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  1. Article ; Online: Telehealth for Women's Preventive Services for Reproductive Health and Intimate Partner Violence: a Comparative Effectiveness Review.

    Cantor, Amy G / Nelson, Heidi D / Pappas, Miranda / Atchison, Chandler / Hatch, Brigit / Huguet, Nathalie / Flynn, Brittny / McDonagh, Marian

    Journal of general internal medicine

    2023  Volume 38, Issue 7, Page(s) 1735–1743

    Abstract: Background: Telehealth delivery of preventive health services may improve access to care; however, its effectiveness and adverse effects are unknown. We conducted a comparative effectiveness review on the effectiveness and harms of telehealth ... ...

    Abstract Background: Telehealth delivery of preventive health services may improve access to care; however, its effectiveness and adverse effects are unknown. We conducted a comparative effectiveness review on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services.
    Methods: We searched MEDLINE, Cochrane Library, CINAHL, and Scopus for English-language studies (July 2016 to May 2022) for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care. Two investigators identified studies and abstracted data using a predefined protocol. Study quality was assessed using study design-specific standardized methods; disagreements were resolved through consensus.
    Results: Eight RCTs, 1 nonrandomized trial, and 7 observational studies (n=10 731) were included (7 studies of contraceptive care and 9 of IPV services). Telehealth interventions to supplement contraceptive care demonstrated similar rates as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]); evidence on abortion was insufficient. Outcomes were also similar between telehealth interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). In these studies, telehealth barriers included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Strategies to ensure safety increased telehealth use for IPV services. Evidence on access, health equity, or harms was lacking.
    Discussion: Telehealth interventions for contraceptive care and IPV services demonstrate equivalent clinical and patient-reported outcomes versus in-person care, although few studies are available. Effective approaches for delivering these services and how to best mobilize telehealth, particularly for women facing barriers to care remain uncertain.
    Trial registration: PROSPERO CRD42021282298.
    MeSH term(s) Pregnancy ; Female ; Humans ; Reproductive Health ; Intimate Partner Violence/prevention & control ; Sexually Transmitted Diseases ; Telemedicine ; Contraceptive Agents
    Chemical Substances Contraceptive Agents
    Language English
    Publishing date 2023-01-17
    Publishing country United States
    Document type Systematic Review ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-023-08033-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Pharmacologic Treatments for Sleep Disorders in Children: A Systematic Review.

    McDonagh, Marian S / Holmes, Rebecca / Hsu, Frances

    Journal of child neurology

    2019  Volume 34, Issue 5, Page(s) 237–247

    Abstract: Sleep problems are common in children, especially those with neurodevelopmental disorders, and can lead to consequences in behavior, functioning, and quality of life. We systematically reviewed the efficacy and harms of pharmacologic treatments for sleep ...

    Abstract Sleep problems are common in children, especially those with neurodevelopmental disorders, and can lead to consequences in behavior, functioning, and quality of life. We systematically reviewed the efficacy and harms of pharmacologic treatments for sleep disorders in children and adolescents. We searched MEDLINE, Cochrane library databases, and PsycINFO through June 2018. We included 22 placebo-controlled randomized controlled trials (1-13 weeks' duration), involving 1758 children (mean age 8.2 years). Single randomized controlled trials of zolpidem and eszopiclone in children with attention-deficit/hyperactivity disorder (ADHD) showed no improvement in sleep or ADHD ratings. Clinical Global Impression Improvement/Severity scores significantly improved with zolpidem ( P = .03 and P = .006, respectively). A single, small randomized controlled trial of diphenhydramine reported small improvements in sleep outcomes (8-10 minutes' better sleep latency and duration) after 1 week. In 19 randomized controlled trials, melatonin significantly improved sleep latency (median 28 minutes; range 11-51 minutes), sleep duration (median 33 minutes; range 14-68 minutes), and wake time after sleep onset (range 12-43 minutes), but not number of awakenings per night (range 0-2.7). Function and behavior improvement varied. Improvement in sleep was greatest in children with autism or other neurodevelopmental disorders, and smaller in adolescents and children with chronic delayed sleep onset. Adverse events were infrequent with melatonin, but more frequent than placebo in children taking eszopiclone or zolpidem. These findings show that melatonin was useful in improving some sleep outcomes in the short term, particularly those with comorbid ASD and neurodevelopmental disorders. Other drugs and outcomes are inadequately studied.
    MeSH term(s) Adolescent ; Child ; Humans ; Neurodevelopmental Disorders/complications ; Neurodevelopmental Disorders/drug therapy ; Randomized Controlled Trials as Topic ; Sleep Wake Disorders/complications ; Sleep Wake Disorders/drug therapy
    Language English
    Publishing date 2019-01-23
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 639288-x
    ISSN 1708-8283 ; 0883-0738
    ISSN (online) 1708-8283
    ISSN 0883-0738
    DOI 10.1177/0883073818821030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Depression in Children and Adolescents: Evaluation and Treatment.

