sábado, 31 de diciembre de 2011

CDC - CoCASA Download and Install Software - Comprehensive Clinic Assessment Software Application - Vaccines

CDC - CoCASA Download and Install Software - Comprehensive Clinic Assessment Software Application - Vaccines

CoCASA (Comprehensive Clinic Assessment Software Application)


Install CoCASA

 Instructions
Print and read these instructions prior to installing CoCASA.

Download CoCASA

download software image

CoCASA Users Guide: Chapter 1

Installing and Initializing Microsoft Word file [421 KB, 3 pages]

Version History

CoCASA Version History Adobe PDF file [488 KB, 19 pages]
Lists the changes made between versions.

System Requirements

To run CoCASA on your computer, you will need the following system requirements:
  • Operating System: Windows XP or Windows 2000 Service Pack 2 or greater. See the important note in the "Instructions" section above if running CoCASA from a computer running Windows 7 or Windows Vista.
  • Processor: Pentium 90 MHz or faster (higher is better)
  • Memory: 96MB RAM or higher (higher is better)
  • Hard Disk: 40MB
  • Other: If installing CoCASA on a computer running Windows XP or 2000, CoCASA requires Service Pack 1 for the .NET Framework 2.0 to be installed. If you receive an error message that states, "The type initializer for … threw an exception." when running CoCASA, you need to install Service Pack 1 for the .NET Framework 2.0External Web Site Icon.

Q&As on Installation, Setup, & Compatibility

Q: I’m getting the following error message when I try to install CoCASA: Exception occurred while initializing the installation:System.BadImageFormat Exception: The format of the file ‘CoCASA.exe’ is invalid.

A: CoCASA could not automatically remove older versions of CoCASA prior to version 4.0 from your system while upgrading to the newer version. Please go to your Add/Remove Programs and manually remove all versions of CoCASA prior to version 4.0. Please do not forget to backup your cocasa.mdb file prior to the upgrade or removal of older versions of CoCASA, in case errors occur during the upgrade or removal. However, please note that removing CoCASA does not delete your database (cocasa.mdb) from your system.

Q: Can I install CoCASA on a network so that my staff can enter data at their computer but the data is saved in one central database?

A: Yes. There is a way to install CoCASA on your network (or a shared drive) so that your staff can enter data in one, central database. There are a few steps required to have this option set up.
Steps for setting up a centralized/shared database:
  1. Install CoCASA on each machine that will be using the shared database.
  2. On the machine that has the database you want to share, use the "Copy Database" function under "Utilities & → Database functions" to make a copy of the application database out on the shared drive.
  3. Then on all the machines that need to use the shared database (including the machine that you used to do the "Copy Database"), you will need to use the "Change Database Location" function to point the application to the database out on the shared drive.
Every time you start up CoCASA, the splash screen has the pathname of the database that CoCASA is ‘pointed to’ so you can verify that the correct database is being used. (You can also look on the "Help → About CoCASA" screen to see the pathname of the database that is being used.)
It is important to note, that difficulties with using CoCASA from a shared drive have been documented. In some cases (particularly where users are accessing it from a remote location rather than from one central site) the software has been very slow to respond. Others have had the application unexpectedly close. If these problems are experienced, we recommend that you go back to using the database on your individual hard drives and exporting data to one, central database on a periodic basis.

Q: Once the setup is imported, will it do any damage to import it again (for a demonstration or by mistake)?

A: You will not do any damage by importing it again for demonstration or by mistake. It will update your setup based on the latest import, so just be sure you are importing the correct setup.

Q: Is the software compatible with any type of hand-held computer to use for direct on-site data entry during the actual site visit?

A: At this time we have not yet tested the application on any hand-held device, so we are not sure if the software is compatible. There is a page on the Microsoft web siteExternal Web Site Icon that lists the minimum system requirements and which machines you should be able to deploy a .NET application.

Q: Which Microsoft operating systems can I use with CoCASA?

A: Currently CoCASA is compatible with Windows XP and 2000. CoCASA is not compatible with Windows 98. If running CoCASA in Windows 7 or Windows Vista, see the important instructions Microsoft Word file [44 KB, 1 page] for running the program in compatibility mode.


Related Pages

Research Activities, January 2012: Research Briefs

open here please:
Research Activities, January 2012: Research Briefs



Alexander, C. (2011). "Seeding trials and the subordination of science." (AHRQ grant HS18996). Archives of Internal Medicine 171(12), pp. 1107-1108.
A seeding trial is a study of an approved drug or device in which the primary objective is marketing, not scientific investigation. Such trials necessarily depend on deception, according to the author. The author comments in detail on an article analyzing a trial of the drug Neurontin, which concludes that the trial was actually a seeding trial used to promote and increase the prescribing of the drug.


Austad, K.E., Avorn, J., and Kesselheim, A.S. (2011, May). "Medical students' exposure to attitudes about the pharmaceutical industry: A systematic review." (AHRQ grant HS18465). PLoS Medicine 8(5) online.
Given the controversy over the pharmaceutical industry's role in undergraduate medical training, synthesizing the current state of knowledge is useful for setting priorities for changes to educational practices. A systematic review of 32 studies concerning the frequency and nature of medical students' exposure to the drug industry found that a substantial proportion of students believe that gifts from industry influence prescribing.


Bracha, Y., Brottman, G., and Carlson, A. (2011). "Physicians, guidelines, and cognitive tasks." (AHRQ Contract No. 290-2006-00020). Evolution and the Health Professions 34(3), pp. 310-335.
This article compares the workflows and knowledge requirements of primary care practice to a set of clinical guidelines, Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Treatment of Asthma, a summary report prepared by the authors for the Agency for Healthcare Research and Quality. It finds discrepancies between the physician workflow and the structure of the EPR-3 and suggests that alternative ways be found to represent guidelines' knowledge and recommendations.


