Evelyn Whitlock - Academia.edu (original) (raw)

Papers by Evelyn Whitlock

Research paper thumbnail of A taxonomy of rapid reviews links report types and methods to specific decision-making contexts

Journal of Clinical Epidemiology, 2015

Describe characteristics of rapid reviews and examine the impact of methodological variations on ... more Describe characteristics of rapid reviews and examine the impact of methodological variations on their reliability and validity. We conducted a literature review and interviews with organizations that produce rapid reviews or related products to identify methods, guidance, empiric evidence, and current practices. We identified 36 rapid products from 20 organizations (production time, 5 minutes to 8 months). Methods differed from systematic reviews at all stages. As timeframes increased, methods became more rigorous; however, restrictions on database searching, inclusion criteria, data extracted, and independent dual review remained. We categorized rapid products based on extent of synthesis. "Inventories" list what evidence is available. "Rapid responses" present best available evidence with no formal synthesis. "Rapid reviews" synthesize the quality of and findings from the evidence. "Automated approaches" generate meta-analyses in response to user-defined queries. Rapid products rely on a close relationship with end users and support specific decisions in an identified timeframe. Limited empiric evidence exists comparing rapid and systematic reviews. Rapid products have tremendous methodological variation; categorization based on timeframe or type of synthesis reveals patterns. The similarity across rapid products lies in the close relationship with the end user to meet time-sensitive decision-making needs.

Research paper thumbnail of Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services

Preventive Medicine, 2004

Background. Research has established the societal cost-effectiveness of providing breast and cerv... more Background. Research has established the societal cost-effectiveness of providing breast and cervical cancer screening to women. Less is known about the cost of motivating women significantly overdue for services to receive screening.Methods. In this intent-to-treat study, a total of 254 women, aged 52–69, who were overdue for both Pap test and mammography, were randomized to two groups, a tailored, motivational

Research paper thumbnail of The primary prevention of heart disease in women through health behavior change promotion in primary care

Women's Health Issues, 2003

Methods. For the behaviors cited, USPSTF and CTF recommendations and their associated systematic ... more Methods. For the behaviors cited, USPSTF and CTF recommendations and their associated systematic evidence reviews (SERs) were retrieved. Individual articles from the USPSTF healthy diet and physical activity SERs that met our inclusion criteria were systematically examined to determine the applicability of this research to women. We supplemented findings from these sources with comprehensive federal research summaries and SERs from focused searches of systematic review databases relevant to primary CVD prevention in women through healthy behavior change.

Research paper thumbnail of Screening HMO Women Overdue for both Mammograms and Pap Tests

Preventive Medicine, 2002

Background. Regular screening has the potential to reduce breast and cervical cancer mortality, b... more Background. Regular screening has the potential to reduce breast and cervical cancer mortality, but despite health plan programs to encourage screening, many women remain unscreened. Tailored communications have been identified as a promising approach to promote mammography and Pap test screening.Methods. The study used a four-group randomized design to compare with Usual Care the separate and combined effects of two

Research paper thumbnail of Recent Patterns of Hormone Replacement Therapy Use in a Large Managed Care Organization

Journal of Women's Health, 1998

Rates of hormone replacement therapy (HRT) in women have varied substantially over the last 25 ye... more Rates of hormone replacement therapy (HRT) in women have varied substantially over the last 25 years. Data on the impact of recent recommendations for widespread use to prevent cardiovascular disease and osteoporosis and factors that influence use are needed. We attempted to (1) describe recent trends in HRT use, (2) investigate the relationship between HRT use and prepaid drug benefit, and (3) detail prescribing frequencies by provider specialty. We conducted a cross-sectional analysis of annual HRT pharmacy dispensings from 1986 to 1995 in a large HMO to all female HMO members aged 45 years and older. HRT rates increased among all age categories, although the magnitude of change varied by age. Highest rates of use were found in those 50-59 years old. Although combined estrogen-progestin use increased, 57% of all estrogen users did not receive progestin in 1995. Unopposed estrogen use was largely limited to hysterectomized women. Women of all ages with no prepaid drug benefit as part of their HMO coverage had the lowest HRT rates. Internal medicine, obstetrics/gynecology, and family practice providers prescribed over 90% of HRT, and prescriber specialty varied with user age. HRT use increased in the HMO from 1986 to 1995, especially among younger women. In 1995, about half of women aged 50-64 years received one or more HRT dispensings. As the benefits, risks, and cost effectiveness of HRT depend on the duration of use, additional information on current use duration is needed. Combined estrogen-progestin use increased and appeared appropriate to hysterectomy status. Research is needed to determine if lower HRT use rates among women without a prepaid drug benefit indicate less prophylactic HRT use, particularly among younger women, for whom this lack of coverage was relatively common.

