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Completed Systematic Reviews




Screening for Hepatitis C Virus Infection in Adolescents and Adults: A Systematic Review Update for the U.S. Preventive Services Task Force [Entered Retrospectively]


Public Project Complete

Statistics: 94 Studies, 9 Key Questions, 1 Extraction Form,
Date Published: Mar 13, 2020 01:58PM
Description: Background: Prior reviews on hepatitis C (HCV) infection screening and treatment used by the U.S. Preventive Services Task Force (USPSTF) to inform its 2013 recommendation found interferon-containing antiviral therapies associated with sustained virologic response (SVR) rates of 68 percent to 78 percent and an association between SVR after antiviral therapy and improved clinical outcomes. Interferon-containing regimens were associated with a high rate of harms. Since the prior reviews, interferon-containing antiviral therapies have been replaced by all-oral direct acting antiviral (DAA) regimens. Purpose: To systematically review the evidence on screening for HCV infection in asymptomatic adults and adolescents, including effects of DAA regimens and interventions to prevent mother-to-child transmission. Data Sources: We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Ovid MEDLINE and ClinicalTrials.gov through February 2019, manually reviewed reference lists, and conducted literature surveillance through November 22, 2019. Study Selection: Randomized controlled trials (RCTs), non-randomized trials, and cohort studies of HCV screening, antiviral therapy, and interventions to prevent mother-to-child transmission of HCV infection on SVR and clinical outcomes; and cohort studies on the association between an SVR after antiviral therapy versus no SVR and clinical outcomes. Treatment studies focused on populations without cirrhosis who are more likely to be asymptomatic and identified by screening. Data Extraction: One investigator abstracted data, and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): No study evaluated the benefits of HCV screening versus no screening, or the yield of repeat versus one-time screening. Previously reviewed studies found that HCV screening might be associated with negative psychological and social consequences, but had important methodological limitations; no new studies were identified. One new study found similar diagnostic yield of risk-based and birth cohort screening, but it was retrospective and assumed perfect implementation of risk-based screening. Ten trials reported improvements in some quality of life and functional outcomes following DAA treatment compared with prior to treatment, but differences were small, studies were open-label, and there was no non-DAA comparison group. Forty-nine trials found DAA regimens associated with pooled SVR rates that ranged from 95.5 percent to 98.9 percent across genotypes; rates of serious adverse events (1.9%) and withdrawal due to adverse events (0.4%) were low. Seven trials reported SVR rates in adolescents with DAA therapy similar to those observed in adults. An SVR after antiviral therapy was associated with decreased risk of all-cause mortality (13 studies, pooled hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.28 to 0.56), liver mortality (4 studies, pooled HR 0.11, 95% CI, 0.04 to 0.27), cirrhosis (4 cohorts in 3 studies, pooled HR 0.36, 95% CI, 0.33 to 0.40), and hepatocellular carcinoma (20 studies, pooled HR 0.29, 95% CI, 0.23 to 0.38) versus no SVR, after adjustment for potential confounders. New evidence on interventions to reduce the risk of mother-to-infant transmission was limited and did not change the conclusion from the prior review that no intervention has been clearly demonstrated to reduce risk. Limitations: Most DAA trials were not randomized and did not have a non-DAA comparison group, almost all DAA trials relied on SVR as the main efficacy outcome, observational studies varied in how well they adjusted for confounders, and few studies evaluated the effectiveness of DAA regimens in adolescents. Conclusions: The USPSTF previously determined that HCV screening is highly accurate. Currently recommended all-oral DAA regimens are associated with very high SVR rates (95.5% to 98.9% across genotypes) and few harms relative to older antiviral therapies. An SVR after antiviral therapy is associated with improved clinical outcomes compared with no SVR, after adjusting for potential confounders. Direct evidence on the benefits of HCV screening remains unavailable, and direct evidence on the effects of antiviral therapy on clinical outcomes remains limited but indicates improved long-term outcomes.
Contributor(s): Roger Chou, MD, FACP Tracy Dana, MLS Rongwei Fu, PhD Bernadette Zakher, MBBS, MPH Jesse Wagner, MA Shaun Ramirez, MPH, CPH Sara Grusing, BA Janice H. Jou, MD, MHS
DOI: DOI pending.
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. HHSA 290201500009I, Task Order No. 7)
Methodology Description: Study Selection: Randomized controlled trials (RCTs), non-randomized trials, and cohort studies of HCV screening, antiviral therapy, and interventions to prevent mother-to-child transmission of HCV infection on SVR and clinical outcomes; and cohort studies on the association between an SVR after antiviral therapy versus no SVR and clinical outcomes. Treatment studies focused on populations without cirrhosis who are more likely to be asymptomatic and identified by screening. Data Extraction: One investigator abstracted data, and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF.