Burda, B.U., Norris, S.L, Holmer, H.K., and others (2011). "Quality varies across clinical practice guidelines for mammography screening in women aged 40-49 years as assessed by AGREE and AMSTAR instruments." (AHRQ grant HS18500). Journal of Clinical Epidemiology 64, pp. 968-976.
This study assessed the quality of clinical practice guidelines for mammography screening for breast cancer in asymptomatic average-risk women 40-49 years of age. It found that among the eleven guidelines appraised, the quality varies considerably. Also, more than one-half of these guidelines have poor-quality evidence reviews and are not recommended for use in practice.


Clancy, C. (2011). "Best practices in systems interventions to reduce the burden of fractures." Osteoporosis International 22(Suppl 3), pp. S441-S444. Reprints (AHRQ Publication No. 12-R008) are available from the AHRQ Publications Clearinghouse.
In a keynote address to the 2010 Bone Health Conference, Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality (AHRQ), discusses some medical care encounters and relates them to various aspects of the Agency's work. She discusses AHRQ's comparative effectiveness research, the Patient-centered Outcomes Research Institute, the scientific infrastructure needed to identify and implement effective systems-based interventions, and the National Health Care Quality Strategy.


Cohen, S.B., Ezzati-Rice, T.M., Zodet, M., and others (2011). "An assessment of the impact of two distinct survey design modifications on health care utilization estimates in the Medical Expenditure Panel Survey." Journal of Economic and Social Measurement 36, pp. 33-69. Reprints (AHRQ Publication No. 12-R004) are available from the AHRQ Publications Clearinghouse.
In 2007, the Medical Expenditure Panel Survey was upgraded to a windows-based Computer Assisted Personal Interview platform and a sample redesign as a result of its linkage to the National Health Interview Survey. This study examined the impact of these survey design modifications on the national estimates of health care utilization patterns.


Croswell, J.M., Kramer, B.S., and Crawford, E.D. (2011, May). "Screening for prostate cancer with PSA testing: Current status and future directions." Oncology 25(6), pp. 1-15. Reprints (AHRQ Publication No. 12-R009) are available from the AHRQ Publications Clearinghouse.
Screening for prostate cancer by prostate-specific antigen (PSA) testing has been advocated as a means of reducing mortality from this disease. However, the best quality evidence currently available suggests that PSA screening for prostate cancer is either ineffective at reducing deaths due to prostate cancer, or confers a modest mortality advantage, but at the cost of an important degree of overdiagnosis and overtreatment.


Curtis, J.R., Delzell, E., Chen, L., and others (2011). "The relationship between bisphosphonates adherence and fracture: Is it the behavior or the medication? Results from the placebo arm of the fracture intervention trial." (AHRQ grant HS16956). Journal of Bone and Mineral Research 26(4), pp. 683-688.
Several studies have reported a strong inverse relation between high compliance with oral bisphosphonates and fracture risk. Among women participating in the Fracture Intervention Trial who were randomized to placebo, there were no significant associations between compliance with placebo and fractures. However, high compliance with placebo was associated with total-hip bone loss and a similar trend was observed for changes in femoral neck bone mineral density.


Daly, J.M., Ely, J.W., Levy, B.T., and others (2011). "Primary care clinicians' perspectives on management of skin and soft tissue infections: An Iowa research network study." Journal of Rural Health 27, pp. 319-328.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is resistant to several commonly used antibiotics and that resistance is increasing. Analysis of a series of 9 focus groups conducted with 78 primary care clinicians found that no well-accepted diagnostic or treatment algorithms were used by physicians attending the focus groups. The clinicians in the study noted that there was considerable confusion and inconsistency in the management of skin and soft tissue infections.


Edwardsen, E.A., Horwitz, S.H., Pless, N.A., and others (2011, June). "Improving identification and management of partner violence: Examining the process of academic detailing: A qualitative study." (AHRQ grant HS11490). BMC Medical Education 11(36), pp.10-14.
Many physicians still do not routinely inquire about intimate partner violence (IPV). After receiving a seven-session modular curriculum over a 10 week period from a non-physician academic detailer, three physicians reported increased clarity with regard to the scope of their responsibility to their patients suffering from IPV. Academic detailing may improve physician attitudes and practices towards patients in violent relationships.


Fagnan, L.J., Dorr, D.A., Davis, M., and others (2011). "Turning on the care coordination switch in rural primary care. Voices from the practices—clinician champions, clinician partners, administrators, and nurse care managers." (AHRQ Contract No. 290-07-10016). Journal of Ambulatory Care Management 34(30), pp. 304-318.
Implementing care coordination to improve chronic illness care faces monumental challenges. This qualitative analysis explored convergence and divergence in perceptions among the four practice cohorts (clinician champions, clinicians, administrators, and nurse care managers) regarding implementation of nurse care management in medium to large rural primary care practices. Based on their analysis of interviews with the different cohorts, the researchers identified seven factors needed to assure the overall success of a care coordination program.


Gadd, C.S., Ho, Y.-X., Cala, C.A., and others (2011). "User perspectives on the usability of a regional health information exchange." (AHRQ Contract No. 290-04-0006). Journal of the Medical Informatics Association 18, pp. 711-716.
The need for electronic health records with information from multiple sites has steadily grown since 1990. The study used a rapid deployment model to develop a health information exchange (HIE). By surveying HIE users, the researchers found that three usability factors were positively predictive of system usage: overall reactions, learning, and system functionality.