Research paper thumbnail of Grading the Strength of a Body of Evidence When Assessing Health Care Interventions: An EPC Update

Journal of Clinical Epidemiology, 2014

To revise 2010 guidance on grading the strength of evidence (SOE) of the effectiveness of drugs, ... more To revise 2010 guidance on grading the strength of evidence (SOE) of the effectiveness of drugs, devices, and other preventive and therapeutic interventions in systematic reviews produced by the Evidence-based Practice Center (EPC) program, established by the US Agency for Healthcare Research and Quality (AHRQ). A cross-EPC working group reviewed authoritative systems for grading SOE [primarily the approach from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group] and conducted extensive discussions with GRADE and other experts. Updated guidance continues to be conceptually similar to GRADE. Reviewers are to evaluate SOE separately for each major treatment comparison for each major outcome. We added reporting bias as a required domain and retained study limitations (risk of bias), consistency, directness, and precision (and three optional domains). Additional guidance covers scoring consistency, precision, and reporting bias, grading bodies of evidence with randomized controlled trials and observational studies, evaluating single study bodies of evidence, using studies with high risk of bias, and presenting findings with greater clarity and transparency. SOE is graded high, moderate, low, or insufficient, reflecting reviewers' confidence in the findings for a specific treatment comparison and outcome. No single approach for grading SOE suits all reviews, but a more consistent and transparent approach to reporting summary information will make reviews more useful to the broad range of audiences that AHRQ's work aims to reach. EPC working groups will consider ongoing challenges and modify guidance as needed, on issues such as combining trials and observational studies in bodies of evidence, weighting domains, and combining qualitative and quantitative syntheses.

Research paper thumbnail of Screening and Interventions for Childhood Overweight: A Systematic Review for the

Background. Childhood and adolescent overweight and obesity are related to health risks, medical ... more Background. Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years.

Research paper thumbnail of Screening for Primary Open-Angle Glaucoma in the Primary Care Setting: An Update for the U.S. Preventive Services Task Force

PURPOSE Primary open-angle glaucoma (POAG) is a leading cause of blindness and vision-related dis... more PURPOSE Primary open-angle glaucoma (POAG) is a leading cause of blindness and vision-related disability. This review examines the effectiveness of screening for and treatment of early POAG in asymptomatic persons.

Research paper thumbnail of Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions

Journal of Clinical Epidemiology, 2014

The purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center met... more The purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center methods white paper was to outline approaches to conducting systematic reviews of complex multicomponent health care interventions. We performed a literature scan and conducted semistructured interviews with international experts who conduct research or systematic reviews of complex multicomponent interventions (CMCIs) or organizational leaders who implement CMCIs in health care. Challenges identified include lack of consistent terminology for such interventions (eg, complex, multicomponent, multidimensional, multifactorial); a wide range of approaches used to frame the review, from grouping interventions by common features to using more theoretical approaches; decisions regarding whether and how to quantitatively analyze the interventions, from holistic to individual component analytic approaches; and incomplete and inconsistent reporting of elements critical to understanding the success and impact of multicomponent interventions, such as methods used for implementation the context in which interventions are implemented. We provide a framework for the spectrum of conceptual and analytic approaches to synthesizing studies of multicomponent interventions and an initial list of critical reporting elements for such studies. This information is intended to help systematic reviewers understand the options and tradeoffs available for such reviews.

Research paper thumbnail of Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force

Annals of internal medicine, Jan 4, 2008

In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended colorectal cancer screening... more In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended colorectal cancer screening for adults 50 years of age or older but concluded that evidence was insufficient to prioritize among screening tests or evaluate newer tests, such as computed tomographic (CT) colonography. To review evidence related to knowledge gaps identified by the 2002 recommendation and to consider community performance of screening endoscopy, including harms. MEDLINE, Cochrane Library, expert suggestions, and bibliographic reviews. Eligible studies reported performance of colorectal cancer screening tests or health outcomes in average-risk populations and were at least of fair quality according to design-specific USPSTF criteria, as determined by 2 reviewers. Two reviewers verified extracted data. Four fecal immunochemical tests have superior sensitivity (range, 61% to 91%), and some have similar specificity (97% to 98%), to the Hemoccult II fecal occult blood test (Beckman Coulter, Fullerton, Ca...

