1. The meta-analysis found that concomitant chemoradiotherapy improved overall survival compared to sequential chemoradiotherapy for locally advanced non-small cell lung cancer, due to better locoregional control, though it increased acute esophageal toxicity.
2. Temozolomide improved survival and delayed progression compared to radiotherapy alone for glioblastoma, but increased early adverse events. For recurrent glioblastoma, temozolomide improved time to progression over standard chemotherapy.
3. Surgery for early cervical adenocarcinoma showed a benefit over radiotherapy in one RCT, but most operated patients required adjuvant radiotherapy with greater morbidity compared to chemoradiation.
1) A systematic review follows a strict methodology to identify and analyze relevant research on a focused question.
2) The process involves developing a protocol, searching multiple databases, screening studies, assessing bias, and synthesizing data.
3) Reporting guidelines like PRISMA ensure transparency and consistency in reporting systematic reviews.
This document provides an overview of systematic literature reviews. It defines systematic reviews as reviews that use explicit and reproducible methods to identify, select, and critically appraise relevant research to answer a specific question. The key steps outlined include developing a protocol, formulating a review question using PICO elements, establishing inclusion/exclusion criteria, systematically searching literature sources, selecting studies, assessing study quality, extracting data, synthesizing results, and interpreting findings. Examples are provided for many of the steps like developing search strategies, creating logs to document the process, and tools for summarizing evidence like PRISMA diagrams and data tables.
This document provides guidance on how to present a journal club. It discusses the definition and history of journal clubs, their aims to keep participants up to date on current literature and teach critical appraisal skills. Journal clubs can cover a range of topics and formats. The document outlines best practices for selecting articles, presenting critically on the content, and facilitating discussion. It emphasizes the benefits of journal clubs for improving knowledge, skills, and evidence-based practice.
This document discusses using the PICO framework to structure systematic review questions and search strategies. It explains the concepts of P, I, C, and O and how they relate to developing search terms for population, intervention, comparison and outcome. The document provides examples of searching Embase for each PICO element, and emphasizes using Emtree terms along with free text searching. It also discusses limits, study type filters, documenting the search process, and upcoming enhancements in Embase.
This document provides tips for making an effective presentation of research work in 3 sentences or less:
The document outlines best practices for creating clear and readable presentation slides, including using point form, limiting text per slide, using large and contrasting fonts, simple backgrounds, and properly formatted graphs and tables. Common mistakes to avoid are discussed, such as small fonts, excessive use of colors and animation, and distracting backgrounds. The presentation should be proofread for spelling and grammar errors, and conclude with a summary of key points and an invitation for questions.
Presenting a published paper:
"Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review
approach"
Randomization aims to equally distribute participant characteristics between treatment groups to prevent bias. There are several types of randomization including simple, block, and stratified block randomization. Blinding, such as double or triple blinding, helps prevent performance, detection, and other biases by keeping parties unaware of treatment assignments. Bias can still occur through factors like selection, performance, detection, laboratory, or sample size biases if randomization and blinding are not properly implemented.
1) A systematic review follows a strict methodology to identify and analyze relevant research on a focused question.
2) The process involves developing a protocol, searching multiple databases, screening studies, assessing bias, and synthesizing data.
3) Reporting guidelines like PRISMA ensure transparency and consistency in reporting systematic reviews.
This document provides an overview of systematic literature reviews. It defines systematic reviews as reviews that use explicit and reproducible methods to identify, select, and critically appraise relevant research to answer a specific question. The key steps outlined include developing a protocol, formulating a review question using PICO elements, establishing inclusion/exclusion criteria, systematically searching literature sources, selecting studies, assessing study quality, extracting data, synthesizing results, and interpreting findings. Examples are provided for many of the steps like developing search strategies, creating logs to document the process, and tools for summarizing evidence like PRISMA diagrams and data tables.
This document provides guidance on how to present a journal club. It discusses the definition and history of journal clubs, their aims to keep participants up to date on current literature and teach critical appraisal skills. Journal clubs can cover a range of topics and formats. The document outlines best practices for selecting articles, presenting critically on the content, and facilitating discussion. It emphasizes the benefits of journal clubs for improving knowledge, skills, and evidence-based practice.
This document discusses using the PICO framework to structure systematic review questions and search strategies. It explains the concepts of P, I, C, and O and how they relate to developing search terms for population, intervention, comparison and outcome. The document provides examples of searching Embase for each PICO element, and emphasizes using Emtree terms along with free text searching. It also discusses limits, study type filters, documenting the search process, and upcoming enhancements in Embase.
This document provides tips for making an effective presentation of research work in 3 sentences or less:
The document outlines best practices for creating clear and readable presentation slides, including using point form, limiting text per slide, using large and contrasting fonts, simple backgrounds, and properly formatted graphs and tables. Common mistakes to avoid are discussed, such as small fonts, excessive use of colors and animation, and distracting backgrounds. The presentation should be proofread for spelling and grammar errors, and conclude with a summary of key points and an invitation for questions.
Presenting a published paper:
"Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review
approach"
Randomization aims to equally distribute participant characteristics between treatment groups to prevent bias. There are several types of randomization including simple, block, and stratified block randomization. Blinding, such as double or triple blinding, helps prevent performance, detection, and other biases by keeping parties unaware of treatment assignments. Bias can still occur through factors like selection, performance, detection, laboratory, or sample size biases if randomization and blinding are not properly implemented.
Meta-analysis is defined as quantitatively combining and integrating the findings of multiple research studies on a particular topic. It was coined by Glass in 1976 and refers to analyzing the results of several studies that address a shared research hypothesis. The key steps in a meta-analysis involve defining a hypothesis, locating relevant studies, inputting empirical data, calculating an overall effect size by standardizing statistics, and analyzing any moderating variables if heterogeneity exists. An example provided is a meta-analysis on coping behaviors of cancer patients that would statistically analyze results from quantitative studies with similar age groups.
Systematic Reviews in the Health SciencesBecky Morin
This document provides an overview of systematic reviews, including what they are, why they are important in health sciences research, and the steps involved in conducting one. It defines a systematic review as a comprehensive study that collects and analyzes data from multiple research studies to answer a specific question. It notes that systematic reviews use explicit and rigorous methods to minimize bias and provide reliable conclusions. The key steps outlined include developing a protocol and research question, conducting comprehensive searches, selecting and assessing studies, extracting and synthesizing data, and disseminating findings.
The characteristics of the Ideal Source for practicing Evidence-Based Medicine are:-
Located in the clinical setting
Easy to use
Fast, reliable connection
Comprehensive /Full Text
Provides primary data
Audio video consenting process and role of CRC or PI during av consentingJagriti Bansal
The document outlines the requirements and process for audio-visual (AV) recording of informed consent for clinical trials in India. Key points include:
1. AV recording of informed consent is now mandatory per a 2013 order from the Drug Controller General of India, following a Supreme Court ruling.
2. The requirements for AV consenting include an approved protocol and consent form, the subject and principal investigator on camera, a private room, and storage of recordings.
3. The process involves introducing all parties, explaining the study and consent form verbally, having the subject sign, and answering questions to ensure understanding before signing.
4. Clinical research coordinators are responsible for assisting with the process, ensuring privacy,
A systematic review is a comprehensive literature review designed to answer a specific clinical question using a pre-defined protocol. It requires at least 12 months to conduct due to extensive searches of published and unpublished studies, validity assessments of included studies, data collection, analysis, and keeping the review up-to-date. In contrast, a traditional literature review does not follow a pre-specified protocol or aim to be comprehensive. Systematic reviews also publish detailed search strategies to allow replication and apply statistical methods like meta-analysis to synthesized data from included studies.
This document provides guidance on how to conduct a journal club by outlining 10 steps for critically appraising a research article. It recommends that articles be of interest to participants, not just published, and report novel methods or applications. The 10 steps include: introducing the article; evaluating the authors, journal, hypothesis, and evidence presented; appraising the study design, methods, results, and discussion; considering the utility of the findings; and providing output such as writing a letter to the editor. Attendees are advised to actively read papers with the steps in mind and plan to participate in discussions. Sources for reporting guidelines are also referenced.
