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Completed Systematic Reviews




Nonsurgical Treatments for Urinary Incontinence in Adult Women: A Systematic Review Update


Public Project Complete

Statistics: 106 Studies, 1 Key Question, 1 Extraction Form,
Date Published: Mar 21, 2019 09:12AM
Description: SR of nonsurgical interventions for stress, urgency, and mixed urinary incontinence in women (excluding neuropathic UI and children). Network meta-analysis of "urinary incontinence outcomes" ("cure", improvement, and satisfaction with the level of incontinence achieved). Qualitative review of quality of life outcomes. Summary of adverse events. This is an update of a 2012 review done by the Minnesota EPC. Available data from eligible studies included in the prior review are uploaded as separate files.
Contributor(s): Brown University Evidence-based Practice Center: Ethan Balk, Gaelen Adam, Peter Jeppson (U New Mexico GYN), Hannah Kimmel, Georgios Markozannes, Iman Saeed, Gowri Raman (Tufts Medical Center [TMC]), Esther Avendano (TMC), Andrew Zullo, Katherine Corsi, Amanda Mogul, Mengyang Di, Valerie Langberg
Funding Source: AHRQ EPC Program
Methodology Description: We updated AHRQ’s 2012 systematic review with new literature searches in MEDLINE, the Cochrane Central Trials Registry, the Cochrane Database of Systematic Reviews, and EMBASE from 2011 through December 4, 2017. We included UI outcomes (cure, improvement, satisfaction), quality of life, and adverse events. For UI outcomes, we conducted network meta-analyses, combining direct and indirect comparisons across studies. Quality of life and adverse event outcomes are narratively described. See full report at AHRQ website for further details.

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Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents


Public Project Complete

Statistics: 90 Studies, 3 Key Questions, 2 Extraction Forms,
Date Published: Mar 21, 2019 09:12AM
Description: Objectives. Attention deficit hyperactivity disorder (ADHD) is a common pediatric neurobehavioral disorder often treated in the primary care setting. This systematic review updates and extends two previous systematic evidence reviews and focuses on the comparative effectiveness of methods to establish the diagnosis of ADHD, updates the comparative effectiveness of pharmacologic and nonpharmacologic treatments, and evaluates different monitoring strategies in the primary care setting for individuals from birth through 17 years of age. Data sources. We searched PubMed®, Embase®, PsycINFO® and the Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1, 2011, through November 7, 2016. Review methods. Two investigators screened each abstract and full-text article for inclusion, abstracted the data, and performed quality ratings and evidence grading. Random-effects models were used to compute summary estimates of effects when sufficient data were available for meta-analysis.
Contributor(s): Alex R. Kemper, M.D., M.P.H, M.S.; Gary R. Maslow, M.D., M.P.H.; Sherika Hill, M.H.A., Ph.D.; Behrouz Namdari, M.D.; Nancy M. Allen LaPointe, Pharm.D., M.H.S.; Adam P. Goode, D.P.T., Ph.D.; Remy R. Coeytaux, M.D., Ph.D.; Deanna Befus, B.A., B.S.N.; Andrzej S. Kosinski, Ph.D.; Samantha E. Bowen, Ph.D.; Amanda J. McBroom, Ph.D.; Kathryn R. Lallinger, M.S.L.S.; Gillian D. Sanders, Ph.D.
Funding Source: Agency for Healthcare Research and Quality (AHRQ)
Methodology Description: We searched MEDLINE® (via PubMed), Embase®, PsycINFO®, and the Cochrane Database of Systematic Reviews (CDSR), limiting the search to studies conducted in children 17 years of age and younger and published from January 1, 2009, to November 7, 2016. Two investigators screened each abstract and full-text article for inclusion, abstracted the data, and performed quality ratings and evidence grading. Random-effects models were used to compute summary estimates of effects. See the review protocol (https://www.effectivehealthcare.ahrq.gov/ehc/products/616/2148/ADHD-Update-protocol-160818.pdf) for full details.

