Hydroxyurea Segal, J.B., Et Al., (2008), Hydroxyurea

¶ … Hydroxyurea Segal, J.B., et al., (2008), Hydroxyurea for the Treatment of Sickle Cell Disease, Baltimore, MD: AHRQ Variables/Key Concepts To determine efficacy, effectiveness, harms, and barriers of the use of hydroxyurea treatment of sickle cell disease for determining solutions and further research need. Sampling Research studies based on variables. Conducted by experts in sickle cell disease management, clinical trial methodology, systematic review, epidemiological studies, and ethics and adherence research. Instruments/Data Collection Instruments were quality assessment, data extraction, and evidence grading. Literature inclusion tailored toward research questions.

Studies on children and adults evaluated separately. Included randomized trials, non-randomized trials, cohort studies with control groups, and pre/post studies. Evaluations of data was based on variable-based research questions. Results Hydroxyurea lowered the rate of hospitizations among children with sickle cell disease and raised HbF cell percentages. Strengths/Limitations Limited evidence for toxicity, barriers, and guide dosing. Insufficient evidence for efficacy and safety. Critique Even with the use of experts, there was no appropriate design method mentioned. Identifies research needs for toxicity, guide dosing, efficacy, and safety.

Strouse, J.J., et al., (2008), Hydroxyurea for Sickle Cell Disease: A Systematic Review for Efficacy and Toxicity in Children, Pediatrics, 122:6. Doi:10.1542/peds.2008-0441, Retrieved from http://www.pediactricsdigest.mobi/content/122/6/1332.full Variables/Key Concepts A synthesized literature review on the efficacy, effectiveness, and toxicity of hydroxyurea in children. Sampling Selected randomized trials, observational studies, and case reports that evaluated the efficacy, and toxicity of hydroxyurea in children with sickle cell disease. Design/Method Two reviewers abstracted data sequentially in study design, patient characteristics, and outcomes. Assessed study quality independently.

Instruments/Data Collection Instruments were databases, quality assessment, data synthesis with detailed evidence tables, and evidence grading. Used studies of randomized controlled trials, cohort studies with control groups, and pre/post studies. Results Strong evidence of increasing HbF and decreasing hospitalization. Moderate evidence of decreasing pain crisis and support of increased risk of reversible cytopenias, and rash. Weak evidence for decreasing neurologic events. Distance to referral center and need of frequent monitoring may be barriers to use. Strengths/Limitations Limited predictors to response. Critique No defined methodology.

Good to evaluate for barriers to use of hydroxyurea as well as suggestions for further research on neurologic events and more evidence on reducing pain measures. Kavanagh, P.L., et al., (2011), Management of Children with Sickle Cell Disease: A Comprehensive Review of Literature, Pediatrics, 128:6. Doi:10.1541/peds.2010-3686, pp e1552-e1574, retrieved from http://pediatrics.aappublications.org/content/1128/6/e1552.full.pdf+hml Variables/Key Concepts Review the quality of literature for preventative interventions and treatment of complications to facilitate the use of evidence-based medicine and need of further research.

Sampling Randomized cohort cases, controlled studies, multiple time series studies, and uncontrolled studies. Design/Method Identified data based on relevant topics dated from January 1995 to April 2010. Data was independently reviewed by two experts. Instruments/Data Collection Instruments were common form, U.S. Preventative Service Task Force ratings, RCTs, and meta-analysis categorized. Isolated studies based on relevancy of 28 topics concerning National Institute of Health guidelines for the care of children with sickle cell disease under three categories.

Results Lack of quality research for pediatric sickle cell disease related topics, many areas lack RCTs, and more research is needed for health and well-being of children with sickle cell disease. Strengths/Limitations Possible missed studies due to refined strategies, more than one third of studies included adults and children, and limited language to English, eliminating foreign studies. Critique This study is good for further research needs in identifying quality of care improvements for children with sickle cell anemia.