AHRQ

The number of ADHD-related medical visits increased from 6.2 million in 2000 to 10.4 million in 2010. (1) Because there is no one medical or physical test that tells if someone has ADHD, we nurses must know how to spot the signs and be prepared to give parents and caregivers the information they need to understand the condition. AHRQ's free patient treatment summary, Treatment Options for ADHD in Children and Teens, is available to help parents and caregivers understand ADHD and take into consideration the treatment options available. The summary outlines both pharmacologic and nonpharmacologic treatments that are available such as parental behavior training, psychosocial therapy, and school-based programs. Here are three things you can discuss with your patients when using this summary: How ADHD affects children or adolescents and their families. Patient and parental preferences regarding diagnosis and treatment options, including pharmacologic and nonpharmacologic interventions. How they can access information from the National Resource Center on ADHD about diagnosis and treatment, educational programs, public benefits, and other issues. The Center is supported with funding from the Federal Government through the Centers for Disease Control and Prevention (CDC). ADHD information can be accessed online at www.help4adhd.org or by phone at 800-233-4050. What other tools for ADHD diagnosis do you currently use? What challenges have you faced while helping to treat children with ADHD? What successes have you had? To share this information with your patients, free copies of the clinician and patient treatment summaries can be ordered by calling 800-358-9295 and using code C-01. (1) http://www.ahrq.gov/news/newsletters/research-activities/sept12/0912RA14.html

Childhood obesity has quickly become a major health issue impacting the US. According to the CDC, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years (1). In 2012, more than one third of children and adolescents were overweight or obese. We nurses are the first point of contact for many families as they look for ways to improve their children's health. We can share life-saving strategies that are easy to implement and can help stop obesity before it begins. AHRQ's free patient summary on childhood obesity is for parents and caregivers who want to know things that can be done at home, in school, and in the community to help children maintain a healthy weight and keep them from becoming overweight or obese. If a child is already overweight or obese, steps can still be taken to keep the child from gaining any more weight. Keeping Children at a Healthy Weight also outlines factors that may lead to children becoming overweight, including: Unhealthy eating habits - Children may eat too much, eat too many unhealthy foods, or drink too many sugary drinks. Not getting enough sleep - Children who do not get enough sleep each night are more likely to become overweight. Not enough physical activity - Children should be active at least 1 hour each day. What kinds of advice do you offer families to help them keep their children at a healthy weight? Are there community-based health programs you refer them to? Please share some of your ideas. To share this information with your patients, free copies of the clinician and patient treatment summaries can be ordered by calling 800-358-9295 and using code C-01. (1) http://www.cdc.gov/healthyyouth/obesity/facts.htm

Keeping women healthy during pregnancy and childbirth is critical not only to the health of the baby but also for the woman's lifelong health. Complications sustained during childbirth, including complications of cesarean birth, can negatively impact a woman's mental and physical health in the immediate postpartum period and in the long-term. Her newborn can be affected as complications can negatively affect breastfeeding, a woman's energy and her adjustment to parenting. A focus area of heightened attention in maternity care has been elective, or non-medically indicated, induction of labor because evidence shows this practice results in higher rates of cesarean for women who have induction of labor with their first pregnancy and/or with an unripe cervix. NOTE: Since this article references materials not developed by AHRQ, we must note that the findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. Evaluating evidence for obstetric practices is complicated because practices, such as induction of labor without medical indications, began when there was less of an emphasis on an evidence basis for practice therefore the risks were not fully known or understood. The practice of elective inductions became culturally-accepted and widely used in obstetrical care. The practice paradigm is shifting away from elective inductions however many women are still expecting to have a non-medically indicated induction for convenience of family and work life. Women need to know the risks of elective inductions for themselves and their baby so they can make an informed decision about their birth choices. Explaining the evidence behind culturally-accepted practices can be hard. Nurses are ideally suited to discuss the safety and harms of non-medically indicated induction of labor with their patients and also friends, family and their communities. No other group of professionals has such an intimate knowledge of the effects of induction on mothers and babies because nurses are responsible for the bedside monitoring of the high-alert medication oxytocin, which is used for most inductions. That's why the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) developed their public health campaign, Don't Rush Me--Go the Full 40, which gives women and nurses 40 reasons to wait for labor to start on its own when pregnancy is healthy. The reasons address what emerging evidence demonstrates regarding healthy labor and birth practices, such as: Reason #3: Let nature take over--there are fewer complications and risks for both you and baby through natural birthReason #15: Give baby's development the benefit of time since you may not know exactly when you got pregnantReason #21: Ignore people who say an induction is more convenient. Nothing is convenient about a longer labor and increasing your risk of cesareanThe benefits of waiting for spontaneous labor and normal birth are well documented and result in giving mom and her baby the best possible start toward bonding, breastfeeding and recovery from labor and birth. Nurses can use the 40 Reasons article of the campaign (English & Spanish) to lead evidence-based, patient-centric discussions with women about the risks of elective induction of labor. Nurses can download a Go The Full 40 toolkit to share with their colleagues and patients, and engage with the Go The Full 40 Champions group, which advocates waiting for spontaneous labor when all is well in pregnancy. Evidence has identified the risks and complications of administering exogenous hormones such as synthetic oxytocin to a woman and her baby to induce labor. An equally importance evidence question yet to be answered is what short and long term benefits do women and babies receive from the powerful natural hormones of spontaneous labor and birth? Lynn Erdman, MN, RN, FAAN AWHONN, Chief Executive Officer

