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 08/11/12 to 28/11/12, 134 new records were added to the DARE database.

Abstracts of the week - a selection

• Acamprosate for alcohol dependence: a sex-specific meta-analysis based on individual patient data.  This high quality individual patient data review of 22 trials concluded that acamprosate had a significant effect, compared with placebo, in improving the rates of abstinence for women and men with alcohol dependence. There were no gender differences in tolerability or efficacy. The conclusions of the review are likely to be reliable.
• Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review.  This generally well-conducted review concluded that both the Canadian C-spine rule and National Emergency X-Radiography Utilization Study (NEXUS) criteria had consistently high sensitivity and were, therefore, useful for ruling out clinically important cervical spine injury; the Canadian C-spine rule appeared to have better diagnostic accuracy than the NEXUS criteria. The conclusions are likely to be reliable.
• A comparison of intracoronary with intravenous glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of randomized controlled trials.  This review concluded that compared to intravenous administration, intra-coronary glycoprotein IIb/IIIa inhibitors did not significantly improve clinical outcomes in people undergoing percutaneous coronary intervention for acute coronary syndromes. However, there was an increase in target coronary flow and myocardial perfusion. The review appears generally well conducted and conclusions appear reasonable given the evidence presented.
• A meta-analysis of randomized controlled trials appraising the efficacy and safety of cilostazol after coronary artery stent implantation.  This review concluded that cilostazol added to aspirin and thienopyridine seemed effective in reducing the risk of restenosis and repeat revascularisation after percutaneous coronary interventions. Most of the studies were subject to a high risk of bias. Despite this the review was well-conducted and results of the included studies were consistent; the overall conclusion is likely to be reliable.
• A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia.  The authors concluded that there was limited evidence for the effectiveness of advance care planning in people with cognitive impairment or dementia and that nursing home settings may be too late for people with dementia to discuss advance care planning. The authors' conclusions appear to be a fair reflection of the limited evidence available and are likely to be reliable.
• Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis.  This review concluded that MRI appeared superior to contrast enhanced echocardiography and single-photon emission computed tomography for the diagnosis of obstructive coronary artery disease. This was a generally well-conducted review, and the conclusions are likely to be reliable, although it is worth noting that the likelihood ratios are similar for all three technologies.
• Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review.  This review found no association between delayed debridement and infection in the treatment of open long-bone fractures, regardless of whether all infections, only deep infections or only more severe fractures were considered. The review was generally well conducted and included a large number of studies and fractures. Its conclusions are likely to be reliable.
• Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: a systematic review.  The review found that several non-pharmacological interventions may improve neuropsychiatric symptoms of dementia in individuals in long-term care, including staff training, mental health consultation, psychosocial activities and sensory stimulation. It also found that insufficient high-quality evidence was available and that the feasibility of some interventions appeared limited. Despite some limitations in the review, these conclusions appear reliable
• Endovascular stent-graft placement or open surgery for the treatment of acute type B aortic dissection: a meta-analysis.  The review concluded that thoracic endovascular aortic repair can be weakly recommended as an alternative for selective treatment of acute type B aortic dissection but cannot replace surgery in all situations. These conclusions are suitably cautious and appear likely to be reliable.
• Fluid resuscitation with 6% hydroxyethyl starch (130/0.4) in acutely ill patients: an updated systematic review and meta-analysis.  The authors concluded that the published trials were of poor quality and there was not enough data to reliably estimate the benefits and risks of 6% hydroxyethyl starch 130/0.4, for fluid resuscitation in acutely ill adults. It appears that the authors’ conclusions are justified and likely to be reliable.
• Interventions to reduce acute paediatric hospital admissions: a systematic review.  The authors concluded that there was little published evidence on the most appropriate method for reducing acute paediatric hospital admissions, and this evidence was of low quality and open to substantial bias. This was a well-conducted systematic review and the authors' cautious conclusions are likely to be reliable.
• Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials.  Compared with open resection, laparoscopic resection for rectal cancer led to a shorter hospital stay, earlier return to bowel function, reduced blood loss, and fewer episodes of postoperative blood transfusion, abdominal postoperative bleeding, late intestinal obstruction by adhesion and late morbidity. Despite some concerns about trial variation, quality and reporting, these conclusions are likely to be reliable.
• Low-dose aspirin and cancer mortality: a meta-analysis of randomized trials.  The review concluded that non-vascular deaths, including cancer deaths, were reduced with low-dose aspirin in the short-term. The review was generally well conducted and the authors’ conclusions seem reasonable. However, the authors’ conclusions (as they recommend) should be considered alongside the risks of low-dose daily aspirin.
• Meta-analysis of the effectiveness of prophylactic antibiotics in the prevention of postoperative complications after tension-free hernioplasty.  This review concluded that antibiotic prophylaxis use in patients undergoing tension-free hernia repair surgery decreased the rate of incision infection by 55%. Although the review was based on a small number of trials (there were some limitations in the search, so relevant studies may have been missed), the authors' conclusions seem reliable.