Research paper thumbnail of Sexual orientation and health: comparisons in the women's health initiative sample

Archives of family medicine

Little is known about older lesbian and bisexual women. Existing research rarely compares charact... more Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women. To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes. Analysis of data from 93,311 participants in the Women's Health Initiative (WHI) study of health in postmenopausal women, comparing characteristics of 5 groups: heterosexuals, bisexuals, lifetime lesbians, adult lesbians, and those who never had sex as an adult. Subjects were recruited at 40 WHI study centers nationwide representing a range of geographic and ethnic diversity. Postmenopausal women aged 50 to 79 years who met WHI eligibility criteria, signed an informed consent to participate in the WHI clinical trial(s) or observational study, and respond...

Research paper thumbnail of Screening rarely screened women: time-to-service and 24-month outcomes of tailored interventions

Preventive Medicine, 2003

Managed care organizations and others reaching out to underscreened women seek strategies to enco... more Managed care organizations and others reaching out to underscreened women seek strategies to encourage mammogram and Pap screening. Female HMO members aged 50-69 years and overdue for a mammogram and a Pap test (n = 501) were followed for 24 months after interventions began. An Outreach intervention (tailored letters and motivational telephone interviews), an Inreach intervention (motivational interview delivered in clinics), and a Combined Inreach/Outreach intervention were compared to Usual Care at 24 months. Logistic regression and Cox hazard models examined predictors of obtaining screening services and time-to-service, respectively. Compared with Usual Care, the odds of Outreach women aged 50-64 obtaining a mammogram (OR = 2.06; 95% CI = 1.59-5.29), a Pap test (OR = 1.97; 95% CI = 1.12-3.53), or both (OR = 2.53; 95% CI = 1.40-4.63) remained significantly increased at 24 months. The average time-to-service for Outreach women was reduced by 4 months. Outreach effects persisted despite intensive, ongoing health plan efforts to improve screening of all women. This brief, tailored outreach intervention was an effective strategy for encouraging cervical and breast cancer screening among women overdue for both screening services. It also shortened time-to-service, an important benefit for early detection and treatment. Alternative strategies are needed for women who remain unscreened.

Research paper thumbnail of Teen Reach: Outcomes From a Randomized, Controlled Trial of a Tobacco Reduction Program for Teens Seen in Primary Medical Care

PEDIATRICS, 2005

Objective. To test the long-term efficacy of brief counseling plus a computer-based tobacco inter... more Objective. To test the long-term efficacy of brief counseling plus a computer-based tobacco intervention for teens being seen for routine medical care.

Research paper thumbnail of Screening for Child and Adolescent Depression in Primary Care Settings: A Systematic Evidence Review for the US Preventive Services Task Force

PEDIATRICS, 2009

Background: Depression among youth is a relatively common, disabling condition that is associated... more Background: Depression among youth is a relatively common, disabling condition that is associated with serious long-term morbidities and risk of suicide. The majority of depressed youth, however, are undiagnosed and untreated, despite opportunities for identification in settings such as primary care.

Research paper thumbnail of Association between Obesity during Pregnancy and Increased Use of Health Care