1) Blinding in clinical trials refers to keeping trial participants, investigators, and assessors unaware of treatment assignments to prevent bias.
2) Potential benefits of blinding include less psychological or physical bias in participants, better compliance, and less bias in outcome assessments.
3) Types of blinding include non-blinded (where all know assignments), single-blinded (one group remains unaware), and double-blinded (participants, investigators, and assessors remain unaware). Placebos are often used to maintain blinding.
This document discusses adaptive clinical trials. Adaptive trials allow changes to the trial design based on interim data analysis in order to make the trial more efficient. Key aspects that can be adapted include sample size, treatments, endpoints, and eligibility criteria. Adaptive designs are well-suited for exploratory trials aimed at learning, but confirmatory trials require more prior data and safeguards to ensure the trial's integrity and the validity of its conclusions. The FDA has provided guidance on adaptive designs to ensure patient safety and that adaptive trials meet evidentiary standards for approval.
This document discusses STROBE-nut, an extension of the STROBE reporting guidelines for nutritional epidemiology studies. It provides context on reporting guidelines and their importance in addressing research waste from incomplete reporting. STROBE-nut was developed through an expert consensus process to include 24 recommendations for transparently reporting nutritional epidemiology and dietary assessment studies. The goal of STROBE-nut is to improve the completeness and transparency of nutritional epidemiology research publications.
Critical appraisal of a journal articleDrSahilKumar
This document provides guidance on critically appraising journal articles. It defines critical appraisal as systematically identifying the strengths and weaknesses of research to assess validity and usefulness. Key aspects to evaluate include relevance of the research question, appropriateness of study design, addressing biases, adherence to original protocol, statistical analyses, and conflicts of interest. Checklists like CASP, CONSORT, and STROBE provide frameworks to appraise study methodologies like randomized trials, systematic reviews, and observational studies. The goal of critical appraisal is for clinicians to identify high-quality evidence to inform clinical practice.
This document discusses assessing risk of bias during systematic reviews. It defines bias as systematic error that deviates from the truth and can lead to over or underestimating effects. Assessing bias in included studies is important because results may be consistent due to flaws. There are seven domains for assessing bias: selection, performance, detection, attrition, reporting, and other biases. Risk of bias is assessed by reviewing study methods, looking for missing information, and making judgments on pre-specified criteria about the likelihood studies were affected by bias in each domain. Tools like risk of bias tables are used to categorize judgments of low, high, or unclear risk of bias in individual studies.
Introduction to Systematic Review & Meta-Analysis Hasanain Ghazi
The document discusses systematic reviews and meta-analyses. It defines systematic reviews as a summary of available healthcare studies that provides high-level evidence on healthcare interventions. Meta-analyses use statistical methods to quantitatively summarize results across multiple studies. The document outlines the steps in conducting systematic reviews, including developing a protocol, searching for evidence, assessing risk of bias, and synthesizing findings. It also discusses how meta-analyses can help determine the strength and consistency of effects across studies.
Post graduate thesis protocol to research cell and insitute ethical committeeRamachandra Barik
The document provides guidelines for students at AIIMS Bhubaneswar to submit research protocols involving human subjects to the Institute Ethics Committee for approval. It outlines the format and content requirements for the protocol, including a cover letter, investigator information, objectives, methodology, ethical considerations, timelines, and references. Students must include an information sheet and informed consent form for participants in both English and the local language Odia. No research can begin without ethics clearance from the committee. The protocol aims to protect participants and obtain their fully informed consent for any risks or benefits of the study.
This document provides guidance on how to present a journal club. It explains that a journal club involves a group meeting regularly to critically evaluate recent scientific literature. The goals are to provide up-to-date medical knowledge and teach critical appraisal skills. It recommends selecting an impactful recent paper, distributing it in advance, and leading a discussion that focuses on the paper's methods, results, and interpretations rather than broad backgrounds. Participants should read the paper thoroughly and ask questions to better understand and critique it.
A systematic review is a structured review that pools the results of multiple studies on a topic using meta-analysis. It aims to summarize evidence from studies addressing a specific clinical question in a rigorous, unbiased manner to explain differences among studies on the same question. Systematic reviews are considered the highest level of evidence and are needed because individual studies may have biases or low statistical power to detect effects.
1) Meta-analysis is a statistical technique that combines the results of multiple studies on a topic and produces a single estimate of the overall effect. It aims to increase power by pooling data.
2) The first meta-analysis was conducted in 1904, and the term was coined in 1976. Meta-analysis is now often called a "systematic review."
3) Meta-analysis can help clinicians and policymakers integrate research findings and determine if relationships are consistent across studies. It increases precision and statistical power compared to individual studies.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Evidence based practice is Integration of best research evidence with clinical expertise and patient values.
Advantages: QUALITY OF CLINICAL PRACTICE IMPROVES BY INCORPORATING LATEST EFFECTIVE CLINICAL TECHNIQUES INTO PATIENT CARE.
Dental practitioner should try to adopt quality evidences in dental practice, accept evidence based new practices and letting go existing theories.
Evidence collected should be combined with clinical experience and patient preferences. Positive environment with advancement in science can help facilitate evidence based change in future.
The Cochrane Library is a collection of databases that provides high-quality, systematic reviews of the effects of healthcare interventions. It contains the Cochrane Database of Systematic Reviews, which summarizes conclusions about the effectiveness of interventions based on empirical evidence. Cochrane Reviews are considered the gold standard for systematic reviews because they are conducted to the highest methodological quality and updated regularly. The Cochrane Library also includes databases of controlled trials, reviews of other systematic reviews, methodology research, and economic evaluations to inform evidence-based healthcare decisions.
This document provides an overview of a workshop on using the Cochrane Library to train health librarians. The workshop covers introductions, an overview of Cochrane and systematic reviews, a demonstration of searching the Cochrane Library database, and small group work. Participants learn about finding and critically appraising systematic reviews to help inform evidence-based healthcare practices and decisions.
Meta-analysis is defined as quantitatively combining and integrating the findings of multiple research studies on a particular topic. It was coined by Glass in 1976 and refers to analyzing the results of several studies that address a shared research hypothesis. The key steps in a meta-analysis involve defining a hypothesis, locating relevant studies, inputting empirical data, calculating an overall effect size by standardizing statistics, and analyzing any moderating variables if heterogeneity exists. An example provided is a meta-analysis on coping behaviors of cancer patients that would statistically analyze results from quantitative studies with similar age groups.
Systematic Reviews in the Health SciencesBecky Morin
This document provides an overview of systematic reviews, including what they are, why they are important in health sciences research, and the steps involved in conducting one. It defines a systematic review as a comprehensive study that collects and analyzes data from multiple research studies to answer a specific question. It notes that systematic reviews use explicit and rigorous methods to minimize bias and provide reliable conclusions. The key steps outlined include developing a protocol and research question, conducting comprehensive searches, selecting and assessing studies, extracting and synthesizing data, and disseminating findings.
The characteristics of the Ideal Source for practicing Evidence-Based Medicine are:-
Located in the clinical setting
Easy to use
Fast, reliable connection
Comprehensive /Full Text
Provides primary data
Audio video consenting process and role of CRC or PI during av consentingJagriti Bansal
The document outlines the requirements and process for audio-visual (AV) recording of informed consent for clinical trials in India. Key points include:
1. AV recording of informed consent is now mandatory per a 2013 order from the Drug Controller General of India, following a Supreme Court ruling.
2. The requirements for AV consenting include an approved protocol and consent form, the subject and principal investigator on camera, a private room, and storage of recordings.
3. The process involves introducing all parties, explaining the study and consent form verbally, having the subject sign, and answering questions to ensure understanding before signing.
