Roger Chou’s research while affiliated with Oregon Health & Science University and other places

Purpose: This Guideline covers the evaluation and treatment of men who present to a clinician with a complaint of chronic pelvic pain. This is Part III of a three-part series focusing on treatment of chronic scrotal content pain (CSCP). CSCP patients typically present with pain described in the testes with tenderness in the epididymis and/or spermatic cord. Patient education of the underlying etiology may promote discussion of treatment options, which often require a multidisciplinary approach that includes management of expectations through supportive counseling during treatment. For discussion of patient evaluation and treatment of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS), refer to Parts I and II of this series. Materials and methods: The systematic review that informs the Guideline statements was based on searches in Ovid MEDLINE (1946 to June 6, 2023), the Cochrane Central Register of Controlled Trials (through May 2023), and the Cochrane Database of Systematic Reviews (through May 2023). An updated search was conducted in June 2024. Results: The Chronic Pelvic Pain Panel developed evidence- and consensus-based statements to provide guidance for treatment of patients with CSCP, which may include lifestyle modification, pharmacologic management, and procedural intervention. Conclusions: Specific data on CSCP are lacking with most management options described as off-label use. While there are multiple evolving treatments for CSCP that have shown promising results, most currently lack sufficient data to recommend as treatment and require further investigation to establish a role in patient care.

Purpose: This Guideline covers the evaluation and treatment of men who present to a clinician with a complaint of chronic pelvic pain. This is Part II of a three-part series focusing on treatment of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS). A challenge for clinicians treating these patients is the necessity to address symptoms and etiologies outside of the usual urologic evaluation. Consequently, recommended treatment utilizes a multimodal/multidisciplinary approach that is highlighted through discussion of referral to other specialists and allied health professionals while continuing to manage urologic symptoms. For discussion of patient evaluation and treatment of chronic scrotal content pain (CSCP), refer to Parts I and III of this series. Materials and methods: The systematic review that informs the Guideline statements was based on searches in Ovid MEDLINE (1946 to June 6, 2023), the Cochrane Central Register of Controlled Trials (through May 2023), and the Cochrane Database of Systematic Reviews (through May 2023). An updated search was conducted in June 2024. Results: The Chronic Pelvic Pain Panel developed evidence- and consensus-based statements to provide guidance for the treatment of patients with CP/CPPS, which may include lifestyle modification, behavioral therapy, pharmacologic and phytotherapeutic options, and procedural intervention. Conclusions: We usually think of pain in response to tissue injury that resolves with healing. We now know that pain can also derive from neurologic origins. Effective treatment of CP/CPPS will require better understanding of what is causing persistence of the pain in addition to further testing of therapies under investigation to establish a role in patient care.

Purpose: This Guideline covers the evaluation and treatment of men who present to a clinician with a complaint of chronic pelvic pain. This is Part I of a three-part series focusing on the evaluation of such patients. The presentation of these men is widely variable. In addition to pelvic pain, they may also have pain in many body areas outside of the pelvis. The wide variety of clinical presentations and multidisciplinary diagnostic and treatment considerations makes management challenging. For discussion of treatment of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) and treatment of chronic scrotal content pain (CSCP), refer to Parts II and II of this series. Materials and methods: The systematic review that informs the Guideline statements was based on searches in Ovid MEDLINE (1946 to June 6, 2023), the Cochrane Central Register of Controlled Trials (through May 2023), and the Cochrane Database of Systematic Reviews (through May 2023). An updated search was conducted in June 2024. Results: The Chronic Pelvic Pain Panel developed evidence- and consensus-based statements to provide guidance for the diagnosis and evaluation of male patients who experience chronic pelvic pain. Conclusions: While the etiology of chronic pelvic pain is unknown, clinicians have a much better understanding of the pathophysiology from the last 25 years of research. Further progress in diagnosis and evaluation of men with suspected CP/CPPS and CSCP will require better understanding of what is causing persistence of the pain in addition to investigation of associated conditions.