Handley, M.A., Shillinger, D., and Shihoski, S. (2011, October). "Quasi-experimental designs in practice-based research settings: Design and implementation considerations." (AHRQ grant HS17261). Journal of the American Board of Family Medicine 24(5), pp. 589-596.
In the area of practice-based research (PBR), quality improvement, and public health, there are many situations where randomization is not possible. The researchers present a review of design features and practical considerations for PBR implementation of the stepped-wedge and wait-list design. They also discuss published examples from studies of clinic-based interventions using these designs. These features allow for the collection of control data, but also permit all participants to receive the intervention.


Haukoos, J.S. (2011, July). "Rethinking how we perform HIV testing in the emergency department." (AHRQ grant HS17526). Annals of Emergency Medicine 58(1), S160-S163.
The author's goals are to briefly summarize a conceptual framework for performing HIV testing in emergency departments (EDs) and to discuss what is generally known about how these approaches work in clinical practice, with an emphasis on the performance of nontargeted opt-out screening. He also provides a few focused thoughts about how to proceed with the evaluation and implementation of ED-based HIV testing both in terms of clinical practice and academic development.


Hayes, H., Parchman, M.L., and Howard, R. (2011, September/October). "A logic model framework for evaluation and planning in a primary care practice-based research network (PBRN)." Journal of the American Board of Family Medicine 24(5), pp. 576-582.
A logic model is a framework for describing the relationships between resources, activities, and results as they relate to a specific program or project goal. The purpose of this article is to describe the development of a logic model and how the framework has been used in a primary care practice-based research network, the South Texas Ambulatory Research Network.


Johnson, K.B., Unertl, K.M., Chen, Q., and others (2011). "Health information exchange usage in emergency departments and clinics: The who, what, and why." (AHRQ Contract No. 290-04-006). Journal of the American Medical Informatics Association 18, pp. 690-697.
The Mid-South eHealth Alliance is an operational health information exchange (HIE). The study evaluates this exchange to characterize the extent and patterns of use as they relate to different HIE workflows, and to inform the national discussion about both HIE implementation strategies and usage benchmarks. Its data should form an important foundation as other sites embark upon HIE implementation.


Kahn, J.M., Hill, N.S., Lilly, C.M., and others (2011, July). "The research agenda in ICU telemedicine." (AHRQ grant HS19946). Chest 140(1), pp. 230-238.
The Critical Care Societies Collaborative convened a working group to provide a conceptual and practical framework for intensive care unit (ICU) telemedicine research. It included experts in critical care delivery, telemedicine delivery, organizational science, health services research, and health care policy. The goals were to examine the state of the science underlying ICU telemedicine, identify key methodological and knowledge gaps, and develop a focused agenda for future research.


Kamalian, S., Maas, M.B., Goldmacher, G.V., and others (2011). "CT cerebral blood flow maps optimally correlate with admission diffusion-weighted imaging in acute stroke but thresholds vary by postprocessing platform." (AHRQ grant HS11392). Stroke 42, pp. 1923-1928.
The purposes of this study were to: (1) determine the optimal computed tomography perfusion parameter to define infarct core using various postprocessing platforms; and (2) establish the degree of variability in threshold values between these different platforms. The researchers found that the marked variability in quantification among different postprocessing software limits generalizability of parameter map thresholds between platforms.


Kappelman, M.D., Dorn, S.D., Peterson, E., and others (2011). "Quality of care for gastrointestinal conditions: A primer for gastroenterologists."(AHRQ grant HS19468). American Journal of Gastroenterology 106, pp. 1182-1187.
The authors review current efforts to measure and improve the quality of care for digestive diseases, with a focus on colonoscopy, inflammatory bowel diseases, gastroesophageal reflux disease, chronic hepatitis C virus infection, and liver transplantation. Incorporation of quality improvement principles into clinical practice will ultimately be needed to improve care and outcomes for patients with these diseases.


Kauffmann, R.M., Landman, M.P., Shelton, J., and others (2011, July/August). "The use of a multidisciplinary morbidity and mortality conference to incorporate ACGME general competencies." (AHRQ grant HS13833). Journal of Surgical Education 68(4), pp. 303-308.
The Department of Surgery at Vanderbilt University Medical Center implemented a multidisciplinary morbidity and mortality (MM&M) conference as a means to establish a culture of safety, while teaching the Accreditation Council of Graduate Medical Education General Competencies to surgery residents. The results discussed in this paper are largely qualitative in nature and describe the process of implementing an MM&M conference.


Kudyakov, R., Bowen, J., Ewen, E., and others (2011, August). "Electronic health record use to classify patients with newly diagnosed versus preexisting type 2 diabetes: Infrastructure for comparative effectiveness research and population health management." (AHRQ Contract No. 290-05-00361). Population Health Management 14. (E-pub ahead of print).
The authors describe a practical approach to identifying a cohort of newly diagnosed type 2 diabetes cases in an electronic health record (EHR). The EHR has advantages over administrative data and prospective clinical trials as a data source for comparative effectiveness research and population management. However, use of data from current systems mandates significant tailoring for application in research. Verifications of EHR data with external data sources is a high-yield step.


Leach, C.R., Schoenberg, N.E., and Hatcher, J. (2011). "Factors associated with participation in cancer prevention and control studies among rural Appalachian women." (AHRQ grant HS16347). Family and Community Health 34(2), pp. 119-125.
In terms of their cancer burden, underserved populations, including minorities and rural residents, tend to be underrepresented in cancer prevention and control research. The two case studies discussed here demonstrate certain overlapping as well as distinctive strategies that can be used to deal with barriers to recruitment and retention of rural participants in research studies.


