Research Methods: Reviews--Narrative, Systematic, Clinical Guidelines

Question 0

What does a systematic review do?

Answer 0

Gathers numeric results. Seeks to answer clearly formulated questions by using rigorous, explicit protocols to:

• identify relevant research studies
• select relevant research studies from those identified
• appraise the selected studies
• gather and analyze data from the selected studies

Question 1

Name a few different types of reviews

Answer 1

Clinical Practice Guidelines
Systematic Review (w/o meta-analysis or w/ meta-analysis)
Narrative Review

Question 2

What kind of review am I?

I synthesize information from multiple studies about a question to provide a cohesive picture of current available evidence.

Answer 2

Narrative Review

Question 3

What do you want to look at to determine, Is the Guideline Valid?

Answer 3

Quality of the Guideline

• Involvement of appropriate stakeholders
• Rigor of development of evidence & recommendations
• Clarity, structure and presentation of findings
• Applicability to current clinal practice
• Editorial independence, reputability of sponsoring group or authors

Question 4

Where in the Hierarchy of Evidence (pyramid) is a Narrative Review?

Answer 4

It is absence from this hierarchy because it is WITHOUT explicit systematic protocols and therefore, are not considered a high level of evidence.

Question 5

how does a systematic review minimize bias?

Answer 5

They include or exclude evidence based on explicit quality criteria.
They may use the statistical method of meta-analysis to determine the summary effect size.
They collapse results of multiple studies into 1 number.

Question 6

Forest Diagram

Answer 6

Meta-analysis process gives weight to each study based on the confidence interval for that study.
Results from the studies with many subjects usually have a BIGGER influence on the combined SES than results from studies with few subjects.

Question 7

Ringo

Answer 7

Dr. States/ cats name

Question 8

I take previously done work and analyze it and am also a secondary analysis, what am I?

Answer 8

systematic review

Question 8

Cochrane Collection

Answer 8

Most complete collection of systematic reviews and is accessible online. Generally a full review (not a shortened version).

Question 10

What 4 things do we need to do to summarize the ‘Included’ studies?

Answer 10

• Align the data from all included studies so they have a similar structure
• Compute a standardized measure of the effect observed in each study
• Standardized effect size = the magnitude of the effect of an experimental intervention, relative to the amount of variability in the data
• Display the results from each RCT as an effect size with its 95% CI

Question 11

If I thematically draw together diverse topics instead of simply comparing data what kind of review am I?

Answer 11

Narrative Review

Question 12

A review ‘in which the results of several independent studies are combined statistically to produce a single estimate of the effect of a particular intervention of health care situation.”

Answer 12

Meta-analysis

Question 13

My goal is to draw a conclusion based on the cumulative weight of the evidence…what kind of review a I?

Answer 13

Systematic

Question 14

A meta-analysis statistically combines the results from “Included Studies” on a particular variable (e.g. muscle strength) into what type of statistic?

Answer 14

Single summary statisitic

Question 16

Clinical Practice Guidelines

Answer 16

Are systematically developed statements to assist the practitioner and patient decisions about appropriate health care for specific circumstances.

Question 17

What should one consider when deciding if the Guideline is Applicable to your patient?

Answer 17

Consider…

• Factors related to the condition of interest
• Similarity to the patient in question
• Other options available
• Setting

Question 18

What the intent of clinical practice guidelines?

Answer 18

To improve the efficiency and effectiveness of health care and are based on current best evidence and expert judgement.

Question 20

Quality of Evidence

Answer 20

Indicates the extent to which we can be confident that an ESTIMATE OF EFFECT IS CORRECT (INternal validity of Studies).
How strong the methodology is the evidence.

Question 21

Do the strength of recommendations tell you about validity?

Answer 21

NO!

Question 22

Strength of a recommendation

Answer 22

Indicates the extent to which we can be confident that adherence to the recommendation will do more good than harm (EFFECT SIZE)