    Selph, Shelley S / McDonagh, Marian S

    American family physician

    2019  Volume 100, Issue 10, Page(s) 609–617

    Abstract: The prevalence of major unipolar depression in children and adolescents is increasing in the United States. In 2016, approximately 5% of 12-year-olds and 17% of 17-year-olds reported experiencing a major depressive episode in the previous 12 months. ... ...

    Abstract The prevalence of major unipolar depression in children and adolescents is increasing in the United States. In 2016, approximately 5% of 12-year-olds and 17% of 17-year-olds reported experiencing a major depressive episode in the previous 12 months. Screening for depression in adolescents 12 years and older should be conducted annually using a validated instrument, such as the Patient Health Questionnaire-9: Modified for Teens. If the diagnosis is confirmed, treatment should be initiated for persistent, moderate, and severe depression. Active support and monitoring may be sufficient for mild, self-limited depression. For more severe depression, evidence indicates greater response to treatment when psychotherapy (e.g., cognitive behavior therapy) and an antidepressant are used concurrently, compared with either treatment alone. Fluoxetine and escitalopram are the only antidepressants approved by the U.S. Food and Drug Administration for treatment of depression in children and adolescents. Fluoxetine may be used in patients older than eight years, and escitalopram may be used in patients 12 years and older. Monitoring for suicidality is necessary in children and adolescents receiving pharmacotherapy, with frequency of monitoring based on each patient's individual risk. The decision to modify treatment (add, increase, change the medication or add psychotherapy) should be made after about four to eight weeks. Consultation with or referral to a mental health subspecialist is warranted if symptoms worsen or do not improve despite treatment and for those who become a risk to themselves or others.
    MeSH term(s) Adolescent ; Antidepressive Agents/therapeutic use ; Child ; Cognitive Behavioral Therapy/methods ; Depression/diagnosis ; Depression/epidemiology ; Depression/therapy ; Humans ; Mass Screening/methods ; Prevalence ; Psychotherapy/methods ; Risk Assessment/methods ; Risk Factors ; United States/epidemiology
    Chemical Substances Antidepressive Agents
    Language English
    Publishing date 2019-11-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 412694-4
    ISSN 1532-0650 ; 0002-838X ; 0572-3612
    ISSN (online) 1532-0650
    ISSN 0002-838X ; 0572-3612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Comparative effectiveness and harms of long-acting insulins for type 1 and type 2 diabetes: A systematic review and meta-analysis.

    Holmes, Rebecca S / Crabtree, Elizabeth / McDonagh, Marian S

    Diabetes, obesity & metabolism

    2019  Volume 21, Issue 4, Page(s) 984–992

    Abstract: Aim: To review evidence comparing benefits and harms of long-acting insulins in patients with type 1 and 2 diabetes.: Methods: MEDLINE and two Cochrane databases were searched during February 2018. Two authors selected studies meeting inclusion ... ...

    Abstract Aim: To review evidence comparing benefits and harms of long-acting insulins in patients with type 1 and 2 diabetes.
    Methods: MEDLINE and two Cochrane databases were searched during February 2018. Two authors selected studies meeting inclusion criteria and assessed their quality. Comparative studies of adult or paediatric patients with diabetes treated with insulin degludec, detemir or glargine were included. Meta-analysis was used to combine results of similar studies, and the I
    Results: Of 2534 citations reviewed, 70 studies met the inclusion criteria. No statistically significant differences in HbA1c were seen between any two insulins or formulations. Hypoglycaemia was less probable with degludec than with glargine, including nocturnal hypoglycaemia in type 1 (rate ratio 0.68, 95% CI 0.56-0.81) and type 2 diabetes (rate ratio 0.73, 95% CI 0.65-0.82), and severe hypoglycaemia in type 2 diabetes (relative risk 0.72, 95% CI 0.54-0.96). Patients with type 2 diabetes had higher rates of withdrawal because of adverse events when treated with detemir compared with glargine (relative risk 2.1, 95% CI 1.4-3.3). Adults taking detemir gained about 1 kg less body weight than those taking degludec (type 1) or glargine (type 2).
    Conclusions: No differences in glycaemic control were seen between insulin degludec, detemir and glargine. Hypoglycaemia was less probable with degludec than glargine, and patients taking detemir gained less body weight than those given degludec or glargine. In type 2 diabetes, withdrawals as a result of adverse events were more probable with detemir than glargine.
    MeSH term(s) Blood Glucose/metabolism ; Comparative Effectiveness Research ; Diabetes Mellitus, Type 1/drug therapy ; Diabetes Mellitus, Type 1/metabolism ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/metabolism ; Glycated Hemoglobin A/metabolism ; Humans ; Hypoglycemia/chemically induced ; Insulin Detemir/therapeutic use ; Insulin Glargine/therapeutic use ; Insulin, Long-Acting/therapeutic use ; Treatment Outcome ; Weight Gain
    Chemical Substances Blood Glucose ; Glycated Hemoglobin A ; Insulin, Long-Acting ; hemoglobin A1c protein, human ; Insulin Glargine (2ZM8CX04RZ) ; Insulin Detemir (4FT78T86XV) ; insulin degludec (54Q18076QB)
    Language English
    Publishing date 2019-01-22
    Publishing country England
    Document type Comparative Study ; Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 1454944-x
    ISSN 1463-1326 ; 1462-8902
    ISSN (online) 1463-1326
    ISSN 1462-8902
    DOI 10.1111/dom.13614
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Testing a filtering strategy for systematic reviews: evaluating work savings and recall.