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Labor Dystocia


Public Project Complete

Statistics: 158 Studies, 9 Key Questions, 1 Extraction Form,
Date Published: Feb 27, 2020 06:46PM
Description: Objectives: This review evaluates the comparative effectiveness of different strategies for treating labor dystocia in women with otherwise uncomplicated pregnancies. Data Sources: We searched PubMed®, Embase®, CINAHL®, and the Cochrane Database of Systematic Reviews (CDSR), limiting the searches to studies in the English-language and comparative studies published from January 1, 2005, to February 15,2019. Review Methods: Two investigators screened each abstract and full-text article for inclusion, abstracted data, rated quality and applicability, and graded evidence. When possible, random-effects models were used to compute summary estimates of effects.
Contributor(s): Evan R. Myers, M.D., M.P.H. Gillian D Sanders Ph.D. Remy R. Coeytaux, M.D., Ph.D. Kara A. McElligott, M.D., M.P.H. Patricia G. Moorman, Ph.D., M.S.P.H. Karen Hicklin, Ph.D. Chad Grotegut, M.D., M.H.SC. Margaret Villers, M.D. Adam Goode, DPT, Ph.D. Hilary Campbell, Pharm.D., J.D. Deanna Befus, Ph.D. Amanda J. McBroom, Ph.D. J. Kelly Davis, B.A. Kathryn Lallinger, M.S.L.S. Robyn Fortman, B.A. Andrzej Kosinski, Ph.D.
DOI: DOI pending.
Funding Source: Agency for Healthcare Research and Quality (AHRQ)
Methodology Description: We searched PubMed®, Embase®, CINAHL®, and the Cochrane Database of Systematic Reviews (CDSR), limiting the searches to studies in the English-language and comparative studies published from January 1, 2005, to February15,2019. 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/labor-dystocia/research-protocol) for full details.

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Impact of Community Health Worker Certification on Workforce and Service Delivery for Asthma and Other Selected Chronic Conditions


Public Project Complete

Statistics: 74 Studies, 2 Key Questions, 2 Extraction Forms,
Date Published: Jan 10, 2020 03:37PM
Description: Technical brief
Contributor(s): Wilson, McArthur, Ibe, Brodine
DOI: DOI pending.
Funding Source: AHRQ
Methodology Description: None Provided

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Achieving Health Equity in Preventive Services


Public Project Complete

Statistics: 85 Studies, 5 Key Questions, 1 Extraction Form,
Date Published: Dec 18, 2019 03:34PM
Description: To summarize research on achieving health equity in ten preventive services for cancer, cardiovascular disease, and diabetes in adults for a National Institutes of Health Pathways to Prevention Workshop by identifying the effects of impediments and barriers that create disparities and the effectiveness of interventions to reduce them.
Contributor(s): Heidi D. Nelson, M.D., M.P.H., M.A.C.P., F.R.C.P. Amy Cantor, M.D., M.P.H. Jesse Wagner, M.A. Rebecca Jungbauer, Dr.P.H., M.P.H, M.A. Ana Quiñones, Ph.D., M.S. Rongwei Fu, Ph.D. Lucy Stillman, B.S. Karli Kondo, Ph.D., M.A
DOI: DOI pending.
Funding Source: AHRQ Contract No. HHSA2902015000091
Methodology Description: Eligible abstracts and full-text articles were independently dual-reviewed for inclusion using pre-established criteria. Data were abstracted into evidence tables and verified for accuracy and completeness. Risk of bias and applicability of studies were independently dual-rated using established criteria; disagreements were resolved by consensus. Strength of evidence and applicability for each Key Question and outcome were assessed through consensus using established methods. A profile likelihood random effects model was used for meta-analysis.

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Systematic reviews on interventions for corneal disease: What is the reliability of the evidence?


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Statistics: 254 Studies, 1 Key Question, 1 Extraction Form,
Date Published: Nov 13, 2019 03:49PM
Description: Although a number of systematic reviews on corneal disease have been published, the reliability of these reviews remains unclear. We will characterize and appraise the methodological reliability of systematic reviews on interventions for corneal disease. The purpose of our study is to evaluate the current available evidence on interventions for corneal disease, state the strengths and limitations and formulate recommendations for improving future review conduct.
Contributor(s): None Provided
Funding Source: National Eye Institute
Methodology Description: None Provided

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