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Evaluating Diagnostic Therapies > Midterm - Narrative, Systematic, Metanalysis > Flashcards

Midterm - Narrative, Systematic, Metanalysis Flashcards

1
Q

This is a compendium of literature on a topic that is organized, explained and analyzed by the author(s) that serves to inform or explain a focused topic.

A

Narrative Review

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2
Q

Narrative reviews are (more/less) than systematic reviews or metaanalysis

A

Less

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3
Q

The focus is informing the reader, not establishing a foundation upon which clinical decisions (diagnostic or therapeutic) would be made

A

Narrative Review

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4
Q

Narrative review is done by… (roughly 7)

A
  1. Create a clinical question that focuses on a condition, evaluation or treatment 2. Compile the literature on that topic (condition, evaluation or treatment) 3. Search the literature on the subject, identifying any literature that relates to the topic 4. Organize the available literature in some way (Study type, specific topic, theme, etc) 5. Describe the studies individually or in methodologically similar groups (e.g. case reports in one-two paragraphs) 6. Synthesize the literature, cataloging what is in the literature and what is not 7. Identify themes, past or emerging trends and gaps
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5
Q

T/F narrative reviews always start with a clinical question that is in PICO style?

A

False does not have to be. (e.g. I want to know the current classification strategies of fibromyalgia syndromes)

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6
Q

T/F all types of literature on a topic can be included in a narrative review?

A

True All types are considered- RCT’s, Systematic Reviews, retrospective designs, cross-sectional designs, surveys, case series, case reports, opinions, editorials, etc.

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7
Q

T/F there is a limitation on the study design that can be included in narrative reviews?

A

False Generally, there is no limitation on the design- anything that addresses the subject is fair game

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8
Q

How is available literature in a narrative reviews organized

A
  • by study type - by specific topic or issue - by theme (For example… in the case of a review of the literature on a diagnosis, one might organize the literature by symptoms, physical assessment, imaging, laboratory, etc. in order for the reader to get a better sense of the spectrum of diagnostic findings one can see with the condition)
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9
Q

T/F All Narrative reviews assess the quality of the literature by offering editorial on the studies’ strengths or shortcomings- no explicit process for assessing quality

A

False, they may but they do not have to

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10
Q

(Which is false?) A narrative review may (but doesn’t have to): 1. Explains or sorts the information in new ways that allows better understanding or organization of the knowledge on the topic 2. Synthesize the literature, cataloging what is in the literature and what is not 3. Creates new frameworks or classifications that better organize what is known about the topic so that it is easier for clinicians to understand the spectrum of a disease, evaluation or treatment process (An example might be a review that offers a comprehensive overview of the treatment options for a condition- physical medicine, pharmacological options and surgical options and then takes a swipe at which patient types best fit in each therapeutic option) 4. Provides perspective about the evolution of the topic over time so that the reader is better informed about current ideas on the subject

A
  1. A narrative review (always) DOES Synthesize the literature, cataloging what is in the literature and what is not
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11
Q

Narrative review vs. systematic review (which is which) A. More technical B. Better for an overview of the topic/question C. Limited to the research evidence D. More transparent & stringent process E. Generally mixed with expert opinion F. A narrow focus on the research G. More causal used of the literature H. More readable

A

A. Systematic B. Narrative C. Systematic D. Systematic E. Narrative F. Systematic G. Narrative H. Narrative

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12
Q

A literature review on a highly focused topic

A

Systematic review

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13
Q

T/F systematic review questions always follow the PICO form

A

True A detailed PICO is a must- it will guide the search process

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14
Q

The systematic review search process is (more/less) thorough and explicit then narrative review?

A

More

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15
Q

more sources are searched for in narrative or systematic reviews?

A

Systematic *Greater detail in documenting the source for literature

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16
Q

Usually focused on research designs that offer greater generalizability and validity

A

Systematic review * Usually establishes inclusion and exclusion criteria for study types- excludes lower rigor and quality research designs

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17
Q

T/F in systematic reviews each citation that makes the “included” list of studies is formally graded for quality, including risk for bias

A

T * The results of review weight those study outcomes that come from better quality and rigor investigations more than those lacking those qualities

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18
Q

The review synthesizes the various study outcomes, integration and offering candid, concise and clear interpretations of the literature (the review should be understandable by clinicians- not just researchers)

A

Systematic reviews

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19
Q

T/F in systematic reviews gaps in evidence, quality and publication are not addressed

A

F They are openly addressed

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20
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Multiple databases

A

Best

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21
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Multiple languages

A

Best

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22
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Redundant searches

A

Best

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23
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Range of publication years (<10 years)

A

He has it as both best and acceptable???????

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24
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Disclosed search string

A

Best

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25
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Filters used

A

Best

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26
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Hand-searched bibliographies

A

He has this as best and acceptable ??????

