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The Systematic Review Data Repository (SRDR) is a powerful and easy-to-use tool for the extraction and management of data for systematic review or meta-analysis. It is also an open and searchable archive of systematic reviews and their data.
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Recently Completed and Deposited Reports Data

Decision Aids for Cancer Screening and Treatment


Public Report Complete
Statistics: 75 Studies, 2 Key Questions, 2 Extraction Forms,
Date Created: Jul 25, 2013 04:46PM
Description: Background: Many health decisions about screening and treatment for cancers involve uncertainty or tradeoffs between the expected benefits and harms. Patient decision aids have been developed to help health care consumers and their providers identify the available alternatives and choose the one that aligns with their values. It is unclear whether the effectiveness of decision aids for decisions related to cancers differs by people’s average risk of cancer or by the content and format of the decision aid.; Objectives: We sought to appraise and synthesize the evidence assessing the effectiveness of decision aids targeting health care consumers who face decisions about cancer screening or prevention, or early cancer treatment (Key Question 1), particularly with regard to decision aid or patient characteristics that might function as effect modifiers. We also reviewed interventions targeting providers for promotion of shared decision making using decision aids (Key Question 2).; Data sources: We searched MEDLINE®, Embase®, the Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO®, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL®) from inception to the end of June 2014.; Review methods: For Key Question 1, we included randomized controlled trials comparing decision aid interventions among themselves or with a control. We included trials of previously developed decision aids that were delivered at the point of the actual decision. We predefined three population groups of interest based on risk or presence of cancer (average cancer risk, high cancer risk, early cancer). The assessed outcomes pertained to measurements of decisional quality and cognition (e.g., knowledge scores), attributes of the decision-making process (e.g., Decisional Conflict Scale), emotion and quality of life (e.g., decisional regret), and process and system-level attributes. We assessed for effect modification by population group, by the delivery format or content of the decision aid or other attributes, or by methodological characteristics of the studies. For Key Question 2, we included studies of any intervention to promote patient decision aid use, regardless of study design and outcomes assessed.; Results: Of the 16,669 screened citations, 87 publications were eligible, corresponding to 83 (68 trials; 25,337 participants) and 5 reports for Key Questions 1 and 2, respectively. Regarding the evolution of the decision aid format and content over time, more recent trials increasingly studied decision aids that were more practical to deliver (e.g., over the Internet or without human mediation) and more often clarified preferences explicitly. Overall, participants using decision aids had higher knowledge scores compared with those not using decision aids (standardized mean difference, 0.23; 95% credible interval [CrI], 0.09 to 0.35; 42 comparison strata with 12,484 participants). Compared with not using decision aids, using decision aids resulted in slightly lower decisional conflict scores (weighted mean difference of -5.3 units [CrI, -8.9 to - 1.8] on the 0-100 Decisional Conflict Scale; 28 comparison strata; 7,923 participants). There was no difference in State-Trait Anxiety Inventory scores (weighted mean difference = 0.1; 95% CrI, -1.0 to 0.7 on a 20-80 scale; 16 comparison strata; 2,958 participants). Qualitative synthesis suggested that patients using decision aids are more likely to make informed decisions and have accurate risk perceptions; further, they may make choices that best agree with their values and may be less likely to remain undecided. Because there was insufficient, sparse, or no information about effects of decision aids on patient-provider communication, patient satisfaction with decision-making process, resource use, consultation length, costs, or litigation rates, a quantitative synthesis was not done. There was no evidence for effect modification by population group, by the delivery format or content of the decision aid or other attributes, or by methodological characteristics of the studies. Data on Key Question 2 were very limited.; Conclusions: Cancer-related decision aids have evolved over time, and there is considerable diversity in both format and available evidence. We found strong evidence that cancer-related decision aids increase knowledge without adverse impact on decisional conflict or anxiety. We found moderate- or low-strength evidence that patients using decision aids are more likely to make informed decisions, have accurate risk perceptions, make choices that best agree with their values, and not remain undecided. This review adds to the literature that the effectiveness of cancer-related decision aids does not appear to be modified by specific attributes of decision aid delivery format, content, or other characteristics of their development and implementation. Very limited information was available on other outcomes or on the effectiveness of interventions that target providers to promote shared decision making by means of decision aids.

SRDR Project Indexing


Public Report Complete
Statistics: 133 Studies, 1 Key Question, 1 Extraction Form,
Date Created: May 20, 2018 11:24PM
Description: This is a Methods Research project that catalogs the various projects with publicly available data on the SRDR Webpage.

