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Completed Systematic Reviews




Care Interventions for People Living With Dementia (PLWD) and Their Caregivers [Entered Retrospectively]


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Statistics: 634 Studies, 1 Key Question, 1 Extraction Form,
Date Published: Sep 25, 2020 01:08PM
Description: Structured Abstract Objective. To understand the evidence base for care interventions for people living with dementia (PLWD) and their caregivers, and to assess the potential for broad dissemination and implementation of that evidence. Data sources. We searched Ovid Medline, Ovid Embase, Ovid PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials, nonrandomized controlled trials, and quasi-experimental designs published and indexed in bibliographic databases through March, 2020. Review methods. We searched for nondrug interventions targeting PLWD, their informal or formal caregivers, or health systems. Two investigators screened abstracts and full-text articles of identified references for eligibility. Eligible studies included randomized controlled trials and quasi-experimental observational studies enrolling people with Alzheimer’s disease or related dementias or their informal or formal caregivers. We extracted basic study information from all eligible studies. We assessed risk of bias, and summarized results for studies not judged to be NIH Stage Model 0 to 2 (pilot or small sample size studies) or to have high risk of bias. We grouped interventions into categories based on intervention target. Results. We identified 9217 unique references, of which 627 unique studies with an additional 267 companion articles were eligible. We classified interventions into 37 major categories. With few exceptions, we did not combine data quantitatively due to variability of interventions, comparison groups, outcomes measured, and study timing. Low-strength evidence shows that an intensive multicomponent intervention for informal caregiver support, with education, group discussion, in-home and phone support, and caregiver feedback (i.e. discrete adaptations of REACH II), may improve informal caregiver depression at 6 months. Low-strength evidence also shows that collaborative care models (i.e. Care Ecosystems or discrete adaptations of the ACCESS models) may improve quality of life for PLWD and health system-level markers, including improvements in guideline-based quality indicators and reducing emergency room visits. The literature does not allow for further determination of whether the very small to small average effects in quality of life applied to all enrolled PLWD or if larger effects were concentrated in an unidentified subgroup. For all other interventions and outcomes, we found the evidence insufficient to draw conclusions. Insufficient evidence does not mean that the intervention is determined to be of no value to PLWD or their caregivers. Rather, it means that due to the uncertainty of the evidence, we could not draw meaningful conclusions at this time. Conclusions. Despite hundreds of studies, very little evidence supports widespread dissemination of any general care approaches for PLWD or caregivers. This review demonstrates the need for larger, longer-term, and more rigorous studies of interventions.
Contributor(s): Mary Butler, Ph.D., M.B.A. Joseph E. Gaugler, Ph.D. Kristine M.C. Talley, Ph.D., R.N., G.N.P.-B.C., F.G.S.A. Hamdi I. Abdi, M.P.H. Priyanka J. Desai, Ph.D., M.S.P.H. Susan Duval, Ph.D. Mary L. Forte, Ph.D., D.C. Victoria A. Nelson, M.Sc. Weiwen Ng, M.P.H. Jeannine M. Ouellette, M.F.A. Edward Ratner, M.D. Jayati Saha, Ph.D., M.P.H. Tetyana Shippee, Ph.D. Brittin L. Wagner, Ph.D. Timothy J. Wilt, M.D., M.P.H. Lobsang Yeshi, M.Sc.
DOI: DOI pending.
Funding Source: AHRQ Contract No. 290-2015-00008-I
Methodology Description: None Provided

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The diagnostic accuracy of digital PCR, ARMS and NGS for detecting KRAS mutation in cell-free DNA of patients with colorectal cancer: a systematic review and meta-analysis