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27
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Grey literature and direct contact with authors in the field

A

Best

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28
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Exclusion/inclusion criteria clearly stated

A

He has this as best and acceptable?????

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29
Q

In literature search qualities, for systematic reviews, is this best or acceptable? # of hits achieved/included in each source category with notes on why studies were excluded

A

Best

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30
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Multiple databases or one really comprehensive database (Medline, Pubmed)

A

Acceptable

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31
Q

In literature search qualities, for systematic reviews, is this best or acceptable? Search string disclosed (especially if only a single database is used)

A

Acceptable

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32
Q

In literature search qualities, for systematic reviews, is this best or acceptable? # of hits achieved/included (without notes on why studies were excluded)

A

Acceptable

33
Q

In quality of individual studies included in the systematic review, is this best or acceptable? Validated study quality assessment instrument (PEDro scale, JADAD scale, Delphi List)

A

Best

34
Q

In quality of individual studies included in the systematic review, is this best or acceptable? An article scores reported (not just “good or bad” or “high or low” quality

A

He has this as best and acceptable?????

35
Q

In quality of individual studies included in the systematic review, is this best or acceptable? Multiple independent assessors

A

Best

36
Q

In quality of individual studies included in the systematic review, is this best or acceptable? Disagreements arbitrated or mediated by independent 3rd party

A

Best

37
Q

In quality of individual studies included in the systematic review, is this best or acceptable? Bias assessment using validated bias assessment tool

A

He has this as best and acceptable??????

38
Q

In quality of individual studies included in the systematic review, is this best or acceptable? Transparent study quality assessment instrument

A

Acceptable *validated study quality assessment instrument is best

39
Q

In quality of individual studies included in the systematic review, is this best or acceptable? If homegrown, each element of quality assessment and scoring reported (ABCD-FIX)

A

Best

40
Q

In quality of individual studies included in the systematic review, is this best or acceptable? Multiple assessors

A

Acceptable *best is there are multiple INDEPENDENT assessors

41
Q

In quality of individual studies included in the systematic review, is this best or acceptable? Disagreements resolved by consensus of reviewers

A

Acceptable *best if arbitrated or mediated by independent 3rd party

42
Q

In the quality of the body of available evidence for systematic reviews, is this the best or accurate? Validated body of evidence quality assessment instrument (GRADE system cochrane)

A

Best

43
Q

In the quality of the body of available evidence for systematic reviews, is this the best or accurate? Actual score reported (not just “bad or good” or “high or low” quality)

A

He has this as best and acceptable

44
Q

In the quality of the body of available evidence for systematic reviews, is this the best or accurate? Overall bias assessment of the literature in the systematic review based on use of validated bias assessment tool

A

Best

45
Q

In the quality of the body of available evidence for systematic reviews, is this the best or accurate? Statistical Heterogeneity assessment of included study subjects

A

Best this is bonus level stuff…

46
Q

In the quality of the body of available evidence for systematic reviews, is this the best or accurate? Body of evidence quality assessment instrument described, with scoring rubric

A

Acceptable

47
Q

In the quality of the body of available evidence for systematic reviews, is this the best or accurate? If homegrown, disclosure of all variables and how scored was arrived at

A

Acceptable

48
Q

In the quality of the body of available evidence for systematic reviews, is this the best or accurate? Overall bias assessment of the literature based on clearly disclosed criteria (preferably numeric, if not then clearly understandable and supportable)

A

Acceptable

49
Q

In the quality of the body of available evidence for systematic reviews, is this the best or accurate? Clinical Heterogeneity assessment of included study subjects

A

Acceptable *If no heterogeneity assessment at all, this is not a deal-breaker… but it’s not great form

50
Q

For Summary and Conclusions for systematic reviews, is this best for acceptable Recommendations for future work

A

Best

51
Q

For Summary and Conclusions for systematic reviews, is this best for acceptable Clear, accurate advice regarding generalizability and how the review can be best used in practice

A

Best

52
Q

a method of evaluating the quality of a body of literature and then statistically aggregating individual studies’ results to achieve a pooled dataset that is larger, more precise and yields more generalizable conclusions about the topic

A

Meta-analysis

53
Q

Uses quantitative statistical methodology to test the pooled data for statistical significance and effect size

A

Meta-analysis

54
Q

allows more precise consideration of the overall strength of the body of evidence, its size and the “holes” in the study field

A

Meta-analysis

55
Q

T/F - The results of a metaanalysis should be robust and precise enough to help you establish or change your clinical decisions and how you practice.

A

T

56
Q

In a meta-analysis, the individual studies’ outcomes may be patient-perceived (e.g. pain, disability, quality of life, satisfaction, etc.) or they may be more _____

A

objective (physical measures such as ROM, strength, orthopedic tests, imaging, etc.)