4. Clinical research coordinators are responsible for assisting with the process, ensuring privacy,
A systematic review is a comprehensive literature review designed to answer a specific clinical question using a pre-defined protocol. It requires at least 12 months to conduct due to extensive searches of published and unpublished studies, validity assessments of included studies, data collection, analysis, and keeping the review up-to-date. In contrast, a traditional literature review does not follow a pre-specified protocol or aim to be comprehensive. Systematic reviews also publish detailed search strategies to allow replication and apply statistical methods like meta-analysis to synthesized data from included studies.
This document provides guidance on how to conduct a journal club by outlining 10 steps for critically appraising a research article. It recommends that articles be of interest to participants, not just published, and report novel methods or applications. The 10 steps include: introducing the article; evaluating the authors, journal, hypothesis, and evidence presented; appraising the study design, methods, results, and discussion; considering the utility of the findings; and providing output such as writing a letter to the editor. Attendees are advised to actively read papers with the steps in mind and plan to participate in discussions. Sources for reporting guidelines are also referenced.
1) Blinding in clinical trials refers to keeping trial participants, investigators, and assessors unaware of treatment assignments to prevent bias.
2) Potential benefits of blinding include less psychological or physical bias in participants, better compliance, and less bias in outcome assessments.
3) Types of blinding include non-blinded (where all know assignments), single-blinded (one group remains unaware), and double-blinded (participants, investigators, and assessors remain unaware). Placebos are often used to maintain blinding.
This document discusses adaptive clinical trials. Adaptive trials allow changes to the trial design based on interim data analysis in order to make the trial more efficient. Key aspects that can be adapted include sample size, treatments, endpoints, and eligibility criteria. Adaptive designs are well-suited for exploratory trials aimed at learning, but confirmatory trials require more prior data and safeguards to ensure the trial's integrity and the validity of its conclusions. The FDA has provided guidance on adaptive designs to ensure patient safety and that adaptive trials meet evidentiary standards for approval.
This document discusses STROBE-nut, an extension of the STROBE reporting guidelines for nutritional epidemiology studies. It provides context on reporting guidelines and their importance in addressing research waste from incomplete reporting. STROBE-nut was developed through an expert consensus process to include 24 recommendations for transparently reporting nutritional epidemiology and dietary assessment studies. The goal of STROBE-nut is to improve the completeness and transparency of nutritional epidemiology research publications.
Critical appraisal of a journal articleDrSahilKumar
This document provides guidance on critically appraising journal articles. It defines critical appraisal as systematically identifying the strengths and weaknesses of research to assess validity and usefulness. Key aspects to evaluate include relevance of the research question, appropriateness of study design, addressing biases, adherence to original protocol, statistical analyses, and conflicts of interest. Checklists like CASP, CONSORT, and STROBE provide frameworks to appraise study methodologies like randomized trials, systematic reviews, and observational studies. The goal of critical appraisal is for clinicians to identify high-quality evidence to inform clinical practice.
This document discusses assessing risk of bias during systematic reviews. It defines bias as systematic error that deviates from the truth and can lead to over or underestimating effects. Assessing bias in included studies is important because results may be consistent due to flaws. There are seven domains for assessing bias: selection, performance, detection, attrition, reporting, and other biases. Risk of bias is assessed by reviewing study methods, looking for missing information, and making judgments on pre-specified criteria about the likelihood studies were affected by bias in each domain. Tools like risk of bias tables are used to categorize judgments of low, high, or unclear risk of bias in individual studies.
Introduction to Systematic Review & Meta-Analysis Hasanain Ghazi
The document discusses systematic reviews and meta-analyses. It defines systematic reviews as a summary of available healthcare studies that provides high-level evidence on healthcare interventions. Meta-analyses use statistical methods to quantitatively summarize results across multiple studies. The document outlines the steps in conducting systematic reviews, including developing a protocol, searching for evidence, assessing risk of bias, and synthesizing findings. It also discusses how meta-analyses can help determine the strength and consistency of effects across studies.
Post graduate thesis protocol to research cell and insitute ethical committeeRamachandra Barik
The document provides guidelines for students at AIIMS Bhubaneswar to submit research protocols involving human subjects to the Institute Ethics Committee for approval. It outlines the format and content requirements for the protocol, including a cover letter, investigator information, objectives, methodology, ethical considerations, timelines, and references. Students must include an information sheet and informed consent form for participants in both English and the local language Odia. No research can begin without ethics clearance from the committee. The protocol aims to protect participants and obtain their fully informed consent for any risks or benefits of the study.
This document provides guidance on how to present a journal club. It explains that a journal club involves a group meeting regularly to critically evaluate recent scientific literature. The goals are to provide up-to-date medical knowledge and teach critical appraisal skills. It recommends selecting an impactful recent paper, distributing it in advance, and leading a discussion that focuses on the paper's methods, results, and interpretations rather than broad backgrounds. Participants should read the paper thoroughly and ask questions to better understand and critique it.
A systematic review is a structured review that pools the results of multiple studies on a topic using meta-analysis. It aims to summarize evidence from studies addressing a specific clinical question in a rigorous, unbiased manner to explain differences among studies on the same question. Systematic reviews are considered the highest level of evidence and are needed because individual studies may have biases or low statistical power to detect effects.
1) Meta-analysis is a statistical technique that combines the results of multiple studies on a topic and produces a single estimate of the overall effect. It aims to increase power by pooling data.
2) The first meta-analysis was conducted in 1904, and the term was coined in 1976. Meta-analysis is now often called a "systematic review."
3) Meta-analysis can help clinicians and policymakers integrate research findings and determine if relationships are consistent across studies. It increases precision and statistical power compared to individual studies.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Evidence based practice is Integration of best research evidence with clinical expertise and patient values.
Advantages: QUALITY OF CLINICAL PRACTICE IMPROVES BY INCORPORATING LATEST EFFECTIVE CLINICAL TECHNIQUES INTO PATIENT CARE.
Dental practitioner should try to adopt quality evidences in dental practice, accept evidence based new practices and letting go existing theories.
Evidence collected should be combined with clinical experience and patient preferences. Positive environment with advancement in science can help facilitate evidence based change in future.
The Cochrane Library is a collection of databases that provides high-quality, systematic reviews of the effects of healthcare interventions. It contains the Cochrane Database of Systematic Reviews, which summarizes conclusions about the effectiveness of interventions based on empirical evidence. Cochrane Reviews are considered the gold standard for systematic reviews because they are conducted to the highest methodological quality and updated regularly. The Cochrane Library also includes databases of controlled trials, reviews of other systematic reviews, methodology research, and economic evaluations to inform evidence-based healthcare decisions.
This document provides an overview of a workshop on using the Cochrane Library to train health librarians. The workshop covers introductions, an overview of Cochrane and systematic reviews, a demonstration of searching the Cochrane Library database, and small group work. Participants learn about finding and critically appraising systematic reviews to help inform evidence-based healthcare practices and decisions.
how to do review research PRISMA-IS2012.pptemebetnigatu1
This document provides an overview of systematic reviews and meta-analyses, including:
1) It describes different types of reviews, specifically narrative reviews which provide an overview but can be biased, and systematic reviews which use explicit scientific methods to identify and summarize studies;
2) Key characteristics of systematic reviews are outlined, including having a focused question, comprehensive search strategy, and explicit inclusion/exclusion criteria;
3) Guidelines for conducting systematic reviews are discussed, including the Cochrane Handbook and PRISMA statement for reporting reviews.
The cochrane library an introduction for rheumatologists - 17 feb 2014Tamara Rader
The Cochrane Library provides high-quality systematic reviews and other evidence to inform healthcare decisions. It contains six databases, including the Cochrane Database of Systematic Reviews which publishes Cochrane Reviews that synthesize medical studies. Cochrane Reviews follow a rigorous methodology to identify and analyze data from relevant studies to determine if interventions are effective. The goal is to provide reliable evidence to help patients, practitioners, and policymakers make informed choices about healthcare.
