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Use of Mixed Treatment Comparisons in Systematic Reviews [Internet]

To summarize publically available guidance for, and current use of, meta-analytic methods for mixed treatment comparison (MTC) evidence synthesis; to identify analyses using these methods and summarize their characteristics; to gain insight regarding the rationale for selection, implementation, and reporting of such methods from investigators.

Methods Research Reports - Agency for Healthcare Research and Quality (US).

Version: August 2012
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Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

This clinical guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health. It sets out clear, evidenceand consensus-based recommendations for healthcare staff on how to treat and manage depression in adults with a chronic physical health problem.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2010
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Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update [Internet]

Given the number of medications available for type 2 diabetes mellitus, clinicians and patients need information about their effectiveness and safety to make informed choices. The objective of this review was to summarize the benefits and harms of medications (metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 [DPP-4] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists), as monotherapy and in combination, for the treatment of adults with type 2 diabetes.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2011
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Faecal Incontinence: The Management of Faecal Incontinence in Adults

For many people faecal incontinence is the result of a complex interplay of contributing factors, many of which can co-exist. Some may be relatively simple to reverse.

NICE Clinical Guidelines - National Collaborating Centre for Acute Care (UK).

Version: 2007
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Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials

OBJECTIVE: To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Review article: the management of paediatric nonalcoholic fatty liver disease

BACKGROUND: Paediatric nonalcoholic fatty liver disease (NAFLD) is a major public health concern given the recent increase in its prevalence and link to obesity and other metabolic comorbidities. Current treatment strategies involve lifestyle changes. Other surgical and pharmacologic interventions have been proposed; however, limited randomised controlled trials (RCTs) in the paediatric population restrict their use.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Treatment for overweight and obesity in adult populations: a systematic review and meta-analysis

BACKGROUND: Obesity is a major public health issue. This review updates the evidence on the effectiveness of behavioural and pharmacologic treatments for overweight and obesity in adults.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Head-to-head studies evaluating efficacy of pharmaco-therapy for obesity: a systematic review and meta-analysis

This review found that sibutramine was significantly more efficacious for achieving weight loss than orlistat, and showed a trend towards a lower dropout rate than orlistat. The possibility of bias, absence of quality assessment of the included trials and lack of participant details made the reliability of the authors' conclusions unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Prevention of type 2 diabetes in obese at-risk subjects: a systematic review and meta-analysis

Different intervention strategies can prevent new cases of type 2 diabetes (T2DM) in obese subjects. The present systematic review and meta-analysis evaluates the effectiveness of different strategies in prevention of type 2 diabetes in obese subjects. Studies were grouped into five different strategies: (1) physical activity ± diet; (2) anti-diabetic drugs (glitazones, metformin, glinides, alfa-glucosidase inhibitors); (3) antihypertensive drugs (ACE inhibitors, ARB); (4) weight loss-promoting drugs and lipid-lowering drugs (orlistat, bezafibrate, phentermine/topiramate controlled release); and (5) bariatric surgery. Only controlled studies, dealing with subjects BMI ≥ 30 kg/m(2), were included in the analysis, whether randomized or non-randomized studies. Appropriate methodology (PRISMA statement) was adhered to. Publication bias was formally assessed. Eighteen studies (43,669 subjects, 30,774 with impaired glucose tolerance and/or impaired fasting glucose), published in English language as full papers, were analyzed to identify predictors of new cases of T2DM and were included in a meta-analysis (random-effects model) to study the effect of different strategies. Intervention effect (new cases of diabetes) was expressed as odds ratio (OR), with 95 % confidence intervals (CIs). In obese subjects, non-surgical strategies were able to prevent T2DM, with different effectiveness [OR from 0.44 (0.36-0.52) to 0.86 (0.80-0.92)]; in morbidly obese subjects, bariatric surgery was highly effective [OR = 0.10 (0.02-0.49)]. At meta-regression analysis, factors associated with effectiveness were weight loss, young age and fasting insulin levels. Publication bias was present only when considering all studies together. These data indicate that several strategies, with different effectiveness, can prevent T2DM in obese subjects.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up

OBJECTIVE: To assist health professionals who counsel patients with overweight and obesity, a systematic review was undertaken to determine types of weight-loss interventions that contribute to successful outcomes and to define expected weight-loss outcomes from such interventions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Efficacy of weight loss drugs on obesity and cardiovascular risk factors in obese adolescents: a meta-analysis of randomized controlled trials

This meta-analysis concluded that orlistat or sibutramine therapy with behavioural modification may have a role in assisting weight loss in overweight adolescents. There was limited evidence to suggest an association with cardiovascular risk factors. Due to a lack of detail about the review methods and the risk of publication bias some caution is needed when interpreting the authors' conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

A systematic review on use of Chinese medicine and acupuncture for treatment of obesity