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Statistics: 33 Studies, 1 Key Question, 1 Extraction Form,
Date Published: Sep 22, 2020 12:18PM
Description: It is required to determine KRAS mutation status in tumor before anti-EGFR therapy is given to patients with colorectal cancer. However, in some recurrent or metastatic colorectal cancer patients, tumor tissue is not available. As an alternative, KRAS mutation detection in cell-free DNA/liquid biopsy samples has been intensively studied using highly sensitive methods. The aim of this systemic review and meta-analysis was to investigate the accuracy of KRAS mutation detection in cell-free DNA sample from patients with colorectal cancer, compared to paired tissue sample.
Contributor(s): Peng Ye, MD, PhD, Peiling Cai, PhD, Jing Xie, MD, Yuanyuan Wei, MD, PhD
DOI: DOI pending.
Funding Source: National Natural Science Foundation of China
Methodology Description: Literature search was performed in Pubmed, Embase, and Cochrane Library. After removing duplicates from the 170 publications found during literature search, eligible studies were identified using the following exclusion criteria: 1) not a human study; 2) not describing KRAS mutation; 3) no liquid biopsy samples or tissue samples included; 4) did not use any techniques among digital PCR, ARMS and NGS; 5) not colorectal cancer; 6) reviews, abstracts, letter to the editor, comments, case reports, or studies with un-interpretable data. Quality of the publications and relevant data were assessed and extracted by two independent researchers. Meta-DiSc and STATA software were used to pool the accuracy parameters from the extracted data.

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Management of Primary Headache During Pregnancy


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Statistics: 52 Studies, 4 Key Questions, 2 Extraction Forms,
Date Published: Aug 18, 2020 08:48PM
Description: This systematic review will assess the prevention and treatment of primary headache during pregnancy, postpartum, and breastfeeding.
Contributor(s): Brown University Evidence-based Practice Center
DOI: DOI pending.
Funding Source: Agency for Healthcare Research and Quality
Methodology Description: A full systematic review

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Management of Acute Diverticulitis


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Statistics: 77 Studies, 4 Key Questions, 2 Extraction Forms,
Date Published: Aug 18, 2020 08:48PM
Description: Purpose of the Review The American College of Physicians (ACP) nominated the topic of management of acute diverticulitis to the Agency for Healthcare Research and Quality for systematic review. 45, 46 The ACP develops guidelines based on the needs of its members and the internal medicine community.47 The scope of the current systematic review was developed to support the ACP in its effort to create a new clinical practice guideline that will address diagnosis and staging of acute diverticulitis, nonsurgical treatment of acute diverticulitis, colorectal cancer screening in people with a history of diverticulitis, and interventions to prevent recurrence of acute diverticulitis. Specifically, (1) the systematic review will summarize existing systematic reviews on the test accuracy of CT imaging for diagnosis and staging of acute diverticulitis and conduct a de novo review of harms related to false positive, false negative, and incidental findings on CT imaging for suspected acute diverticulitis; (2) it will address effectiveness, comparative effectiveness, and harms of hospitalization for acute uncomplicated diverticulitis, antibiotics use for acute complicated or uncomplicated diverticulitis, and interventional radiology techniques for acute complicated diverticulitis; (3) it will review the benefits and harms of colonoscopy in people with a history of diverticulitis; and (4) it will evaluate pharmacologic, nonpharmacologic, and elective surgical interventions to prevent recurrent diverticulitis. Of note, this review will not evaluate the need for, or the choice of, surgery for the patient with acute diverticulitis. The intended audience includes guideline developers, clinicians and other providers of care for patients with diverticulitis, healthcare policy makers, and patients.
Contributor(s): Brown Evidence-based Practice Center
DOI: DOI pending.
Funding Source: AHRQ
Methodology Description: Systematic Review

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Therapies for Clinically Localized Prostate Cancer [Entered Retrospectively]