• Meta-analysis: vasoactive medications for the management of acute variceal bleeds.  Compared to control, vasoactive agents were associated with a significant reduction in acute all-cause mortality and transfusion requirements, improved bleeding control and shorter hospital stay. Studies that compared different vasoactive treatments did not demonstrate a difference in efficacy. Despite limited information on the quality of the studies the conclusions of this review are likely to be reliable.
• Mould-active compared with fluconazole prophylaxis to prevent invasive fungal diseases in cancer patients receiving chemotherapy or haematopoietic stem-cell transplantation: a systematic review and meta-analysis of randomised controlled trials.  Compared with fluconazole prophylaxis, mould-active prophylaxis significantly reduced the number of proven or probable invasive fungal infection, invasive aspergillosis and invasive fungal infection-related mortality in patients who received chemotherapy or haematopoietic stem cell transplantation. Despite limitations in study quality and uncertainty about heterogeneity for the secondary outcomes, the conclusions reflected the evidence and are probably reliable.
• Sensory integration therapy for autism spectrum disorders: a systematic review.  The authors concluded that sensory integration therapy had no consistently positive effect as a treatment for children with autism spectrum disorders. Despite some potential methodological flaws in the review the conclusion reflects the evidence presented and seems likely to be reliable.
• Systematic review of the clinical effectiveness of wound-edge protection devices in reducing surgical site infection in patients undergoing open abdominal surgery.  This review concluded that wound–edge protection devices may have been efficient for reducing postoperative surgical site infections in patients who underwent open abdominal surgery, compared with standard care. The poor quality of the evidence indicated a need for a large good quality randomised controlled trial. This seems a reliable conclusion from a well-conducted review.
• The effect of growth hormone treatment or physical training on motor performance in Prader-Willi syndrome: a systematic review.  This review concluded that, in children/adults with Prader-Willi syndrome, growth hormone treatment had a positive effect on motor performance (not demonstrated in all studies). Physical training seemed to improve motor performance and health status. Given the limited quality of available data and small study sizes, the authors' conclusions should be treated with caution; their recommendations for further research seem appropriate.
• The impact of renin-angiotensin-aldosterone system inhibitors on Type 1 and Type 2 diabetic patients with and without early diabetic nephropathy.  The authors concluded that renin angiotensin aldosterone system inhibitors (RAASI) reduced urinary albumin excretion for type 1 diabetic patients with microalbuminuria but not with normoalbuminuria and for type 2 diabetic patients with and without microalbuminuria. This appeared to be a well conducted review but it is difficult to assess the reliability of the findings without further information about the quality of the studies.
• Tolerability of angiotensin-receptor blockers in patients with intolerance to angiotensin-converting enzyme inhibitors: a systematic review and meta-analysis.  This review concluded that in patients with angiotensin-converting enzyme inhibitor intolerance, angiotensin receptor blockers had similar rates of discontinuation, cough and angioedema compared with placebo and diuretics. However, significantly higher incidences of hypotension, renal dysfunction and hyperkalaemia were associated with angiotensin receptor blockers when compared to placebo. These conclusions reflect the evidence presented and are likely to be reliable.
• Adjuvant chemotherapy, with or without taxanes, in early or operable breast cancer: a meta-analysis of 19 randomized trials with 30698 patients.  The review concluded that taxane-based adjuvant chemotherapy could reduce the risk of cancer recurrence and death in patients with early or operable breast cancer but drug-related toxicities should be considered. This was a generally well-conducted review and the authors' conclusion is likely to be reliable.
• Advanced practice nurse outcomes 1990-2008: a systematic review.  This review concluded that advanced practice registered nurses provided safe, effective and quality care in a variety of settings and in partnership with physicians and other providers had a significant role in the promotion of health. There were questions about data quality and some of the review methods but the relatively conservative conclusions appear reasonable.
• Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis.  The review found that tigecycline was no more effective than standard antimicrobial regimens for treating serious complicated infections and was associated with a higher rate of adverse effects, especially vomiting and nausea. The review was generally well conducted and these conclusions appear reliable.
• Immunogenicity and safety of pandemic influenza A (H1N1) 2009 vaccine: systematic review and meta-analysis.  The authors concluded that the pandemic influenza (H1N1) 2009 vaccine, with or without adjuvant, appeared generally to be seroprotective after just one dose and safe among healthy populations aged at least three years. Despite some limitation of the review and the included trials, the authors' conclusions reflect the evidence presented and are likely to be reliable.
• Is cognitive behavioural therapy an effective complement to antidepressants in adolescents? A meta-analysis.  This review found that combined antidepressants and cognitive-behavioural therapy appeared to be more effective, in improving global functioning and general symptoms, than antidepressants alone, for adolescent patients with major depressive and anxiety disorders. The authors' conclusions are likely to be reliable.
• Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis.  The review found that there was strong evidence that oral antiseptics helped prevent ventilator-associated pneumonia compared to oral care without antiseptics. The review was generally well-conducted and these conclusions appear reliable.

Website: University of York Centre for Reviews and Dissemination