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The purpose of this page is to bring all the links to outside articles and web pages onto one page for ease of use and to point Radiographers in the direction of information that may be of great importance to them and the profession or just show them articles that may be of interest to them.
Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis
The authors concluded that there was a modest increase in survival over five years in patients with gastric cancer for adjuvant fluorouracil chemotherapy compared with surgery alone. This conclusion reflected the evidence presented and is likely to be reliable. However, the other eligible chemotherapy regimens were indistinguishable from fluorouracil.
The review was published in JAMA in 2010. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12010002842
Tiny url
http://tinyurl.com/2vhzrar
Can a wire-guided cannulation technique increase bile duct cannulation rate and prevent post-ERCP pancreatitis? A meta-analysis of randomized controlled trials
The authors concluded that the wire-guided technique increased the primary cannulation rate and reduced risk of post endoscopic retrograde cholangiopancreatography pancreatitis compared with the standard contrast injection method. Large well-performed randomised controlled trials were needed to confirm the findings. The authors' conclusions reflected the evidence presented and appear reliable.
The review was published in the American Journal of Gastroenterology in 2009. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009108858
Tiny url
http://tinyurl.com/32y4ym3
Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media: meta-analysis of randomized controlled trials
This generally well-conducted review concluded that iodixanol was not associated with a reduced risk of contrast media-induced nephrotoxicity compared with low-osmolar contrast media, except in patients with intra-arterial administration and renal insufficiency. The authors' conclusions reflected the results of the review and should be reliable, but differences between the interventions were not fully explored.
The review was published in Radiology in 2009. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009102979
Tiny url
http://tinyurl.com/2brre6d
Sham feed or sham? A meta-analysis of randomized clinical trials assessing the effect of gum chewing on gut function after elective colorectal surgery
This review of gum chewing after elective colorectal surgery concluded that there was no convincing evidence that was beneficial for earlier gut function recovery and it did not reduce hospital stay or postoperative complications. Due to significant clinical, methodological and statistical heterogeneity, the meta-analysis results may not be reliable. But the overall conclusion appears suitably cautious.
The review was published in the International Journal of Colorectal Disease in 2009. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009104701
Tiny url
http://tinyurl.com/39hns2z
Diagnostic testing for celiac disease among patients with abdominal symptoms: a systematic review
This review assessed diagnostic accuracy of tests for coeliac disease in adults who presented with abdominal symptoms in primary care or similar settings and concluded that Immunoglobulin-A anti-tissue transglutaminase antibodies and Immunoglobulin-A anti-endomysial antibodies showed good diagnostic performance. The authors' conclusions appear to reflect the evidence, but there may have been some bias in the included studies and review process.
The review was published in JAMA in 2010. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12010002843
Tiny url
http://tinyurl.com/2wqc7wp
Cost-effectiveness of 5-aminosalicylic acid therapy for maintenance of remission in ulcerative colitis
The objective was to assess the cost-effectiveness of 5-aminosalicylic acid (mesalazine) therapy for the maintenance of remission in ulcerative colitis. The authors concluded that maintenance mesalazine therapy might decrease the risk of flare-ups, but its cost was considerable, and cost-effectiveness depended on society’s willingness to pay. The methods were good and were reported in detail, as were the results. The authors’ conclusions appear to be valid for the scope of the analysis.
The study was published in Gastroenterology in 2006. To view the full NHS EED abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=22009100567
Tiny url
http://tinyurl.com/36z5x26
N Engl J Med 2010;362:1795-803
Quality Indicators for Colonoscopy and the Risk of Interval Cancer
http://content.nejm.org/cgi/content/abstract/362/19/1795
The Polish national screening programme uses colonoscopy to find and treat asymptomatic colorectal cancers and adenomatous polyps. Between 2000 and 2004, 186 endoscopists did the screening tests, and some were better than
others at finding adenomas. A detection rate below 20% (adenomatous lesions
reported in less than one in five patients) was one of the few independent
predictors of interval cancers in a study from the Polish programmeGo. The
detection rate for adenomas is already a popular quality indicator for
endoscopists, say the authors. These data suggest it is a good one, unlike
caecal intubation rate, which is another widely used indicator that wasn't
associated with risk of interval cancers in this study.
