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Making friends with
systematic reviews:
Be comfortable assessing quality &
interpreting forest plots in 90 minutes!
March ...
Disclosure of Commercial
Support
CFPC Conflict of Interest
Presenter Disclosure
Presenter:  Maureen Dobbins
Relationships ...
Today’s Objectives
1. To refresh EIDM knowledge and skill
2. To become familiar with systematic
reviews
3. To identify the...
Model of EIDM in Public Health
4
Community
Health Issues,
Local Context
Research
Evidence
Public Health
Resources
Communit...
Evidence-informed
public health
5
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary...
Hierarchy of Evidence
6
Electronic systems, such as clinical
decision aids.
Outline of management options for a given heal...
Systematic Review
• A synthesis or summary of single
studies on a health topic
• A formalized (systematic), transparent,
s...
Steps of a systematic review
1. Stating the objectives of the research
2. Defining eligibility criteria for studies to be
...
Anatomy of a systematic review
• Introduction (background, objectives)
• Methods (search strategy, analytic approach)
• Re...
Ekeland,E., Heian,F., & Hagen,K.B. (2005). Can exercise improve self esteem in children and young people? A systematic rev...
Appraising a systematic review
1. Clearly focused question?
2. Inclusion / exclusion criteria?
3. Thorough search?
4. Appr...
Appraising a review, continued
6. Quality of included evidence described?
7. Methods transparent?
8. Appropriate to combin...
Critical Appraisal
Do I trust the
findings and can I
use the research in
my setting?
13
Objectives -- EIDM – Systematic re...
Critical Appraisal
- Identify study type
- Identify CA tool
- Conduct appraisal
14
Objectives -- EIDM – Systematic reviews...
Critical Appraisal
Type of study (appropriate tool)
Summary/ Guideline
(AGREE tool)
Brouwers, M., et al. (2010)
Systematic...
Summary:
• What is EIDM?
• What is a systematic review?
• What are the processes and parts of a
review?
• How do I read a ...
Questions?
17
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Additional Resources
• HE Practice Tools:
http://www.healthevidence.org/practice-tools.aspx
• NCCMT Online Learning Module...
References
• Brouwers, M., Kho, M.E., Browman, G.P., Burgers, J.S., Cluzeau, F., Feder, G., Fervers, B.,
Graham, I.D., Gri...
Thank you!
Contact us:
dobbinsm@mcmaster.ca
kdecorby@healthevidence.org
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TOPHC 2014: Making friends with systematic reviews

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Slides from a workshop delivered at The Ontario Public Health Convention 2014, entitled: "Making friends with systematic reviews".

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TOPHC 2014: Making friends with systematic reviews

