Recently Published Projects

Published on October 25, 2022
Screening for Impaired Visual Acuity in Older Adults - 1 of 2
51 Citations • 5 Key Questions • 14 Extraction Forms
Project created on September 24, 2021
Last updated on October 13, 2022
Objectives: Background: In 2016, the United States Preventive Services Task Force (USPSTF) concluded that the current evidence was insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults (I Statement). Although the USPSTF found that screening can identify persons with impaired visual acuity and that effective treatments are available for common causes of impaired visual acuity, direct evidence found no differences between vision screening versus no screening on visual acuity or other clinical outcomes. Purpose: To systematically review the evidence on screening for impaired visual acuity in older adults for populations and settings relevant to primary care in the United States. Data Sources: We searched the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and MEDLINE (through February 9, 2021), reviewed the studies in the prior USPSTF report, and manually reviewed reference lists. Study Selection: Randomized controlled trials (RCTs) and controlled observational studies on benefits and harms of screening versus no screening; studies on diagnostic accuracy of screening tests and instruments (including questionnaires); and benefits and harms of vascular endothelial growth factor (VEGF) inhibitors for wet age-related macular degeneration (AMD) and antioxidant vitamins and minerals for dry AMD in adults age 65 years and older. Data Extraction: One investigator abstracted data and a second checked accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): A total of 25 studies were included in this review (13 trials, 11 diagnostic accuracy studies, and one systematic review [of 19 trials]). Sixteen studies were carried forward from the 2016 review for the USPSTF, eight studies were new, and the systematic review utilized in the 2016 review for the USPSTF was updated to include six new trials. Four trials (N=4,819) of screening versus no screening, usual care, or delayed screening of older adults found no differences in visual acuity or other clinical outcomes. Visual acuity tests (3 studies; N=6,493) were associated with suboptimal diagnostic accuracy for identifying visual conditions compared with a complete examination by an ophthalmologist (sensitivity 0.27 to 0.75 and specificity 0.51 to 0.87); evidence on other screening tests was limited. Three studies (N=5,203) found that a screening question was not accurate for identifying older persons with impaired visual acuity compared with a visual acuity eye chart (sensitivity 0.17 to 0.81 and specificity 0.19 to 0.84). For wet AMD, four trials (N=2,086) found VEGF inhibitors associated with greater likelihood of ≥15 letters (3 lines) of visual acuity gain (risk ratio [RR] 2.92, 95% confidence interval [CI] 1.20 to 7.12, I2=76%; absolute risk difference [ARD] 10%), <15 letters (3 lines) of visual acuity loss (RR 1.46, 95% CI 1.22 to 1.75, I2=80%; ARD 27%) and having vision 20/200 or better (RR 1.47, 95% CI, 1.30 to 1.66, I2=42%; ARD 24%) at 1 year versus sham injection. VEGF inhibitors were associated with better vision-related function and quality of life measures versus sham injection at 1 and 2 years, the difference (~8 points on a 0 to 100 scale) was above the minimum clinically important difference threshold. For dry AMD, a systematic review of 19 trials found antioxidant multivitamins associated with decreased risk of progression to late AMD (3 trials, N=2,445 people, odds ratio [OR] 0.72, 95% CI 0.58 to 0.90) and >3 lines visual acuity loss (1 trial, N=1,791 people, OR 0.77, 95% CI 0.62 to 0.96) versus placebo. Results were primarily driven by the large (n=3,640) Age-Related Eye Disease Study (AREDS). Zinc was associated with decreased risk of progression to late AMD versus placebo (3 trials, N=3,790 people, OR 0.83, 95% CI 0.70 to 0.98) and decreased risk of >3 lines visual acuity loss that was of borderline statistical significance (2 trials, 3,791 people, RR 0.87, 95% CI 0.75 to 1.00). Evidence on the effects of other vitamins and mineral treatments was limited or showed no clear effects on AMD progression or visual acuity. The AREDS trial found zinc use associated with increased risk for hospitalization due to genitourinary causes versus nonuse (7.5% vs. 4.9%, RR, 1.47, 95% CI, 1.19 to 1.80); other serious harms were infrequent, with no differences between groups. The AREDS 2 trial found the AREDS formulation with beta carotene associated with increased risk of lung cancer versus the AREDS formulation without beta carotene when current smokers were excluded from the analysis (2.0% vs. 0.9%, p=0.04); almost all lung cancers occurred in former smokers. Limitations: Screening trials had methodological limitations that could have attenuated potential benefits; utilized an update to a previously included systematic review on antioxidant multivitamins and minerals for dry AMD; evidence on the effectiveness of treatment for dry AMD relied heavily on results of a single trial (AREDS); non-English–language studies excluded; too few randomized trials to perform formal assessments for publication bias with graphical or statistical methods for small sample effects; statistical heterogeneity in pooled estimates for VEGF inhibitors versus sham, though inconsistency was in magnitude (not direction) of effect. Conclusions: Impaired visual acuity is common in older adults and effective treatments are available for common causes of impaired visual acuity. Visual acuity testing is the reference standard for identifying impaired visual acuity, but has low diagnostic accuracy compared with an ophthalmological exam for identifying visual conditions not necessarily associated with impaired visual acuity; screening questions have low diagnostic accuracy compared with visual acuity testing. Direct evidence found no significant difference between vision screening in older adults in primary care settings versus no screening in visual acuity-related outcomes or other clinical outcomes.