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Diagnostic Accuracy of Screening Tests and Treatment of Post-Acute Coronary Syndrome (ACS) Depression: A Systematic Review


Public Project Complete

Statistics: 10 Studies, 2 Key Questions, 2 Extraction Forms,
Date Published: Mar 21, 2019 09:12AM
Description: Objective: To evaluate (1) the diagnostic accuracy of selected depression screening instruments and strategies versus a validated criterion standard in adult patients within 3 months of an acute coronary syndrome (ACS) event, and (2) the comparative safety and effectiveness of a broad range of pharmacologic and nonpharmacologic treatments for depression in adult patients who have received a criterion-based diagnosis of depression or had clinically important depressive symptoms using a validated depression scale, and who are within 3 months of an ACS event. Data Sources: We searched PubMed®, Embase®, PsycINFO®, CINAHL®, and the Cochrane Database of Systematic Reviews for English-language studies published from January 1, 2003, to April 27, 2017, that evaluated the accuracy of tools for diagnosing depression in patients after ACS or that evaluated interventions for treating post-ACS patients identified with depression. Review Methods: Two investigators individually screened each abstract and full-text article for inclusion; abstracted data; and rated quality, applicability, and strength of evidence. Where appropriate, random-effects models were used to compute summary estimates of effects.
Contributor(s): John W. Williams Jr., M.D., M.H.Sc.; Jason A. Nieuwsma, Ph.D.; Natasha Namdari, M.D. ; Jeffrey B. Washam, Pharm.D.; Giselle Raitz, M.D.; James A. Blumenthal, Ph.D.; Wei Jiang, M.D.; Roshini Yapa, M.B.B.S.; Amanda J. McBroom, Ph.D.; Kathryn Lallinger, M.S.L.S.; Robyn Schmidt, B.A.; Andrzej S. Kosinski, Ph.D.; Gillian D. Sanders, Ph.D.
Funding Source: Agency for Healthcare Research and Quality (AHRQ)
Methodology Description: We searched MEDLINE® (via PubMed), Embase®, PsycINFO®, CINAHL®, and the Cochrane Database of Systematic Reviews (CDSR), limiting the search to articles published from January 1, 2003, to April 27, 2017. Two investigators screened each abstract and full-text article for inclusion, abstracted the data, and performed quality ratings and evidence grading. Random-effects models were used to compute summary estimates of effects. See the review protocol (https://effectivehealthcare.ahrq.gov/topics/acs-depression/research-protocol/) for full details.

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The Role of Immunotherapy in the Treatment of Asthma


Public Project Complete

Statistics: 130 Studies, 4 Key Questions, 2 Extraction Forms,
Date Published: Mar 21, 2019 09:12AM
Description: To evaluate the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in the treatment of allergic asthma
Contributor(s): Sandra Y. Lin, M.D., Antoine Azar, M.D., Catalina Suarez-Cuervo, M.D., Gregory B. Diette, M.D., MHS, Emily Brigham, M.D., Jessica Rice, D.O., MHS, Murugappan Ramanathan, Jr., M.D., F.A.C.S., Jessica Gayleard, B.S. and Karen A. Robinson, Ph.D.
Funding Source: AHRQ and NHLBI
Methodology Description: We searched PubMed, Embase®, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1,2005 through May 8, 2017. We followed the PICOTS framework in developing the criteria for inclusion of studies. Two reviewers independently screened to select randomized controlled trials (RCTs) of the efficacy of SCIT and SLIT and RCTs, observational studies, and case series or case reports on safety. Two reviewers independently assessed the risk of bias for each study and together graded the strength of the evidence.

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


Public Project Complete

Statistics: 59 Studies, 8 Key Questions, 1 Extraction Form,
Date Published: Mar 21, 2019 09:12AM
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.
Contributor(s): Howard A. Fink, M.D., M.P.H. Roderick MacDonald, M.S. Mary L. Forte, Ph.D., D.C. Christina E. Rosebush, M.P.H. Kristine E. Ensrud, M.D., M.P.H. John T. Schousboe. M.D., Ph.D. Victoria A. Nelson, M.Sc. Kristen Ullman, M.P.H. Mary Butler, Ph.D., M.B.A. Carin M. Olson, M.D. Brent C. Taylor, M.P.H., Ph.D. Michelle Brasure, Ph.D., M.S.P.H., M.L.I.S. Timothy J. Wilt, M.D., M.P.H.
Funding Source: Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA2902015000081)
Methodology Description: None Provided

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