Reviews and Guidelines EBP Flashcards
What are the strongest forms of evidence?
Has at least one systematic review or at least 1 properly designed R.C.T.
Evidence from well designed trials w/out randomisation
Another way:
- cochrane systematic review - Other syst review and meta analysis - evidence guidelines - evidence summaries
How do reviews help in evidence based decision making?
Summarising and synthesising evidence
Identifying best practices
Evaluating risk and benefit
Informing policy developments
Public engagement
Strengthening accountability
List the types of reviews within evidence synthesis
Narrative review
Scoping review
Systematic review
Systematic review - meta analysis
Rapid review
What are some pros/cons about a narrative review?
traditional
lacks structure and protocol
Opinion driven?
What are some pros/cons about a scoping review?
Useful when research area is broad and diverse
Maps and summarise breadth of literature
What does a systematic review do?
answer a specific RQ by rigorously identifying, appraising, synthesizing existing research studies that meet predefined criteria
What does a systematic -meta analysis review do?
Systematic review + generation of new data from collapsing primary studies data (meta analysis)
What is a rapid review?
accelerated form of evidence synthesis that aims to provide timely and relevant information to inform decision making
What are the 6 key steps to a systematic review process?
Plan = method, RQ, planning
Search
Screen
Evaluate
Analyse
Communicate
List the steps involved in the development of systematic review
State objective of review and outline eligibility criteria
comprehensively search for trials
Tabulate characteristics of each trial identified and assess method quality
Apply eligibility criteria and justify any exclusions
Analyse results of eligible RCT using statistical analysis synthesis of data
Provide interpretation of results, strength/limitation of included study
Prep critical summary of review, aims, describing material, report results
Prove implication of research and practice in conclusion
What is PRISMA?
“Preferred reporting item for systematic reviews and meta analysis”
tool used to develop and critically appraise the quality of a systematic/meta analysis review
List some data sources for writing systematic reviews
Medical database (medline, cochrane)
Other medical or paramedical databases
foreign language literature
grey literature = non-peer reviewed literature, theses, pharmaceutical industry files)
References listed in primary resources
Unpublished sources know to experts in the field
Raw data from published trials
List the forms of bias commonly seen in reviews
Language bias
Selection bias
Publication bias
What is language bias?
Using only articles published in the author’s primary language –> may affect results of review
What is selection bias in reviews?
Selective screening of studies for inclusion
How reduce = review authors should be blinded to: names of study authors (avoid political/personal issue), institution of publication, results of studies
What is publication bias?
Tendency for negative results to be unequally reported in literature
e.g. ADR excluded in an efficacy review
What is a meta-analysis?
Combination and analysis of results from multiple independent studies on same topic, aim to provide more comprehensive and precise estimate of overall effect
Draws more reliable and generalisable conclusion than achieved by analysing each study individually
What is a forest plot? What is it used for?
Its a graphical representation of different studies and determine whether there is a consistent effect across them
Allows for visual representation of results of multiple studies that investigate the same RQ
Also measures heterogeneity and variability
What are the two stages in the development of a meta-analysis?
First stage = calc of a measure of treatment effect w/ 96% CI for each study, results used to measure odds ration, relative risk, and risk difference
Second stage = overall treatment effect is calculated as weighted average
What do the black squares on a forest plot indicate?
Odds ration of individual studies
What do the horizontal lines on a forest plot indicate?
the 95% CI of individual studies
What does the area of the black squares on a forest plot indicate?
Reflects the weight each trial contributes in the meta analysis
What do the solid vertical lines on a forest plot indicate?
Corresponds to no effect of treatment arm against control
What does the diamond on the bottom of a forest plot indicate?
overall treatment effect from the meta-analysis summarises the CI
What can be used to assess heterogeneity in a meta analysis?
Cochran Chi square (Cochran Q)
If cochrane Q/df (degrees of freedom) ratio is >1 = possible heterogeneity
If cochrane Q/df ratio <1 = heterogeneity very unlikely
What are evidence based guidelines?
Utilise rigorous systematic process involving review and critical evaluation of med literature to develop final recommendation
What is a consensus based guidelines?
Utilise experience of expert in practice area to draw conclusions and develop recommendations
Useful for orphan disease, incomplete info, non conclusive info to allow for final recommendation
What are evidence and consensus based guidelines?
Mixed evidence based and consensus-based practice guideline uses evidence to construct guideline and supplement steps without evidence with experience of the experts
List the steps involved in development of guidelines
Identification of therapeutic area
Formation of guideline development group
Systematic review of evidence
Formulation of clinical statement
Evidence grading
Development of recommendation and pilot run
External review and implementation of recommendations
Revision/updates
Highlight some important points about the application of guidelines
Outdated after 2 yrs
Practice guidelines created for facilitating clinical decision making, improving QOH, providing consistent tx across environment
Important attributes = clinical applicability, validity, clinical flexibility, accessibility, clarity, multidisciplinary development process, documentation, scheduled review