Published on October 12, 2022
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication
65 Citations • 6 Key Questions • 65 Extraction Forms
Project created on August 03, 2022
Last updated on October 12, 2022
Objectives: Background: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in the United States. A 2016 review for the US Preventive Services Task Force (USPSTF) found statin therapy associated with decreased risk of all-cause and cardiovascular mortality and CVD events in adults at increased CVD risk but without prior CVD events. Purpose: To update the 2016 review on statins for primary prevention in adults to inform an updated USPSTF recommendation. Data Sources: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Ovid MEDLINE, from May, 2016 to November 12 2021, and reference lists; with surveillance through May 20, 2022. Study Selection: Randomized controlled trials (RCTs) on the benefits and harms of statin therapy versus placebo or no statin and large cohort studies on harms of statin therapy in adults without prior cardiovascular events. 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): 22 trials (N=90,624) with followup from 6 months to 6 years compared statin therapy versus placebo or no statin, one additional trial compared statins of different intensities (N=5,144) and three cohort studies (N=417,523) cohort study reported harms. Compared to the 2016 USPSTF review, additional data were available from three trials (1 new trial and 2 older trials that reported results for the primary prevention population) and one large cohort study (n=261,032). Statin therapy was associated with decreased risk of all-cause mortality (relative risk [RR] 0.92, 95% confidence interval [CI], 0.87 to 0.98; absolute risk difference [ARD], −0.35%; number needed to treat [NNT] 286), stroke (RR 0.78, 95% CI, 0.68 to 0.90; ARD −0.39%; NNT 256), myocardial infarction (RR 0.67, 95% CI, 0.60 to 0.75; ARD −0.85%; NNT 118), and composite cardiovascular outcomes (RR 0.72, 95% CI, 0.64 to 0.81; ARD −1.28%; NNT 78); though the estimate for all-cause mortality was mildly attenuated compared to the 2016 USPSTF review. With the inclusion of additional data, the estimate for cardiovascular mortality was no longer statistically significant (RR 0.91, 95% CI, 0.81 to 1.02; ARD −0.13%; NNT 769). Overall, relative benefits appeared to be consistent in groups defined by demographic and clinical characteristics, including populations with cardiovascular risk factors without marked dyslipidemia. Data for older persons remains sparse and imprecise, particularly for persons >75 years of age. Statin therapy was not associated with significantly increased risk of serious adverse events (RR 0.97, 95% CI, 0.93 to 1.01), myalgia (RR 0.98, 95% CI, 0.86 to 1.11), or liver-related harms (RR 0.94, 95% CI, 0.78 to 1.13). Statin therapy was not associated with increased risk of diabetes (RR 1.04, 95% CI, 0.92 to 1.19), though statistical heterogeneity was present (I2=52%), and one trial found that high-intensity statins were associated with increased risk (RR 1.25, 95% CI, 1.05 to 1.49). Otherwise, there were no clear differences in benefits or harms based on intensity of statin therapy. Limitations: Restricted to English language, statistical heterogeneity in some pooled analyses, methodological limitations in some trials, and limited ability to assess for publication bias. Conclusions: In adults at increased CVD risk but without prior CVD events, statin therapy is associated with reduced risk of all-cause mortality and CVD events; with the inclusion of additional data, effects on cardiovascular mortality are not statistically significant. Benefits of statin therapy appear to be present across diverse demographic and clinical populations, with greater absolute benefits in patients at higher baseline risk, and do not appear to be restricted to patients with marked dyslipidemia.
Published on October 06, 2022
Maternal and Child Outcomes Associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
82 Citations • 2 Key Questions • 82 Extraction Forms
Project created on March 04, 2022
Last updated on October 03, 2022
Objectives: This systematic review evaluates whether participation in WIC is associated with nutrition and health outcomes for women, infants, and children, and whether the associations vary by duration of participation or across sub-groups. Because of major revisions to the WIC food package in 2009, we prioritized studies published since 2009 and included studies comparing outcomes before and after the 2009 food package change.
Published on September 29, 2022
The effect of volunteering on the health and wellbeing of volunteers: an umbrella review
28 Citations • 1 Key Questions • 31 Extraction Forms
Project created on July 25, 2022
Last updated on October 05, 2022
Objectives: Volunteerism has been explored in terms of the benefits to the health of wellbeing of recipients, but also for the volunteers. However, a synthesis of these findings is needed to explore the psychological, physical and social effects of volunteering on the wellbeing of volunteers, and how these interact with each other and other demographic factors.
Published on September 21, 2022
Systematic Review on Noninvasive Nonpharmacological Treatment for Chronic Pain
36 Citations • 5 Key Questions • 36 Extraction Forms
Project created on May 12, 2022
Last updated on September 19, 2022
Objectives: This review focuses on noninvasive nonpharmacological treatment for chronic pain including exercise, mind-body practices, psychological therapies, multidisciplinary rehabilitation, mindfulness practices, manual therapies, physical modalities, and acupuncture. Many trials have examined the impact of these interventions on outcomes during or immediately after the course of treatment reporting improved function and reduced pain. However, given the persistence of chronic pain, understanding whether the benefits are durable would be very helpful for informing selection of therapies. Therefore, this report focuses on durability of treatment effects, defined as at least 1 month following the end of a course of treatment.