Systematic reviews

Question 1

systematic reviews are also known as

Answer 1

evidence sysntheis

Question 2

review

Answer 2

what is there

Question 3

synthesis

Answer 3

what does it mean

Question 4

Lord Rayleigh

Answer 4

a victorian scientist who discovered Argon, believed it is more important to make sense of what we already know, instead of discovering new things e.g. secondary research

Question 5

evidence synthesis brings

Answer 5

all the evidence to one place

Question 6

how many peer reviewed articles published in 2014

Answer 6

1. 36 mill

- one every 20 second

Question 7

systematic review is

Answer 7

more methodical- you can see how they were done- can be replicated

Question 8

systematic reviews give accounts of

Answer 8

the search, appraisal and synthesis methods

Question 9

systematic also means

Answer 9

exhaustive- has ALL the info out there

Question 10

some people say that if you don’t include all the info-

Answer 10

then you are not carrying out a systematic review

Question 11

which statistical representation are used in systematic reviews

Answer 11

forest plots

Question 12

forets plots show

Answer 12

• down the far left= the trial
• shows odd rations- depending on how far one rah plot is not he control/ treatment side of the plot
• plots have confidence intervals
• can make cumulative forest pots where fata from diff studies synthesis- should decrease confidence limits

Question 13

if confidence limits are on1

Answer 13

not signif

Question 14

if confidence limits do not spread past 1

Answer 14

then the results are significant

-

Question 15

meta-analyses will have

Answer 15

narrower confidence intervals

Question 16

forest plots can be used to

Answer 16

look at trial o specific topic one ra lon period of time e.g. thrombosis
e.g. is it ethical to give control, ten years after it has been proven to be the favourable treatment

Question 17

forest plots example

Answer 17

1987- the clinical value of thrombolysis remains uncertain

Question 18

p value

Answer 18

the probability that if this was repeated you would get the same result- significance

Question 19

SRs in terms o hierarchy of evidence

Answer 19

at the top

• quantitative
• used to decide whether treatment/ diagnostic technique should be employed

Question 20

negative of SR

Answer 20

dint hel popel decide how they feel about the new treatment/ diagnostic technique- not qualitative

Question 21

Steps in a systematic review

Answer 21

1) ask the Q
2) get the stuff - search- how
3) check the study- appraisal, how
4) synthesise the stuff- what does it mean, meta-analysis
5) apply in the decision

Question 22

summary of SR

Answer 22

find- appraise- act

Question 23

when asking a q

Answer 23

• focus on what knowledge is needed
• identify the most important unknowns
• not all qs are equal

Question 24

important that we use the right evidence

Answer 24

to help patient and service development

Question 25

(1)Structuring a Q using PICO

Answer 25

P- population
I- intervention
C- control
O- outcome

Question 26

population

Answer 26

the kind of people you are interested in

Question 27

Intervention

Answer 27

what may happen to the group

Question 28

control

Answer 28

what will happen without the intervention

Question 29

Outcome

Answer 29

consequences of interest to the patients

Question 30

(2) find the evidence

Answer 30

• electornic bibliographic databases
• not all databases are equal
  e. g. Meddling, EmBase, PsycIfo

Question 31

peer reviewed articles are

Answer 31

vastly over respected

- may things which are peer reviewed are rubbish

Question 32

where can you find grey ‘non-peer reviewed’ literature

Answer 32

SIGLE

Question 33

(3) Appraise the evidence

Answer 33

-did they find enough
-what does it mean?
-should you believe it?
Will it help with your uncertainty? What was the Question? what si the context?

Question 34

(4) Synthesis

Answer 34

• depending on kind of review
• different kind of synthesis for diagnosis and critical reviews
• cause use forest plots

Question 35

On forest plots systematic reviews will

Answer 35

have the narrowest Ci

Question 36

Heterogeneity

Answer 36

level is 0.1

Question 37

heterogeneity is

Answer 37

reers to variation in study outcomes between studies

Question 38

Heterogeneity is represented by

Answer 38

I^2

Question 39

I^2

Answer 39

how much of the variation is due to chance vs heterogeneity - between variance/ total vairance

Question 40

low I^2

Answer 40

may not be a porblem

Question 41

high I^2

Answer 41

substantial heterogeneity

Question 42

heterogeneity needs to be

Answer 42

explored- could be due to different populations/ doses

Question 43

why may heterogeneity occur

Answer 43

• look for wide CIs

- studies data will disagree significantly

Question 44

Biases

Answer 44

• positive Studie sage mir eliekly to be published and quicker
• positive outcomes
• langauge

Question 45

funnel plot- publication bias

Answer 45

• larger studies have higher/ lower odds
• negative studies are much less likely to be published
• review will have more positive the negative outcome trials

Question 46

funnel plots illustrate why it is important to

Answer 46

use unpublished literature too
- showing studies with equal stand error are subjected to publication bias based on whether they yield positive or negative results

Question 47

types of SR

Answer 47

• effectiveness

- epidemiological