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 weeks of 30/08/12 to 19/09/12, 54 new records were added to the DARE database.

Abstracts of the week - a selection

• Acupuncture for chronic pain: individual patient data meta-analysis.  This meta-analysis concluded that acupuncture added to standard care was more effective than standard care alone or standard care with sham acupuncture for four types of chronic pain. Differences between true and sham acupuncture were relatively modest. The authors' conclusions reflect the high quality evidence presented and appear to be reliable.
• Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis.  The authors concluded that omega-3 polyunsaturated fatty acid supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction or stroke. There were some limitations in the review process and the included studies, but the authors' conclusions are likely to be reliable as they reflect the evidence presented and the evidence was consistent across the studies.
• Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis.  This generally well conducted review concluded that the lift-off test had the highest diagnostic utility, particularly for confirming subacromial impingement syndrome. This broadly reflected the results of the meta-analyses, but data suggested that the drop arm test could also be a useful rule in test. As noted by the authors, results may not be applicable to primary care.
• Effectiveness of rifaximin and fluoroquinolones in preventing travelers' diarrhea (TD): a systematic review and meta-analysis.  The findings showed that rifaximin and fluoroquinolones were effective in prevention of travellers' diarrhoea. The authors acknowledged some limitations of this review but their overall conclusion reflect the evidence presented and appear likely to be reliable.
• Effects of combined aspirin and clopidogrel therapy on cardiovascular outcomes: a systematic review and meta-analysis.  The addition of aspirin to clopidogrel resulted in small relative reductions in major cardiovascular events, myocardial infarction and stroke, but it resulted in a relative increase in major bleeding events. The authors' conclusion reflects the evidence presented and seems reliable.
• First-generation versus second-generation antipsychotics in adults: comparative effectiveness.  The authors concluded it was unclear if there were differences between first and second generation antipsychotics. In addition, there was insufficient evidence to compare safety and adverse events between these interventions. This was a well conducted systematic review and the authors' conclusions appear to be reliable.
• Lipid-modifying therapies and risk of pancreatitis: a meta-analysis.  The review concluded that statin therapy was associated with a reduction in the risk of pancreatitis in patients with normal or mildly elevated triglyceride levels. The authors' conclusions appear likely to be reliable.
• Risks of harms using antifibrinolytics in cardiac surgery: systematic review and network meta-analysis of randomised and observational studies.  This review concluded that some concerns remained about the safety of aprotinin, and that tranexamic and epsilon-aminocaproic acid were effective alternatives that could be safer for patients. There may have been potential for errors during the data extraction process, but the review was generally well-conducted and the authors' conclusions seem appropriate given the evidence presented.
• Two monitoring methods of oral anticoagulant therapy in patients with mechanical heart valve prothesis: a meta-analysis.  This generally well-conducted review concluded that self monitoring or self management could improve the quality of oral anticoagulant therapy in patients with mechanical heart valve prostheses compared with traditional monitoring. Although the evidence base was limited, the authors' conclusions are likely to be reliable.
• A systematic review and economic evaluation of the use of tumour necrosis factor-alpha (TNF-alpha) inhibitors, adalimumab and infliximab, for Crohn's disease.  This review concluded that therapy with adalimumab or infliximab may have a beneficial effect compared with standard care on outcome measures for induction and maintenance therapy for Crohn's disease. Issues with the reliability of the trial evidence were documented by the authors and their conclusion rests on a well-conducted review and appears likely to be reliable.
• Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and Bayesian random-effects meta-analyses of randomized trials.  This generally well-conducted review concluded that available evidence suggested intensive blood pressure control (135mmHg or lower) reduced the risk of macrovascular events (death or stroke) in participants with type 2 diabetes mellitus/impaired fasting glucose or glucose intolerance, but increased the risk of serious adverse events. The authors' conclusions are likely to be reliable.
• Effectiveness of mammography screening in reducing breast cancer mortality in women aged 39-49 years: a meta-analysis.  This review concluded that mammography screenings were effective and reduced breast cancer mortality in women aged 39 to 49 by 17%. This represented a reduction from a very low absolute risk; the authors further concluded that women should be clearly informed of both positive and negative aspects of screening. The conclusion as a whole is likely to be reliable.
• Efficacy and safety comparison of continuous glucose monitoring and self-monitoring of blood glucose in type 1 diabetes: systematic review and meta-analysis.  Continuous glucose monitoring, particularly its real-time system, had a favourable effect on glycaemic control in patients with type 1 diabetes, compared with self monitoring of blood glucose. This was a well conducted systematic review and despite the limited quality of some of the included trials, the authors' conclusions are likely to be reliable.
• High-dose imatinib for newly diagnosed chronic phase chronic myeloid leukemia.  The review concluded that there was insufficient evidence available to support the routine use of higher doses of imatinib as frontline treatment for chronic phase chronic myeloid leukaemia. The review was generally well conducted, and the authors' conclusion is likely to be reliable.
• Impact of care pathways for in-hospital management of COPD exacerbation: a systematic review.  The authors concluded that based on the limited available research, accurate conclusions on the impact of chronic obstructive pulmonary disease care pathways could not be drawn. This reflects the evidence presented and, despite some potential limitations in the review process, these conclusions are likely to be reliable.
• Long-term outcome after sirolimus-eluting stents versus bare metal stents in patients with diabetes mellitus: a patient-level meta-analysis of randomized trials.  This review concluded that, compared with bare metal stents, Sirolimus-eluting stents effectively reduced the risk for major cardiac events, and were safe in diabetic patients with coronary artery disease. Although there was a lack of reporting on study quality, the authors' conclusions reflect the evidence presented and appear likely to be reliable.

Website: University of York Centre for Reviews and Dissemination