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 107/05/12 to 03/06/12, 140 new records were added to the DARE database.

Abstracts of the week - a selection

• Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis.  The authors concluded that using probiotics as adjunct therapy reduced the risk of antibiotics-associated diarrhoea. The conclusions of this well-conducted review are likely to be reliable, although gaps in the reporting of the studies and differences between the included studies should be considered when interpreting the results.
• The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials.  This meta-analysis of individual patient data concluded that in individuals with five-year risk of major vascular events lower than 10%, each 1mmol/L reduction in low-density lipoprotein cholesterol produced an absolute reduction in major vascular events of about 11 per 1,000 over five years. The authors' conclusions are likely to be reliable.
• Aspirin effect on the incidence of major adverse cardiovascular events in patients with diabetes mellitus: a systematic review and meta-analysis.  The authors concluded that the results suggested aspirin reduced the risk of major adverse cardiovascular events in patients with diabetes without cardiovascular disease, but that there also appeared to be higher rates of bleeding and gastrointestinal complications. The authors' conclusions reflect the evidence presented and are likely to be reliable.
• A systematic review of randomized controlled trials: web-based interventions for smoking cessation among adolescents, college students, and adults.  The review found that evidence that supported the use of web-based interventions for smoking cessation was insufficient to moderate in adults and insufficient in college students and adolescents. The review was well-conducted and the authors’ conclusions appear reliable.
  Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review.  The review concluded that just over half of computerised clinical decision support systems showed improvements in the process of chronic disease management and some improved patient outcomes, but the evidence was limited. This was a well-conducted review and the authors' cautious conclusions seem appropriate.
• Corticosteroid and antiviral therapy for Bell's palsy: a network meta-analysis.  The review concluded that treating Bell's palsy with antiviral treatment plus corticosteroid may lead to slightly higher recovery rates compared with treating with prednisone alone (without reaching statistical significance) and that prednisolone remains the best evidence-based treatment. Though studies may have been missed, the authors' conclusions reflect the evidence available and appear likely to be reliable.
• Intensive statin therapy compared with moderate dosing for prevention of cardiovascular events: a meta-analysis of >40,000 patients.  This review found that intensive dosing with statins for prevention of cardiovascular events was associated with significant reductions in non-fatal events. The review was well-conducted and the authors' conclusions are likely to be reliable.
• Length of stay and treatment completion for mothers with substance abuse issues in integrated treatment programmes.  The authors concluded that findings suggested integrated programmes for women with substance-abuse issues and their children may be associated with a small advantage over non-integrated programmes in length of stay. The authors' cautious conclusions and recommendations for further research reflected the evidence presented and are likely to be reliable.
• Pressure and volume limited ventilation for the ventilatory management of patients with acute lung injury: a systematic review and meta-analysis.  This review found that pressure and volume limited ventilation strategies were associated with reductions in mortality and associated with increased use of paralytic agents in patients with acute lung injury or acute respiratory distress syndrome. The review was generally well-conducted and the authors conclusions are likely to be reliable.
• Standard chemotherapy is superior to high-dose chemotherapy with autologous stem cell transplantation on overall survival as the first-line therapy for patients with aggressive non-Hodgkin lymphoma: a meta-analysis.  The authors concluded that high-dose chemotherapy was associated with a disadvantage in overall survival compared with standard chemotherapy in patients with aggressive non-Hodgkin lymphoma. The authors’ conclusion reflects the evidence presented and is likely to be reliable.
• The effectiveness of various models of primary care-based follow-up after stroke: a systematic review.  The authors concluded the findings do not support the use of stroke support workers, care co-ordinators or case managers to deliver the primary care-based health care and social care review after stroke. The authors’ cautious conclusions reflect the evidence presented and are likely to be reliable.
• The role of triage nurse ordering on mitigating overcrowding in emergency departments: a systematic review.  The review concluded that triage nurse ordering appeared to be an effective intervention to reduce length of stay in emergency departments, but this was based on a small number of studies with weak methodological quality. The review was well-conducted. The authors’ conclusions are suitably cautious and seem appropriate.
• Twelve-month clinical outcomes of everolimus-eluting stent as compared to paclitaxel- and sirolimus-eluting stent in patients undergoing percutaneous coronary interventions, A meta-analysis of randomized clinical trials.  This well-conducted review found that treatment with everolimus-eluting stents was associated with decreased target-lesion revascularisation and myocardial infarction rates after 12 months compared with paclitaxel-eluting and sirolimus-eluting stents, with similar mortality. The authors' conclusions' are likely to be reliable.
• The clinical effectiveness and cost-effectiveness of topotecan for small cell lung cancer: a systematic review and economic evaluation.  This well-conducted review concluded that compared with best supportive care alone, oral topotecan for patients with relapsed small cell lung cancer was associated with improved outcomes at increased cost. These conclusions seem both reasonable and reliable.
• A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness.  This review concluded that repetitive functional task practice can be effective for improving lower limb function at any time after stroke, but the duration of the effect was unclear and there was insufficient good quality evidence to make firm recommendations for upper limb interventions. This was a well-conducted review and the authors' conclusions are likely to be reliable.

Website: University of York Centre for Reviews and Dissemination