdomyolysis in statin treated patients is approximately 3.3 events per 100,000 patient years) or quite common (e.g., the average percentage of nausea and vomiting in chemotherapy-treated cancer...

This systematic review is an update of the evidence for the U.S. Preventive Services Task Force (USPSTF) on the effectiveness and adverse effects of risk assessment, genetic counseling, and genetic testing for breast cancer susceptibility gene (BRCA)-related cancer in women who do not have cancer but are potentially at increased risk. Its purpose is to evaluate and summarize evidence addressing specific key questions important to the USPSTF as it considers new recommendations for primary care practice. In 2005, based on results of a previous review, the USPSTF recommended against routine...

Traditionally, preoperative testing has been part of the preoperative care process to inform patient selection by determining fitness for anesthesia and identifying patients at high risk for perioperative complications. The American Society of Anesthesiologists defines routine preoperative tests as those done in the absence of any specific clinical indication or purpose; they typically include a panel of blood tests, urine tests, chest radiography, and electrocardiogram. These tests are performed to find latent abnormalities, such as anemia or silent heart disease, that could impact how,...

Chronic venous leg ulcers affect between 500,000 and 2 million persons annually, and over 50 percent of leg ulcers in the United States are classified as venous ulcers. They are caused by elevated venous pressure, turbulent venous flow, and inadequate venous return that can be due to occlusion or reflux in the venous system. The Johns Hopkins University Evidence-based Practice Center performed a systematic review to determine the effectiveness and safety of advanced wound dressings, systemic antibiotics, and surgical interventions relative to either compression systems or each other among...