The authors analysed data from 45 026 men and women who were screened
successfully, had adequate bowel preparation, and were cleared of all
visible disease. Forty two people, screened by 32 endoscopists, developed an
interval cancer between their first colonoscopy and the scheduled time of
their next one, three to five years later. After multiple adjustments, the
authors found a significant association between interval cancers and
endoscopists with a relatively poor track record of finding adenomas-hazard
ratios were greater than 10 (although confidence intervals were wide) for
all categories of detection rate below 20%. They weren't able to explore the
effect of endoscopists' experience on risk of interval cancers, because
experience is inaccurately recorded in the screening programme's database.
Should WOC nurses measure health-related quality of life in patients undergoing intestinal ostomy surgery?
This review concluded both that intestinal ostomy surgery had a clinically impact on health-related quality of life and that nursing interventions can ameliorate this effect. Several methodological limitations and the limited quantity and uncertain quality of the retrieved evidence undermine the reliability of these conclusions.
The review was published in the Journal of Wound Ostomy and Continence Nursing in 2009. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009108384
Tiny url
http://tinyurl.com/y9thfnp
Systematic review: standard- and double-dose proton pump inhibitors for the healing of severe erosive oesophagitis - a mixed treatment comparison of randomized controlled trials
This review concluded that 40mg esomeprazole appeared to have higher healing rates than licensed standard- and double-dose proton pump inhibitors, for severe erosive oesophagitis. The evidence presented appeared to support these conclusions, but the reliance on indirect mixed treatment comparisons and the poor reporting of trial characteristics, make it difficult to assess the reliability of the findings.
The review was published in Alimentary Pharmacology and Therapeutics in 2009. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009109195
Tiny url
http://tinyurl.com/ya3h5g3
08 July 2009 - Comprehensive review of procedures for total colonic aganglionosis
The Author’s concluded that operative techniques for treating total colonic aganglionosis were comparable in terms of mortality, morbidity, enterocolitis and functional outcome. However these conclusions should be regarded with some caution, due to a lack of good-quality evidence, the presence of heterogeneity in the study findings and weaknesses in the review methods.
The review was published in Journal of Pediatric Surgery in 2009. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009102603
Tiny url
http://tinyurl.com/l9x23u
Effectiveness of probiotics in the treatment of irritable bowel syndrome
The authors of this review of randomised controlled trials concluded that probiotics may improve symptoms in patients with irritable bowel syndrome, but that benefits were uncertain and further research was required. These cautious conclusions appear to reflect the evidence presented, but the limited search, lack of reporting of review methods and an incomplete validity assessment made it difficult to comment on reliability.
The review was published in Pharmacotherapy in 2008. To view the full DARE abstract and access the PubMed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12008106445
Tiny url
http://tinyurl.com/lrhef3
The following titles have recently been added to the HTA Database.
Please note, these records are bibliographic references only and the quality of the technology appraisals has not been assessed by CRD.
Detection of deamidated gliadin peptides for the diagnosis of celiac disease
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=32009100170
Bevacizumab for the treatment of patients with advanced colorectal cancer
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=32009100107
Celiac disease screening
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=32009100174
Cetuximab for the management of advanced colorectal cancer
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=32009100108
Infliximab in Crohn disease
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=32009100189
Natural orifice translumenal endoscopic surgery NOSLA
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=32009100177
Usefulness of multislice computed tomography for the assessment of liver metastases
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=32009100110
- BMJ paper of GI related interest:
Research: Imaging strategies for detection of urgent conditions in
patients
with acute abdominal pain: diagnostic accuracy study
http://www.bmj.com/cgi/content/abstract/338/jun26_2/b2431?papetoc
Editorial: Imaging in patients with acute abdominal pain
http://www.bmj.com/cgi/content/full/338/jun26_2/b1678
PS Thought you two might be interested in this methods paper:
The impact of measuring patient-reported outcomes in clinical practice: a
systematic review of the literature
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12008103445
BMJ paper of GI related interest:
Research: Imaging strategies for detection of urgent conditions in
patients with acute abdominal pain: diagnostic accuracy study
http://www.bmj.com/cgi/content/abstract/338/jun26_2/b2431?papetoc
Editorial: Imaging in patients with acute abdominal pain
http://www.bmj.com/cgi/content/full/338/jun26_2/b1678
The impact of measuring patient-reported outcomes in clinical practice:
a systematic review of the literature
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12008103445
New HTA Programme project announced:>
The value of Positron-Emission-Tomography (PET) in pre-operative staging of
colorectal cancer.
