The Database of Abstracts of Reviews of Effects (DARE)

Systematic reviews are useful tools for busy decision-makers because they identify, appraise and synthesise the available research evidence on a particular topic. Many thousands of systematic reviews relevant to health care have been published. However, they can be difficult to locate and their quality is variable. DARE (the Database of Abstracts of Reviews of Effects) contains summaries of systematic reviews which have met strict quality criteria. Each summary also provides a critical commentary on the quality of the review. DARE covers a broad range of health care related topics and can be used for answering questions about the effects of health care interventions, as well as for developing clinical guidelines and policy making. DARE is available free of charge on the internet (http://nhscrd.york.ac.uk), and as part of the Cochrane Library. Alternatively, DARE can be searched, on your behalf, by CRD information staff (tel: 01904 433707 or email [email protected])

Participation and quality of life outcomes among individuals with earthquake-related physical disability: a systematic review

Objective: A literature review to evaluate quality of life and participation outcomes of individuals with earthquake-related physical injury. Data sources: A systematic review was performed using National Health Service (NHS) Centre for Reviews and Dissemination (CRD) guidelines. MEDLINE, Embase, PsychINFO, CINAHL and AMED electronic databases were searched from 1966 to January 2014. Study selection: Studies that measured quality of life or participation outcomes among individuals who acquired a physical disability as a result of an earthquake injury were included, with no limits on research design. Data extraction: The search yielded 961 potentially relevant articles after removal of duplicates. Of these, only 8 articles met the inclusion criteria. Studies were rated for quality using the Critical Appraisal Skills Programme (CASP) guidelines. Data synthesis: A narrative synthesis was performed due to the heterogeneity of the included studies. Results: Injured earthquake survivors in developing countries experience diminished participation and reduced quality of life. Small sample sizes and lack of uniformity in outcome measurement limit generalizability. No studies from developed countries were identified. Conclusion: To maximize our understanding of quality of life and participation in injured earthquake survivors, future research should consider both the functional consequences of the injury and the environmental impact of the earthquake. The research should be based on representative samples of the injured earthquake survivors and use validated condition-specific outcome measures that are clearly defined within the publications. In addition, research should include all countries that are affected by earthquakes

Ophthalmic artery Doppler for prediction of pre‐eclampsia: systematic review and meta‐analysis

Objective To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre‐eclampsia (PE). Methods MEDLINE, EMBASE, CINAHL and The Cochrane Library were searched for relevant citations without language restrictions. Two reviewers independently selected studies that evaluated the accuracy of ophthalmic artery Doppler to predict the development of PE and extracted data to construct 2 × 2 tables. Individual patient data were obtained from the authors if available. A bivariate random‐effects model was used for the quantitative synthesis of data. Logistic regression analysis was employed to generate receiver–operating characteristics (ROC) curves and obtain optimal cut‐offs for each investigated parameter, and a bivariate analysis was employed using predetermined cut‐offs to obtain sensitivity and specificity values and generate summary ROC curves. Results A total of 87 citations matched the search criteria of which three studies, involving 1119 pregnancies, were included in the analysis. All included studies had clear description of the index and reference tests, avoidance of verification bias and adequate follow‐up. Individual patient data were obtained for all three included studies. First diastolic peak velocity of ophthalmic artery Doppler at a cut‐off of 23.3 cm/s showed modest sensitivity (61.0%; 95% CI, 44.2–76.1%) and specificity (73.2%; 95% CI, 66.9–78.7%) for the prediction of early‐onset PE (area under the ROC curve (AUC), 0.68; 95% CI, 0.61–0.76). The first diastolic peak velocity had a much lower sensitivity (39.0%; 95% CI, 20.6–61.0%), a similar specificity (73.2%; 95% CI, 66.9–78.7%) and a lower AUC (0.58; CI, 0.52–0.65) for the prediction of late‐onset PE. The pulsatility index of the ophthalmic artery did not show a clinically useful sensitivity or specificity at any cut‐off for early‐ or late‐onset PE. Peak ratio above 0.65 showed a similar diagnostic accuracy to that of the first diastolic peak velocity with an AUC of 0.67 (95% CI, 0.58–0.77) for early‐onset PE and 0.57 (95% CI, 0.51–0.63) for late‐onset disease. Conclusions Ophthalmic artery Doppler is a simple, accurate and objective technique with a standalone predictive value for the development of early‐onset PE equivalent to that of uterine artery Doppler evaluation. The relationship between ophthalmic Doppler indices and PE cannot be a consequence of trophoblast invasion and may be related to maternal hemodynamic adaptation to pregnancy. The findings of this review justify efforts to elucidate the effectiveness and underlying mechanism whereby two seemingly unrelated maternal vessels can be used for the prediction of a disease considered a ‘placental disorder’