The document provides an overview and training guide for accessing and using the Cochrane Library. It introduces the Cochrane Library as the best source of reliable information on the effects of interventions in health care. It describes the different databases within the Cochrane Library, including the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment Database, and NHS Economic Evaluation Database. It provides instructions on how to access, register for, and browse the various resources within the Cochrane Library.
The document provides information about accessing and using The Cochrane Library database. It discusses the origins and purpose of The Cochrane Collaboration, the different databases contained within The Cochrane Library, and how to search them effectively using techniques like Medical Subject Headings (MeSH) and Boolean logic. Live demonstrations are available to help users navigate the site at www.thecochranelibrary.com.
The document discusses evidence-based medicine (EBM) and its importance in clinical decision making. It defines EBM as using systematic reviews of scientific research to guide healthcare practices and decisions. The four steps of EBM are outlined as formulating a clear clinical question, searching literature, critically evaluating evidence, and implementing useful findings. Pioneers of EBM like Archie Cochrane recognized the need for medical decisions to be based on scientific evidence rather than assumptions. The Cochrane Collaboration was formed to produce systematic reviews of randomized controlled trials to synthesize evidence on healthcare interventions.
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
Levels of evidence, systematic review and guidelinesAboubakr Elnashar
1) Evidence-based medicine requires integrating the best research evidence with clinical expertise and patient values and circumstances.
2) Levels of evidence are used to rank types of medical studies, with systematic reviews and randomized controlled trials ranked highest.
3) Systematic reviews use explicit and reproducible methods to identify, select, and critically appraise relevant research to answer a specific clinical question.
GHGH FGHGH GHGHGH VHGH
This work aims to provide a practical guide to assist students of Computer Science
courses and related fields to conduct a systematic literature review. The steps proposed
in this paper to conduct a systematic review were extracted from a technical report
published by the researcher Bárbara Kitchenham [1] and arranged in a more objective
format, in order to make information more accessible and practical, especially for those
who are having their first contact with this technique.
This document provides guidance for writing a systematic literature review, including defining a clear research question, following reporting standards like PRISMA, registering the review, developing an exhaustive search strategy across multiple databases, and using reference management software to organize sources. Key steps include creating a protocol that outlines the question, search terms, inclusion/exclusion criteria, and reporting plan in order to conduct a rigorous and unbiased review that identifies what is already known about the topic and guides future research.
This document discusses methods for identifying priority topics for future Cochrane reviews, specifically regarding their relevance to low- and middle-income countries. It identifies several existing approaches used by Cochrane entities for priority setting and evaluates them based on criteria like inclusiveness, equity, and accountability. The document also outlines challenges like relying on volunteer work and a lack of funding. It proposes comparing different priority setting processes using a framework that evaluates objectives, criteria, implementation, and transparency. Key discussion questions focus on selecting and applying criteria, consulting stakeholders, and integrating priority setting with current Cochrane roles and new funding opportunities.
Evaluating the priority setting processes used across the Cochrane Collaborationmonalisa2n
This document discusses various methods that Cochrane entities use to prioritize topics for future Cochrane reviews. It identifies 17 entities that do not have a priority setting process and 27 that do or plan to. Common criteria for priority setting include clinical relevance, importance of the topic, impact on outcomes, and importance to specific populations. The document evaluates different approaches like the "Accountability for Reasonableness" framework and compares criteria like inclusiveness and equity. It poses discussion questions about selecting and applying criteria, evidence mapping, and integrating priority setting into the Collaboration's entities and strategies.
This document provides an overview of systematic reviews and meta-analysis. It discusses the need for critical analysis of multiple studies on a topic, as individual studies can produce conflicting results. The key steps in conducting a systematic review are planning, conducting searches and screening studies, extracting and synthesizing data, and reporting results. Meta-analysis allows for quantitatively combining results across studies to obtain a pooled effect size. Conducting systematic reviews and meta-analyses helps provide more robust evidence for healthcare decisions compared to individual studies.
C A N C A C Training Day R A D E R 12 J A N08Tamara Rader
The document discusses evidence-based healthcare and the Cochrane Collaboration's role in systematically reviewing medical literature and producing high-quality evidence summaries. It notes challenges like the large volume of published studies, variability in quality, and individual studies potentially being misleading. The Cochrane Collaboration addresses these issues through systematic reviews and meta-analyses. It also discusses the National Network of Libraries for Health, which aims to provide equal access to medical information for healthcare providers and consumers in Canada.
This document provides an overview of systematic reviews, outlining the key steps in conducting one. It defines a systematic review as a secondary study that uses a structured methodology to identify and evaluate all available primary research on a topic to answer a specific research question. The main steps outlined are: 1) defining a clear question, 2) identifying relevant studies through searching, 3) assessing study quality and selecting studies, 4) summarizing results through evidence synthesis, and 5) interpreting the findings.
Systematic Reviews and Knowledge Syntheses: What a Librarian Needs to KnowLorie Kloda
Librarians can play important roles in supporting systematic reviews and knowledge syntheses by conducting comprehensive literature searches, developing search strategies, managing references, and acquiring the necessary skills through training. As the number of systematic reviews and syntheses grows, standards and guidelines have been developed for conducting reviews. Agencies that fund reviews also recommend or require the involvement of a librarian with the appropriate competencies to support the review process.
This document outlines the process for conducting a systematic review. It begins by defining a systematic review as a review of research on a clearly formulated question that uses explicit and reproducible methods. It notes systematic reviews aim to identify, appraise, and synthesize all high-quality research evidence relevant to that question. The document then discusses why systematic reviews are important for summarizing evidence, limiting bias, and avoiding errors. It provides examples of how systematic reviews can help establish evidence-based practices. Finally, it describes the typical steps involved in conducting a systematic review, from developing a question to interpreting results.
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATROKanhu Charan
This document appears to be a newsletter or e-book with summaries of oncology research articles and case studies from March 2024 to mid-April 2024. It includes summaries on topics like radiotherapy dosing in head and neck cancer, genetic factors in breast cancer treatment, algorithms for surveillance of colorectal polyps, emerging tracers in neuro-oncology, target delineation workflows for various cancer sites, radiation therapy options for pituitary adenoma, comparisons of APBI guidelines for breast cancer, and associations between Chlamydia psittaci and orbital MALT lymphoma. The document also notes that April is National Oral Cancer Awareness Month.
TARGET DELINEATION OF THORACIC NODAL. STATIONKanhu Charan
The document discusses the different thoracic nodal stations that are relevant for staging lung cancer. It lists 24 different nodal station groups in the thoracic region, including supraclavicular, upper paratracheal, prevertebral, lower paratracheal, subaortic, para aortic, carinal, paraesophageal, and hilar nodal stations. Accurate identification of involved nodal stations is important for determining the stage and treatment planning for lung cancer patients.
TARGET DELINEATION IN RECTUM CANCER BY DR KANHUKanhu Charan
This document outlines the workflow for target delineation in radiation oncology for carcinoma of the rectum. It defines the gross tumor volume for the primary tumor (GTVp) and involved nodes (GTVn), as well as the clinical target volumes (CTVs) which add margins around the GTVs to cover microscopic disease. It describes the borders of the mesorectum and lists the lymph node regions included in the CTV for involved nodes. It concludes by specifying the planning target volumes (PTVs) which expand the CTVs and listing the dose schedules.
TARGET DELINEATION IN ANAL CANAL CANCER BY DR KANHUKanhu Charan
1. The document discusses target delineation and radiation therapy workflow for anal cancer, including definitions of gross tumor volume (GTV) and clinical target volumes (CTVs) based on anatomical locations.
2. It provides guidelines for determining margins around the GTV and nearby anatomical structures to create the CTVs for the primary tumor (CTVp), involved nodes (CTVn), and elective nodal regions (CTVnLR) to cover possible microscopic disease.
