Screening for Celiac Disease: A Systematic Review for the U.S. Preventive Services Task Force Agency for Healthcare Research and Quality U.S. Department of Health and Human Services

Agency for Healthcare Research and Quality U.S. Department of Health and Human Services.
Evidence Synthesis Number 144. AHRQ Publication No. 14-05215-EF-1. May 2016.

Background: Unrecognized celiac disease (CD) may have adverse effects on morbidity and mortality. Purpose: To review the evidence on screening for CD in asymptomatic adults, adolescents, and children 3 years of age and older for the United States Preventive Services Task Force.
Data Sources: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to February 2016).
Study Selection: Randomized clinical trials, cohort studies, and case-control studies of screening versus no screening, one screening strategy versus another, treatment versus no treatment, or immediate versus delayed treatment that evaluated clinical outcomes; and studies on diagnostic accuracy of serological tests for CD.
Data Extraction: One investigator abstracted data, a second checked data for accuracy, and two investigators independently assessed study quality using predefined criteria. Data Synthesis (Results): We identified no trials of screening for CD. One recent, good-quality systematic review found serological tests to be accurate for diagnosing CD, but two studies conducted in asymptomatic populations reported lower sensitivity than in studies not restricted to asymptomatic populations. One fair-quality, small (n=40), Finnish treatment trial of screendetected, asymptomatic adults with positive serological findings found initiation of a gluten-free diet associated with small improvement in gastrointestinal symptoms versus no gluten-free diet (less than 1 point on a 1 to 7 scale) at 1 year, with no differences on most measures of quality of life. No withdrawals due to adverse events occurred during the trial.
Limitations: Limited or no evidence for all key questions; limited to English language studies. Conclusions: More research is needed to understand the effectiveness of screening and treatment for CD in asymptomatic adults, adolescents, and children; accuracy of screening tests; and optimal screening strategies.

Integrating Bodies of Evidence: Existing Systematic Reviews and Primary Studies. Methods Guide for Comparative Effectiveness Reviews.

Robinson KA, Chou R, Berkman ND, Newberry SJ, Fu R, Hartling L, Dryden D, Butler M, Foisy M, Anderson J, Motu’apuaka ML, Relevo R, Guise JM, Chang S. Integrating Bodies of Evidence: Existing Systematic Reviews and Primary Studies. Methods Guide for Comparative Effectiveness Reviews (Prepared by the Scientific Resource Center under Contract No. 290-2012-00004-C). AHRQ Publication No. 15-EHC007-EF. Rockville, MD: Agency for Healthcare Research and Quality. February 2015. 

http://www.effectivehealthcare.ahrq.gov/ehc/products/597/2049/integrating-evidence-report-150226.pdf 

The increasing number of systematic reviews, along with the time and money required to undertake a review, has motivated a desire to incorporate existing systematic reviews in a new review. In considering the integration of existing systematic reviews into new reviews, there is a tradeoff between accepting the results of the prior review and needing to either complete again the selected elements of the review or the review in its entirety. The key is to find the right balance in terms of an efficient and unbiased approach to conducting and reporting the integration of existing systematic reviews into the new review. In this working document, we have provided preliminary guidance to help find that balance.

Communication and Dissemination Strategies To Facilitate the Use of Health and Health Care Evidence

Background and Objectives for the Systematic Review

The Agency for Healthcare Research and Quality (AHRQ) Effective Healthcare (EHC) Program funds individual researchers, research centers, and academic organizations to work with AHRQ to produce effectiveness and comparative effectiveness research for clinicians and consumers.1 Comparative effectiveness research (CER) compares the benefits, harms, and effectiveness of health interventions for the prevention, diagnosis, treatment, and management of clinical conditions and the improvement of health care delivery. The purpose of CER is to assist patients and consumers, clinicians and other providers, and purchasers and payers to make informed decisions that will improve health care at both the individual and population levels.1

One EHC goal is to make CER accessible to these decisionmakers. The Institute of Medicine’s list of 100 priority topics for CER highlights the importance of translating and disseminating this research.2 The specific topic (“compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others”) was listed among the first quartile of topics recommended for initial focus. Many hope that better communication and dissemination of CER will result in more widespread use of such information.

Coupled with these mandates is the fact that the ad hoc Uncertainty Committee of the EHC Stakeholder Group is interested in promoting effective ways to communicate uncertainty about health and health care evidence to end-users. The committee would like to know what approaches to conveying uncertainty increase the likelihood that audiences receiving such information will understand it and be able to factor it into their decisionmaking.

This systematic review has three related components; all focus on promoting informed health and health care decisions among patients and providers. First, it addresses the comparative effectiveness of communicating the evidence in various contents and formats that increases the likelihood that it will be understood and used by the target audience. Second, it examines the comparative effectiveness of a variety of approaches for disseminating the evidence from those who develop it to its potential users. Third, it examines the comparative effectiveness of various ways of communicating uncertainty associated with health and health care evidence to different target audiences.

http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1208