New England Journal of Medicine, 2008

In the United States, obesity during pregnancy is common and increases obstetrical risks. An esti... more In the United States, obesity during pregnancy is common and increases obstetrical risks. An estimate of the increase in use of health care services associated with obesity during pregnancy is needed. We used electronic data systems of a large U.S. group-practice health maintenance organization to identify 13,442 pregnancies among women 18 years of age or older at the time of conception that resulted in live births or stillbirths. The study period was between January 1, 2000, and December 31, 2004. We assessed associations between measures of use of health care services and body-mass index (BMI, defined as the weight in kilograms divided by the square of the height in meters) before pregnancy or in early pregnancy. The women were categorized as underweight (BMI <18.5), normal (BMI 18.5 to 24.9), overweight (BMI 25.0 to 29.9), obese (BMI 30.0 to 34.9), very obese (BMI 35.0 to 39.9), or extremely obese (BMI > or =40.0). The primary outcome was the mean length of hospital stay for delivery. After adjustment for age, race or ethnic group, level of education, and parity, the mean (+/-SE) length of hospital stay for delivery was significantly (P<0.05) greater among women who were overweight (3.7+/-0.1 days), obese (4.0+/-0.1 days), very obese (4.1+/-0.1 days), and extremely obese (4.4+/-0.1 days) than among women with normal BMI (3.6+/-0.1 days). A higher-than-normal BMI was associated with significantly more prenatal fetal tests, obstetrical ultrasonographic examinations, medications dispensed from the outpatient pharmacy, telephone calls to the department of obstetrics and gynecology, and prenatal visits with physicians. A higher-than-normal BMI was also associated with significantly fewer prenatal visits with nurse practitioners and physician assistants. Most of the increase in length of stay associated with higher BMI was related to increased rates of cesarean delivery and obesity-related high-risk conditions. Obesity during pregnancy is associated with increased use of health care services.

Research paper thumbnail of Toward a Transdisciplinary Model of Evidence-Based Practice

Milbank Quarterly, 2009

Context: This article describes the historical context and current developments in evidence-based... more Context: This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal "three circles" model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines.

Research paper thumbnail of Race/Ethnicity, Socioeconomic Status, and Lifetime Morbidity Burden in the Women's Health Initiative: A Cross-Sectional Analysis

Journal of Women's Health, 2006

We sought to assess the extent to which race/ethnicity and socioeconomic status (SES) are indepen... more We sought to assess the extent to which race/ethnicity and socioeconomic status (SES) are independently and jointly related to lifetime morbidity burden by comparing the impact of SES on lifetime morbidity among women of different racial/ethnic groups: white, black, Hispanic, American Indian/Alaska Native (AIAN), and Asian/Pacific Islander (API). Using baseline data from the Women's Health Initiative (WHI), a national study of 162,000 postmenopausal women, we measured lifetime morbidity burden using a modified version of the Charlson Index, and measured SES with educational attainment and household income. In multivariable simple polytomous logistic regression models, we first assessed the effect of SES on lifetime morbidity burden among women of each racial/ethnic group, then assessed the combined effect of race/ethnicity and SES. Five percent of all women in the study population had high lifetime morbidity burden. Women with high lifetime morbidity were more likely to be AIAN or black; poor; less educated; divorced, separated, or widowed; past or current smokers; obese; uninsured or publicly insured. Lower SES was associated with higher morbidity among most women. The extent to which morbidity was higher among lower SES compared to higher SES women was about the same among Hispanic women and white women, but was substantially greater among black and AIAN women compared with white women. This study demonstrates the importance of considering race/ethnicity and class together in relation to health outcomes.

Research paper thumbnail of Concern about weight gain associated with quitting smoking: Prevalence and association with outcome in a sample of young female smokers

Journal of Consulting and Clinical Psychology, 1999

This study investigated the relationship between weight gain concern and outcomes of a largescale... more This study investigated the relationship between weight gain concern and outcomes of a largescale smoking cessation study among 506 young female smokers attending Planned Parenthood clinics. Results of this prospective study did not support the clinical importance of weight gain concerns. Using an index of weight concern that was predictive in previous research, baseline weight concern was unrelated to smoking cessation efforts, whether participants made a quit attempt, reduced the number of cigarettes they smoked, or reported a change in self-efficacy for stopping smoking. Both the overall level of concern expressed in this sample of predominantly White young women and the lack of relationship between weight gain concern and smoking cessation outcomes suggest that weight gain concern may not be a critical factor for cessation programs targeting similar female smokers.

Research paper thumbnail of AHRQ Series Paper 3: Identifying, selecting, and refining topics for comparative effectiveness systematic reviews: AHRQ and the Effective Health-Care program

Journal of Clinical Epidemiology, 2010

Objective: This article discusses the identification, selection, and refinement of topics for com... more Objective: This article discusses the identification, selection, and refinement of topics for comparative effectiveness systematic reviews within the Agency for Healthcare Research and Quality's Effective Health Care (EHC) program.