3. Treatment planning volumes (PTVs) are created by adding margins to the CTVs, with the PTV-HR receiving the full prescription dose and the PTV-LR receiving a lower dose.
TARGET DELINEATION IN VULVAL CANCER BY DR KANHUKanhu Charan
The document outlines the steps and guidelines for target delineation in vulval cancer radiation therapy planning. It discusses delineating the gross tumor volume (GTV), clinical target volume (CTV), organs at risk (OAR), and planning target volume (PTV). Specific guidelines are provided for contouring depending on the location and extent of the primary tumor, including the vulva, mons pubis, vagina, anorectum, urethra, and clitoris. Radiation dose parameters and OAR constraints are also reviewed. The target delineation workflow aims to adequately cover suspected disease while minimizing dose to surrounding healthy tissues.
TARGET DELINEATION IN CERVIX CANCER BY DR KANHUKanhu Charan
This document outlines the 10 step workflow for target delineation in cervical cancer radiotherapy treatment planning. It describes the clinical target volumes that should be contoured for the primary gross tumor (GTVp), primary clinical target (CTVp), nodal gross tumor (GTVn), nodal clinical targets (CTVn) and elective nodal volumes. It provides explanations and guidelines for delineating each target volume, including the parametrium and nodal regions. Diagrams and images are included to illustrate the anatomical locations and boundaries of the target volumes.
Oncology cartoons by Dr Kanhu Charan PatroKanhu Charan
This document provides guidance on target volume delineation for vulval cancer from the Royal College of Radiologists. It outlines the clinical target volume (CTV) for different disease sites, including the vulva, mons pubis, vagina, anorectum, urethra and pelvic nodes. Contouring workflows and organ-at-risk constraints are also discussed. Recommendations are given for radiation dose and treatment of resectable and unresectable head and neck cancer. The final item notes that smoking increases the risk of kidney cancer.
RADIATION THERAPY IN BILIARY TRACT CANCERKanhu Charan
This document provides information on biliary tract cancers and the role of chemoradiotherapy in their treatment. It discusses the anatomy and types of biliary cancers, risk factors, presentation, diagnosis, staging, and standard treatment approaches including surgery. It then focuses on the evidence and guidelines for use of radiation therapy, including as adjuvant therapy after surgery for positive margins or nodes, as radical/definitive therapy for unresectable disease, and for palliation of symptoms from local or metastatic disease. Key findings are that chemoradiation improves local control and survival as adjuvant or radical therapy, and brachytherapy and external beam radiation are effective for palliation. Optimal regimens involve fluorouracil or capec
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUMEKanhu Charan
Dr Kanhu Charan Patro provides summaries of statistical concepts in 3 sentences or less, beginning each summary with the date. Summaries from January 19th to February 15th are presented, covering topics such as p-values, censoring in survival analysis, hazard ratios, and ISRS guidelines for stereotactic radiosurgery. On February 15th, a 3 sentence summary of World Cancer Day is provided, noting the date it is held, the organization that leads it, and the 2024 slogan of "Close the care gap".
Molecular Profile of Endometrial cancer.Kanhu Charan
The document discusses molecular analysis and classification of endometrial cancer, which impacts staging and treatment decisions. It describes aggressive histological subtypes and how molecular markers like POLE mutations, MMRd, and p53 abnormalities determine low, intermediate, or high risk stratification. Ongoing PORTEC trials are exploring the impact of molecular profiling on adjuvant treatment, with POLE mutations potentially downstaging while p53 mutations upstage disease. Molecular analysis provides predictive significance for personalized adjuvant therapies in endometrial cancer.
ONCOLOGY CARTOONS JANUARY 2024 BY DR KANHU CHARAN PATROKanhu Charan
This document discusses cervical cancer awareness month in January and provides 3 recommendations: 1) Be loyal to your partner to reduce risk of HPV infection, 2) Maintain genital hygiene, 3) Get vaccinated against HPV to prevent cervical cancer, and 4) Get screened regularly to detect cervical cancer early.
TYPES OF STATISTICAL DATA BY DR KANHU CHARAN PATROKanhu Charan
This document discusses types of data in statistics. It defines qualitative and quantitative data, and describes different types of quantitative data like discrete, continuous, ordinal, and nominal. Examples of love and fight data are provided to illustrate these concepts. The document concludes with a short poem about not fighting in marriage.
WHY STEREOTATXY IN CRANIAL AVM / DR KANHU CHARAN PATROKanhu Charan
This document discusses stereotactic radiosurgery (SRS) for the treatment of cerebral arteriovenous malformations (AVMs). It begins by explaining what an AVM is and the risks they pose if untreated, such as bleeding in the brain. It then covers treatment options for AVMs and why SRS is often preferred for certain cases, such as when the AVM is in an eloquent or deep brain area. The document provides details on patient selection, imaging and planning for SRS, anticipated outcomes, and risks of treatment complications. It emphasizes the importance of multidisciplinary discussion and informed consent when determining if SRS is appropriate for a patient's individual AVM.
1) SBRT is an effective treatment for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). In a study of 70 HCC patients with PVTT treated with SBRT, median survival was 10 months and 6-month and 12-month survival rates were 67.3% and 40% respectively.
2) Patients who received SBRT combined with transarterial chemoembolization (TACE) had significantly longer survival compared to those who did not receive TACE after SBRT.
3) SBRT is a promising bridging therapy prior to liver transplantation or hepatectomy by downstaging PVTT to make these curative procedures possible.
DR KANHU CHARTAN PATRO/ FOR ENT SURGEONSKanhu Charan
1. Radiotherapy plays a crucial role in the treatment of head and neck cancers, both as a primary treatment and in combination with surgery. It is used for cancers of the nasopharynx, larynx, hypopharynx, and as postoperative treatment for most oral cancers.
2. Advances in radiotherapy technology such as IMRT have allowed for better tumor targeting while minimizing doses to surrounding healthy tissues, reducing treatment toxicities. Imaging techniques such as PET-CT provide improved visualization of tumors and affected lymph nodes, helping determine accurate target volumes.
3. Organ preservation approaches using radiotherapy and chemotherapy are increasingly used to treat head and neck cancers, avoiding disfiguring surgeries while achieving high
DECEMBER 2023 ONCOLOGY CARTOONS DRKANHU CHARAN PATROKanhu Charan
Here are the key points about the hepatitis B vaccine and liver cancer:
- Hepatitis B virus (HBV) infection can lead to chronic hepatitis B and significantly increase the risk of developing liver cancer later in life.
- The hepatitis B vaccine is effective at preventing HBV infection and therefore helps prevent liver cancers caused by the virus. It was the first vaccine referred to as an "anti-cancer" vaccine by the FDA.
- Around 25% of people with chronic HBV infection may develop liver cancer according to the CDC. Getting vaccinated helps avoid this risk.
- The hepatitis B vaccine is available and affordable in India, ranging from around 45 rupees per pediatric dose to 250 rupees for the
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
4. MAVERICK STREAK
If you describe someone
as a maverick, you mean
that they
are unconventional and
independent, and do
not think or behave in the
same way as other
people
4
5. IT HAPPENS
5
1. Archie, as he was known,
came from a wealthy family,
thereby enjoying lifelong
financial security.
2. As a young man, he suffered
from a sexual dysfunction
for which he could not find
treatment in the United
Kingdom.
7. CRITICISM
Cochrane was pilloried by
colleagues for appearing on
television to promote abortion
and to claim (rightly, at the
time) that there was no
evidence of benefit from
routine cervical smears
7
9. 1. In this seminal book, first
published in 1972 by the
Nuffield Provincial
Hospitals Trust
2. He called for an
international register of
randomised controlled
trials, and for clear quality
criteria for appraising
published research, but
neither goal was achieved
in his lifetime.
9
10. On returning to England,
he enlisted in the
International Brigade to
fight fascism in Spain.
During World War II, he
was held prisoner for 4
years
10
11. 1. After the war, Archie studied
the chest diseases of mining
populations in Wales,
launching a series of
remarkable surveys that
reached more than 90% of
their target populations.