Background: People with disabilities are less likely than the general population to receive clinical preventive services. Purpose: To summarize barriers to and facilitators of receipt of preventive services and effectiveness of interventions to improve receipt of preventive services among people with disabilities. Data sources: Five electronic databases through September 2024. Study selection: Dual independent screening of abstracts and full texts for 20 recommended preventive services. Data extraction: Single reviewer, with a second reviewer verifying accuracy. Data synthesis: Among 11 586 references, 74 studies were included (60 on barriers and facilitators, 16 on interventions, and 2 on both barriers/facilitators and interventions). Most evidence was on screening for breast (n = 48) and cervical (n = 33) cancer. Barriers to and facilitators of breast and cervical cancer screening spanned all disability types and across environment, individual, provider, and health care levels. Six randomized controlled trials studied educational interventions for people with physical disabilities (n = 2); cognitive, intellectual, or developmental disabilities (n = 2); sensory disabilities (n = 1); and serious mental illness (n = 1), with mixed findings on effectiveness for different preventive services. Evidence on specific components or harms of interventions was limited. Limitations: High methodological or clinical heterogeneity and limited data for most preventive services and disability types. Conclusion: Barriers and facilitators for people with disabilities are described for breast and cervical cancer screening at the environment, individual, provider, and health care levels. Randomized studies on general educational interventions target the patient, the caregiver, and providers of people with specific disabilities. Research is needed on interventions that address barriers to and facilitators of receipt of preventive services for people with disabilities. Primary funding source: Agency for Healthcare Research and Quality. (Protocol registered at https://effectivehealthcare.ahrq.gov/products/people-with-disabilities/protocol).

Environmental exposures, including widespread industrial pollution, impact human health and are amplified in more highly exposed communities. Policy and regulatory frameworks for making decisions and recommendations on interventions to mitigate or prevent exposures tend to narrowly focus on exposure and some health-related data related to risks. Typically, such frameworks do not consider other factors, including essentiality, health equity, and distribution of benefits and costs. Further, decisions and recommendations lack transparency regarding how they were developed. We developed the Navigation Guide Evidence-to-Decision Framework for Environmental Health (E2DFEH) to provide a structured and transparent framework incorporating a range of scientific information and factors for decision-making. We reviewed current evidence-to-decision frameworks and engaged in an iterative consensus-based process involving 30 experts from 25 organizations in the academic, government, and nonprofit sectors. The E2DFEH framework includes three Foundations that are structural factors considered as part of recommendation development: 1) Essentiality, 2) Human Rights, and 3) Quality of the Evidence. It also includes three core Criteria that guide the development of a specific recommendation, informed by an evaluation of relevant evidence: 1) Environmental Justice, 2) Maximizing Benefits and Reducing Harm, and 3) Sociocultural Acceptability and Feasibility. The framework’s goal is to make the decision process transparent and comprehensive through explicit consideration of core factors important for decisions, leading to more equitable and health-protective interventions.

Background Point-of-care (PoC) hepatitis B virus (HBV) DNA viral load (VL) assays represent an alternative to laboratory-based standard-of-care (SoC) VL assays to accelerate diagnosis and treatment. We evaluated the impact of using PoC versus SoC approaches on the uptake of VL testing, treatment, and turnaround times from testing to treatment across the HBV care cascade. Methods We searched five databases, six conference websites, and contacted manufacturers for unpublished reports, for articles with or without a comparator (SoC VL testing), and had data on the uptake of VL testing, treatment, or turnaround times between HBsAg testing, VL testing, and treatment in the cascade. We performed a random-effects meta-analysis on rates of VL testing and treatment initiation. Results Six studies, comprising nine arms, were included. Three PoC arms reported less than one day between screening for HBsAg positivity and VL testing, and the other one (two arms) reported it between 7 and 11 days. Five arms reported the time to available VL test results (<1 day). Three studies reported 1-8 days between VL testing results and treatment initiation. Two studies reported the turnaround time between a positive HBsAg screening and treatment initiation (the same day and 27 days). Overall, 84.1% of those with HBsAg positivity were tested for DNA VL, and 88.3% of eligible people initiated treatment. Conclusion HBV PoC DNA testing appears to be associated with a turnaround time of <1 day for receipt of VL results and appears associated with high rates of DNA testing and initiation of treatment among those eligible. Clinical Trials Registration PROSPERO CRD42023398440.