    Proescholdt, Randi / Hsiao, Tzu-Kun / Schneider, Jodi / Cohen, Aaron M / McDonagh, Marian S / Smalheiser, Neil R

    AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science

    2022  Volume 2022, Page(s) 406–413

    Abstract: Systematic reviews are extremely time-consuming. The goal of this work is to assess work savings and recall for a publication type filtering strategy that uses the output of two machine learning models, Multi-Tagger and web RCT Tagger, applied ... ...

    Abstract Systematic reviews are extremely time-consuming. The goal of this work is to assess work savings and recall for a publication type filtering strategy that uses the output of two machine learning models, Multi-Tagger and web RCT Tagger, applied retrospectively to 10 systematic reviews on drug effectiveness. Our filtering strategy resulted in mean work savings of 33.6% and recall of 98.3%. Of 363 articles finally included in any of the systematic reviews, 7 were filtered out by our strategy, but 1 "error" was actually an article using a publication type that the SR team had not pre-specified as relevant for inclusion. Our analysis suggests that automated publication type filtering can potentially provide substantial work savings with minimal loss of included articles. Publication type filtering should be personalized for each systematic review and might be combined with other filtering or ranking methods to provide additional work savings for manual triage.
    Language English
    Publishing date 2022-05-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2676378-3
    ISSN 2153-4063 ; 2153-4063
    ISSN (online) 2153-4063
    ISSN 2153-4063
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Update Alert: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings.

    Chou, Roger / Dana, Tracy / Jungbauer, Rebecca / Weeks, Chandler / McDonagh, Marian S

    Annals of internal medicine

    2020  Volume 173, Issue 5, Page(s) W86

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Humans ; Masks ; Pandemics ; Pneumonia, Viral/epidemiology ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-07-20
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/L20-0948
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Update Alert 2: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings.

    Chou, Roger / Dana, Tracy / Jungbauer, Rebecca / Weeks, Chandler / McDonagh, Marian S

    Annals of internal medicine

    2020  Volume 173, Issue 7, Page(s) 132

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Humans ; Masks ; Pandemics ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Severe Acute Respiratory Syndrome/epidemiology
    Keywords covid19
    Language English
    Publishing date 2020-08-27
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/L20-1067
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Cannabis-Based Products for Chronic Pain : A Systematic Review.

    McDonagh, Marian S / Morasco, Benjamin J / Wagner, Jesse / Ahmed, Azrah Y / Fu, Rongwei / Kansagara, Devan / Chou, Roger

    Annals of internal medicine

    2022  Volume 175, Issue 8, Page(s) 1143–1153

    Abstract: Background: Contemporary data are needed about the utility of cannabinoids in chronic pain.: Purpose: To evaluate the benefits and harms of cannabinoids for chronic pain.: Data sources: Ovid MEDLINE, PsycINFO, EMBASE, the Cochrane Library, and ... ...

