The Centre for Reviews and Dissemination (CRD)

CRD is part of the National Institute for Health Research (NIHR) and is a department of the University of York. CRD, which was established in 1994, is one of the largest groups in the world engaged exclusively in evidence synthesis in the health field. CRD undertakes systematic reviews evaluating the research evidence on health and public health questions of national and international importance.  They produce the DARE, NHS EED and HTA databases which are used extensively by health professionals, policy makers and researchers around the world.  They also undertake methods research and produce internationally accepted guidelines for undertaking systematic reviews.

CRD databases updated
In the week of 01/03/13 to 03/04/13, 156 new records were added to the DARE database.

Abstracts of the week - a selection

• Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data.  The authors concluded that people with more severe depression at baseline benefited at least as much as those with less severe depression, from low-intensity interventions. This was a well-conducted review and, despite limitations in the availability of the data, the authors' conclusions appear to be reliable.
• Patient safety strategies targeted at diagnostic errors: a systematic review.  The authors concluded that there was a growing amount of research on diagnostic errors, with promising interventions that should be evaluated, in large studies and various settings. The review focused on the results of randomised controlled trials and was largely well conducted. The authors' conclusion reliably reflects the limited evidence from trials, and their research recommendations seem justified.
• Pharmacologic therapy for primary restless legs syndrome: a systematic review and meta-analysis.  Among individuals with primary restless legs syndrome with long-term high-moderate to very severe symptoms, dopamine agonists and alpha-2-delta ligands increased rates of response to treatment, reduced symptoms and improved sleep outcomes and disease-specific quality of life. Adverse events and associated treatment withdrawals were common. The conclusions of this well-conducted review are likely to be reliable.
• Preventing in-facility pressure ulcers as a patient safety strategy: a systematic review.  The authors concluded that moderate-strength evidence suggested that implementing multicomponent initiatives for pressure ulcer prevention in acute and long-term care settings could improve the processes of care and reduce pressure ulcer rates. This was a largely well-conducted review and the authors' conclusion seems reliable.
• Promoting a culture of safety as a patient safety strategy: a systematic review.  This well-conducted review concluded that the strength of evidence for the effect of interventions to improve safety culture was low, but available evidence suggested they could improve perceptions of safety culture and potentially reduce patient harm. This represents an accurate summary of variable studies with generally high risk of bias and is likely to be reliable.
• Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis.  This well-conducted review concluded that diagnostic tests, for symptoms with a low risk of serious illness, did little to reassure patients, decrease their anxiety, or resolve their symptoms, but they could prevent some subsequent primary care visits. This conclusion reflects the results of the review and appears likely to be reliable.
• Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review.  This well-conducted review concluded that there was moderate evidence to support the effectiveness of sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma, but high-quality trials were needed to determine the best dosing strategies. These findings are likely to be reliable.
• Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis.  This generally well-conducted review concluded that ultrasound imaging could reduce the risk of a failed or traumatic lumbar puncture or epidural catheterisation. Limitations in the quality of the evidence, and uncertainty around the reliability and generalisability of the pooled estimates, mean that the authors' conclusions seem too strong.
• Can broad-range 16S ribosomal ribonucleic acid gene polymerase chain reactions improve the diagnosis of bacterial meningitis? A systematic review and meta-analysis.  This review concluded that high sensitivity and specificity values supported the use of 16S ribosomal ribonucleic acid gene polymerase chain reaction test as an adjunctive tool for the diagnosis of bacterial meningitis. The review was generally generally well conducted and the authors' conclusions reflect the data presented and are likely to be reliable.
• Cancer outcomes and all-cause mortality in adults allocated to metformin: systematic review and collaborative meta-analysis of randomised clinical trials.  The review concluded that there was no statistically significant beneficial effect of metformin on cancer or mortality outcomes compared with other drugs, placebo or usual care. The review was generally well conducted. The authors noted shortcomings in the quality of the evidence base, imprecision in the estimates and clinical differences between studies and appropriately concluded that more research was required.
• Comparative effectiveness of focused shock wave therapy of different intensity levels and radial shock wave therapy for treating plantar fasciitis: a systematic review and network meta-analysis.  This well-conducted review concluded that medium-intensity therapy with the highest level of energy output was the ideal form of focused shockwave therapy for plantar fasciitis (heel pain and inflammation), with radial shockwave a cheaper and possibly more effective alternative. Despite limited details on included trial comparability, the authors' conclusions follow from the evidence and are likely to be reliable.
• Effect of statin therapy on the progression of coronary atherosclerosis.  The authors concluded that statins can significantly decrease plaque volume, with a twofold decrease in patients with acute coronary syndrome compared to patients with stable angina. There was no change in plaque composition. There were some uncertainties surrounding study designs but otherwise the review was generally well conducted. Overall results seem reliable but some subgroup analyses should be interpreted cautiously.
• Efficacy and tolerability of oxycodone in moderate-severe cancer-related pain: a meta-analysis of randomized controlled trials.  The authors concluded that oxycodone was superior to other strong opioids including morphine sulphate, codeine and tramadol, supporting its use as an opioid for cancer-related pain in China. This was a well-conducted review and the results are likely reliable.
• Maternal exercise and growth in breastfed infants: a meta-analysis of randomized controlled trials.  The authors concluded that mothers could exercise and breast-feed without reducing their infant's growth, but this was based on limited evidence and required further research. This was a well-conducted review and the authors' tentative conclusion and recommendations for further research appear to be reliable.
• Meta-analysis: sequential therapy for Helicobacter pylori eradication in children.  This review found that sequential therapy could be considered as an alternative to triple therapy for the eradication of Helicobacter pylori infection in children. The poor quality of most of the trials means that the the primary data was unlikely to be reliable. However, as the review was well conducted and thorough, its overall conclusions may be reliable.
• Neurokinin-1 receptor antagonists for chemotherapy-induced nausea and vomiting: a systematic review.  This review found that neurokinin-1 receptor antagonists improved the control of chemotherapy-induced nausea and vomiting, but that they may increase infection rates. This was a well conducted review with a large number of trials and patients; the results and authors' conclusions are likely to be reliable.
• Photoselective vaporization versus transurethral resection of the prostate for benign prostatic hyperplasia: a meta-analysis.  The review concluded that photoselective vaporisation and transurethral resection of the prostate had comparable functional outcomes in benign prostatic hyperplasia. Vaporisation had better safety outcomes. Transurethral resection had shorter surgery and lower reoperation risk. The review was generally well conducted but limitations in the evidence base, potential publication bias and substantial heterogeneity mean the authors' conclusions should be considered tentative.
• Rituximab for the first-line treatment of stage III-IV follicular lymphoma (review of Technology Appraisal No 110): a systematic review and economic evaluation.  This review found that addition of rituximab to chemotherapy regimens for stage III-IV follicular lymphoma showed an improvement in clinical outcomes with minimal clinically relevant extra adverse events or toxicity. This was a generally well-conducted review. The authors' conclusions reflect the evidence presented and appear reliable.
• Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials.  The authors concluded that wound protectors reduced the rate of surgical site infection after gastrointestinal or biliary tract surgery, and they recommended their routine use in clinical practice. This was a well-conducted review, and the authors' conclusions seem reliable.

Website: University of York Centre for Reviews and Dissemination