Systematic Review & Meta-Analysis Course - Summary Slides


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Summary slides for "Systematic Review and Meta-Analysis Course for Healthcare Professionals", January 8-9, 2013, King Abdullah Medical City, Makkah, Saudi Arabia

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Systematic Review & Meta-Analysis Course - Summary Slides

  1. 1. Systematic Review & Meta-Analysis Course January 8-9, 2013 “Summary Slides” SohailBajammal, MBChB, MSc, FRCSC, PhD(c) SohaElmorsy, MD, PhD, MSc KAMCResearch
  2. 2. Acknowledgements Big Thank You KAMC Research Center  Dr. DoaaAbdelmotey  Dr. RawanIkram  Ms. RaniaFelemban KAMC CPD Administration  Ms. Huda Altalhi  Ms. NisreenAlhazmi  Johnny Fagyan  Eng. Mohammad Alqethami  Mr. MazinJizani  Mr. Mohammad Alabbasi
  3. 3. How to Conducta Systematic Review/Meta-Analysis 1. Ask Research Question 2. Search the Literature 3. Select the Studies 4. Appraise the Studies 5. Extract the Data 6. Summarize the Data 7. Reporting
  4. 4. Systematic Review & Meta-Analysis Definitions & Importance A systematic review:a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies. Meta-analysis:the use of statistical techniques in a systematic review to integrate the results of included studies.Cochrane Collaboration Definition DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. ACP Journal Club, 2009
  5. 5. Types of Reviews Narrative Systematic Feature “Review Article” Review Study Question Broad FocusedSources and Search Not usually specified Comprehensive Selection Not usually specified Criterion based selection Appraisal Variable Rigorous appraisal Synthesis Often qualitative Often quantitative Inferences Sometimes evidence based Usually evidence based
  6. 6. 1. Ask Research QuestionP • PopulationI • InterventionC • ComparatorO • OutcomeS • Study designT • Time frame
  7. 7. 2. Search the Literature Strategy  Keywords (synonyms & spellings) &MeSH: for each concept of the PICOS  Combine terms within concept with OR  Combine between concepts with AND Multiple sources  Published:  Electronic Databases (time frame): MEDLINE, EMBASE, Cochrane, CINAHL, AMED  Hand Search: Journals, Reference lists of included studies  Unpublished (grey literature): authors/experts, conference proceedings, companies, trials registry Process  Done by at least 2 reviewers, assess agreement & solve disagreement  Documentation of every step
  8. 8. Hands-on PubMed Search Develop a Search STRATEGY • Keywords • MeSH terms • Publication Type • Automatic Term Mapping • Limits: Dates, Languages, Species, Ages • Advanced Search & History
  9. 9. 3. Select the Studies 2 reviewers apply inclusion/exclusion criteria:  Screening of titles & abstract  Assessment of full text for eligibility  Final inclusion of studies Remove duplicate publications Record reasons for exclusion Assess agreement (kappa)
  10. 10. 4. Appraise the Studies 2 reviewers assess for risk of bias in included studies:  Scoring scales: e.g., Jadad, Detsky (not recommended by PRISMA or Cochrane)  Domains: random sequence generation, allocation concealment, blinding, loss of follow-up Resolve disagreement by consensus or third reviewer What to do with poor quality studies?  ? Exclude  ? Sensitivity analysis  ? Weighting in meta-analysis
  11. 11. 5. Extract the Data Data Pilot the extraction form Extraction Form 2 reviewers Quality Study Outcome Assessment Characteristics Measures Criteria Consider e-form Study Study Quality Study Characteristics Criteria Outcomes
  12. 12. 6. Summarize the Data Qualitative (systematic review) Quantitative (meta-analysis)  When to do a meta-analysis?  Choice of summary statistics  Dichotomous outcome: OR, RR, RD  Continuous outcome: mean difference, weighted or standardized  Time to event: HR  Fixed effects or Random effects  Forest plot  Heterogeneity testing  Funnel plot  Sensitivity analysis  Subgroup analysis
  13. 13. Hands-on RevMan Exercise
  14. 14. 7. Reporting
  15. 15. Other Activities by KAMCResearch KAMCResearch