2. Diseases of lung diseases and
his papers on quality of
health and medical care
services are characterized by
innovation and even bravery.
11
12. Cochrane retired to his home, Rhoose Farm House,
in the Vale of Glamorgan, Wales, where he created a
prize winning garden, hung an impressive art
collection, and entertained epidemiologists from
around the world. He died in 1988 at the age of 79
12
13. Cochrane's raw moral courage, his efforts
pursuit of the truth, and his irreverence
towards the scientific establishment remain
an inspiration
1. ethical committees,
2. grant giving bodies
3. journal editors
INSPIRATION
13
16. 1. Cochrane was developed in response
to Archie Cochrane's call for up-to-date,
systematic reviews of all relevant
randomized controlled trials of health
care
2. Cochrane, previously known as
the Cochrane Collaboration, was
founded in 1993 under the leadership
of Iain Chalmers
16
17. Sir Iain Chalmers
• Between 1978 and 1992, he was the first
director of the National Perinatal
Epidemiology Unit in Oxford.
• There, Chalmers led the development of the
electronic Oxford Database of Perinatal
Trials (ODPT)
• Chalmers was appointed director of the UK
Cochrane Centre, leading to the development
of the international Cochrane Collaboration
17
28. Cochrane Central Register of Controlled
Trials (CENTRAL)
1. CENTRAL is comprised of these Specialized Registers, relevant
records retrieved from MEDLINE and EMBASE , and records retrieved
through hand searching (planned manual searching of a journal or
conference proceedings to identify all reports of
randomised controlled trials and controlled clinical trials).
2. The Cochrane Central Register of Controlled Trials (CENTRAL) is a
bibliographic database that provides a highly concentrated source of
reports of randomized controlled trials.
3. Records contain the list of authors, the title of the article, the source,
volume, issue, page numbers, and, in many cases, a summary of the
article (abstract).
4. They do not contain the full text of the article.
28
31. Cochrane Library (CLIB)
• All Cochrane reviews published in CLIB
• Published by Wiley-Blackwell (indexed by PubMed, impact factor 6.1)
• Free access in the UK and many other countries
31http://www.thecochranelibrary.com/
32. WHAT IS METAANALYSIS?
Meta-analysis is a statistical technique for
combining data from multiple studies on a
particular topic. Compared to other study
designs (such as randomized controlled trials
or cohort studies), the meta-analysis comes
in at the top of the 'levels of evidence'
pyramid in evidence-based healthcare
32
33. What is the difference between a
systematic review and meta analysis?
1. Systematic review answers a defined research
question by collecting and summarizing all
empirical evidence that fits pre-specified
eligibility criteria.
2. A meta-analysis is the use of statistical
methods to summarize the results of these
studies.
33
35. Cochrane SR
• Development of Cochrane SR is coordinated
by the Cochrane Collaboration
– Established in 1993
– International network of 28,000 from 100 countries
– About 4,600 Cochrane reviews published
– They are internationally recognised as a benchmark for
high quality information about the effectiveness of
healthcare
http://www.cochrane.org
35
36. Methodology of Cochrane reviews
• Methodology robustly
developed (continuous
improvements)
• Handbook – free online
access:
http://www.cochrane.org/t
raining/cochrane-
handbook
• Good to follow even if doing “non-
Cochrane” SR
• UK Cochrane Centre - training
36
37. Process of conducting Cochrane SR
• PROTOCOL – important
– Minimise potential bias in the
review conduct:
– Reviews are retrospective,
– need to establish the
methods in advance
– Planning
– Review team
– Cochrane protocols are peer
reviewed and published
37
38. Cochrane review conduct – key points-1
• Protocol
• Objectives
– Focused well defined research question
– Primary outcome (one)
– Minimum number of secondary outcomes
– Include adverse events (harms) if relevant
• Literature search
– Comprehensive (electronic databases, grey literature, reference lists,
personal communication, ..)
– Useful to involve an information specialist in developing search
strategies (consider peer review)
– Keep detailed record of search methods and search results!
38
39. Cochrane review conduct – key points (2)
• Data collection and analysis
– Selection of studies using predefined selection
criteria
– Independently done by more than one reviewer
– Important to determine how to solve disagreements
between reviewers
• Data extraction
– Data extraction form (pilot – items, format, ..)
– Independently done by more than one reviewer
39
40. Cochrane review conduct – key points (3)
• ASSESSMENT OF RISK OF BIAS
– Problems with the design and execution of individual studies of healthcare
interventions raise questions about the validity of their findings
– In clinical trials, biases can be broadly categorized as selection bias, performance
bias, detection bias, attrition bias, reporting bias and other biases that do not fit
into these categories
– Cochrane Collaboration developed the ‘Risk of bias tool’ 7 specific domains:
• sequence generation (selection bias)
• allocation concealment (selection bias)
• blinding of participants and personnel (performance bias)
• blinding of outcome assessment (detection bias)
• incomplete outcome data (attrition bias)
• selective outcome reporting (reporting bias)
• other potential sources of bias
40
41. Cochrane review conduct – key points (4)
• Data synthesis
– Qualitative: descriptive summary
– Quantitative - meta-analysis: pooling data from a
number of studies when there are
• Minimal differences between studies
• Outcome measured in the same way
• Data are available
Study weight
Different statistical
methods for pooling
Subgroup analysis
Sensitivity analysis
41
42. Interpretation of results
• Clear statement of findings
• Authors conclusions should reflect findings
• Clear presentation is important
• Summary of findings tables
– Key information in a quick and accessible format
– Relating the quality of evidence to the outcomes
42
45. Poor reporting of systematic reviews
• Good reporting of primary studies is crucial for
SR development
BUT
• Reviews are not immune to the problems of
poor reporting
– Moher et al. assessed epidemiological and
reporting characteristics and bias-related aspects
of 300 systematic reviews (of which 125 were
Cochrane reviews).
[Moher; PLoS Medicine 2007]
45
46. Example of bad reporting
• Nowhere in the paper any mention of the review
methodology!
46
48. Publishing SR
• Differences between publishing SR in the Cochrane Library and in a
journal:
– Cochrane has some specific rules (e.g. titles structure: a title cannot
start with ‘A’ or ‘The’; should not not include ‘a systematic review of’)
• Publishing in a journal: PRISMA Statement
– Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(2009)
– 27-item checklist, flow diagram
– PRISMA authors are also heavily involved in the Cochrane work, high
compatibility of both guides
http://www.prisma-statement.org/
48
53. THE PRISMA DEVELOPMENT
1. In 1987, Cynthia Mulrow examined for the first time the methodological quality of a
sample of 50 review articles published in four leading medical journals between 1985
and 1986 She found that none met a set of eight explicit scientific criteria, and that the
lack of quality assessment of primary studies was a major pitfall in these reviews
2. IN 1996, an international group of 30 clinical epidemiologists, clinicians, statisticians,
editors, and researchers convened The Quality of Reporting of Meta-analyses
(QUOROM) conference to address standards for improving the quality of reporting of
meta-analyses of clinical randomized controlled trials
3. The conference resulted in the QUOROM, a checklist, and a flow diagram that
described the preferred way to present the abstract, introduction, methods, results,
and discussion sections of a report of a systematic review or a meta-analysis.
4. Eight of the original 18 items formed the basis of the QUOROM reporting. Evaluation of
reporting was organized into headings and subheadings regarding searches, selection,
validity assessment, data abstraction, study characteristics, and quantitative data
synthesis.
5. In 2009, the QUOROM was updated to address several conceptual and practical
advances in the science of systematic reviews, and was renamed PRISMA (Preferred
Reporting Items of Systematic reviews and Meta-Analyses)
6. A three-day meeting was held in Ottawa, Canada, in June 2005 with 29 participants,
including review authors, methodologists, clinicians, medical editors, and a consumer.