    Abstract Background: Contemporary data are needed about the utility of cannabinoids in chronic pain.
    Purpose: To evaluate the benefits and harms of cannabinoids for chronic pain.
    Data sources: Ovid MEDLINE, PsycINFO, EMBASE, the Cochrane Library, and Scopus to January 2022.
    Study selection: English-language, randomized, placebo-controlled trials and cohort studies (≥1 month duration) of cannabinoids for chronic pain.
    Data extraction: Data abstraction, risk of bias, and strength of evidence assessments were dually reviewed. Cannabinoids were categorized by THC-to-CBD ratio (high, comparable, or low) and source (synthetic, extract or purified, or whole plant).
    Data synthesis: Eighteen randomized, placebo-controlled trials (
    Limitation: Variation in interventions; lack of study details, including unclear availability in the United States; and inadequate evidence for some products.
    Conclusion: Oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation. Studies are needed on long-term outcomes and further evaluation of product formulation effects.
    Primary funding source: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. (PROSPERO: CRD42021229579).
    MeSH term(s) Analgesics ; Cannabinoids/adverse effects ; Cannabis ; Chronic Pain/drug therapy ; Dizziness/chemically induced ; Dronabinol/adverse effects ; Humans
    Chemical Substances Analgesics ; Cannabinoids ; Dronabinol (7J8897W37S)
    Language English
    Publishing date 2022-06-07
    Publishing country United States
    Document type Journal Article ; Review ; Systematic Review ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/M21-4520
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: A study of the value of requesting information from drug manufacturers for systematic reviews; 9 years of experience from the drug effectiveness review project.

    McDonagh, Marian S / Thakurta, Sujata / Peterson, Kim

    Systematic reviews

    2018  Volume 7, Issue 1, Page(s) 172

    Abstract: Background: Systematic reviews (SRs) depend on comprehensive searches for evidence to provide balanced, accurate results. Requesting published and unpublished studies from pharmaceutical manufacturers has been proposed as a method to engage industry ... ...

    Abstract Background: Systematic reviews (SRs) depend on comprehensive searches for evidence to provide balanced, accurate results. Requesting published and unpublished studies from pharmaceutical manufacturers has been proposed as a method to engage industry stakeholders and potentially reduce reporting bias. The Drug Effectiveness Review Project (DERP) has been requesting such evidence since 2003; the purpose of this study was to retrospectively evaluate the type and impact of the evidence received.
    Methods: Data from "dossiers" submitted by pharmaceutical manufacturers for a set of 40 SRs conducted for DERP from July 2006 to June 2015 were retrospectively evaluated. Characteristics of data submitted in dossiers, including numbers, types, and characteristics of studies submitted and then included in DERP SRs, were abstracted. Time trends, study quality, publication status, and whether the submission represented a unique study or supplemental data to a published study were assessed. The impact of this evidence on SR conclusions was assessed using dual review. Differences were resolved through a consensus.
    Results: Over 9 years, 160 dossiers were received, relating to 40 DERP SRs. Out of 7360 studies/datasets submitted, 2.2% (160) were included in a SR. The ratio of submitted-to-included increased over time. Most were unique studies (23% were supplemental data sets), and almost 42% of the studies were unpublished. The majority of the studies were rated fair quality, with 7.3% rated good and 14% rated poor quality by the original SR authors. Considering all literature search sources, 7.2% of all studies included in the 40 SRs came from a dossier, and 16% of dossier studies were included in a meta-analysis. The dossier studies resulted in changes to conclusions in 42% of the SRs. Out of 46 unpublished unique studies included in a SR, 25 (54%) influenced the conclusions in favor of the manufacturers drug, 8% favored a competitor drug, and 40% favored neither. In 92% of cases favoring the manufacturer's drug, the dossier study was the only evidence for that drug in a specific population or outcome.
    Conclusions: In SRs conducted for DERP, few studies submitted by pharmaceutical manufacturers were ultimately included in a SR. The included data helped to reduce reporting and publication bias by filling important gaps and in some cases led to altered conclusions.
    MeSH term(s) Bias ; Datasets as Topic ; Drug Industry ; Drug Therapy ; Humans ; Information Dissemination ; Information Seeking Behavior ; Publication Bias ; Research Design/standards ; Research Report/standards ; Research Report/trends ; Retrospective Studies ; Systematic Reviews as Topic
    Language English
    Publishing date 2018-10-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 2662257-9
    ISSN 2046-4053 ; 2046-4053
    ISSN (online) 2046-4053
    ISSN 2046-4053
    DOI 10.1186/s13643-018-0834-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Book ; Online: Improving antibiotic prescribing for uncomplicated acute respiratory tract infections

    McDonagh, Marian S

    (Comparative effectiveness review ; no. 163 ; AHRQ publication ; no. 15(16)-EHC033-EF)

    2016  

    Abstract: OBJECTIVES: To assess the comparative effectiveness of interventions for improving antibiotic use for acute respiratory tract infections (RTIs) in adults and children. DATA SOURCES: Electronic databases (MEDLINE(r) from 1990 and the Cochrane Library ... ...