Obesity is a major health hazard and despite lifestyle modification, many patients frequently regain any lost body weight. The use of western anti-obesity drugs has been limited by side effects including mood changes, suicidal thoughts, and gastrointestinal or cardiovascular complications. The effectiveness and safety of traditional Chinese medicine including Chinese herbal medicine (CHM) and acupuncture provide an alternative established therapy for this medical challenge. In this systematic review, we used standard methodologies to search, review, analyse and synthesize published data on the efficacy, safety and relapse of weight regain associated with use of CHM and acupuncture. We also examined the rationale, mechanisms and potential utility of these therapies. A total of 12 electronic databases, including Chinese, English, Korean and Japanese, were searched up to 28 February 2010. Randomized controlled trials (RCTs) for CHM and/or acupuncture with comparative controls were considered. We used the Jadad scale to assess methodological qualities, the random effect model in the pooled analysis of therapeutic efficacy to adjust for heterogeneity and funnel plots to explore publication bias. After screening 2,545 potential articles from the electronic databases, we identified 96 RCTs; comprising of 49 trials on CHM treatment, 44 trials on acupuncture treatment and 3 trials on combined therapy for appraisal. There were 4,861 subjects in the treatment groups and 3,821 in the control groups, with treatment duration ranging from 2 weeks to 4 months. Of the 77 publications written in Chinese, 75 had a Jadad score <3, while 16 of the 19 English publications had a Jadad score of >3. Efficacy was defined as body weight reduction ≥ 2 kg or body mass index (BMI) reduction ≥ 0.5 kg/m(2) . Compared with placebo or lifestyle modification, CHM and acupuncture exhibited respective 'risk ratio' (RR) of 1.84 (95% CI: 1.37-2.46) and 2.14 (95% CI: 1.58-2.90) in favour of body weight reduction, with a mean difference in body weight reduction of 4.03 kg (95% CI: 2.22-5.85) and 2.76 kg (95% CI: 1.61-3.83) and a mean difference in BMI reduction of 1.32 kg m(-2) (95% CI: 0.78-1.85) and 2.02 kg m(-2) (95% CI: 0.94-3.10), respectively. Compared with the pharmacological treatments of sibutramine, fenfluramine or orlistat, CHM and acupuncture exhibited an RR of 1.11 (95% CI: 0.96-1.28) and 1.14 (95% CI: 1.03-1.25) in body weight reduction, mean difference in body weight reduction of 0.08 kg (95% CI: -0.58 to 0.74) and 0.65 kg (95% CI: -0.61 to 1.91), and mean difference in BMI reduction of 0.18 kg m(-2) (95% CI: -0.39 to 0.75) and 0.83 kg m(-2) (95% CI: 0.29-1.37), respectively. There were fewer reports of adverse effects and relapses of weight regain in CHM intervention studies conducted in China than studies conducted outside China. CHM and acupuncture were more effective than placebo or lifestyle modification in reducing body weight. They had a similar efficacy as the Western anti-obesity drugs but with fewer reported adverse effects. However, these conclusions were limited by small sample size and low quality of methodologies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Efficacy and safety of anti-obesity drugs in children and adolescents: systematic review and meta-analysis

This review concluded that sibutramine produced clinically meaningful reductions in body mass index for overweight and obese children and adolescents and was well tolerated. Orlistat modestly reduced body mass index with frequent gastrointestinal adverse effects. This review was generally well conducted and the authors' conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Long-term effects of weight-reducing interventions in hypertensive patients: systematic review and meta-analysis

The authors concluded that weight loss diet or orlistat reduced weight and blood-pressure (BP) in patients with essential hypertension. Although sibutramine reduced weight, it did not reduce BP. This was generally a well-conducted and clearly presented review and the authors’ conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Effect of anti-obesity drug on cardiovascular risk factors: a systematic review and meta-analysis of randomized controlled trials

This review concluded that anti-obesity therapy was associated with weight loss regardless of the drug used. Orlistat and rimonabant may be associated with cardiovascular risk factor improvements, but sibutramine may contribute to increased incidence of cardiovascular events. Given the unknown risk for publication bias, missing detail on placebo treatments and limited quality assessment, these conclusions should be interpreted cautiously.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Pharmacotherapy for overweight/obesity in ethnic minorities and White Caucasians: a systematic review and meta-analysis

The review concluded that there were few studies of weight loss pharmacotherapy for comparisons of ethnic groups. The data appeared to show positive weight management results with orlistat and sibutramine; weight loss with sibutramine was significantly lower in ethnic minorities versus Caucasians. The review was generally well conducted. The authors’ conclusions were suitably cautious and appear appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Long-term randomized clinical trials of pharmacological treatment of obesity: systematic review

The review concluded that pharmacological interventions achieved modest weight loss and resulted in a high incidence of adverse events. Unexplained baseline differences between studies and the fact that the relative influence of other components within the intervention package could not be determined mean that some caution is warranted in judging the reliability of the authors' conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

What is the clinical effectiveness and cost-effectiveness of using drugs in treating obese patients in primary care? A systematic review

The authors concluded that their mixed-treatment comparison of anti-obesity drugs (orlistat, sibutramine or rimonabant) showed that all were effective at reducing weight and body mass index. The authors' conclusions are a fair reflection of the evidence presented, but the limited quality assessment and analysis of sensitivity to trial quality, make it difficult to evaluate their reliability.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Effectiveness of primary care-relevant treatments for obesity in adults: a systematic evidence review for the US preventive services task force

This review concluded that behavioural interventions were safe and effective for weight loss and maintenance. The authors' conclusions reflect the evidence presented, but this evidence had limitations, such as poor reporting, high rates of withdrawal, and variability between studies, that should be borne in mind when interpreting the conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement

This review of obesity treatments in adults concluded that there are beneficial effects of orlistat, sibutramine and metformin and low-fat diets, and that exercise and/or behaviour therapy appear to improve weight loss when added to diet. The review was generally well-conducted and the conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Systematic Reviews in PubMed

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Systematic Review Methods in PubMed

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