Telehealth for Acute and Chronic Care Consultations


Public Report Complete
Statistics: 216 Studies, 5 Key Questions, 1 Extraction Form,
Date Created: Jan 04, 2019 11:05PM
Description: Objectives: To conduct a systematic review to identify and summarize the available evidence about the effectiveness of telehealth consultations and to explore using decision modeling techniques to supplement the review. Telehealth consultations are defined as the use of telehealth to facilitate collaboration between two or more providers, often involving a specialist, or among clinical team members, across time and/or distance. Consultations may focus on the prevention, assessment, diagnosis, and/or clinical management of acute or chronic conditions. Data Sources. We searched Ovid MEDLINE®, the Cochrane Central Register of Controlled Trials (CCRCT), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL®) to identify studies published from 1996 to May 2018. We also reviewed reference lists of identified studies and systematic reviews, and we solicited published or unpublished studies through an announcement in the Federal Register. Data for the model came both from studies identified via the systematic review and from other sources. Methods. We included comparative studies that provided data on clinical, cost, or intermediate outcomes associated with the use of any technology to facilitate consultations for inpatient, emergency, or outpatient care. We rated studies for risk of bias and extracted information about the study design, the telehealth interventions, and results. We assessed the strength of evidence and synthesized the findings using quantitative and qualitative methods. An exploratory decision model was developed to assess the potential economic impact of telehealth consultations for traumatic brain injuries in adults. Results. The search yielded 9,366 potentially relevant citations. Upon review, 8,356 were excluded and the full text of 1,010 articles was pulled for review. Of these, 233 articles met our criteria and were included—54 articles evaluated inpatient consultations, 73 emergency care, and 106 outpatient care. The overall results varied by setting and clinical topic, but generally the findings are that telehealth improved outcomes or that there was no difference between telehealth and the comparators. Remote intensive care unit (ICU) consultations likely reduce ICU and total hospital mortality with no significant difference in ICU or hospital length of stay; specialty telehealth consultations likely reduce the time patients spend in the emergency department; telehealth for emergency medical services likely reduces mortality for patients with heart attacks, and remote consultations for outpatient care likely improve access and a range of clinical outcomes (moderate strength of evidence in favor of telehealth). Findings with lower confidence are that inpatient telehealth consultations may reduce length of stay and costs; telehealth consultations in emergency care may improve outcomes and reduce costs due to fewer transfers and also may reduce outpatient visits and costs due to less travel (low strength of evidence in favor of telehealth). Current evidence reports no difference in clinical outcomes with inpatient telehealth specialty consultations, no difference in mortality but also no difference in harms with telestroke consultations, and no difference in satisfaction with outpatient telehealth consultations (low strength of evidence of no difference). Too few studies reported information on potential harms from outpatient telehealth consultations for conclusions to be drawn (insufficient evidence). An exploratory cost model underscores the importance of perspective and assumptions in using modeling to extend evidence and the need for more detailed data on costs and outcomes when telehealth is used for consultations. For example, a model comparing telehealth to transfers and in-person neurosurgical consultations for acute traumatic brain injury identified that the impact of telehealth on costs may depend on multiple factors including how alternatives are organized (e.g., if the telehealth and in-person options are part of the same health care system) and whether the cost of a telehealth versus an in-person consultation differ. Conclusions. In general, the evidence indicates that telehealth consultations are effective in improving outcomes or providing services with no difference in outcomes; however, the evidence is stronger for some applications, and less strong or insufficient for others. Exploring the use of a cost model underscored that the economic impact of telehealth consultations depends on the perspective used in the analysis. The increase in both interest and investment in telehealth suggests the need to develop a research agenda that emphasizes rigor and focuses on standardized outcome comparisons that can inform policy and practice decisions.

Management of Infertility


Public Report Complete
Statistics: 151 Studies, 7 Key Questions, 1 Extraction Form,
Date Created: Jan 09, 2019 05:11PM
Description: Objective. Previous studies have demonstrated varying success for treatment of infertility. Much of this literature however does not focus on treatment of women with specific diagnoses. This systematic review evaluated the comparative effectiveness and safety of fertility treatment strategies for (a) women of reproductive age (18-44) who are infertile due to polycystic ovary syndrome (PCOS), endometriosis, unknown reasons, or tubal or peritoneal factors or (b) couples with male factor infertility; and evaluated short- and long-term health outcomes of gamete donors in infertility. Data sources. We searched PubMed®, Embase®, and the Cochrane Database of Systematic Reviews for English-language studies published from January 1, 2007, to October 3, 2018, that reported live birth rates, pregnancy and neonatal outcomes, time to pregnancy, and short-term and long-term adverse outcomes for mothers and children born after infertility treatment. For male and female donors, we searched for studies reporting short- and long-term adverse effects and quality-of-life outcomes. Review methods. Two investigators screened each abstract and full-text article for inclusion; abstracted data; and performed quality ratings, applicability ratings, and evidence grading. Where appropriate, random-effects models were used to compute summary estimates of effects.