Research paper thumbnail of Low-Fat Dietary Pattern and Risk of Colorectal Cancer

Research paper thumbnail of A taxonomy of rapid reviews links report types and methods to specific decision-making contexts

Journal of Clinical Epidemiology, 2015

Describe characteristics of rapid reviews and examine the impact of methodological variations on ... more Describe characteristics of rapid reviews and examine the impact of methodological variations on their reliability and validity. We conducted a literature review and interviews with organizations that produce rapid reviews or related products to identify methods, guidance, empiric evidence, and current practices. We identified 36 rapid products from 20 organizations (production time, 5 minutes to 8 months). Methods differed from systematic reviews at all stages. As timeframes increased, methods became more rigorous; however, restrictions on database searching, inclusion criteria, data extracted, and independent dual review remained. We categorized rapid products based on extent of synthesis. "Inventories" list what evidence is available. "Rapid responses" present best available evidence with no formal synthesis. "Rapid reviews" synthesize the quality of and findings from the evidence. "Automated approaches" generate meta-analyses in response to user-defined queries. Rapid products rely on a close relationship with end users and support specific decisions in an identified timeframe. Limited empiric evidence exists comparing rapid and systematic reviews. Rapid products have tremendous methodological variation; categorization based on timeframe or type of synthesis reveals patterns. The similarity across rapid products lies in the close relationship with the end user to meet time-sensitive decision-making needs.

Research paper thumbnail of Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services

Preventive Medicine, 2004

Background. Research has established the societal cost-effectiveness of providing breast and cerv... more Background. Research has established the societal cost-effectiveness of providing breast and cervical cancer screening to women. Less is known about the cost of motivating women significantly overdue for services to receive screening.Methods. In this intent-to-treat study, a total of 254 women, aged 52–69, who were overdue for both Pap test and mammography, were randomized to two groups, a tailored, motivational

Research paper thumbnail of The primary prevention of heart disease in women through health behavior change promotion in primary care

Women's Health Issues, 2003

Methods. For the behaviors cited, USPSTF and CTF recommendations and their associated systematic ... more Methods. For the behaviors cited, USPSTF and CTF recommendations and their associated systematic evidence reviews (SERs) were retrieved. Individual articles from the USPSTF healthy diet and physical activity SERs that met our inclusion criteria were systematically examined to determine the applicability of this research to women. We supplemented findings from these sources with comprehensive federal research summaries and SERs from focused searches of systematic review databases relevant to primary CVD prevention in women through healthy behavior change.

Research paper thumbnail of Screening HMO Women Overdue for both Mammograms and Pap Tests

Preventive Medicine, 2002

Background. Regular screening has the potential to reduce breast and cervical cancer mortality, b... more Background. Regular screening has the potential to reduce breast and cervical cancer mortality, but despite health plan programs to encourage screening, many women remain unscreened. Tailored communications have been identified as a promising approach to promote mammography and Pap test screening.Methods. The study used a four-group randomized design to compare with Usual Care the separate and combined effects of two

Research paper thumbnail of Recent Patterns of Hormone Replacement Therapy Use in a Large Managed Care Organization

Journal of Women's Health, 1998

Rates of hormone replacement therapy (HRT) in women have varied substantially over the last 25 ye... more Rates of hormone replacement therapy (HRT) in women have varied substantially over the last 25 years. Data on the impact of recent recommendations for widespread use to prevent cardiovascular disease and osteoporosis and factors that influence use are needed. We attempted to (1) describe recent trends in HRT use, (2) investigate the relationship between HRT use and prepaid drug benefit, and (3) detail prescribing frequencies by provider specialty. We conducted a cross-sectional analysis of annual HRT pharmacy dispensings from 1986 to 1995 in a large HMO to all female HMO members aged 45 years and older. HRT rates increased among all age categories, although the magnitude of change varied by age. Highest rates of use were found in those 50-59 years old. Although combined estrogen-progestin use increased, 57% of all estrogen users did not receive progestin in 1995. Unopposed estrogen use was largely limited to hysterectomized women. Women of all ages with no prepaid drug benefit as part of their HMO coverage had the lowest HRT rates. Internal medicine, obstetrics/gynecology, and family practice providers prescribed over 90% of HRT, and prescriber specialty varied with user age. HRT use increased in the HMO from 1986 to 1995, especially among younger women. In 1995, about half of women aged 50-64 years received one or more HRT dispensings. As the benefits, risks, and cost effectiveness of HRT depend on the duration of use, additional information on current use duration is needed. Combined estrogen-progestin use increased and appeared appropriate to hysterectomy status. Research is needed to determine if lower HRT use rates among women without a prepaid drug benefit indicate less prophylactic HRT use, particularly among younger women, for whom this lack of coverage was relatively common.