Through Internet searches, social media posts, television commercials and advice from friends and family our patients might become overwhelmed by the sheer number of facts and figures about heart health. Whether we are involved in the intake of new patients, diagnosis of hypertension, or treatment of high cholesterol, we have an opportunity to share information on cardiovascular disease that can help patients manage their condition. AHRQ's heart and blood vessel consumer summaries are tools that can help you educate patients on the best treatment options for their condition. Other tools that help keep you up-to-date include: - Research reviews on diagnosis and treatment strategies for coronary artery disease - Research summaries for clinicians on high blood pressure and high cholesterol - Free continuing education materials (CMEs) for health care professionals Visit the Clinical Bottom Line Web page and download the latest heart health summary products and publications. Use these materials to help lead the effort against heart disease year round. So when your patient comes to you with information gathered from here and there and has questions about their heart health, how do you respond? How do you take action to combat heart disease?

Clostridium difficile infections can be painful, dangerous or even deadly. Because of this, reducing the number of patients infected with Clostridium difficile or C. difficile is a public health imperative. Hospital billing data collected by AHRQ shows that more than 9% of C. diff-related hospitalizations end in death-nearly five times the rate for other hospital stays. That adds up to more than 30,000 fatalities among the 347,000 C. diff hospitalizations in 2010 (1). While healthy individuals who are infected with C. difficile generally do not become ill, for those with weakened immune systems it can lead to serious health consequences. Because the infection is best managed by rapidly recognizing symptoms, AHRQ has developed tools to help you and others at your hospital of practice keep your patients safe. Get the Clinical Bottom Line on C. difficile Infection (CDI) AHRQ research finds that the three major standard antibiotic treatments--oral vancomycin, metronidazole, and the newly approved fidaxomicin--are equally effective for curing initial C. difficile infections. The report also examined the comparative effectiveness of current diagnostic tests, prevention methods, and the use of fewer general antibiotics to minimize the likelihood of creating drug-resistant infections. Give a presentation to your hospital staff on the CDI Clinical Bottom Line using an EHC Program slide presentation. Learn how to talk to your patients who are infected C-diff about their treatment options. Use the consumer summary entitled Clostridium difficile Infections: Diagnosis, Treatment, and Prevention. Implement a C-diff quality and safety program in your hospital by using the "]ERASE C-difficile toolkit from AHRQ. What concerns you most of C-difficle infections and how to control them? _________________________________ (1) http://www.hcup-us.ahrq.gov/reports/statbriefs/sb124.jsp and http://www.ahrq.gov/news/newsletters/research-activities/mar12/0312RA39.html