Link to project: http://www.hta.ac.uk/project/1812.asp?src=alr
One for Irish members:
Ireland's recommended colorectal cancer screening programme will not get
extra government funding
http://www.bmj.com/cgi/content/full/338/jun23_1/b2551
There's also this summary of a JAMA article in the BMJ:
http://www.bmj.com/cgi/content/full/338/jun22_1/b2511?papetoc
Computed tomographic colonography is a reasonable screening option for
some
high risk adults
JAMA 2009;301:2453-61[Abstract/Full Text]
Colonoscopy is the gold standard screening test for adults at risk of
colorectal cancer, but it's invasive and unpleasant. A study from the US
suggests that computed tomographic colonography could be a more
acceptable
alternative for some patient groups.
The new test picked up 151 of the 177 advanced lesions detected by
colonoscopy, and thus had an overall sensitivity of 85.3% (95% CI 79.0%
to
90.0%). Specificity and positive and negative predictive values were
87.8%
(85.2% to 90.0%), 61.9% (55.4% to 68.0%), and 96.3% (94.6% to 97.5%),
respectively. The study included 937 adults with a family history of
colorectal cancer, a personal history of colorectal adenoma, or a
positive
faecal occult blood test. All participants had computed tomographic
colonography immediately followed by colonoscopy.
Computed tomographic colonography is a reasonably accurate alternative
to
colonoscopy, says an editorial (pp 2498-9), although it's too early to
recommend it for all high risk adults. Computed tomography colonography
is
less invasive and more convenient, but there are trade offs including
radiation exposure and a small chance of missing something potentially
lethal. In this study, 26 of the 731 patients cleared by computed
tomographic colonography actually had an advanced adenoma or cancer.
Computed tomographic colonography seemed least useful for the subgroup
with
a positive faecal occult blood test.
25th June 2009 - GIRSIG members might also be interested in this free access BMJ article
and letter:
Risk of colorectal cancer seven years after flexible sigmoidoscopy
screening: randomised controlled trial
http://www.bmj.com/cgi/content/full/338/may29_2/b1846
Letters: Colorectal cancer; Limitations of trial
http://www.bmj.com/cgi/content/full/338/jun23_3/b2531
17th June 2009 - Use of colonic stents in emergent malignant left colonic obstruction.
The objective was to examine the cost-effectiveness of colonic stenting as a bridge to surgery versus surgery alone for emergent, malignant left colonic obstruction in patients with potentially curable colorectal cancer without evidence of metastatic disease. The authors concluded that colonic stenting as a bridge to surgery was more effective and less expensive than emergent surgery, especially in high-risk patients. The study was well conducted and presented. The authors conclusions appear to be valid and robust.
The study was published in Diseases of the Colon and Rectum in 2007. To view the full NHS EED abstract and access the Pubmed record click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=22007002502
Tiny url
http://tinyurl.com/m3dtgn
18th June 2009 - EURORAD NOW IN ARRS GOLDMINER
On the occasion of EURORAD’s admission to the ARRS GoldMiner® search engine, for the first time since its foundation ESR offers free access to EURORAD for everyone! This popular online tool will be freely available for 3 months until mid-September 2009, providing full access to over 3,000 published cases.
http://www.nitgofer.at/_/ov.php?smc=uR/MoXYSIOoFs&smid=15319638
17th June 2009 - As tests evolve and costs of cancer care rise: reappraising stool-based screening for colorectal neoplasia
This study determined the cost-effectiveness of faecal DNA testing every three years, annual faecal occult blood testing (FOBT), annual faecal immunochemical testing (FIT), and colonoscopy every 10 years, as screening strategies for colorectal cancer. Given the current reimbursement for cancer care, FOBT and FIT were the most cost-effective strategies. Generally, the study methodology was valid, although little information on the clinical sources was provided. The authors’ conclusions appear to be valid and enhanced by the comprehensive sensitivity analysis.