The objective of the Ottawa meeting was to revise and expand the QUOROM checklist
and flow diagram, as needed
53
54. THE PRISMA IMPCAT
1. The use of checklists like PRISMA is likely to improve the reporting quality of
a systematic review and provides substantial transparency in the selection
process of papers in a systematic review.
2. The PRISMA Statement has been published in several journals.
3. Many journal's publishing health research refer to PRISMA in their
Instructions to Authors and some require authors to adhere to them.
4. The PRISMA Group advised that PRISMA should replace QUOROM for those
journals that endorsed QUOROM in the past.
5. Recent surveys of leading medical journals evaluated the extent to which the
PRISMA Statement has been incorporated into their Instructions to Authors.
6. In a sample of 146 journals publishing systematic reviews, the PRISMA
Statement was referred to in the instructions to authors for 27% of journals;
more often in general and internal medicine journals (50%) than in specialty
medicine journals (25%).
7. These results showed that the uptake of PRISMA guidelines by journals is still
inadequate although there has been some improvement over time.
54
55. PRISMA CHECKLIST
The checklist includes 27 items pertaining to the
content of a systematic review and meta-analysis,
which include the title, abstract, methods, results,
discussion and funding.
55
58. PRISMA explanation & elaboration paper
– Explanation and rationale for reporting of suggested
information (items)
– Examples of good reporting
– Relevant data about how this information is reported
presently
58
71. RESULTS
1. 7 eligible trials, data from six trials were received (1,205 patients, 92% of all
randomly assigned patients).
2. Median follow-up was 6 years.
3. There was a significant benefit of concomitant radiochemotherapy on
overall survival (HR, 0.84; 95% CI, 0.74 to 0.95; P .004), with an absolute
benefit of 5.7% (from 18.1% to 23.8%) at 3 years and 4.5% at 5 years.
4. For progression-free survival, the HR was 0.90 (95% CI, 0.79 to 1.01; P=.07).
5. Concomitant treatment decreased locoregional progression (HR, 0.77; 95%
CI, 0.62 to 0.95; P .01); its effect was not different from that of sequential
treatment on distant progression (HR, 1.04; 95% CI, 0.86 to 1.25; P .69).
6. Concomitant radiochemotherapy increased acute esophageal toxicity
(grade 3-4) from 4% to 18% with a relative risk of 4.9 (95% CI, 3.1 to 7.8; P
.001).
7. There was no significant difference regarding acute pulmonary toxicity.
8. survival benefit of more than 5% at 3 years, concomitant
radiochemotherapy
71
72. AUTHOR CONCLUSION
Concomitant radiochemotherapy, as
compared with sequential
radiochemotherapy, improved survival of
patients with locally advanced NSCLC,
primarily because of a better loco regional
control, but at the cost of manageable
increased acute esophageal toxicity
72
74. Authors conclusion
1. Temozolomide when given in both concomitant and
adjuvant phases is an effective primary therapy in GBM
compared to radiotherapy alone.
2. It prolongs survival and delays progression without
impacting on QoL but it does increase early adverse
events.
3. In recurrent GBM, temozolomide compared with standard
chemotherapy improves time-to-progression (TTP) and
may have benefits on QoL without increasing adverse
events but it does not improve overall.
4. In the elderly, temozolomide alone appears comparable to
radiotherapy in terms of OS and PFS but with a higher
instance of adverse events
74
76. Author conclusion
• Analysis of a subgroup of one RCT showed that surgery for
early cervical AC was better than radiotherapy.
• However, the majority of operated patients required
adjuvant radiotherapy, which is associated with
greater morbidity.
• Furthermore, the radiotherapy in this study was not
optimal, and surgery was not compared to chemoradiation,
which is currently recommended in most centres.
• the risk of 'double trouble' caused by surgery and adjuvant
radiotherapy.
76
78. Author conclusion
• 15 trials with 6515 patients
• Median follow up was six years
• Mostly oropharynx and larynx
• There was a significant survival benefit with
altered fractionation radiotherapy
• Corresponding to an absolute benefit of 3.4%
at five years (hazard ratio (HR) 0.92,
95% CI 0.86 to 0.97; P = 0.003)
78
79. Author conclusion
• The benefit was significantly higher with
hyperfractionated radiotherapy (8% at five years)
than with accelerated radiotherapy (2% with
accelerated fractionation .
• The benefit was significantly higher in the
youngest patients (under 50 year old)
• There was a benefit in locoregional control in
favour of altered fractionation versus
conventional radiotherapy (6.4% at five years; P <
0.0001),
79
81. Author conclusion
• 18 trials were identified and 15 of these were eligible for inclusion in the
main analysis.
• On the basis of 13 trials that compared chemoradiotherapy versus the same
radiotherapy, there was a 6% improvement in 5-year survival with
Chemoradiotherapy (hazard ratio (HR) = 0.81, P < 0.001).
• A larger survival benefit was seen for the two further trials in which chemotherapy
was administered after Chemoradiotherapy.
• There was a significant survival benefit for both the group of trials that used
platinum-based (HR = 0.83, P = 0.017) and non-platinum based (HR = 0.77, P= 0.009)
Chemoradiotherapy, but no evidence of a difference in the size of the benefit by
radiotherapy or chemotherapy dose or scheduling was seen.
• Chemoradiotherapy also reduced local and distant recurrence and progression and
improved disease-free survival (DFS).
• There was a suggestion of a difference in the size of the survival benefit with tumor
stage, but not across other patient subgroups.
• Acute haematological and gastro-intestinal toxicity were increased with
Chemoradiotherapy, but data were too sparse for an analysis of late toxicity. 81
83. • There was no difference in progression‐free
survival in the study comparing surgery plus
WBRT versus stereotactic radiosurgery plus
WBRT
• there were no differences in quality of life
83
84. Interventions for the treatment of brain
radionecrosis after radiotherapy or
radiosurgery
84
85. Author conclusion
1. Bevacizumab showed radiological response
which was associated with minimal improvement
in cognition or symptom severity
2. Edaravone plus corticosteroids versus
corticosteroids alone reported greater reduction
in the surrounding oedema with combination
treatment but no effect on the enhancing
radionecrosis lesion.
85
86. Author conclusion
Edaravone, sold as under the brand
names Radicava and Radicut, is an intravenous
medication used to help with recovery following
a stroke and to treat amyotrophic lateral
sclerosis (ALS).
86
88. Based on very low quality evidence, primary
whole gland cryotherapy has uncertain effects
on oncologic outcomes, QoL, and major
adverse events compared to external beam
radiotherapy
88
90. AUTHOR CONCLUSION
1. There is high‐certainty evidence that HPV vaccines
protect against cervical precancer in adolescent girls
and young women aged 15 to 26.
2. The effect is higher for lesions associated with
HPV16/18 than for lesions irrespective of HPV type.
3. The effect is greater in those who are negative for
hrHPV or HPV16/18 DNA at enrolment than those
unselected for HPV DNA status.
4. There is moderate‐certainty evidence that HPV vaccines
reduce CIN2+ in older women who are HPV16/18
negative, but not when they are unselected by HPV
DNA status 90
92. Author conclusion
1. Use of bisphosphonates in participants with MM reduces pathological
vertebral fractures, SREs and pain.
2. Bisphosphonates were associated with an increased risk of developing
ONJ.
3. For every 1000 participants treated with bisphosphonates, about one
patient will suffer from the ONJ.
4. We found no evidence of superiority of any specific
aminobisphosphonate (zoledronate, pamidronate or ibandronate) or
non‐aminobisphosphonate (etidronate or clodronate) for any outcome.
5. Zoledronate was found to be better than placebo and first‐generation
bisposphonate (etidronate) in pooled direct and indirect analyses for
improving OS and other outcomes such as vertebral fractures.