Importance In 2015 the US Preventive Services Task Force (USPSTF) found insufficient evidence to assess the balance of benefits and harms of routine screening and supplementation for iron deficiency anemia during pregnancy. Objective To update the 2015 review on screening for iron deficiency anemia, in addition to iron deficiency during pregnancy, to inform the USPSTF. Data Sources Ovid MEDLINE and Cochrane databases through May 24, 2023; surveillance through May 24, 2024. Study Selection Randomized clinical trials of iron supplementation, screening effectiveness, treatment, and harms; observational studies of screening. Data Extraction and Synthesis Dual review of abstracts, full-text articles, study quality, and data abstraction. Data were pooled using a random-effects model. Main Outcomes and Measures Maternal and infant clinical outcomes, hematologic indices, and harms. Results Seventeen trials (N = 24 023) on maternal iron supplementation were included. Iron supplementation was associated with decreased risk of maternal iron deficiency anemia at term (4 trials, n = 2230; 8.6% vs 19.8%; relative risk, 0.40 [95% CI, 0.26-0.61]; I ² = 20.5%) and maternal iron deficiency at term (6 trials, n = 2361; 46% vs 70%; relative risk, 0.47 [95% CI, 0.33-0.67]; I ² = 81.9%) compared with placebo or no iron supplement. There were no statistically significant differences in maternal quality of life, rates of gestational diabetes, maternal hemorrhage, hypertensive disorders of pregnancy, cesarean delivery, preterm birth, infant low birth weight, or infants small for gestational age for maternal iron supplementation compared with placebo or no supplementation. Harms of iron supplementation included transient gastrointestinal adverse effects. No studies evaluated the benefits or harms of screening for iron deficiency or iron deficiency anemia during pregnancy. Data on the association between iron status and health outcomes, such as hypertensive disorders of pregnancy and preterm birth, were very limited. Conclusions and Relevance Routine prenatal iron supplementation reduces the incidence of iron deficiency and iron deficiency anemia during pregnancy, but evidence on health outcomes is limited or indicates no benefit. No studies addressed screening for iron deficiency or iron deficiency anemia during pregnancy. Research is needed to understand the association between changes in maternal iron status measures and health outcomes.

"Spin" refers to misleading reporting, interpretation, and extrapolation of findings in primary and secondary research (such as in systematic reviews). The study of spin primarily focuses on beneficial outcomes. The objectives of this research were threefold: first, to develop a framework for identifying spin associated with harms in systematic reviews of interventions; second, to apply the framework to a set of reviews, thereby pinpointing instances where spin may be present; and finally, to revise the spin examples, offering guidance on how spin can be rectified. The authors developed their framework through an iterative process that engaged an international group of researchers specializing in spin and reporting bias. The framework comprises 12 specific types of spin for harms, grouped by 7 categories across the 3 domains (reporting, interpretation, and extrapolation). The authors subsequently gathered instances of spin from a random sample of 100 systematic reviews of interventions. Of the 58 reviews that assessed harm and the 42 that did not, they found that 28 (48%) and 6 (14%), respectively, had at least 1 of the 12 types of spin for harms. Inappropriate extrapolation of the results and conclusions for harms to populations, interventions, outcomes, or settings not assessed in a review was the most common category of spin in 17 of 100 reviews. The authors revised the examples to remove spin, taking into consideration the context (for example, medical discipline, source population), findings for harms, and methodological limitations of the original reviews. They provide guidance for authors, peer reviewers, and editors in recognizing and rectifying or (preferably) avoiding spin, ultimately enhancing the clarity and accuracy of harms reporting in systematic review publications.

Importance The United States Preventive Services Task Force (USPSTF) has considered the topic of prevention of child maltreatment multiple times over its nearly 40-year history, each time reaching the conclusion that the evidence is insufficient to recommend for or against interventions aimed at preventing this important health problem with significant negative sequelae before it occurs. In the most recent evidence review, which was conducted from August 2021 to November 2023 and published in March 2024, the USPSTF considered contextual questions on the evidence for bias in reporting and diagnosis of maltreatment in addition to key questions regarding effectiveness of interventions to prevent child maltreatment. Observations A comprehensive literature review found evidence of inaccuracies in risk assessment and racial and ethnic bias in the reporting of child maltreatment and in the evaluation of injuries concerning for maltreatment, such as skull fractures. When children are incorrectly identified as being maltreated, harms, such as unnecessary family separation, may occur. Conversely, when children who are being maltreated are missed, harms, such as ongoing injury to the child, continue. Interventions focusing primarily on preventing child maltreatment did not demonstrate consistent benefit or information was insufficient. Additionally, the interventions may expose children to the risk of harm as a result of these inaccuracies and biases in reporting and evaluation. These inaccuracies and biases also complicate assessment of the evidence for making clinical prevention guidelines. Conclusions and Relevance There are several potential strategies for consideration in future efforts to evaluate interventions aimed at the prevention of child maltreatment while minimizing the risk of exposing children to known biases in reporting and diagnosis. Promising strategies to explore might include a broader array of outcome measures for addressing child well-being, using population-level metrics for child maltreatment, and assessments of policy-level interventions aimed at improving child and family well-being. These future considerations for research in addressing child maltreatment complement the USPSTF’s research considerations on this topic. Both can serve as guides to researchers seeking to study the ways in which we can help all children thrive.