Research paper thumbnail of Grading the Strength of a Body of Evidence When Assessing Health Care Interventions: An EPC Update

Journal of Clinical Epidemiology, 2014

To revise 2010 guidance on grading the strength of evidence (SOE) of the effectiveness of drugs, ... more To revise 2010 guidance on grading the strength of evidence (SOE) of the effectiveness of drugs, devices, and other preventive and therapeutic interventions in systematic reviews produced by the Evidence-based Practice Center (EPC) program, established by the US Agency for Healthcare Research and Quality (AHRQ). A cross-EPC working group reviewed authoritative systems for grading SOE [primarily the approach from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group] and conducted extensive discussions with GRADE and other experts. Updated guidance continues to be conceptually similar to GRADE. Reviewers are to evaluate SOE separately for each major treatment comparison for each major outcome. We added reporting bias as a required domain and retained study limitations (risk of bias), consistency, directness, and precision (and three optional domains). Additional guidance covers scoring consistency, precision, and reporting bias, grading bodies of evidence with randomized controlled trials and observational studies, evaluating single study bodies of evidence, using studies with high risk of bias, and presenting findings with greater clarity and transparency. SOE is graded high, moderate, low, or insufficient, reflecting reviewers' confidence in the findings for a specific treatment comparison and outcome. No single approach for grading SOE suits all reviews, but a more consistent and transparent approach to reporting summary information will make reviews more useful to the broad range of audiences that AHRQ's work aims to reach. EPC working groups will consider ongoing challenges and modify guidance as needed, on issues such as combining trials and observational studies in bodies of evidence, weighting domains, and combining qualitative and quantitative syntheses.

Research paper thumbnail of Screening and Interventions for Childhood Overweight: A Systematic Review for the

Background. Childhood and adolescent overweight and obesity are related to health risks, medical ... more Background. Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years.

Research paper thumbnail of Screening for Primary Open-Angle Glaucoma in the Primary Care Setting: An Update for the U.S. Preventive Services Task Force

PURPOSE Primary open-angle glaucoma (POAG) is a leading cause of blindness and vision-related dis... more PURPOSE Primary open-angle glaucoma (POAG) is a leading cause of blindness and vision-related disability. This review examines the effectiveness of screening for and treatment of early POAG in asymptomatic persons.

Research paper thumbnail of Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions

Journal of Clinical Epidemiology, 2014

The purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center met... more The purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center methods white paper was to outline approaches to conducting systematic reviews of complex multicomponent health care interventions. We performed a literature scan and conducted semistructured interviews with international experts who conduct research or systematic reviews of complex multicomponent interventions (CMCIs) or organizational leaders who implement CMCIs in health care. Challenges identified include lack of consistent terminology for such interventions (eg, complex, multicomponent, multidimensional, multifactorial); a wide range of approaches used to frame the review, from grouping interventions by common features to using more theoretical approaches; decisions regarding whether and how to quantitatively analyze the interventions, from holistic to individual component analytic approaches; and incomplete and inconsistent reporting of elements critical to understanding the success and impact of multicomponent interventions, such as methods used for implementation the context in which interventions are implemented. We provide a framework for the spectrum of conceptual and analytic approaches to synthesizing studies of multicomponent interventions and an initial list of critical reporting elements for such studies. This information is intended to help systematic reviewers understand the options and tradeoffs available for such reviews.

Research paper thumbnail of Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force

Annals of internal medicine, Jan 4, 2008

In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended colorectal cancer screening... more In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended colorectal cancer screening for adults 50 years of age or older but concluded that evidence was insufficient to prioritize among screening tests or evaluate newer tests, such as computed tomographic (CT) colonography. To review evidence related to knowledge gaps identified by the 2002 recommendation and to consider community performance of screening endoscopy, including harms. MEDLINE, Cochrane Library, expert suggestions, and bibliographic reviews. Eligible studies reported performance of colorectal cancer screening tests or health outcomes in average-risk populations and were at least of fair quality according to design-specific USPSTF criteria, as determined by 2 reviewers. Two reviewers verified extracted data. Four fecal immunochemical tests have superior sensitivity (range, 61% to 91%), and some have similar specificity (97% to 98%), to the Hemoccult II fecal occult blood test (Beckman Coulter, Fullerton, Ca...