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease: Cochrane systematic review protocol

A large number of people, considered at increased risk of vascular disease, remainunidentified, untreated and not reached by lifestyle advice or intervention, despite publichealth and clinical efforts. This has prompted the initiation of national  screening/systematic risk assessment programmes for vascular disease in healthy populations. These exist in addition to the more ad hoc opportunistic risk assessment initiatives undertaken worldwide. There is currently not enough indisputable evidence either showing clear clinical or economic benefits of systematic screening-like programmes over opportunistic risk assessment of cardiovascular disease (CVD) in primary care. We present the rationale and methodology of a Cochrane systematic review, assessing the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD

Scoping studies: towards a methodological framework

This paper focuses on scoping studies, an approach to reviewing the literature which to date has received little attention in the research methods literature. We distinguish between different types of scoping studies and indicate where these stand in relation to full systematic reviews. We outline a framework for conducting a scoping study based on our recent experiences of reviewing the literature on services for carers for people with mental health problems. Where appropriate, our approach to scoping the field is contrasted with the procedures followed in systematic reviews. We emphasize how including a consultation exercise in this sort of study may enhance the results, making them more useful to policy makers, practitioners and service users. Finally, we consider the advantages and limitations of the approach and suggest that a wider debate is called for about the role of the scoping study in relation to other types of literature reviews

Hospital-based alternatives to acute paediatric admission: a systematic review

Objective: To synthesise published evidence of the impacts of introducing hospital-based alternatives to acute paediatric admission. Design: Systematic review of studies of interventions published in English. Patients: Children with acute medical problems referred to hospitals. Interventions: Services provided in a hospital as an alternative to inpatient admission. Main outcome measures: Admission or discharge, unscheduled returns to hospital, satisfaction of parents and general practitioners, effects on health service activity and costs. Results: 25 studies were included: one randomised controlled trial, 23 observational or cross-sectional studies and one qualitative study. Many studies were of uncertain quality or were open to significant potential bias. About 40% of children attending acute assessment units in paediatric departments, and over 60% of those attending acute assessment units in A & E departments, do not require inpatient admission. There is little evidence of serious clinical consequences in children discharged from these units, although up to 7% may subsequently return to hospital. There is some evidence that users are satisfied with these services and that they are associated with reductions in inpatient activity levels and certain hospital costs. Evidence about the impact of urgent outpatient clinics is very limited. Conclusions: Current evidence supports a view that acute paediatric assessment services are a safe, efficient and acceptable alternative to inpatient admission, but this evidence is of limited quantity and quality. Further research is required to confirm that this type of service reorganisation does not disadvantage children and their families, particularly where inpatient services are withdrawn from a hospital

Belimumab : a technological advance for systemic lupus erythematosus patients? Report of a systematic review and meta-analysis

Objectives: To undertake a systematic review and meta-analysis to investigate clinical effectiveness of belimumab for patients with systemic lupus erythematosus (SLE) and antinuclear and/or anti-double-stranded DNA (dsDNA) autoantibodies. Methods: We searched eight electronic databases and reference lists for randomised controlled trials (RCTs) of belimumab against placebo or best supportive care. Quality assessment and random effects meta-analysis were undertaken. Design: A meta-analysis of RCTs. Participants: 2133 SLE patients. Primary and secondary outcome measures: SLE Responder Index (SRI) at week 52. Results: Three double-blind placebo-controlled RCTs (L02, BLISS-52 BLISS-76) investigated 2133 SLE patients. BLISS-52 and BLISS-76 trials recruited patients with antinuclear and/or anti-dsDNA autoantibodies and demonstrated belimumab effectiveness for the SRI at week 52. Ethnicity and geographical location of participants varied considerably between BLISS trials. Although tests for statistical heterogeneity were negative, BLISS-52 results were systematically more favourable for all measured outcomes. Meta-analysis of pooled 52-week SRI BLISS results showed benefit for belimumab (OR 1.63, 95% CI 1.27 to 2.09). By week 76, the primary SRI outcome in BLISS-76 was not statistically significant (OR 1.31, 95% CI 0.919 to 1.855)