Loit, E., Tricco, A.C., Tsouros, S., and others (2011). "Pre-analytic and analytic sources of variations in thiopurine methyltransferase activity measurement in patients prescribed thiopurine-based drugs: A systematic review." (AHRQ Contract No. 290-2007-10059). Clinical Biochemistry 44, pp. 754-757.
The authors' review summarizes the evidence regarding thiopurine methyltransferase (TPMT) testing in chronic autoimmune disease. Their review showed that sufficient pre-analytical data were available to recommend preferred specimen collection, stability, and storage conditions for determination of TPMT status. There was no clinically significant effect on TPMT activity of age, gender, various co-administered drugs, or most morbidities.


Meddings, J., and Saint, S. (2011). "Disrupting the life cycle of the urinary catheter." (AHRQ grant HS19767). Clinical Infectious Diseases 52(11), pp. 1291-1293.
Tackling unnecessary urinary catheter use is certainly the most important goal in preventing catheter-associated urinary tract infection. However, kicking the catheter habit can be difficult. The authors discuss an article by Knoll, et al. in this issue describing a 5-year hospital-wide "catheter quit program," which is similar in its successes and challenges to aspects of other habit-changing programs such as treating an addiction to tobacco.


Meyers, D. (2011). "A tribute to Dr. David Lanier." Journal of the American Board of Family Medicine 24(5), pp. 494-495. Reprints (AHRQ Publication No. 12-R011) are available from the AHRQ Publications Clearinghouse.
Dr. David Meyers, director of the Agency for Healthcare Research and Quality's (AHRQ) Center for Primary Care, pays tribute to David Lanier, M.D., on the occasion of his retirement from AHRQ in December 2010. Over the past decade, Dr. Lanier provided visionary leadership as he designed, implemented, and nurtured AHRQ's primary care Practice-based Research Networks.


Murray, D.J. (2011, May). "Current trends in simulation training in anesthesia." (AHRQ grant HS18374). Minerva Anesthesiologica 77, pp. 528-533.
Simulation includes a number of devices and technologies that, when used in training, offer the potential to accelerate the acquisition of skills and expand the breadth of a trainee's clinical experiences. The purpose of this review is to highlight some of the more recent studies that have advanced simulation-based training and assessment strategies, with particular emphasis on those studies that either describe the results of a curriculum intervention or provide insight about the future uses of simulation.


Navathe, A.S., Clancy, C., and Glied, S. (2011). "Advancing research data infrastructure for patient-centered outcomes research." Journal of the American Medical Association 306(11), pp. 1254-1255. Reprints (AHRQ Publication No. 12-R013) are available from the AHRQ Publications Clearinghouse.
Much of patient-centered outcomes research relies on observational and quasi-experimental methods applied to data generated as a byproduct of providing care. While existing data sources have improved, there remain important data-related barriers to rapid, efficient research. The latest developments in information technology (virtual data access and distributed data network technologies) can help create an efficient data infrastructure supporting patient-centered care.


Newcomer, S.R., Steiner, J.F., and Bayliss, E.A. (2011). "Identifying subgroups of complex patients with cluster analysis." (AHRQ grant HS15476). American Journal of Managed Care 17(8), pp. e324-e332.
Cluster analyses are common in psychology and sociology, but have been used to a limited extent in health services research, mainly to discover patterns of multimorbidities. This study demonstrated the application of such methods for identifying clusters of patients with high health care utilization that may suggest opportunities for enhanced care management in a managed care setting.


Ritchie, C.S., Roth, D.L., and Allman, R.M. (2011). "Living with an aging parent. It was a beautiful invitation." (AHRQ grant HS 17786). Journal of the American Medical Association 306(7), pp. 746-753.
Increasing numbers of older parents are living with their adult children. Using the case of a couple receiving care from their daughter in her home, the authors review the prevalence and epidemiology of adult children caring for a parent in an adult child's home, important issues to consider, and a framework for clinicians to help guide their patients through this transition.


Sawchuk, C.N., Russo, J.E., Bogart, A., and others (2011, May). "Barriers and facilitators to walking and physical activity among American Indian elders." (AHRQ grant HS108542). Preventing Chronic Disease: Public Health Research, Practice, and Policy 8(3), pp. 1-9.
The researchers used descriptive statistics to report barriers and facilitators to walking and physical activity among older American Indians. Lack of willpower was the most commonly reported barrier. Health-related quality of life was inversely related to physical activity barriers, and poor mental health quality of life was more strongly associated with total barriers than poor physical health.


Schiff, G.D., Galanter, W.L., Duhig, J., and others (2011, July). "Principles of conservative prescribing." (AHRQ grant HS16973). Archives of Internal Medicine 171(16), pp. 1433-1440.
Prescribing is often driven by pharmaceutical marketing and by patients requesting drugs they hear advertised. To counterbalance these prescribing pressures, which include often unrealistic patient expectations, practice time constraints, and paucity of data and practical guidance, the authors (physicians, pharmacists, and educators) have identified principles for safer and more evidence-based prescribing.

Research Activities, January 2012: Announcements: Two EHC program report series identify research needs and provide guidance on identifying gaps in clinical evidence

Research Activities, January 2012: Announcements: Two EHC program report series identify research needs and provide guidance on identifying gaps in clinical evidence


Two EHC program report series identify research needs and provide guidance on identifying gaps in clinical evidence

Needs for Future Research

A growing series of reports from the Effective Health Care (EHC) Program of the Agency for Healthcare Research and Quality (AHRQ) identifies gaps in clinical evidence so that researchers and funders of research can improve the body of knowledge available to health care decisionmakers. The series, Future Research Needs, currently includes eight reports that identify research needs in areas such as management of gestational diabetes, treating prostate cancer, and treating common hip fracture. Forty reports are expected over the next several years. These reports are produced by AHRQ-supported Evidence-based Practice Centers, which conduct systematic reviews of existing research on the effectiveness, comparative effectiveness, and comparative harms of different health care interventions. Gaps in evidence identified in these projects are highlighted in the Future Research Needs series. The reports are designed to help researchers and funders of research identify research projects that will expand the body of patient-centered outcomes research available to help health care decisionmakers make evidence-based decisions.
Download and read the Future Research Needs reports at http://www.effectivehealthcare.ahrq.gov/futureresearch.cfm.