Research paper thumbnail of Sexual orientation and health: comparisons in the women's health initiative sample

Archives of family medicine

Little is known about older lesbian and bisexual women. Existing research rarely compares charact... more Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women. To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes. Analysis of data from 93,311 participants in the Women's Health Initiative (WHI) study of health in postmenopausal women, comparing characteristics of 5 groups: heterosexuals, bisexuals, lifetime lesbians, adult lesbians, and those who never had sex as an adult. Subjects were recruited at 40 WHI study centers nationwide representing a range of geographic and ethnic diversity. Postmenopausal women aged 50 to 79 years who met WHI eligibility criteria, signed an informed consent to participate in the WHI clinical trial(s) or observational study, and respond...

Research paper thumbnail of Screening rarely screened women: time-to-service and 24-month outcomes of tailored interventions

Preventive Medicine, 2003

Managed care organizations and others reaching out to underscreened women seek strategies to enco... more Managed care organizations and others reaching out to underscreened women seek strategies to encourage mammogram and Pap screening. Female HMO members aged 50-69 years and overdue for a mammogram and a Pap test (n = 501) were followed for 24 months after interventions began. An Outreach intervention (tailored letters and motivational telephone interviews), an Inreach intervention (motivational interview delivered in clinics), and a Combined Inreach/Outreach intervention were compared to Usual Care at 24 months. Logistic regression and Cox hazard models examined predictors of obtaining screening services and time-to-service, respectively. Compared with Usual Care, the odds of Outreach women aged 50-64 obtaining a mammogram (OR = 2.06; 95% CI = 1.59-5.29), a Pap test (OR = 1.97; 95% CI = 1.12-3.53), or both (OR = 2.53; 95% CI = 1.40-4.63) remained significantly increased at 24 months. The average time-to-service for Outreach women was reduced by 4 months. Outreach effects persisted despite intensive, ongoing health plan efforts to improve screening of all women. This brief, tailored outreach intervention was an effective strategy for encouraging cervical and breast cancer screening among women overdue for both screening services. It also shortened time-to-service, an important benefit for early detection and treatment. Alternative strategies are needed for women who remain unscreened.

Research paper thumbnail of Teen Reach: Outcomes From a Randomized, Controlled Trial of a Tobacco Reduction Program for Teens Seen in Primary Medical Care

PEDIATRICS, 2005

Objective. To test the long-term efficacy of brief counseling plus a computer-based tobacco inter... more Objective. To test the long-term efficacy of brief counseling plus a computer-based tobacco intervention for teens being seen for routine medical care.

Research paper thumbnail of Screening for Child and Adolescent Depression in Primary Care Settings: A Systematic Evidence Review for the US Preventive Services Task Force

PEDIATRICS, 2009

Background: Depression among youth is a relatively common, disabling condition that is associated... more Background: Depression among youth is a relatively common, disabling condition that is associated with serious long-term morbidities and risk of suicide. The majority of depressed youth, however, are undiagnosed and untreated, despite opportunities for identification in settings such as primary care.

Research paper thumbnail of Association between Obesity during Pregnancy and Increased Use of Health Care