The Agency for Healthcare Research and Quality (AHRQ) is one of twelve agencies within the U.S. Department of Health and Human Services (HHS). Its mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ supports research that helps people make more informed health care decisions and improves the quality of health care services. What other types of work does AHRQ do? I thought they only focused on quality and patient safety. You may know the Agency for Healthcare Research and Quality for its safety and quality programs, but did you know they also have a program dedicated to turning comparative effectiveness research into treatment decisionmaking tools for clinicians like you? AHRQ's Effective Health Care (EHC) Program works with researchers, research centers, and academic organizations to produce comparative effectiveness research and translate findings into useful formats for a variety of audiences. The Program provides evidence-based tools for clinicians, patients, and caregivers to aid in shared decisionmaking, using information on the benefits, risks, and possible side effects of treatments to guide patients to the best treatment options for their needs. Tools include: Research reviews and summaries Clinician research summaries Patient research summaries What is comparative effectiveness research? Comparative effectiveness research, a type of patient-centered outcomes research, provides information that helps clinicians and patients work together to treat an illness or condition. By comparing drugs, medical devices, tests, surgeries, or ways to deliver health care, patients, and their families can make more informed choices. Findings are descriptive, not prescriptive, and are intended as tools for informed decisionmaking, not recommendations. Findings highlight current evidence about effectiveness, risks, and side effects. The comparative effectiveness research reports and products identify areas of clinical uncertainty. The summaries for clinicians and patients efficiently and clearly present evidence and help clinicians and patients share decisionmaking. Share Your Thoughts How do you think these tools will be useful to you and your patients? What types of topics would you like to see the Agency explore? What tools do you think would help support shared decisionmaking discussions with your patients?

Don't you wish there was one place to go for research that compares the effectiveness, risks, and side effects of drugs, medical devices, tests, surgeries, or ways to deliver health care? Look no further than Treatment Options: Explore. Compare. Prepare. and the Clinical Bottom Line. Treatment Options: Explore. Compare. Prepare., is a new initiative from AHRQ that promotes Effective Health Care (EHC) Program resources that you're already familiar with--patient and clinician summaries--in a new and interesting way. The initiative offers new resources to help health professionals, patients, and caregivers access tools that can be used to improve patient health and health care experiences. These resources include English and Spanish Facebook pages; a series; public service announcements and brochures; a text messaging program; and digital tools for partner organizations.For health care professionals, there is a companion effort called Clinical Bottom Line that provides research and CME/CE tools and resources to members of the entire health care team. These resources support all members who make treatment decisions and/or provide patient education in the primary care setting. The Treatment Options initiative, its Spanish language version Toma las Riendas, and its companion health care professional effort was developed with input from partner organizations across the United States, representing physicians, nurses, pharmacists, patients, consumer advocates, and many others who support the EHC Program's goals. Are you ready to get involved in our effort to improve the health and health care experiences of patients and caregivers? See how.

Hello Teresa, Yes, we are thinking about the same systematic review. Thanks for your help on that! And I agree that we don’t yet know about the contribution of turning toward pressure ulcer prevention or treatment. It’s frustrating, right? The reality is that it’s difficult to prevent, treat and research pressure ulcers. Turning patients on a schedule is a time-consuming and often physically difficult task. If we just knew that it really worked, it would make it feel less frustrating. But the reality, as we know, isn’t that simple. We need to work with our colleagues, including physical therapists and nutritionists, as well as physicians and pharmacists, to tackle this issue together. The question of turning is similar to your next suggestion regarding routine physical assessments. It’s a really good question. Perhaps there are others on this forum who would like to join you in a small project. There are several approaches that you could take. You could pick a couple common diagnoses or procedures and document all the findings from physical assessments for a month. Are there any patterns in those findings? Are they improved after 3 days post-op for example? If so, is there a physician who would be willing to change the order after 3 days to once a day? (again, just an idea – the data may show something different). Then continue to collect data and compare the outcome of once a day to tid (or whatever is standard). A second approach would be to have a journal club on the topic and discuss what evidence does (or does not) exist. If you’re not used to journal clubs, maybe just start with a nurse-only group. Then ask an NP, CNS or physician if there is evidence that was missed. With evidence (or lack thereof), they may be open to changes in the protocol. Good luck! Beth

Given the interest, we'll start a discussion topic on pressure ulcers soon. You're always welcome to post any research and to include links to relevant resources.