57
Q

for a metanalysis, to combine the results from different studies using perhaps different ways of measuring patient- perceived or objective measures, a combining statistic is used ____________ or __________

A

Standard mean difference Or Effect size * These two methods create a common metric that each individual measure can be converted to so that when combined the results are using “apples to apples” data.

58
Q

In a metaanalysis, (Effect size/standard mean difference) can mean within group changes using RR, OR, NNT, or other measures that are consistent in their calculation from study to study

A

Effect size

59
Q

In a metaanalysis, (effect size/standard mean difference) is used for measures that need to be converted to standard deviations on a curve. Then they can be compared against other standard deviations on a curve- they are then being expressed on a “level playing field” that is both sensitive to the way they were originally calculated, but also comparable to each other mathematically

A

Standard mean difference

60
Q

In a metaanalysis, When graphed on a chart, the kurtosis (Peakness of the curves) and the degree of overlap between compared curves are used to create the _____

A

Standard mean difference

61
Q

The further the distance between the peaks the (smaller OR larger?) the difference between the groups

(used in metaanalysis)

A

larger

62
Q

The greater the overlap, the (more OR less
similar?) the treatment benefits are and the (smaller OR larger?) the SMDs separating them. The less overlap, the (smaller OR larger?) the SMD

(used in metaanalysis)

A

More

smaller

larger

63
Q

Effect size describes the ___________ above (or below) the baseline the effect is.

(used in metaanalysis)

A

Standard deviations

64
Q

As the effect size increases the NNT (number needed to treat- the number of cases needed to receive the therapy before a case of cure that is attributable to the treatment in question is achieved) reduces.

(used in metaanalysis)

A

NNT (number needed to treat- the number of cases needed to receive

65
Q

When the effect size = 0.2, the NNT =

(used in metaanalysis)

A

16

66
Q

When the effect size = 0.5, the NNT =

(used in metaanalysis)

A

6

67
Q

When the effect size = 0.8, the NNT =

(used in metaanalysis)

A

3.5

68
Q

When the effect size = 2, the NNT =

(used in metaanalysis)

A

1.4

69
Q

____ is the amount of variation in the reported outcomes and
whether it is beyond what would be expected by chance

(used in metaanalysis)

A

Heterogeneity (statistical heterogeneity)

Bond (James Bond)

70
Q

What are two tests used to quntify heterogeneity?

(used in metaanalysis)

A

Chi2 test and I2 (Higgins I2) test

71
Q

In a Chi2 test, a high p value of _____ reflects the probability that the differences among the studies (i.e., the heterogeneity) are likely due to random chance—consequently, the
outcomes are statistically similar enough to be pooled.

(used in metaanalysis)

A

>0.05

72
Q

We WANT chi squared to be above ____ (in other words we want the result to be
NOT statistically significant. When that occurs we can attribute any heterogeneity
that does exist to random effects. When significant, the error may be systematic

(used in metaanalysis)

A

0.05

73
Q

The I2 ranges from 0% to 100%. The (lower/higher) the percentage, the greater the
amount of variation there is across the studies.

(used in metaanalysis)

A

higher

74
Q

The (Chi2 or I2) test is not affected by the number of studies that are pooled.

(used in metaanalysis)

A

I2

75
Q

In the I2 test, ___ = low heterogeneity, ____= medium heterogeneity, ____ = high heterogeneity

(used in metaanalysis)

A

25%,50%, 75%

76
Q

Some suggest that I2 above ____ reflects too much variation in the results for effective pooling

(used in metaanalysis)

A

50%

77
Q

______ is an “eyeball” measure of the amount of heterogeneity based on an understanding of the conditions, the populations and their various manifestations. While not needing to be identical, the pooled studies do need to be reasonably similar. Unfortunately, there are no statistical methods to measure clinical heterogeneity. This is a judgment call.

(used in metaanalysis)

A

Heterogeneity (clinical heterogeneity)

78
Q

What is this?

A

Forest plot

(used in metaanalysis)

79
Q

When you see this image, you need to identify which side of the plot favors the treatment (it changes), and identify the consistency of direction of study outcomes

also, the

study size =___,

point estimate of effect = ___,

CI = ___,

effect size = ____,

diamond at the bottom = ____

(used in metaanalysis)

A
  • Study size= size of box at the point estimate
  • Point Estimate of effect= the location of the box
  • CI = the horizontal line with each box- the shorter, the more precise the CI is
  • Effect Size= how far from the “no effect” line the box and the CI line are
    • If the CI line crosses the “no effect” line, the result is not statistically significan (at the 95th percentile most often)
  • The Diamond at the bottom of each outcome is the pooled estimate of effect (the diamond shape matters- lateral width is the CI… a narrower diamond is more precise estimate)

Evaluating Diagnostic Therapies (2 decks)

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