New England Journal of Medicine, 2008

In the United States, obesity during pregnancy is common and increases obstetrical risks. An esti... more In the United States, obesity during pregnancy is common and increases obstetrical risks. An estimate of the increase in use of health care services associated with obesity during pregnancy is needed. We used electronic data systems of a large U.S. group-practice health maintenance organization to identify 13,442 pregnancies among women 18 years of age or older at the time of conception that resulted in live births or stillbirths. The study period was between January 1, 2000, and December 31, 2004. We assessed associations between measures of use of health care services and body-mass index (BMI, defined as the weight in kilograms divided by the square of the height in meters) before pregnancy or in early pregnancy. The women were categorized as underweight (BMI <18.5), normal (BMI 18.5 to 24.9), overweight (BMI 25.0 to 29.9), obese (BMI 30.0 to 34.9), very obese (BMI 35.0 to 39.9), or extremely obese (BMI > or =40.0). The primary outcome was the mean length of hospital stay for delivery. After adjustment for age, race or ethnic group, level of education, and parity, the mean (+/-SE) length of hospital stay for delivery was significantly (P<0.05) greater among women who were overweight (3.7+/-0.1 days), obese (4.0+/-0.1 days), very obese (4.1+/-0.1 days), and extremely obese (4.4+/-0.1 days) than among women with normal BMI (3.6+/-0.1 days). A higher-than-normal BMI was associated with significantly more prenatal fetal tests, obstetrical ultrasonographic examinations, medications dispensed from the outpatient pharmacy, telephone calls to the department of obstetrics and gynecology, and prenatal visits with physicians. A higher-than-normal BMI was also associated with significantly fewer prenatal visits with nurse practitioners and physician assistants. Most of the increase in length of stay associated with higher BMI was related to increased rates of cesarean delivery and obesity-related high-risk conditions. Obesity during pregnancy is associated with increased use of health care services.

Research paper thumbnail of Toward a Transdisciplinary Model of Evidence-Based Practice

Milbank Quarterly, 2009

Context: This article describes the historical context and current developments in evidence-based... more Context: This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal "three circles" model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines.

Research paper thumbnail of Race/Ethnicity, Socioeconomic Status, and Lifetime Morbidity Burden in the Women's Health Initiative: A Cross-Sectional Analysis

Journal of Women's Health, 2006

We sought to assess the extent to which race/ethnicity and socioeconomic status (SES) are indepen... more We sought to assess the extent to which race/ethnicity and socioeconomic status (SES) are independently and jointly related to lifetime morbidity burden by comparing the impact of SES on lifetime morbidity among women of different racial/ethnic groups: white, black, Hispanic, American Indian/Alaska Native (AIAN), and Asian/Pacific Islander (API). Using baseline data from the Women's Health Initiative (WHI), a national study of 162,000 postmenopausal women, we measured lifetime morbidity burden using a modified version of the Charlson Index, and measured SES with educational attainment and household income. In multivariable simple polytomous logistic regression models, we first assessed the effect of SES on lifetime morbidity burden among women of each racial/ethnic group, then assessed the combined effect of race/ethnicity and SES. Five percent of all women in the study population had high lifetime morbidity burden. Women with high lifetime morbidity were more likely to be AIAN or black; poor; less educated; divorced, separated, or widowed; past or current smokers; obese; uninsured or publicly insured. Lower SES was associated with higher morbidity among most women. The extent to which morbidity was higher among lower SES compared to higher SES women was about the same among Hispanic women and white women, but was substantially greater among black and AIAN women compared with white women. This study demonstrates the importance of considering race/ethnicity and class together in relation to health outcomes.

Research paper thumbnail of Concern about weight gain associated with quitting smoking: Prevalence and association with outcome in a sample of young female smokers

Journal of Consulting and Clinical Psychology, 1999

This study investigated the relationship between weight gain concern and outcomes of a largescale... more This study investigated the relationship between weight gain concern and outcomes of a largescale smoking cessation study among 506 young female smokers attending Planned Parenthood clinics. Results of this prospective study did not support the clinical importance of weight gain concerns. Using an index of weight concern that was predictive in previous research, baseline weight concern was unrelated to smoking cessation efforts, whether participants made a quit attempt, reduced the number of cigarettes they smoked, or reported a change in self-efficacy for stopping smoking. Both the overall level of concern expressed in this sample of predominantly White young women and the lack of relationship between weight gain concern and smoking cessation outcomes suggest that weight gain concern may not be a critical factor for cessation programs targeting similar female smokers.

Research paper thumbnail of AHRQ Series Paper 3: Identifying, selecting, and refining topics for comparative effectiveness systematic reviews: AHRQ and the Effective Health-Care program

Journal of Clinical Epidemiology, 2010

Objective: This article discusses the identification, selection, and refinement of topics for com... more Objective: This article discusses the identification, selection, and refinement of topics for comparative effectiveness systematic reviews within the Agency for Healthcare Research and Quality's Effective Health Care (EHC) program.

Research paper thumbnail of Low-Fat Dietary Pattern and Risk of Colorectal Cancer