EBM systematic review Flashcards
What is a narrative review?
when is it useful?
classic review article
there is no attempt to be systematic in…
1) formulation of clinical question
2) search strategy for evidence
3) assessment of quality of evidence
4) summary of results
useful for background questions!!
ex. of a narrative review source
UpToDate
a novice asks background questions, an expert asks foreground questions
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what is a systematic review?
- asks a focused clinical question
- comprehensive search of multiple evidence sources
- explicit inclusion and exclusion criteria for primary studies!!!
- methodological quality of primary articles is assessed!!
- synthesis is systematic (both quant and qual) - if quantitative with summary of effect size, then it is a META ANALYSIS.
What is the process of conducting a systematic review?
1) define the question
2) conduct a literature search
3) apply inclusion and exclusion criteria
4) create data abstraction
5) conduct analysis
(read slide for full details)
when using a review, what three questions to ask?
are the results valid?
what are the results?
how can i apply this to pt care?
when thinking about if the results are valid, which questions should you keep in mind?
what question (PICO) did the systematic review address?
is it unlikely that important, relevant studies were missed?
were the criteria used to select articles for inclusion appropriate?
were the included studies sufficiently valid for the type of question asked?
wee the results similar from study to study?
For validity, make sure studies are high quality studies (RCT) and have reproducible assessments…. Cochrane is a good place to look for those
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For therapy studies, look for if the pts were randomized and if follow up was complete
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for diagnosis studies, make sure pt sample was representative of disorder and that the diagnosis verified using credible criteria that were independent of the items of medical history, PE, lab tests, or imaging in the study
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for harm studies, look if the investigators demonstrate similarity in all known determinants of outcome or adjust for difference in analysis and if the follow up was sufficiently complete
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for prognosis studies, look to see if there was a representative sample of pts and if follow up was sufficient and complete
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for results section, check to see if there were similar results from study to study and if there was precision with CI
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did the authors attempt to explain heterogeneity?
variable pts, interventions, comparisons, outcomes, methods
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when looking at the similarity of results of studies, what two things to look at?
visual estimates (how similar are the pts and do CI overlap?)
statistical tests (yes or no tests for heterogeneity - expressed as a P value AND I2 statistic)
