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Completed Systematic Reviews




Environmental Cleaning for the Prevention of Healthcare-Associated Infections


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Statistics: 70 Studies, 4 Key Questions, 2 Extraction Forms,
Date Published: Feb 17, 2016 06:30PM
Description: The cleaning of hard surfaces in hospital rooms is essential for reducing the risk of healthcare-associated infections (HAIs). Many methods are available for cleaning and monitoring cleanliness, but their comparative effectiveness is not well understood. This Technical Brief summarizes the evidence base addressing environmental cleaning of high-touch surfaces in hospital rooms and highlights future research directions.
Contributor(s): Brian F. Leas, Nancy Sullivan, Jennifer H. Han, David A. Pegues, Janice L. Kaczmarek, Craig A. Umscheid
Funding Source: Agency for Healthcare Research and Quality (AHRQ)
Methodology Description: Technical Brief

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Sling surgery for stress urinary incontinence in women: SGS 2013


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Statistics: 104 Studies, 2 Key Questions, 2 Extraction Forms,
Date Published: Feb 17, 2016 06:26PM
Description: The SR compares use of different slings versus other surgical interventions to treat stress urinary incontinence in women.
Contributor(s): Society for Gynecologic Surgeons Systematic Review Group sling subgroup
Funding Source: Society for Gynecologic Surgeons
Methodology Description: None Provided

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Behavioral programs for diabetes mellitus


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Statistics: 166 Studies, 6 Key Questions, 2 Extraction Forms,
Date Published: Feb 17, 2016 06:26PM
Description: A systematic review focusing on the effectiveness of behavioral programs for type 1 diabetes (T1DM), and identifying factors contributing to program effectiveness for type 2 diabetes (T2DM).
Contributor(s): Jennifer Pillay, B.Sc. Pritam Chordiya, B.D.S., M.Sc. Sanjaya Dhakal, M.B.B.S., M.P.H. Ben Vandermeer, M.Sc. Lisa Hartling, Ph.D. Marni J. Armstrong, Ph.D., R.C.E.P. Sonia Butalia, M.D., M.Sc. Lois E. Donovan, M.D. Ronald J. Sigal, M.D., M.P.H. Robin Featherstone, M.L.I.S. Megan Nuspl, B.Sc. Donna M. Dryden, Ph.D.
Funding Source: Agency for Healthcare Research and Quality
Methodology Description: Two reviewers independently assessed studies for fit with predetermined selection criteria and assessed risk of bias. We included prospective controlled studies and randomized controlled trials (RCTs) for T1DM and RCTs for T2DM, evaluating behavioral programs compared with usual care, active controls (e.g., didactic education), or other behavioral programs. One reviewer extracted data, with verification by a second reviewer. For T1DM, we conducted pairwise meta-analysis to assess program effectiveness; subgroup analyses to examine patient variables (e.g., age, race/ethnicity, glycemic control); and meta-regressions to assess potential moderators of effectiveness, such as program components (i.e., diabetes self-management education [DSME], DSME plus support, lifestyle), intensity, delivery format, and personnel. For T2DM, we conducted network meta-analysis (incorporating direct and indirect comparisons) to assess potential moderation of program effectiveness, and subgroup analyses to assess the impact of patient variables. Strength of the body of evidence (SOE) for key outcomes in T1DM was assessed to determine our confidence in the results.

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Genetic Testing for Developmental Disabilities, Intellectual Disability, and Autism Spectrum Disorder