Methods for Future Research

Another EHC Program series of reports titled, Future Research Needs—Methods Research, is also available from AHRQ. These reports provide guidance on methodological approaches to identifying gaps in clinical evidence. They are intended to support the ongoing effort to evaluate and improve the knowledge base in priority clinical areas. The series complements the Future Research Needs series.
You can download and read the methods research series at http://www.effectivehealthcare.ahrq.gov/futureresearchneedsmethods.cfm.

Research Activities, January 2012: Announcements: Report explores prevalence of hypertension and use of antihypertensive drugs

Research Activities, January 2012: Announcements: Report explores prevalence of hypertension and use of antihypertensive drugs

Report explores prevalence of hypertension and use of antihypertensive drugs

A new Data Points report, Utilization of Antihypertensive Drug Classes Among Medicare Beneficiaries with Hypertension, 2007 to 2009, is available from the Agency for Healthcare Research and Quality. This report explores the prevalence of hypertension and utilization of antihypertensive drugs among Medicare fee-for-service beneficiaries from 2007 to 2009, as well as the costs of antihypertensive drugs.

You can access the report at AHRQ's Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov/.

Research Activities, January 2012: Agency News and Notes: Evidence is weak on whole-body vibration therapy for osteoporosis

Research Activities, January 2012: Agency News and Notes: Evidence is weak on whole-body vibration therapy for osteoporosis


Evidence is weak on whole-body vibration therapy for osteoporosis

A new report finds that there is little scientific evidence evaluating the benefits and harms of whole-body vibration (WBV) therapy for the prevention and treatment of osteoporosis, and claims about its effectiveness cannot be made without further research. The review of the published literature and discussions with osteoporosis clinicians, researchers, patient advocates, and WBV device manufacturers describes the state of the science and summarizes the key issues related to the use of whole-body vibration therapy.

The technical brief, produced by the Agency for Healthcare Research and Quality's Effective Health Care Program, identifies a number of questions about the optimal population for treatment, optimal treatment protocol, key outcome measures, and whether whole-body vibration therapy is an adjunctive or distinctive therapy.

Osteoporosis is a significant public health problem that leads to increased bone fragility and greater fracture risk, especially of the wrist, hip, and spine. In the United States an estimated 1.5 million yearly osteoporotic fractures result in more than 500,000 hospitalizations, 800,000 emergency room visits, 2.6 million physician office visits, and 180,000 nursing home placements. By 2020, approximately half of all older Americans will be at risk for fractures from osteoporosis or osteopenia.

You can read Whole-Body Vibration Therapy for Osteoporosis at AHRQ's Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov/.

Research Activities, January 2012: Agency News and Notes: Potential role of physical therapy in ICU patients

Research Activities, January 2012: Agency News and Notes: Potential role of physical therapy in ICU patients


Potential role of physical therapy in ICU patients

A recent issue of the Agency for Healthcare Research and Quality's Web M&M (http://www.webmm.ahrq.gov/home.aspx) examines the risks of immobility associated with an intensive care unit (ICU) stay and the criteria that can indicate if a patient is a good candidate for physical therapy. The Spotlight Case involves a man with a prolonged ICU visit for injuries that included a dislocated shoulder. The physical therapist consulted after the patient's release from the ICU felt that the limitations due to the shoulder injury could have been mitigated with earlier physical therapy interventions in the ICU. A commentary on the case, including criteria to inform decisionmaking, is provided by Jim Smith, an associate professor of physical therapy at Utica College, NY.

The Perspectives on Safety section features an interview with Paul G. Shekelle, M.D., Ph.D., who directs the Southern California Evidence-based Practice Center at Rand Corporation.  Dr. Shekelle led an AHRQ-funded effort to better define the role of context in patient safety.  In the accompanying Perspective, John Øvretveit, Ph.D., professor of health improvement, implementation, and evaluation at The Karolinska Institute, Stockholm, Sweden, discusses how social sciences can help us understand influences that affect patient safety.

Research Activities, January 2012: Agency News and Notes: Evidence lacking on optimal transition-of-care programs for heart attack and stroke patients following hospitalization

Research Activities, January 2012: Agency News and Notes: Evidence lacking on optimal transition-of-care programs for heart attack and stroke patients following hospitalization


Evidence lacking on optimal transition-of-care programs for heart attack and stroke patients following hospitalization

Few studies support the adoption of any specific transition-of-care program as a matter of health policy, according to a new report from the Agency for Healthcare Research and Quality (AHRQ). Despite advances in the quality of acute-care management of stroke and heart attacks, gaps in knowledge persist about effective programs that improve the post-hospitalization quality of care for patients who have undergone a stroke or heart attack.

Researchers at AHRQ's Duke University Evidence-based Practice Center, who conducted the evidence review, found no interventions that consistently improved functional recovery after stroke or heart attack.  None seemed to consistently improve quality of life or factors such as anxiety or depression.  The researchers, led by DaiWai M. Olson, Ph.D., found that some components of care transition, such as early supported discharge from hospital with rehabilitation at home following stroke, appear to shorten the length of hospital stay without increased death rates or adverse effects on functional recovery. Additionally, specialty care followup after a heart attack was associated with reduced mortality. 

Researchers noted that additional research is needed before any conclusion can be reached that a specific care transition approach is effective and worthy of widespread adoption. 

You can access a copy of the report, Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention, at http://www.ahrq.gov/clinic/tp/strokecaretp.htm.

