Block 4 Week 3: Systematic Reviews Flashcards

1
Q

Define a systematic review

A

A review of a clearly forumulated question that uses systematic & explicit method to identify, select and critically appraise relavent research & to collect and analyse data from the studies that are included in the rewview

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2
Q

Why have systematic reviews?

A

Identify which forms of healthcare work and do not work

Busy HCP need quick effective ways of identifying what works best for pt

Health care providers need to be evidence based to ensure practice is up to date

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3
Q

What are the three key functions of a systematic review?

A

Synthesise the evidence

Understand hetrogeneity in treatment effects

Set the research & practice agenda

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4
Q

What are the steps to a systematic review?

A
  • Rationale/ Familiarise with process
  • Question
  • Protocol
  • Literature search
  • Screening
  • Eligibility
  • Dataabstraction
  • Quality assessment
  • Analysis
  • Summary& Writeup
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5
Q

Systematic review: Rationale/ Familarise with protocol

A

Rationale

  • What is already known
  • Someone else already done/ doing review

Familarise with Protocol:

  • Start preparing protocol
  • Follow reporting guidelines eg: PRISMA-P
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6
Q

SR: Question

A

PICOS (study design= S)

SPICE (Setting, Population, Intervention, Comparison, Evaluation) for qualitative

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7
Q

SR: Prtocol

A

Informed by & refined from research question

Include:

  • Search strategy
  • Inclusion/ Exclusion criteria
  • Data extraction
  • Risk of bias assessment
  • Analysis/ Synthesis plan
  • Presentation and Interpretation
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8
Q

SR: Literature Search/ Study Retrieval

A
  • Identify where you plan to search
  • Identify search terms
  • Search techniques
  • Number of records identified through database search/ other sources
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9
Q

SR: Screening

A
  • Number post De-duplicates
  • Is the study relevant to research question
  • Record number screened (Include (if seems relevant)/ Exclude)
  • Record all references
  • Assessed by x2 reviewers
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10
Q

SR: Eligibility

A
  • Obtain full text
  • Ax against each domain: PICO/SPICE.

No to one domain–> Exclusion. Unsure speak to colleague/ 3rdreviewer

  • Inclusion/Exclusion Number recorded
  • Excluded record with reason
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11
Q

SR: Data Abstraction

A

Extract data relavant to question

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12
Q

SR: Quality Assessment

A

•Suitable tool: Inform analysis & Interpretation

Look for Bias (& summarise for each study)

  • Selection
  • Performance
  • Detection
  • Attrition
  • Reporting
  • Other
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13
Q

Discuss the types of Quality Assessment types of Bias

A

Selection Bias:

  • Systematic bias in the way participants are selected

Performance Bias

  • Systematic differences in the care provided to the participants in the comparison groups other than the intervention under investigation

Detection Bias

  • Systematic differences between the comparison groups in outcome assessment

Attrition Bias

  • Systematic differences between the comparison groups in the loss of participants from the study

Reporting Bias

  • Selective reporting of study outcomes

Other Bias

  • Funding, error is results
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14
Q

SR: Analysis

Define Meta-Analysis

A

Quantitative:

  • Meta-Analysis if possible
  • Results of individual studies combined to produce overall statistic.
  • Subject to any biases during selection process –> Mathematically precise bu tclinically misleading result
  • ForestPlot

Qualitative:

  • Narrative Analysis
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15
Q

Meta-Analysis

What are looking for?

What is hetrogeneity, how is it measured? Why is it importnant?

A
  • Outcome being examined
  • Time frame for the outcome?
  • Summary effect size being used?
  • Number of trials included?
  • Heterogeneity in the comparison?
    • I2 understand heterogeneity
    • Percentage of variation between studies in meta-analysis due to differences between studies & not just sampling error
    • 0%, 25% low, 50% moderate, 75% high
    • Important:shapesunderstanding pooled effect- Is this true effect or the average effect in a distribution
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16
Q

SR: Summary & Write up

A

Presentation & Interpretation of findings

17
Q

What are the types of Bias that may occur in a systematic review?

A
  • Duplicate
  • Lanaguage
  • Outcome Reporting
  • Citation
  • Publication
    • Funnel plot for 10 or more studies
    • Should see equal distribution
    • Bias: Trial with significant result produced –> Asymmetrical funnel plot
18
Q

What does a high quality SR consist of?

A
  • Search Strategy: Inclusive & Reproducible
  • Flow of all studies/papers-PRISMA
  • How inclusion & Exclusion criteria applied (PICOS/ SPICE)
  • Table of characteristics of studies (Included & Excluded- Reasons)
  • Qualityassessment: Cohesive synthesis/ Analysis (+/- meta-analysis)
  • Practical application of findings
  • Strengths & Limitation of SR