Evidence Development & Decision Science

The systematic production and application of medical knowledge to clinical practice. LDI Senior Fellows analyze the process by which data affect coverage and clinical decisions, and conducts comparative effectiveness and cost effectiveness studies.

Detection Of COVID-19 In A Vulvar Lesion

Jul. 2, 2020

Elizabeth S. Rubin, Stephanie A. Sansone, Adi Hirshberg, Elizabeth G. Clement, Sindhu K. Srinivas

Abstract [from journal]

As new information about coronavirus disease 2019 (COVID-19) is rapidly discovered, clinicians are better equipped to make informed decisions for their patients. While current research suggests COVID-19 viral antigen is not found in vaginal secretions, its detectability in the female lower genital tract may have clinical implications for obstetric and gynecologic care for women. We present a case of a woman at 31 weeks' gestation with simultaneous upper respiratory symptoms and vulvovaginitis. She was found to have a vulvar lesion


Practice Gap In Atrial Fibrillation Oral Anticoagulation Prescribing At Emergency Department Home Discharge

Jun. 29, 2020

Bory Kea, Bethany T. Waites, Amber Lin, Merritt Raitt, David R. Vinson, Niroj Ari, Luke Welle, Andrew Sill, Dana Button, Benjamin C. Sun

Abstract [from journal]

Introduction: Current U.S. cardiology guidelines recommend oral anticoagulation (OAC) to reduce stroke risk in selected patients with atrial fibrillation (AF), but no formal AF OAC recommendations exist to guide emergency medicine clinicians in the acute care setting. We sought to characterize emergency department (ED) OAC prescribing practices after an ED AF diagnosis.

Methods: This retrospective study included index visits for OAC-naive patients ≥18 years old who were discharged home from


Early Impact Of Pennsylvania Act 112 On Follow-Up Of Abnormal Imaging Findings

Hanna M. Zafar, MD, MHS
Jun. 21, 2020

Govind S. Mattay, Gregory S. Mittl, Hanna M. Zafar, Tessa S. Cook

Abstract [from journal]

Objective: Pennsylvania Act 112 requires diagnostic imaging facilities to directly notify outpatients about significant imaging abnormalities that require follow-up care within 3 months. The effects of Act 112 on patient care are unclear. We sought to characterize follow-up discussions and care received by outpatients with significant imaging abnormalities as defined by Act 112.

Methods: We evaluated findings flagged for patient notification under Act 112 at our institution over a 1-month


Association Of Suicide Prevention Interventions With Subsequent Suicide Attempts, Linkage To Follow-Up Care, And Depression Symptoms For Acute Care Settings: A Systematic Review And Meta-Analysis

Jun. 17, 2020

Stephanie K. Doupnik, Brittany Rudd, Timothy Schmutte, Diana Worsley, Cadence F. Bowden, Erin McCarthy, Elliott Eggan, Jeffrey A. Bridge, Steven C. Marcus

Abstract [from journal]

Importance: To prevent suicide deaths, acute care settings need tools to ensure individuals at risk of suicide access mental health care and remain safe until they do so.

Objective: To examine the association of brief acute care suicide prevention interventions with patients' subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up.

Data sources: Ovid MEDLINE, Scopus, CINAHL, PsychINFO, Embase, and references of included studies using


Association Among Surgeon Experience, Patient Risk, And Outcomes In Coronary Artery Bypass Grafting

Jun. 13, 2020

Jason J. Han, Markian M. Bojko, Matthew M. Duda, Amit Iyengar, John J. Kelly, William L. Patrick, Mark R. Helmers, Pavan Atluri

Abstract [from journal]

Background: There is an association between surgeon experience and outcomes following cardiac surgery. However, this association is not well studied in the context of patient risk. The purpose of this single-center, retrospective, observational study was to describe how surgeon experience relates to patient risk in isolated coronary artery bypass graft (CABG) surgery and how this impacts patient outcomes.

Methods: Surgeon experience was defined as time between the surgeon finishing fellowship


A Qualitative Assessment Of Factors That Children, Parents, And Clinicians Prioritize In The Setting Of Elective Anesthesia And Surgery

Jun. 3, 2020

Wallis T Muhly, Brittany Wohler, Maria N Nelson, Jonathan M Tan, Frances K Barg, William England, Carolyn Fazzini, Luis Sequera-Ramos, Paul A Stricker

Abstract [from journal]

Background: Assessing the postoperative recovery of pediatric patients is challenging as there is no validated comprehensive patient-centered recovery assessment tool for this population. A qualitative investigative approach with in-depth stakeholder interviews can provide insight into the recovery process and inform the development of a comprehensive patient-centered postoperative assessment tool for children.

Methods: We conducted open-ended, semistructured interviews with children 6-12 years


Assessment Of Physician Prescribing Of Muscle Relaxants In The United States, 2005-2016

Sean Hennessy
Jun. 1, 2020

Samantha E. Soprano, Sean Hennessy, Warren B. Bilker, Charles E. Leonard

Abstract [from journal]

Importance: Little is known to date about national trends in the prescribing of skeletal muscle relaxants (SMRs), the use of which is associated with important safety concerns, especially in older adults and in those who use concomitant opioids.

Objective: To measure national trends in SMR prescribing over a 12-year period.

Design, setting, and participants: This cross-sectional study used data from the National Ambulatory Medical Care Survey from January 2005 to


Vaccine Rationing And The Urgency Of Social Justice In The Covid-19 Response

May. 28, 2020

Harald Schmidt

Abstract [from journal]

The Covid-19 pandemic needs to be considered from two perspectives simultaneously. First, there are questions about which policies are most effective and fair in the here and now, as the pandemic unfolds. These polices concern, for example, who should receive priority in being tested, how to implement contact tracing, or how to decide who should get ventilators or vaccines when not all can. Second, it is imperative to anticipate the medium- and longer-term consequences that these policies have. The case of vaccine rationing is


Levels Of Evidence Supporting Drug, Device, And Other Recommendations In The American Heart Association/American College Of Cardiology Guidelines

May. 8, 2020

Alexander C Fanaroff, Marat Fudim, Robert M Califf, Stephan Windecker, Sidney C Smith Jr, Renato D Lopes

Abstract [from journal]

Clinical guideline documents reflect the evidence supporting clinical practice, but few recommendations in cardiovascular guidelines are supported by evidence from randomized controlled trials (RCTs), the highest level of evidence. Incentives for generating evidence from RCTs differ by topic of guideline recommendation, and it is uncertain whether evidence supporting guideline recommendations differs based on the topic of the recommendation.

Methods: We abstracted recommendation statements from current ACC/AHA