Research Activities, January 2012: Agency News and Notes: Screening and treatment of subclinical thyroid dysfunction inadequately studied

Research Activities, January 2012: Agency News and Notes: Screening and treatment of subclinical thyroid dysfunction inadequately studied

Screening and treatment of subclinical thyroid dysfunction inadequately studied

A new research review, Effectiveness of Subclinical Hypothyroidism or Subclinical Hyperthyroidism, focuses on whether evidence demonstrates that treatment improves morbidity rates in adults with screen-detected thyroid disease, as well as the benefits and harms of treating subclinical hypo- or hyperthyroidism. The report updates a 2004 United States Preventive Services Task Force (USPSTF) report.

The 2004 USPSTF report established that subclinical thyroid dysfunction is quite prevalent and that the serum thyroid stimulating hormone test is a readily available, reliable, and acceptable test to detect the condition. However, in 2004, it remained unclear whether treating subclinical thyroid dysfunction would reduce morbidity.

This review by the Effective Health Care Program of the Agency for Healthcare Research and Quality indicates that the benefits and harms of screening for subclinical thyroid dysfunction remain inadequately studied. It also highlights the need for more research related to treatment for subclinical hypo- or hyperthyroidism. Larger clinical trials that are longer in duration would help improve the quality of evidence for all of these outcomes.

You can read the full review at the Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov/.

Research Activities, January 2012: Agency News and Notes: ADHD medications don't increase serious heart risks in children or adults

Research Activities, January 2012: Agency News and Notes: ADHD medications don't increase serious heart risks in children or adults

ADHD medications don't increase serious heart risks in children or adults

Medications used to treat attention-deficit/ hyperactivity disorder (ADHD) are not linked to increased risk of heart attack or other serious cardiovascular problems in children or adults, according to two studies from the Effective Health Care Program of the Agency for Healthcare Research and Quality (AHRQ).

The first study, published November 1 in the New England Journal of Medicine, reported no evidence of increased risk of serious cardiovascular effects among children and young people who use ADHD medications. The study used data from more than 1.2 million children and young adults from ages 2 to 24.

The second study, published December 8 in the Journal of the American Medical Association, found medications used to treat ADHD in adults are not linked to increased risk of heart attack, sudden cardiac death, or stroke. The study of adults ages 25 to 64 included more than 150,000 users and nearly 300,000 non-users of ADHD medications. Researchers found no evidence of an increased risk of serious cardiac outcomes associated with current use compared to non-use or former use of ADHD medications.
Researchers also found little support for an increased risk for any specific medication or with longer duration of current use.

Both studies resulted from a research collaboration between AHRQ and U.S. Food and Drug Administration. The research was conducted by Vanderbilt University's and the HMO Research Network DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) centers. Both reports can be viewed at AHRQ's Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov/.

Research Activities, January 2012: Child/Adolescent Health: Pediatric cardiology centers vary in treatment of infants with single-ventricle congenital heart disease

Research Activities, January 2012: Child/Adolescent Health: Pediatric cardiology centers vary in treatment of infants with single-ventricle congenital heart disease

Pediatric cardiology centers vary in treatment of infants with single-ventricle congenital heart disease

Pediatric cardiology centers vary greatly in their initial treatment of infants and newborns with single-ventricle congenital heart defects (CHD) such as hypoplastic left heart syndrome (HLHS), according to three studies supported in part by the Agency for Healthcare Research and Quality (HS16957). This variability makes the initial treatment of these congenital heart problems, in which the infant is missing the left ventricle, a clear target for quality improvement efforts, note the researchers from the Joint Council on Congenital Heart Disease's National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC).

Repair of HLHS involves a series of surgeries that are typically performed over the child's first 4 years of life, with stage-I surgery typically occurring within days after birth. Additional corrective surgeries are performed at later ages (typically between 4–6 months and 18 months to 3 years, respectively). Since the infant is missing the left ventricle, which normally pumps oxygen-rich blood to the body, the goal of the initial Norwood procedure is to reroute blood flow from the right ventricle to serve this function.

To conduct the studies, the researchers drew on data for the first 100 infants enrolled in the NPC-QIC registry through 21 participating centers. Most of the infants (75 percent) had received a prenatal diagnosis of their heart disease. The three studies are briefly described here.


Brown, D.A., Connor, J.A., Pigula, F.A., and others. "Variation in preoperative and intraoperative first-stage palliation of single-ventricle heart disease: A report from the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Cooperative." (2011, March/April). Congenital Heart Disease 6(2), pp. 108–115.

This study found substantial variation across surgical centers in the successful initial palliation of infants with single-ventricle heart disease, particularly with regard to choice of palliation strategy and intraoperative techniques such as use of regional perfusion and depth of hypothermia. Infants with a prenatal diagnosis of CHD were significantly less likely to have preoperative problems than those diagnosed after birth (45 percent versus 84 percent). The median age of stage-I repair was 5 days, but ranged from 2–78 days.

The majority of infants (55 percent) were treated with a stage-I right ventricle to pulmonary artery (RV-PA) conduit, with 28 percent receiving a stage-I Norwood shunt. There was great variation in the surgical approach taken by the 11 centers contributing at least 4 patients to the database. Several of the centers used only the RV-PA conduit procedure, while another center performed mostly hybrid stage-I procedures (and accounted for 89 percent of such procedures in the registry).

Excluding the patients who underwent hybrid stage-I repairs, the median time for a patient to be on total cardiopulmonary bypass during surgery was 137 minutes, with most participating centers' medians staying in the 100 to 200 minute range. The intraoperative procedures with the greatest degree of center-specific variation were circulatory arrest (used in 77 percent of the patients for a median of 10 minutes; range = 0–79 minutes) and hypothermia (median lowest temperature in the operating room of 18°C, and under 20°C for most of the participating centers). Immediately after surgery, three patients required use of extracorporeal membrane oxygenation support, but most only required postoperative mechanical ventilation (a median of 9 days on ventilation in the intensive care unit). Reoperations were done on 19 patients, in 6 cases to manage recurrent bleeding.