  1. 1. Making friends with systematic reviews: Be comfortable assessing quality & interpreting forest plots in 90 minutes! March 31, 2014 Maureen Dobbins RN, PhD Kara DeCorby, MSc McMaster University
  2. 2. Disclosure of Commercial Support CFPC Conflict of Interest Presenter Disclosure Presenter:  Maureen Dobbins Relationships with commercial interests: • Grants/Research Support:      None • Speakers Bureau/Honoraria: None • Consulting Fees:                        None • Other:                                          None
  3. 3. Today’s Objectives 1. To refresh EIDM knowledge and skill 2. To become familiar with systematic reviews 3. To identify the parts of a forest plot 4. To learn and practice how to read forest plots 5. To increase comfort with critical appraisal criteria and how to assess review quality 3 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  4. 4. Model of EIDM in Public Health 4 Community Health Issues, Local Context Research Evidence Public Health Resources Community and Political Preferences and Actions Public Health Expertise National Collaborating Centre for Methods and Tools. (2012). A Model for Evidence‐Informed Decision‐Making in Public Health. [fact sheet].  Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf. Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  5. 5. Evidence-informed public health 5 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions National Collaborating Centre for Methods and Tools. STEPS in Evidence‐Informed Public  Health in Evidence‐Informed Public Health. Retrieved  February 10, 2013.  From  http://www.nccmt.ca/eiph/index‐eng.html
  6. 6. Hierarchy of Evidence 6 Electronic systems, such as clinical decision aids. Outline of management options for a given health issue; incorporate highest quality and most synthesized research. Summarize the findings and implications of high quality systematic reviews. Rigorous summary of primary research relevant to a particular focused question. Brief summary of results and implications of Single, high-quality studies. Related to a particular focused question. Systems Single studies Syntheses Synopses of syntheses Summaries Synopses of single studies Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions Dicenso, Alba, Bayley, Liz, & Haynes, R. Brian. (2009a). Accessing pre‐appraised evidence: fine‐tuning the 5S model into a 6S model. Evidence‐ Based Nursing, 12(4), 99‐101. DiCenso, Alba, Bayley, Liz, & Haynes, R. Brian. (2009b). ACP Journal Club. Editorial: Accessing preappraised evidence: fine‐tuning the 5S model  into a 6S model. Annals of Internal Medicine, 151(6), JC3‐2, JC3‐3
  7. 7. Systematic Review • A synthesis or summary of single studies on a health topic • A formalized (systematic), transparent, scientific process • Multiple reviewers involved 7 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  8. 8. Steps of a systematic review 1. Stating the objectives of the research 2. Defining eligibility criteria for studies to be included 3. Searching for (all) potentially eligible studies 4. Applying eligibility criteria 5. Assembling the most complete dataset feasible 6. Analyzing this dataset, using statistical synthesis and sensitivity analyses, if appropriate and possible 7. Preparing a structured report of the research. 8 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  9. 9. Anatomy of a systematic review • Introduction (background, objectives) • Methods (search strategy, analytic approach) • Results (studies included, data, statistical results) • Discussion (interpretation, applicability, limitations, future research) • Appendices (data analyses) 9 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  10. 10. Ekeland,E., Heian,F., & Hagen,K.B. (2005). Can exercise improve self esteem in children and young people? A systematic review of randomised  controlled trials. British Journal of Sports Medicine, 39(11), 792‐798. Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  11. 11. Appraising a systematic review 1. Clearly focused question? 2. Inclusion / exclusion criteria? 3. Thorough search? 4. Appropriate search timeframe? 5. Level of evidence described? 11 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  12. 12. Appraising a review, continued 6. Quality of included evidence described? 7. Methods transparent? 8. Appropriate to combine? 9. Results weighted? 10.Conclusions believable? 12 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  13. 13. Critical Appraisal Do I trust the findings and can I use the research in my setting? 13 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  14. 14. Critical Appraisal - Identify study type - Identify CA tool - Conduct appraisal 14 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  15. 15. Critical Appraisal Type of study (appropriate tool) Summary/ Guideline (AGREE tool) Brouwers, M., et al. (2010) Systematic review (HE tool) Health Evidence. (2013) Single study – RCT, cohort, case control, qualitative (CASP tools) Public Health Resource Unit (2006) 15 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  16. 16. Summary: • What is EIDM? • What is a systematic review? • What are the processes and parts of a review? • How do I read a forest plot? • How do I assess quality of a review (critical appraisal)? 16 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  17. 17. Questions? 17 Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
  18. 18. Additional Resources • HE Practice Tools: http://www.healthevidence.org/practice-tools.aspx • NCCMT Online Learning Modules: http://www.nccmt.ca/modules/index-eng.html – Intro to EIDM; – Searching for Research Evidence in PH 18
  19. 19. References • Brouwers, M., Kho, M.E., Browman, G.P., Burgers, J.S., Cluzeau, F., Feder, G., Fervers, B., Graham, I.D., Grimshaw, J., Hanna, S., Littlejohns, P., Makarski, J., Zitzelsberger, L. for the AGREE Next Steps Consortium. (2010). AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Canadian Medical Association Journal, 182(18), e839-e842. doi:10.1503/cmaj.090449 • Dicenso, Alba, Bayley, Liz, & Haynes, R. Brian. (2009a). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence-Based Nursing, 12(4), 99-101. • DiCenso, Alba, Bayley, Liz, & Haynes, R. Brian. (2009b). ACP Journal Club. Editorial: Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6), JC3-2, JC3-3 • Ekeland,E., Heian,F., & Hagen,K.B. (2005). Can exercise improve self esteem in children and young people? A systematic review of randomised controlled trials. British Journal of Sports Medicine, 39(11), 792-798. • Health Evidence. Quality assessment tool: Review articles. http://www.healthevidence.org/documents/our-appraisal- tools/QA_tool&dictionary_18.Mar.2013.pdf . 2013. McMaster Univerisity. • National Collaborating Centre for Methods and Tools. (2012). A Model for Evidence-Informed Decision-Making in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf. • National Collaborating Centre for Methods and Tools. STEPS in Evidence-Informed Public Health in Evidence-Informed Public Health. Retrieved February 10, 2014 From http://www.nccmt.ca/eiph/index-eng.html • Public Health Resource Unit (2006). The Critical Skills Appraisal Programme: making sense of evidence. Public Health Resource Unit, England. Retrieved from: http://www.casp-uk.net/19
  20. 20. Thank you! Contact us: dobbinsm@mcmaster.ca kdecorby@healthevidence.org

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