Femtosecond Laser Versus Mechanical Microkeratome in Thin-Flap Laser in Situ Keratomileusis (Lasik) for Correction of Refractive Errors an Evidence-Based Effectiveness and Cost Analysis

INTRODUCTION: To compare the efficacy and cost-effectiveness of Femtosecond laser versus mechanical Microkeratome corneal flap creation in correction of refractive errors.METHODS: I this review, a comprehensive search of Medline, SCOPUS, Cochrane, TRIP database, supplemented by HTA and economic databases was performed. We searched for randomized controlled trials (RCTs) of Femtosecond laser which included mechanical Microkeratome in other arm. The quality of the retrieved studies was appraised by two independent reviewers and appropriate articles were finalized.RESULTS: A total of 1142 articles were identified, of which, 1059 were excluded after review of the titles and abstracts and 83 articles remained. Systematic reviews and RCTs were evaluated through CASP international worksheet. Eventually, 61 titles were excluded, leaving 22 articles to be reviewed.Safety: There was no individual evidence to cover all safety components about Femtosecond laser, but in summary, this modality seems a safe method for corneal flap creation.Effectiveness: No statistically significant difference was shown in visual acuity and refractive errors. The important secondary end point of this review was diffuse Lamellar keratitis in 17% of the femtosecond group versus 5% in mechanical Microkeratome. Inflammation was low-grade and improved during the first 3 months of follow-up period with a low dose medication without corneal scarring. The two groups was comparable in all clinical outcomes including Unorrected Visual Acuity (UCVA), Best Special Corrected Visual Acuity (BSCVA), manifest refraction, wave front aberrometry, Schirmer test, and Tear Break up time (TBUT).Cost Analysis: Results showed that marginal cost incurred due to Femtosecond technology adoption may vary from 27 to 117 € (resulted from sensitivity analysis). It is clear that additional cost may be a small proportion of LASIK procedure total cost.CONCLUSION: Although Femtosecond flap creation is a modern method with a good quality of corneal flap, but, there is no high-quality evidence to show superiority of Femtosecond laser in clinical outcomes. Although the efficacy and cost of the systems is almost equal, traditional method still remains as the standard approach.

Green Light Photo Selective Vaporization of the Prostate vs. Transurethral Resection of Prostate for Benign Prostatic Hyperplasia

INTRODUCTION: Green light photo selective vaporization of the prostate (PVP) is a minimally invasive method of treatment for clinical benign prostatic hyperplasia with fewer side effects. The aim of this study is to evaluate the safety, effectiveness and cost analysis of PVP compared with transurethral resection of prostate.METHODS: A systematic search was done in Cochrane, TRIP database, MEDLINE, NHS EED, NIHR HTA, CRD, Health star database, Pro Quest, Psycoinfo and Google Scholar to find randomized control trials, systematic reviews and HTA reports. The searched keywords were Green light laser (PVP or KTP) and prostate. The cost analysis was done by the perspective of society and providers.RESULTS: Complication rate in 12 included evidences ranged from 0-9.3%. The complication rate of TUR-P (Transurethral Resection of Prostate) was more than PVP. Changing in flow rate reducing residual urine, improving patients’ symptoms and QOL (Quality of life), and operative outcome length of operation varied from no significant to significant differences in favor of TURP. Unit cost in both social and provider view was significantly high in PVP in comparison with TURP. Increasing the number of patients did not change the cost analysis.CONCLUSION: PVP is a safe method for treatment of clinical BPH, but there is a lack of evidence for the evaluation of effectiveness. Overall, the unit cost for PVP was significantly more than TURP; for this reason this method could not be conducted in very wide indications, because of high cost