Baker-Smith, C.M., Neish, S.R., Klitzner, T.S., and others (2011, March/April). "Variation in postoperative care following stage I palliation for single-ventricle patients: A report from the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Cooperative." Congenital Heart Disease 6(2), pp. 116–127.

This study examined variations in treatment while the infant was still in the hospital after stage-I surgery for HLHS. Infants stayed a median of 11 days in the intensive care unit (ICU) following stage-I surgery, with a range between 3 and 68 days. The 47 infants with the aortic atresia variety of HLHS stayed in the ICU longer than 24 infants with the aortic hypoplasia variety (10 vs. 8 median days). The length of postoperative stay in the ICU also varied depending on the type of surgery performed, from a median of 18 days for the 16 patients who underwent the modified Blalock-Taussig shunt (mBTS), to a median of 11 days for the 44 patients undergoing the RV-PA shunt, to a median of 9 days for the 10 patients undergoing hybrid repair.
However, ICU stays varied by center, as did use of inotropic agents (that affect the strength of cardiac contraction), need for reoperation or cardiac catheterization, and postoperative complications.
Neurologic injury was the most common complication (15 events occurred in 13 patients); 20 postoperative infections occurred in 15 patients; and 22 instances of arrhythmia occurred in 19 patients. Complications occurred least frequently for infants who underwent the hybrid procedure (2 patients, or 20 percent) and were most common for those who underwent the RV-PA shunt (27 patients, or 49 percent). Some patients experienced more than one complication.


Schidlow, D.N., Anderson, J.B., Klitzner, T.S., and others. "Variation in interstage outpatient care after the Norwood Procedure: A report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative." (2011, March/April). Congenital Heart Disease 6(2); pp. 98–107.

This study examined the care and outcomes of infants after discharge from the hospital following stage-I repair of HLHS. Of the 100 infants in the group, 62 received outpatient care from the center that performed their surgery, 25 infants were cared for at another center, and 13 infants received care from more than one center. Communication with the patients' outpatient physicians (a written medication list, nutrition plan, and red-flag checklist) was quite variable and incomplete for the majority of these practitioners. Nearly half of the outpatient primary cardiologists (45 percent) received all three elements of the communications compared with only 26 percent of the primary care physicians (PCPs). None of the elements of communications were received by 10 outpatient cardiologists and 19 PCPs.

Nutrition management was quite variable, with 49 infants fed orally, 38 receiving a combination of oral and nasogastric/nasojejunal feeding, and 6 receiving a combination of oral and gastronomy tube feeding. One infant was fed by gastronomy tube exclusively. Caloric density ranged from 20 to 30 kcal/oz of nonfortified formula or breast milk, with more than half the infants using fortified formula initially (24 kcal/oz at time of hospital discharge).

The use, type, location, and frequency of monitoring strategies varied widely. Nineteen of the infants had no monitoring done between visits to the cardiology center. Surveillance strategies were used in 81 infants; the majority were monitored in the home. Of these infants, 77 had both weight and blood-oxygen levels measured regularly, and 4 had only oxygen levels monitored.

Research Activities, January 2012: Child/Adolescent Health: Clostridium difficile infection rate has risen among hospitalized children since late 1990s

Research Activities, January 2012: Child/Adolescent Health: Clostridium difficile infection rate has risen among hospitalized children since late 1990s

Clostridium difficile infection rate has risen among hospitalized children since late 1990s

The number of cases of Clostridium difficile infection (CDI) among hospitalized children in the United States more than doubled over a 10-year period, according to a new study. A bacterium that can colonize the gastrointestinal tract, C. difficile can cause symptoms ranging from nothing to severe diarrhea, inflammation of the colon, bowel perforation, and even death. The researchers found that the incidence of CDI in hospitalized children increased from 3,565 cases in 1997 to 7,779 cases in 2006.

Children with CDI had a 20 percent greater risk of death and a 36 percent higher risk of requiring surgery to remove part of or the entire colon. In addition, children diagnosed with CDI were four times more likely to have an extended hospital stay and twice as likely to have higher hospital costs than hospitalized children not infected by C. difficile.

The researchers found no trend in the severity of CDI over time, despite the disease's increased incidence. However, patients with inflammatory bowel disease were 11.4 times as likely to have CDI compared with childlren without this condition. Solid-organ transplants, HIV infection, and transplantation of blood-forming stem cells—all requiring or resulting in immune suppression—increased the odds of CDI 3.3- to 4.5-fold in adjusted multivariable analysis.

The researchers used data from the AHRQ-funded Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID) for 1997, 2000, 2003, and 2006. HCUP-KID is a stratified random sample of 5.8 million inpatient discharges for children from 22 to 38 States (depending on the year). For 2006, it represented an estimated 89 percent of all pediatric hospital discharges in the United States. The study was funded in part by the Agency for Healthcare Research and Quality (HS016957).

More details are in "Clostridium difficile infection in hospitalized children in the United States," by Cade M. Nylund, M.D., Anthony Goudie, Ph.D., Jose M. Garza, M.D., and others in the May 2011 Archives of Pediatrics and Adolescent Medicine 165(5), pp. 451-457.
Research Activities, January 2012: Child/Adolescent Health: Clostridium difficile infection rate has risen among hospitalized children since late 1990s

Research Activities, January 2012: Child/Adolescent Health: A large proportion of hospitalized children receive numerous medications during their hospitalization


Research Activities, January 2012: Child/Adolescent Health: A large proportion of hospitalized children receive numerous medications during their hospitalization


A large proportion of hospitalized children receive numerous medications during their hospitalization

A large proportion of hospitalized babies and children are given five or more drugs and therapeutic agents during each day they are in the hospital, reveals a new study. Children with less common conditions were more likely to be exposed to more drugs. A dozen drugs and therapeutic agents were taken over the course of the hospitalization for the typical child admitted to a children's hospital (median stay of 5 days) and two drugs and therapeutic agents for the typical child admitted to a general hospital (median stay of 2 days). However, these differences between hospital types were nullified when patient clinical characteristics were taken into account.