    Institution United States. / Agency for Health Care Policy and Research,
    Oregon Health & Science University. / Pacific Northwest Evidence-based Practice Center,
    Effective Health Care Program (U.S.)
    Author's details prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Pacific Northwest Evidence-based Practice Center, Portland, OR ; investigators, Marian McDonagh, Kim Peterson, Kevin Winthrop, Amy Cantor, Brittany Holzhammer, David I. Buckley
    Series title Comparative effectiveness review ; no. 163
    AHRQ publication ; no. 15(16)-EHC033-EF
    Abstract OBJECTIVES: To assess the comparative effectiveness of interventions for improving antibiotic use for acute respiratory tract infections (RTIs) in adults and children. DATA SOURCES: Electronic databases (MEDLINE(r) from 1990 and the Cochrane Library databases from 2005 to February 2015), reference lists of included systematic reviews, and Scientific Information Packets from point-of-care test manufacturers and experts. REVIEW METHODS: Using predefined criteria, we selected studies of any intervention designed to improve antibiotic use for acute RTIs for which antibiotics are not indicated. Interventions were organized into education, communication, clinical, system-level, and multifaceted categories. We identified interventions that had evidence of reducing resistance to antibiotics, improving appropriate prescribing (i.e., concordant with guidelines), or decreasing overall prescribing of antibiotics for acute RTIs and not causing adverse consequences such as medical complications or patient dissatisfaction. The quality of included studies was rated and the strength of the evidence was assessed. Clinical and methodological heterogeneity limited quantitative analysis. RESULTS: Although reduction in antibiotic resistance is a major goal of these interventions, there were too few studies to assess this outcome. The few studies that attempted to assess appropriate prescribing had important limitations and lack of consistency in outcome definition and ascertainment methods across studies. Therefore, reduction in overall prescribing was the only commonly reported benefit across interventions. Actual use of antibiotics was also reported in too few studies to assess separately from prescribing. No intervention had high-strength evidence for any outcome. The best evidence, from an evidence base of 133 studies, including 88 randomized controlled trials, was for four interventions with moderate-strength evidence of improved or reduced antibiotic prescribing compared with usual care that also had low-strength evidence of not causing adverse consequences. These were clinic-based parent education (21% overall prescribing reduction; similar return visits); public patient education campaigns combined with clinician education (improved appropriate prescribing; 7% reduction in overall prescribing; similar complications and satisfaction); procalcitonin for adults (12% to 72% overall prescribing reduction; similar continuing symptoms, limited activity, missing work, adverse events or lack of efficacy, treatment failure, hospitalizations, and mortality); and electronic decision support systems (improved appropriate prescribing and 5% to 9% reduction in overall prescribing; similar complications and health care use). Additionally, public parent education campaigns had low-strength evidence of reducing overall prescribing, not increasing diagnosis of complications, and decreasing subsequent visits. Other interventions had evidence of improved or reduced prescribing, but evidence on adverse consequences was lacking (streptococcal antigen testing, rapid multiviral testing in adults), insufficient (clinician and patient education plus audit and feedback plus academic detailing), or mixed (delayed prescribing, C-reactive protein [CRP] testing, clinician communication training, communication training plus CRP testing). Interventions with evidence of no impact on antibiotic prescribing were clinic-based education for parents of children 24 months or younger with acute otitis media, point-of-care testing for influenza or tympanometry in children, and clinician education combined with audit and feedback. Furthermore, limited evidence suggested that using adult procalcitonin algorithms in children is not effective and results in increased antibiotic prescribing. CONCLUSIONS: The best evidence supports the use of specific education interventions for patients/parents and clinicians, procalcitonin in adults, and electronic decision support to reduce overall antibiotic prescribing (and in some cases improve appropriate prescribing) for acute RTIs without causing adverse consequences, although the reduction in prescribing varied widely. Other interventions also reduced prescribing, but evidence on adverse consequences was lacking, insufficient, or mixed. Future studies should use a complex intervention framework and better evaluate measures of appropriate prescribing, adverse consequences such as hospitalization, sustainability, resource use, and the impact of potential effect modifiers. PROSPERO number: CRD42014010094.
    MeSH term(s) Respiratory Tract Infections/drug therapy ; Acute Disease/therapy ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/therapeutic use ; Drug Prescriptions/standards ; Drug Resistance, Microbial
    Language English
    Size 1 online resource (1 PDF file (various pagings)) :, illustrations.
    Document type Book ; Online
    Database Catalogue of the US National Library of Medicine (NLM)

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