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 26/07/12 to 29/08/12, 142 new records were added to the DARE database.

Abstracts of the week - a selection

• Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses.  Statistically significant differences were found between auto-titrating positive airway pressure and continuous positive airway pressure in patients with moderate-to-severe obstructive sleep apnoea without comorbidities. Results were based on short-term effects. Clinical importance was unclear. The authors' conclusions reflect the evidence presented and are likely to be reliable.
• Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis.  This well-conducted review concluded that statins decreased mortality and cardiovascular events in persons with early stages of chronic kidney disease, had little or no effect in people who received dialysis and had uncertain effects in kidney transplant recipients. The authors' conclusions reflect the evidence available and appear likely to be reliable.
• Glycemic control in non-critically ill hospitalized patients: a systematic review and meta-analysis.  The authors concluded that intensive control hyperglycaemia in patients hospitalised in non-critical care settings may reduce the risk of infection but not mortality, stroke, myocardial infarction or incidence of hypoglycaemia. The quality of evidence was low and mainly derived from studies in surgical settings. This conclusion reflects the evidence presented and is likely to be reliable.
• Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials.  Transradial access site in percutaneous coronary intervention for ST elevation myocardial infarction was associated with a significant reduction in mortality, major adverse cardiac events and major access site complications. The authors acknowledged that the absence of sufficiently large trials precluded any definitive conclusion. Despite imperfections in the conduct of the review, the conclusions are likely to be reliable.
• Intensive and standard blood pressure targets in patients with type 2 diabetes mellitus: systematic review and meta-analysis.  This well-conducted review concluded that, compared with standard blood pressure targets, the use of more intensive (lower) targets was associated with a small reduction in the risk of stroke. There was no evidence that intensive targets reduced risk of death or heart attack. These conclusions reflect the evidence presented and appear reliable.
• Lipid-lowering therapy in persons with chronic kidney disease: a systematic review and meta-analysis.  The authors concluded that lipid-lowering therapy reduced rates of cardiac death and cardiovascular events in people with chronic kidney disease. The review was well conducted; having a large number of patients. It is possible that results in patients with mild disease may not extend to those with advanced disease, but the authors’ conclusions are likely to be reliable.
• Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the U.S. preventive services taskforce recommendations.  Postmenopausal therapy using oestrogen with progestin or oestrogen alone decreased risk of fractures but increased risks of stroke, thromboembolic events, gallbladder disease and urinary incontinence. Oestrogen plus progestin increased risks of breast cancer and probable dementia. Oestrogen-only decreases the risk of breast cancer. The conclusions were based on the evidence presented and appear reliable.
• Outcomes with various drug eluting or bare metal stents in patients with diabetes mellitus: mixed treatment comparison analysis of 22 844 patient years of follow-up from randomised trials.  This well-conducted review concluded that, compared with bare-metal stents, the available drug-eluting stents were highly efficacious at reducing the risk of target vessel and target lesion revascularisation without compromising safety among patients with diabetes. Among the drug-eluting stents, everolimus-eluting stents were the safest and most efficacious. The authors' conclusions are likely to be reliable.
• The relative clinical effectiveness of ranibizumab and bevacizumab in diabetic macular oedema: an indirect comparison in a systematic review.  This review concluded that there appeared to be no difference in effectiveness between ranibizumab and bevacizumab for the treatment of diabetic macular oedema, but the wide credible intervals could not exclude the possibility that either drug might be superior. This was a well conducted review and the authors' conclusions are appropriate.
• Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials.  The moderate quality of evidence suggested that orally administered zinc reduced the duration of symptoms of the common cold. However, the evidence of benefit was limited to adults, and even in this patient group uncertainty remained about its clinical benefit. This was a well-conducted review and the conclusions seem appropriate.
• Anti-vascular endothelial growth factor antibody bevacizumab reduced the risk of anemia associated with chemotherapy: a meta-analysis.  The review concluded that bevacizumab may have significantly reduced the risk of anaemia with chemotherapy in cancer patients. This was a generally well-conducted review and the authors' cautious conclusion appears likely to be reliable.
• Cardiac resynchronization therapy in patients with mild heart failure: a systematic review and meta-analysis of randomized controlled trials.  This review found that treatment with cardiac resynchronisation therapy was associated with reductions in heart failure-related hospitalisations and mortality in patients with mild heart failure. The authors' conclusions are based on the evidence presented and are likely to be reliable.
• Clinical efficacy of neoadjuvant chemotherapy with platinum-based regimen for patients with locoregionally advanced head and neck squamous cell carcinoma: an evidence-based meta-analysis.  This review found no significant differences in survival and recurrence outcomes between neoadjuvant chemotherapy with platinum-based regimens and conventional locoregional treatment for patients with Stage III-IV head and neck squamous cell carcinoma. The authors' cautious conclusions are likely to be reliable.
• Clopidogrel 150 vs 75 mg/day in patients undergoing percutaneous coronary intervention: a meta-analysis.  This review concluded that 150mg/day maintenance dose of clopidogrel for patients who underwent percutaneous coronary intervention could reduce major adverse cardiac and/or cerebrovascular events, but could increase the risk of minor bleeding. This was a generally well conducted review and the conclusions are probably reliable.
• Depression screening and patient outcomes in cancer: a systematic review.  This review found no evidence on the effectiveness of depression screening in cancer patients, either alone or in the context of optimal depression care. One trial of depression treatment reported modest improvement in depressive symptoms. These conclusions reflect the available evidence and are likely to be reliable.