Children younger than 1 year at children's hospitals, who were at the 90th percentile of the number of the distinct drugs received, received 11 drugs on the first day of hospitalization, while children 1 year and older received 13 drugs; in general hospitals, the numbers were 8 and 12 drugs, respectively. By hospital day 7, those in children's hospitals who were younger than 1 year and at the 90th percentile of drug exposure had received 29 drugs and those 1 year or older had received 35 drugs; in general hospitals, the numbers were 22 and 28 drugs, respectively.

Cumulative numbers of distinct agents varied substantially among hospitals for three common conditions (asthma, appendectomy, and seizure), even after accounting for differences in length of stay for the condition. This suggests that actions can be taken to reduce the degree to which a child is exposed to multiple medications for common ailments while maintaining—or even improving—patient outcomes, note Chris Feudtner, M.D., Ph.D., M.P.H., of Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, and colleagues.

Their findings were based on 2006 data from the Pediatric Health Information System (40 children's hospitals) and the Perspective Data Warehouse (423 academic and community hospitals nationwide). The study was funded in part by the Agency for Healthcare Research and Quality (HS17991) to the University of Pennsylvania School of Medicine's Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit http://www.certs.hhs.gov/.

More details are in "Prevalence of polypharmacy exposure among hospitalized children in the United States" by Chris Feudtner, M.D., Ph.D., M.P.H., Dingwei Dai, Ph.D., Kari R. Hexem, M.P.H., and others in the September 2011 Archives of Pediatric and Adolescent Medicine (E-pub ahead of print).

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National Public Health Practice and Resource Centers on Health Promotion for People with Disabilities [CDC-RFA-DD12-1205]

The purpose of this cooperative agreement is to promote health, wellness and the adoption of healthy behaviors with the objective of preventing and/or reducing chronic conditions associated with disability. All activities should target people with disabilities that have mobility, physical limitations, and/or intellectual disabilities (hereafter referred to as PWDs). Closing Date: February 06, 2012

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Public Health Conference Support Program [CDC-RFA-EH12-1201]

The CDC/ATSDR announces the pending availability of appropriated fiscal year (FY) 2012 funds for the CDC/ATSDR Public Health Conference Support Program. This program addresses the "Healthy People 2020" focus areas of Environmental Health. This announcement is only for conferences planned to occur within the date range of May 1, 2012 through April 30, 2013. Beyond the April 30, 2013 date, requires a new Funding Opportunity Announcement (FOA). Applicants can only submit an application for a single conference for a one-year project period. Closing Date: Feb 02, 2012.

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Mentored Research Scientist Development Award (K01) [PAR-10-132]

The goal of the CDC/NIOSH Mentored Research Scientist Development Award (K01) is to help ensure the availability of adequate numbers of highly trained scientists to address occupational health and safety and to provide new occupational health and safety scientists and educators with appropriate mentoring. The purpose of the K01 is to provide support and 75% “protected time” for an intensive, supervised career development experience in occupational health and safety research leading to research independence. May 08, 2013.

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Identifying Modifiable Protective Factors for Intimate Partner Violence or Sexual Violence Prevention [RFA-CE-12-003]

The purpose of this announcement is to support new research or an extension to existing research that identifies modifiable protective factors for IPV and/or SV perpetration that can be leveraged to improve primary prevention efforts, and empirically tests the extent to which these factors are associated with IPV or SV perpetration. Closing Date: March 16, 2012.

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Research Grants for Preventing Violence and Violence Related Injury [RFA-CE-12-002]

The purposes of the program are to: (1) Build the scientific base for the prevention of violence by helping to expand and advance our understanding of the primary prevention of interpersonal and self-directed violence; (2) Encourage professionals from a wide spectrum of disciplines of epidemiology, behavioral and social sciences, medicine, biostatistics, public health, health economics, law, and criminal justice to perform research in order to prevent violence more effectively; and (3) Encourage investigators to propose research that involves the development and testing of primary prevention strategies as well as research on methods to enhance the adoption and maintenance of effective strategies among individuals, organizations, or communities. Closing Date: March 16, 2012.

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National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, Public Health Conference Support [CDC-RFA-PS12-1204]
The purpose of the program is to announce the availability of appropriated fiscal year (FY) 2012 funds for the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, Public Health Conference Support. This program addresses the “Healthy People 2020” focus area(s) of HIV and Sexually Transmitted Diseases. This announcement is only for non-research activities supported by CDC/NCHHSTP. Closing Date: February 10, 2012.


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Development and Evaluation of a Clinic-Based Screening and Brief Intervention (SBI) for Changing Behaviors Related to Cytomegalovirus (CMV) Transmission in Pregnant Women [RFA-DD-12-005]
The purpose of this research is to learn how to more effectively change behaviors related to Cytomegalovirus Virus (CMV) transmission among pregnant women in order to reduce the incidence of congenital CMV infection. The research will be carried out in settings providing prenatal care with the intent of developing an effective intervention that will be both acceptable to clinic staff and feasible to implement as part of routine clinical prenatal care. Closing Date: February 10, 2012.
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EL BIRUNI: DIRECTORIO DE DOCUMENTOS EDITADOS EN DICIEMBRE 2011 [*] 12

Sábado 31 de diciembre de 2011
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