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Statistics: 67 Studies, 1 Key Question, 1 Extraction Form,
Date Published: Aug 10, 2020 12:58PM
Description: Structured Abstract Objective. To identify new information that updates findings from previous AHRQ and AUA funded reviews evaluating therapies for clinically localized prostate cancer (CLPC). Sources. Bibliographic databases (2013-January 2020); ClinicalTrials.gov; systematic reviews Methods. Controlled studies of CLPC (T1-T3a) treatments with duration ≥5 years for mortality and metastases and ≥1 year for quality of life and harms. Interventions included watchful waiting (WW), active surveillance or monitoring (AS, AM), androgen deprivation (AD), focal and whole gland therapies or combinations. We evaluated how patient and tumor characteristics modify treatment outcomes and how provider/hospital characteristics modify effectiveness of radical prostatectomy (RP) compared to other therapies. One investigator rated risk of bias (ROB), extracted data, and assessed certainty of evidence; a second checked accuracy. We analyzed English-language studies with low or medium ROB. We incorporated findings from RCTs identified in the 2014 AHRQ and 2016 AUA funded reviews if new RCTs provided information on the same intervention comparison. We derived thresholds defining “small”, “moderate” and “large” effect, summarize key findings from prior reviews and the impact of new research. Results. We identified 67 eligible references; 17 unique RCTs. Among clinically, rather than PSA detected CLPC, WW may increase overall and prostate-cancer mortality, and metastases versus RP at 20+ years. Urinary and erectile dysfunction were lower with WW versus RP. WW‘s effect on mortality may have varied by tumor risk and age but not by race, health status, comorbidities or PSA. AM probably results in little to no difference in overall or prostate-cancer mortality in PSA detected CLPC versus RP or EBR plus AD through 10 years regardless of tumor risk. Metastases were infrequent but slightly higher with AM. Harms were greater with RP than AM and mixed between EBR plus AD versus AM. 3D-Conformal EBR and AD plus low-dose-rate brachytherapy (BT) provided a small reduction in all-cause mortality versus 3D-CRT and AD but little to no difference on metastases. EBR plus AD versus EBR alone may have resulted in a small reduction in overall and prostate-cancer mortality and metastases in higher risk disease but may increase sexual harms. EBR plus initiating neoadjuvant AD versus EBR plus initiating concurrent AD may result in little to no difference in mortality at 12 years and genitourinary toxicity at 3 years. Conventionally fractionated EBR versus ultra-hypofractionated EBR may result in little to no difference in mortality and metastasis at 5 years and urinary and bowel toxicity at 2 years. Limited evidence suggested that AS results in fewer harms than photodynamic therapy and laparoscopic RP resulted in more harms than robotic-assisted RP. There was little to no information on long-term comparative effectiveness of other treatments. No studies evaluated WW or AS in screen detected CLPC or MRI for risk assessment or were conducted since effective pharmacologic therapies for advanced disease. No studies assessed provider or hospital factors of RP comparative effectiveness. Conclusions. RP reduces mortality versus WW in clinically detected CLPC but causes more harms. Effectiveness may be limited to younger men, those with intermediate risk disease and requires many years to occur. AM results in little to no mortality difference versus RP or EBR plus AD. EBR plus AD reduces mortality versus EBR alone in higher risk CLPC but may worsen sexual function. Adding low-dose-rate BT to 3D-Conformal EBR and AD may reduce mortality in higher risk CLPC. Little information exists on other treatments or the effects of patient, tumor and provider factors. Large, long-term RCTs in PSA-detected and MRI staged CLPC are needed.
Contributor(s): Philipp Dahm, M.D., M.H.S.C. Michelle Brasure, Ph.D., M.S.P.H., M.L.I.S. Elizabeth Ester, M.D. Eric J. Linskens, B.S. Roderick MacDonald, M.S. Victoria A. Nelson, M.Sc. Charles Ryan, M.D. Jayati Saha, Ph.D. Shahnaz Sultan, M.D., M.H.S.C. Kristen E. Ullman, M.P.H. Timothy J. Wilt, M.D., M.P.H.
DOI: DOI pending.
Funding Source: AHRQ Contract HHSA290201500008I
Methodology Description: None Provided

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