• Does duration of perioperative antibiotic prophylaxis matter in cardiac surgery? A systematic review and meta-analysis.  This review comparing long-term and short-term antibiotic prophylaxis regimens in patients undergoing cardiac surgery concluded that uncertainty was too high to determine comparative effectiveness. This conclusion reflects the evidence and is reliable.
• Do wound complications or lymphoceles occur more often in solid organ transplant recipients on mTOR inhibitors? A systematic review of randomized controlled trials. This review found that immediate use of mammalian target of rapamycin (mTOR) inhibitors lead to a higher incidence of wound complications and lymphoceles in solid organ transplant patients, and should be avoided in the first few months after transplantation. There was some potential for bias in the review, but the authors' conclusions reflect the evidence and seem reliable.
• Efficacy and safety comparison of rapid-acting insulin aspart and regular human insulin in the treatment of type 1 and type 2 diabetes mellitus: a systematic review. This well-conducted review found that rapid-acting insulin aspart resulted in moderately better metabolic control and treatment satisfaction than regular (short-acting) human insulin for patients with type 1 diabetes, and improvement in postprandial glucose for patients with type 2 diabetes. These conclusions are likely to be reliable.
• Emotional impact of screening: a systematic review and meta-analysis.  Screening did not appear to have a negative emotional impact in the longer term (beyond four weeks following screening). There was insufficient data to assess the emotional impact of screening in the shorter term. Despite some concerns about the quality of some trials and heterogeneity, the review conclusions reflect the evidence and appear likely to be reliable.
• Haemodynamic goal-directed therapy and postoperative infections: earlier is better; a systematic review and meta-analysis.  The authors concluded that within the limitations of the existing evidence, goal-directed therapy effectively reduced the incidence of infectious complications in particular the rate of surgical site infections, pneumonia and urinary tract infections. This was a generally well conducted review. The authors' conclusions to reflect the evidence and are likely to be reliable.
• Herpes simplex virus type 2 serological testing and psychosocial harm: a systematic review.  The review concluded that HSV-2 diagnosis by type-specific serological testing did not result in long-term psychosocial harm in most people without an identified history of genital herpes. The review was generally well conducted and the authors' conclusions are likely to be reliable.
• Multifocal versus single vision lenses intervention to slow progression of myopia in school-age children: a meta-analysis.  The review concluded that multifocal lenses in school-aged children slowed myopia progression compared to single vision lenses, but the effect was of limited clinical significance. The conclusions of this generally well-conducted review reflected the evidence and are likely to be reliable.
• Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis.  This individual patient data meta-analysis of nine trials found that racecadotril as an adjunct to oral rehydration solution had a clinically relevant effect in reducing diarrhoea (duration, stool output and number) in children with acute gastroenteritis. Despite some shortcomings regarding the available evidence and model uncertainty, this conclusion is likely to be reliable.
• Systematic review of the effectiveness of weight management schemes for the under fives.  This well-conducted review concluded that evidence on weight management interventions for prevention of obesity in under-fives was scarce and disparate (no evidence on treatment). There was some evidence of positive trends in weight measures, but except for one subgroup this was not statistically significant. Further randomised controlled trials were required. This conclusion is likely to be reliable.
• Tirofiban use with clopidogrel and aspirin decreases adverse cardiovascular events after percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials.  Routine early tirofiban use plus aspirin and clopidogrel in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention may have reduced major adverse cardiovascular events without increasing major bleeding rates. The conclusions were not definitive due to limited evidence. The authors' conclusions were appropriately cautious and are likely to be reliable.
• Treatment of arterial hypertension in the very elderly: a meta-analysis of clinical trials.  This review concluded that antihypertensive drug therapies reduced non-fatal strokes and the incidence of heart failure but did not change overall mortality in patients over 75 years old with moderate-to-severe hypertension. The conclusions appear to be reliable, but reasons for variation in effectiveness remain unknown.
• Ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: a meta-analysis.  This review found that ustekinumab was a safe and effective treatment for psoriasis in adult patients. Despite some limitations in the review and in the evidence base, the authors' conclusions are likely to be reliable.
• Bevacizumab, sorafenib tosylate, sunitinib and temsirolimus for renal cell carcinoma: a systematic review and economic evaluation.  This review concluded that bevacizumab plus interferon and sunitinib had clear advantages over interferon alone for patients with metastatic renal cell carcinoma. Temsirolimus had clinically relevant advantages over interferon for patients with poor prognosis. Sorafenib tosylate was more effective than best standard care as second-line therapy. The conclusions of this well-conducted review are likely to be reliable.
• Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis.  This review concluded that there was some evidence to support the role of early referral for chronic kidney disease, with benefits in blood pressure control and renal progression. The evidence showed the need for good quality randomised controlled trials (RCTs) to assess methods of care delivery and timing of interventions. These conclusions appear likely to be reliable.
• Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome: a meta-analysis of individual patient data.  This individual patient data review concluded that a routine invasive strategy reduced long-term frequency of death or nonfatal myocardial infarction compared to a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome. There was no evidence that effectiveness was influenced by baseline risk. The results of this review are likely to be reliable.

Website: University of York Centre for Reviews and Dissemination