Venous leg ulcers are extremely common in the United States. They affect between 500,000 and 2 million people annually, and are responsible for over 50 percent of all lower extremity ulcers. Elevated venous pressure, turbulent flow, and inadequate venous return are the common causes of venous leg ulcers. Risk factors for chronic venous disease include underlying conditions associated with poor venous return (such as congestive heart failure and obesity) and primary destruction of the venous system (such as prior deep venous thrombosis, recreational injected drug use, phlebitis, and venous...

The Agency for Healthcare Research and Quality (AHRQ) sponsors research to improve the quality, effectiveness, and safety of health care in the United States. Evidence reports and technology assessments generated through AHRQ's Effective Health Care Program provide science-based information about common, relevant health conditions and technologies to serve the needs of patients, clinicians, insurance payers, and other end users. Evidence reports typically target scientific researchers in related fields, rather than the patients or clinicians who ultimately make health-related decisions. For...

Dementia is an acquired condition that is characterized by a decline in at least two cognitive domains (e.g., loss of memory, attention, language, or visuospatial or executive functioning) that is severe enough to affect social or occupational functioning. Patients with dementia may also exhibit behavioral and psychological symptoms. The proposed Diagnostic and Statistical Manual, version 5 (DSM-V) subsumes dementia under a new syndrome, "major neurocognitive disorder." Patients with major neurocognitive disorder experience a significant cognitive decline that is significant enough to...

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...