Telehealth for Acute and Chronic Care Consultations


Public Report Complete
Statistics: 216 Studies, 5 Key Questions, 1 Extraction Form,
Date Created: Jan 04, 2019 11:05PM
Description: Objectives: To conduct a systematic review to identify and summarize the available evidence about the effectiveness of telehealth consultations and to explore using decision modeling techniques to supplement the review. Telehealth consultations are defined as the use of telehealth to facilitate collaboration between two or more providers, often involving a specialist, or among clinical team members, across time and/or distance. Consultations may focus on the prevention, assessment, diagnosis, and/or clinical management of acute or chronic conditions. Data Sources. We searched Ovid MEDLINE®, the Cochrane Central Register of Controlled Trials (CCRCT), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL®) to identify studies published from 1996 to May 2018. We also reviewed reference lists of identified studies and systematic reviews, and we solicited published or unpublished studies through an announcement in the Federal Register. Data for the model came both from studies identified via the systematic review and from other sources. Methods. We included comparative studies that provided data on clinical, cost, or intermediate outcomes associated with the use of any technology to facilitate consultations for inpatient, emergency, or outpatient care. We rated studies for risk of bias and extracted information about the study design, the telehealth interventions, and results. We assessed the strength of evidence and synthesized the findings using quantitative and qualitative methods. An exploratory decision model was developed to assess the potential economic impact of telehealth consultations for traumatic brain injuries in adults. Results. The search yielded 9,366 potentially relevant citations. Upon review, 8,356 were excluded and the full text of 1,010 articles was pulled for review. Of these, 233 articles met our criteria and were included—54 articles evaluated inpatient consultations, 73 emergency care, and 106 outpatient care. The overall results varied by setting and clinical topic, but generally the findings are that telehealth improved outcomes or that there was no difference between telehealth and the comparators. Remote intensive care unit (ICU) consultations likely reduce ICU and total hospital mortality with no significant difference in ICU or hospital length of stay; specialty telehealth consultations likely reduce the time patients spend in the emergency department; telehealth for emergency medical services likely reduces mortality for patients with heart attacks, and remote consultations for outpatient care likely improve access and a range of clinical outcomes (moderate strength of evidence in favor of telehealth). Findings with lower confidence are that inpatient telehealth consultations may reduce length of stay and costs; telehealth consultations in emergency care may improve outcomes and reduce costs due to fewer transfers and also may reduce outpatient visits and costs due to less travel (low strength of evidence in favor of telehealth). Current evidence reports no difference in clinical outcomes with inpatient telehealth specialty consultations, no difference in mortality but also no difference in harms with telestroke consultations, and no difference in satisfaction with outpatient telehealth consultations (low strength of evidence of no difference). Too few studies reported information on potential harms from outpatient telehealth consultations for conclusions to be drawn (insufficient evidence). An exploratory cost model underscores the importance of perspective and assumptions in using modeling to extend evidence and the need for more detailed data on costs and outcomes when telehealth is used for consultations. For example, a model comparing telehealth to transfers and in-person neurosurgical consultations for acute traumatic brain injury identified that the impact of telehealth on costs may depend on multiple factors including how alternatives are organized (e.g., if the telehealth and in-person options are part of the same health care system) and whether the cost of a telehealth versus an in-person consultation differ. Conclusions. In general, the evidence indicates that telehealth consultations are effective in improving outcomes or providing services with no difference in outcomes; however, the evidence is stronger for some applications, and less strong or insufficient for others. Exploring the use of a cost model underscored that the economic impact of telehealth consultations depends on the perspective used in the analysis. The increase in both interest and investment in telehealth suggests the need to develop a research agenda that emphasizes rigor and focuses on standardized outcome comparisons that can inform policy and practice decisions.