Teresag_CNS, this is an excellent comment for a number of reasons. You've identified a real and important problem that nurses face every day, but more so, you described the full context and kept it patient-centered. You've described the topic in a way that researchers can actually study it. As you suggest, most research focuses on the patient outcomes and less on the workforce outcomes that go along with them. But I haven't answered your question yet... I believe this would be an excellent question to suggest for new research. But at the same time, I'd suggest we first look at the body of literature. Fortunately, AHRQ recently published two systematic reviews on pressure ulcers (in May 2013). One focuses on assessment and prevention and the other focuses on treatment strategies. Since you focus on turning, I think that the assessment and prevention report is more relevant to the issue you describe. In this report, despite lots of studies, the evidence was sporifice for many interventions although turning (called "repositioning" in the report) "was an exception. The summary of repositioning was as follows... "An exception was repositioning, for which there were three good- or fair-quality trials, although these reported somewhat inconsistent results. One trial found that a repositioning intervention was more effective than usual care in preventing pressure ulcers. Although other trials of repositioning did not clearly find decreased risk of pressure ulcers compared with usual care, the usual-care control group incorporated standard repositioning practices (i.e., the trials compared more intense repositioning vs. usual repositioning, not vs. no repositioning). A recently completed trial of repositioning, consisting of high-risk and moderate-risk arms that were randomized to repositioning at 2-, 3-, or 4-hour intervals, should provide more rigorous evidence on the effectiveness of repositioning." It goes on to say "Therefore, it would be inappropriate to conclude that standard repositioning, skin care, nutrition, and other practices should be abandoned, as these were the basis of usual-care comparisons." There is obviously a need for a research study on repositioning and in addition to what is suggested in the systematic review, it seems wise to consider your suggestion to measure nursing and workforce outcomes as well. Now I have a question for you and other readers... Would you like us to start a discussion topic on pressure ulcers, using these recent reports as a jumping-off point?

Ever wish there were more hours in the day? Especially when it comes to having discussions with your patients about treatment options for a condition? Every minute with your patient counts. Maximize your time and effectiveness with reliable tools from AHRQ that support evidence-based medicine. To help facilitate the discussions with your patients about treatment options, the AHRQ Effective Health Care (EHC) Program has included talking points in all of our clinician research summaries. For example, the 'What To Discuss With Your Patients' section of the Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension clinician summary suggests you discuss: The importance of effectively controlling high blood pressure. The link between measuring blood pressure and controlling high blood pressure. Adherence to strategies aimed at managing hypertension such as lifestyle and dietary modifications and medication. How self-measured blood pressure allows patients to participate more actively in managing their blood pressure. The types of self-measured blood pressure devices available and how to operate the device selected for the patient. And, all clinician research summaries have a corresponding patient summary for use in discussions. For more information on AHRQ's EHC Program and how you can stay updated on evidence-based treatment information for you and your patients, visit www.effectivehealthcare.ahrq.gov. The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency within the U.S. Department of Health and Human Services charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. Comments from anyone outside of AHRQ do not imply an endorsement by the U.S. Department of Health and Human Services, AHRQ, or any other Federal agencies such as the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Centers for Medicare & Medicaid Services, and the Health Resources and Services Administration.

Over the last several decades, advancements in research and health care have led to an overwhelming amount of information and increase in the number of treatments for many conditions and in a corresponding increase in journal articles reporting on these advancements. While it is essential for nurses to remain up-to-date with the latest clinical research, finding the time to read the huge amount of published articles can be difficult. The Effective Health Care (EHC) Program of AHRQ wants to help. How do you stay on top of all of the research and know which treatment options you should share with your patients? How do you use the clinical research that is available to you so that you can engage your patients in constructive discussions about their health care? Let's talk about ways the AHRQ EHC Program can make that easier for you. A good place to start is with a free continuing education activity on Understanding Comparative Effectiveness Research and Applicability to Practice. The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency within the U.S. Department of Health and Human Services charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. Comments from anyone outside of AHRQ do not imply an endorsement by the U.S. Department of Health and Human Services, AHRQ, or any other Federal agencies such as the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Centers for Medicare & Medicaid Services, and the Health Resources and Services Administration.