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Statistics: 141 Studies, 2 Key Questions, 1 Extraction Form,
Date Published: Feb 17, 2016 06:25PM
Description: Background: Genetics research in recent decades has discovered numerous genetic variants that help explain the etiology of developmental disabilities (DDs). Genetic tests (e.g., array comparative genomic hybridization, sequencing) are rapidly diffusing into clinical practice for diagnosing DDs or, more often, for determining their genetic etiology. An urgent need exists for a better understanding of these tests and their clinical utility. Purpose: This Technical Brief collects and summarizes information on genetic tests that are clinically available in the United States to detect genetic markers that predispose to DDs. It also identifies, but does not systematically review, existing evidence addressing the tests’ clinical utility. This Brief primarily focuses on patients with idiopathic or unexplained DDs, particularly intellectual disability, global developmental delay, and autism spectrum disorder. Several better-defined DD syndromes, including Angelman syndrome, fragile X syndrome, Prader-Willi syndrome, Rett syndrome, Rubinstein-Taybi syndrome, Smith-Magenis syndrome, velocardiofacial syndrome, and Williams syndrome are also included. Patient-centered health outcomes (e.g., functional or symptomatic improvement) and intermediate outcomes (e.g., changes in clinical decisions or family reproductive decisions, the tests’ diagnostic accuracy and analytic validity) are examined. Methods: We sought input from nine Key Informants to identify important clinical, technology, and policy issues from different perspectives. We searched the National Center for Biotechnology Information’s Genetic Testing Registry (GTR) to identify genetic tests. A structured search of studies published since 2000 was performed to identify available evidence that addresses genetic tests’ clinical utility. Findings: Our search of the GTR database identified 672 laboratory-developed tests offered by 63 providers in 29 States. We also identified one test cleared by the U.S. Food and Drug Administration. Common genetic testing methods used include array comparative genomic hybridization, microarray, DNA sequencing (the Sanger method or next-generation sequencing), and polymerase chain reaction. We did not identify any studies that directly assessed the impact of genetic testing on health outcomes. Most of the clinical studies identified for indirect assessment of clinical utility are case series reporting on a test’s diagnostic yield.
Contributor(s): Fang Sun, M.D., Ph.D. Jeff Oristaglio, Ph.D. Susan E. Levy, M.D., M.P.H. Hakon Hakonarson, M.D., Ph.D. Nancy Sullivan, B.A. Joann Fontanarosa, Ph.D. Karen M. Schoelles, M.D., M.S., FACP
Funding Source: AHRQ
Methodology Description: None Provided

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Imaging Techniques for the Diagnosis and Staging of Hepatocellular Carcinoma [Retrospectively Entered]


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Statistics: 281 Studies, 9 Key Questions, 9 Extraction Forms,
Date Published: Feb 17, 2016 06:23PM
Description: Hepatocellular carcinoma (HCC) is the most common primary malignant neoplasm of the liver, and accurate diagnosis and staging of HCC are important for guiding treatment and other clinical decisions. A number of imaging modalities are available for detection of HCC in surveillance and non-surveillance settings, evaluation of focal liver lesions to identify HCC, and staging of HCC. The purpose of this review is to compare the effectiveness of imaging techniques for HCC on test performance, clinical decisionmaking, clinical outcomes, and harms.
Contributor(s): Roger Chou, M.D., FACP Carlos Cuevas, M.D. Rongwei Fu, Ph.D. Emily Beth Devine, Ph.D., Pharm.D., M.B.A. Ngoc Wasson, M.P.H. Alexander Ginsburg, M.A., M.C.R.P. Bernadette Zakher, M.B.B.S. Miranda Pappas, M.A. Elaine Graham, M.L.S. Sean Sullivan, Ph.D.
Funding Source: This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00014-I).
Methodology Description: We used predefined criteria to determine study eligibility. We selected studies of ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) that evaluated test performance for detection of HCC lesions, evaluation of focal liver lesions, or staging of HCC. We also included randomized trials and comparative observational studies on effects of imaging on clinical decisionmaking, clinical outcomes, and harms. The risk of bias (quality) of included studies was assessed, data were extracted, and results were summarized quantitatively (through meta-analysis) and qualitatively. Analyses were stratified by imaging type and unit of analysis (patient or HCC lesion). Additional analyses were conducted to evaluate the effects of the reference standard used and study, patient, tumor, and technical characteristics on estimates of test performance.

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