Long-term Drug Therapy and Drug Holidays for Osteoporosis Fracture Prevention: A Systematic Review [Entered Retrospectively]


Public Report Complete
Statistics: 59 Studies, 8 Key Questions, 1 Extraction Form,
Date Created: Dec 04, 2018 09:34PM
Description: Objective. To summarize evidence on outcomes of long-term osteoporosis drug therapy to prevent fractures, on continuing versus discontinuing osteoporosis drug therapy (i.e., placebo drug holidays), and on whether osteoporosis drug intervention effects vary as a function of patient, bone, or drug characteristics. Data sources. MEDLINE, Embase and Cochrane databases from 1995 to June 2018; ClinicalTrials.gov; bibliographies of relevant systematic reviews Review methods. Long-term osteoporosis drug therapy was defined as >3 years and drug holiday as osteoporosis drug discontinuation for ≥1 year after ≥1 year of prior osteoporosis drug use. Two reviewers independently rated risk of bias (ROB) and strength of evidence (SOE), resolving discrepancies by consensus. Included studies were English-language trials for incident fractures and harms and controlled observational studies for additional harms outcomes. For low or medium ROB studies, one reviewer extracted data and a second verified accuracy. Results. Of 56 eligible publications, 44 had low or medium ROB, including 32 publications of trials (7 unique studies) and 12 publications of observational studies (10 unique studies). Nearly all studies were comprised of postmenopausal women. Mean participant age was 72 years; all but 2 studies had a mean age <80 years. In postmenopausal women with osteoporosis, compared with placebo, 4 years of alendronate or raloxifene reduced risk of incident vertebral fractures (high SOE), 4 years of alendronate reduced risk of incident clinical fractures (moderate SOE). In postmenopausal women with past fractures, compared with placebo, both long-term estrogen and long-term estrogen/progestin reduced risk of incident clinical fractures and long-term estrogen reduced risk of incident hip fractures (all low SOE). Alendronate, denosumab and raloxifene for 4 years each significantly increased total hip and lumbar spine bone mineral density (BMD) versus placebo. Continuation versus discontinuation of alendronate after 5 years reduced risk of incident clinical vertebral fractures in one large trial (10 vs. 5 years, moderate SOE), but not in another smaller trial (7 vs. 5 years, low SOE). Continuation versus discontinuation of zoledronic acid (6 vs. 3 years) reduced risk of incident radiographic vertebral fractures (moderate SOE), but evidence was insufficient about risk of incident clinical vertebral fractures. Neither alendronate nor zoledronic acid continuation reduced risk of nonvertebral fractures (low SOE) versus discontinuation; for both, continuation was associated with generally stable hip BMD compared to small, but significant declines with discontinuation. Based primarily on observational studies, long-term bisphosphonates may increase risks of radiologically confirmed atypical femoral fractures (AFF), subtrochanteric or femoral shaft fractures without confirmed AFF features, and osteonecrosis of the jaw (ONJ). Limitations. Minimal data for men or individuals with comorbidities. Low power to assess risks of incident clinical fractures. No data compared long-term effects of sequential treatments (e.g., anabolic followed by anti-resorptive) or different durations of drug holidays. Analyses of possible treatment effect modifiers almost entirely post hoc. Observational studies used variable drug treatment and control exposures and harms definitions. Conclusions. For postmenopausal women with osteoporosis by BMD or past fractures, long-term alendronate and raloxifene reduced risk of incident vertebral fractures; long-term alendronate, estrogen, and estrogen/progestin reduced risk of clinical fractures; and long-term estrogen reduces risk of incident hip fractures. Longer-term use of bisphosphonates versus discontinuation may lower vertebral fracture risk and stabilize hip BMD, but doesn’t reduce nonvertebral fracture risk and may increase risk of AFF and ONJ. Long-term estrogen and estrogen/progestin increased risk of cardiovascular disease, and long-term estrogen increased risk of dementia and breast cancer. To address remaining knowledge gaps, future trials and observational studies should enroll diverse populations (sex, comorbidity), examine the effects of sequential treatments and compare drug holidays of different durations, be powered for clinical fractures, and use standard AFF and ONJ definitions. A priori analyses to examine whether treatment outcomes vary by patient, bone and drug treatment characteristics may inform individualized treatment decisions.



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The data contained in this project are distributed under the terms of the Creative Commons Attribution-NonCommerical license, which permits the use, dissemination, and reproduction in any medium, provided the original work is properly cited, and that the use is non-commercial and otherwise in compliance with the license. See: https://creativecommons.org/licenses/by-nc/3.0/

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