Search and Selection Flashcards
Role of Systematic Review
Should report all relevent evidence to answer the focus clinical question
Role of Meta Analysis
Individual study may not represent the total body of evidence
- Can use meta-analysis to provide a summary estimate of effect
- Provides a greater range of patients than a single study
- Results can be more generalizable
Clinical Decision Making and Meta-Analysis/Systematic Reviews
Treatment Regimens
- What dose to use
Patient Populations
- Specific Characteristics
Monitoring
- How frequently, what to measure
Sample Size Calculation
- For planning studies
Major steps of a systematic review and meta-analysis
- Research Hypothesis
2a. Identify all studies
2b. Extract key information - Statistical Analysis
- Formulate conclusions
Research Hypothesis Step
Develop PICO question and develop a protocol for statistical appraisal
Identify All Studies Step
- Initiate protocol search strategy
- Have clear inclusion/exclusion strategies
- Use multiple databases
Extract Key Information Step
- Extract elements of study protocol with two authors independently
- Extract results
- Assess risk of bias
Statistical Analysis Step
- Regression Models
- Forest Plots
- Statistical Heterogenicity
- Models
Formulate Conclusions
- Assess quality and certainty of meta analysis
- Draw conclusions based on findings and quality of evidence
What does AMSTAR2 stand for
A Measurement Tool to Assess Systematic Reviews (Version 2)
AMSTAR2 Steps (Search and Selection)
- Research questions and Inclusion Criteria includes PICO
- Review methods established before review was conducted
- Selection of studies explained (Randomized vs Observational)
- Author used a comprehensive literature search strategy
- Study selection performed in duplicate
- Data extraction performed in duplicate
- Excluded studies include justification
Literature Review
Narrative driven
- Follows authors opinion
- Meant to establish general overview on a topic
Systematic Review
Focuses on a clinical based question
- Qualitative, descriptive summary of information
Meta Analysis
Uses statistical analyses to provide a quantitative summary of study observations
- Combines results to create a pooled set of data
Can you have a meta analysis without a systematic review
Yes, both are not dependent on each other
- Can have one without the other
Where to find PICO
Intro, Abstract, Methods
Where to find Inclusion Criteria
Inclusion and Exclusion Criteria and Study Characteristics Table
Protocol and Bias
Ensure a protocol was developed before the study to mitigate risks
Where to find when Protocol was developed
- Methods
- Registry PROSPERO
- Publication protocol of the journal
- Date submitted to research office / ethics board
What is PROSPERO
A repository of systematic reviews that have already been done
Randomized Controlled Trials vs Observational Studies
RCT: Best estimate of treatment effect
- Could be too restrictive and specific
Observational: Offers more wider arrays of info with a larger sample sizes
- Prone to bias
Author has to explain if they used RCT, Observational, or both and the reason why
Comprehensive Literature Search Strategy
Pubmed or Medline
Cochrane
Embase
Web of Science
Pubmed Or Medline?
Medline contains most of all of Pubmeds references
- Just use 1 or the other
Ideal description of comprehensive literature search strategyFai
At least 2 electronic databases
Full search strategy
Years covered
Publication Bias
Failure to publish all results
- Can leave unfavorable results to boost the study
Sources of Publication Bias
Trial Design
Final Results
Manuscript Submission
Study Selection Duplicate
Prevent selection bias by having 2 or more investigators selecting studies
Where to find if the Study Selection was done in duplicate
Methods
Why may a study be excluded
May be necessary because the population, intervention, control, or outcomes of the study are irrelevant
- Should not exclude studies based on their quality