The study was published in Alimentary Pharmacology and Therapeutics in 2008. To view the full NHS EED abstract click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=22008100403
Tiny url
http://tinyurl.com/n5wv8p
Meta-analysis of prophylactic corticosteroid use in post-ERCP pancreatitis
This review found that there are no significant benefits in prophylactic corticosteroids in patients scheduled to undergo endoscopic retrograde cholangiopancreatography (ERCP) and/or endoscopic sphincterotomy. Despite poor reporting of some aspects of review methodology the authors’ conclusions were likely to be reliable.
The review was published in BMC Gastroenterology in 2008. To view the full DARE abstract click here.
Full url
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12008102419
Tiny url
http://tinyurl.com/psukto
4th June 2009
QUALITY ASSESSED SYSTEMATIC REVIEW EVIDENCE
The CRD databases, (DARE, NHS EED and HTA) have become a key resource for health professionals, policy makers and researchers around the world. Research evidence evaluating the effects and cost-effectiveness of health care interventions is growing year on year, and can be difficult and time consuming to identify and appraise. The databases assist health professionals by systematically identifying and critically describing systematic reviews and economic evaluations.
The databases can be accessed free of charge from CRD’s website (www.crd.york.ac.uk). Highlighted below are examples of reviews that are likely to be of interest to members of GIRSIG.
________________________________________
Will the history and physical examination help establish that irritable bowel syndrome is causing this patient's lower gastrointestinal tract symptoms?
This review assessed the ability of components of clinical history and physical examination (alone or in combination) to predict a diagnosis of irritable bowel syndrome (IBS) without full investigation of the lower GI tract. The authors' conclusion that individual symptoms and existing diagnostic criteria have only moderate accuracy was a reasonable interpretation of the limited data available.
The review was published in JAMA in 2008. To view the full DARE abstract and access the Pubmed record
click here.
________________________________________
Clinical utility of diagnostic tests for constipation in adults: a systematic review
This review assessed the usefulness of diagnostic tests in the work-up of patients with constipation. The authors concluded that there is a lack of evidence supporting blood tests, radiography and endoscopy, and that further research is required. The limited search strategy and poor reporting of review methodology mean that the completeness and accuracy of the data presented are uncertain.
The review was published in the American Journal of Gastroenterology in 2005. To view the full DARE abstract and access the Pubmed record
click here.
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Cost-effectiveness analysis for determining optimal cut-off of immunochemical faecal occult blood test for population-based colorectal cancer screening.
The study used both a receiver operating characteristics curve analysis and a cost-effectiveness analysis. The authors concluded that screening dominated no screening regardless of the cut-off value of iFOBT and the most cost-effective cut-off was at 110ng/mL. The analysis appears to have been satisfactorily carried out, although an investigation of uncertain areas of the study would have further strengthened the authors’ conclusions.
The review was published in the Journal of Medical Screening in 2007. To view the full NHS EED abstract and access the Pubmed record
click here.
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Colorectal cancer screening: health impact and cost effectiveness.
This study was an update of evidence-based recommendations, made in 2001, on the clinical preventive services for colorectal cancer (CRC) in adults aged 50 years and older. CRC screening was a high-impact, cost-effective health intervention which was underused in US society. The study appears to have been based on valid methodology although it was not extensively reported because the bulk of the methods and findings were presented in a companion paper. The authors’ conclusions appear to be robust.
The review was published in the American Journal of Preventive Medicine in 2006. To view the full NHS EED abstract and access the Pubmed record
click here.
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