6. Direct head‐to‐head trials of the second‐generation bisphosphonates
are needed to settle the issue if zoledronate is truly the most efficacious
bisphosphonate currently used in practice 92
93. Flexible sigmoidoscopy versus faecal
occult blood testing for colorectal cancer
screening in asymptomatic individuals
93
94. 1. 9 studies comprising 338,467 individuals randomized to
screening and 405,919 individuals to the control
groups.
2. In the analyses based on indirect comparison of the two
screening methods, the relative risk of dying from
colorectal cancer was 0.85 (95% credibility interval 0.72
to 1.01, low quality evidence) for flexible sigmoidoscopy
screening compared to FOBT.
3. There is high quality evidence that both flexible
sigmoidoscopy and faecal occult blood testing reduce
colorectal cancer mortality when applied as screening
tools
AUTHOR CONCLUSION
94
96. AUTHOR CONCLUSION
1. Included 44 RCTs involving 37,302 women.
2. For women with EBC, bisphosphonates reduce the risk of bone
metastases and provide an overall survival benefit compared to
placebo or no bisphosphonates
3. There is preliminary evidence suggestive that bisphosphonates
provide an overall survival and disease‐free survival benefit in
postmenopausal women only when compared to placebo or no
bisphosphonate
4. In women with ABC without clinically evident bone metastases,
there was no evidence of an effect of bisphosphonates on bone
metastases
5. Bisphosphonates did not significantly reduce the incidence of
fractures when compared to placebo/no bisphosphonates
96
98. AUTHOR CONCLUSION
1. 17 published and two unpublished) including 4580 patients
2. Concomitant chemoradiation appears to improve overall survival
and progression‐free survival in locally advanced cervical cancer.
3. The review strongly suggests chemoradiation improves overall
survival and progression free survival, whether or not platinum
was used with absolute benefits of 10% and 13% respectively.
4. There was some evidence that the effect was greater in trials
including a high proportion of stage I and II patients
5. Chemoradiation also showed significant benefit for local
recurrence and a suggestion of a benefit for distant recurrence
98
99. Chemotherapy as an adjunct to
radiotherapy in locally advanced
nasopharyngeal carcinoma
99
100. AUTHOR CONCLUSION
1. 8 trials with 1753 patients were included. One trial with a 2 x 2
design was counted twice in the analysis.
2. The median follow up was 6 years
3. he pooled hazard ratio of death was 0.82 (95% confidence interval
(CI) 0.71 to 0.95; P = 0.006) corresponding to an absolute survival
benefit of 6% at five years from chemotherapy (from 56% to 62%)
4. Chemotherapy led to a small but significant benefit for overall
survival and event‐free survival. This benefit was essentially
observed when chemotherapy was administered concomitantly
with radiotherapy.
5. A significant interaction was observed between chemotherapy
timings and overall survival (P = 0.005), explaining the
heterogeneity observed in the treatment effect (P = 0.03) with the
highest benefit from concomitant chemotherapy. 100
101. Early versus delayed postoperative
radiotherapy for treatment of
low‐grade gliomas
101
102. AUTHOR CONCLUSION
1. 1 large, multi‐institutional, prospective RCT, involving 311 participants
2. The median OS in the early radiotherapy group was 7.4 years, while the
delayed radiotherapy group experienced a median overall survival of 7.2
years
3. People with LGG who undergo early radiotherapy showed an increase in
time to progression compared with people who were observed and had
radiotherapy at the time of progression
4. There was no significant difference in overall survival between people
who had early versus delayed radiotherapy
5. People who underwent early radiation had better seizure control at one
year than people who underwent delayed radiation
6. There were no cases of radiation‐induced malignant transformation of
LGG
7. However, it remains unclear whether there are differences in memory,
executive function, cognitive function, or quality of life between the
two groups since these measures were not evaluated. 102
103. The role of additional
radiotherapy for primary central
nervous system lymphoma
103
104. AUTHOR CONCLUSION
1. 556 potentially relevant studies only two met the inclusion criteria
2. In summary, the currently available evidence (one RCT) is not
sufficient to conclude that WBR plus chemotherapy and
chemotherapy alone have similar effects on overall survival in
people with PCNSL.
3. The findings suggest that the addition of radiotherapy (WBR) to
chemotherapy may increase progression‐free survival, but may also
increase the incidence of neurotoxicity compared to chemotherapy
only (methotrexate monotherapy).
4. As the role of chemoradiotherapy in the treatment of PCNSL remains
unclear, further prospective, randomised trials are needed before
definitive conclusions can be drawn.
104
106. AUTHOR CONCLUSION
1. 4 multicentre RCTs involving 1269 women with primary FIGO
stage III/IV endometrial cancer.
2. There is moderate quality evidence that chemotherapy
increases survival time after primary surgery by approximately
25% relative to radiotherapy in stage III and IV endometrial
cancer.
3. There is limited evidence that it is associated with more adverse
effects.
4. There is some uncertainty as to whether triplet regimens offer
similar survival benefits over doublet regimens in the long‐term.
5. Further research is needed to determine which chemotherapy
regimen(s) are the most effective and least toxic, and whether
the addition of radiotherapy further improves outcomes. 106
108. AUTHOR CONCLUSION
1. No new RCTs were identified by the updated search. Out of twelve
identified papers only one met the selection criteria.
2. Although primary radiotherapy for the groin results in less short
term and long term morbidity compared with inguinal and femoral
groin dissection, there is not enough evidence to prove that it is as
effective regarding control of tumours in the groin.
3. In the only RCT, tumour recurrence and survival were both better in
the surgery arm overall, although the irradiation dose may have been
inadequate.
4. In daily practice this means that surgery is the first choice treatment
for the groin lymph nodes in early vulvar cancer.
5. When the condition of the patient is such that the increased risk of
morbidity with the use of surgery outweighs the chances of cure,
then primary radiotherapy is a good alternative treatment
108
110. AUTHOR CONCLUSION
1. 46 trials (542 participants) that met our inclusion criteria
2. From the available RCTs, we found insufficient evidence that hormonal
treatment in any form, dose or as part of combination therapy improves
the survival of patients with advanced or recurrent endometrial cancer.
3. However, a large number of patients would be needed to demonstrate
an effect on survival in a RCT and none of the included trials in this
review had a sufficient number of patients to demonstrate a significant
difference.
4. In view of the absence of a proven survival advantage and the
heterogeneity of patient populations, the decision to use any type of
hormonal therapy should be individualised and with the intent to palliate
the disease.
5. It is debatable whether outcomes such as quality of life, treatment
response or palliative measures such as relieving symptoms should take
preference over overall and progression‐free survival as the major
objectives of future trials. 110
113. WHAT IS GREEN TEA?
1. Tea is one of the most commonly consumed beverages
worldwide.
2. Teas from the plant Camellia sinensis can be grouped into
green, black and oolong tea.
3. Cross‐culturally tea drinking habits vary.
4. Camellia sinensis contains the active ingredient
polyphenol, which has a subgroup known as catechins.
5. Catechins are powerful antioxidants. It has been
suggested that green tea polyphenol may inhibit cell
proliferation
6. observational studies have suggested that green tea may
have cancer‐preventative effects 113
114. AUTHOR CONCLUSION
1. 51 studies with more than 1.6 million participants were included.
2. 27 of them were case‐control studies, 23 cohort studies and one
randomised controlled trial (RCT)
3. There is insufficient and conflicting evidence to give any firm
recommendations regarding green tea consumption for cancer
prevention.
4. The results of this review, including its trends of associations, need to be
interpreted with caution and their generalisability is questionable, as the
majority of included studies were carried out in Asia (n = 47) where the
tea drinking culture is pronounced.
5. Desirable green tea intake is 3 to 5 cups per day (up to 1200 ml/day),
providing a minimum of 250 mg/day catechins.
6. If not exceeding the daily recommended allowance, those who enjoy a
cup of green tea should continue its consumption.
7. Drinking green tea appears to be safe at moderate, regular and habitual
use.
114
116. AUTHOR CONCLUSION
1. 9 studies
2. There is no evidence for recommending supplements of vitamins A,
C, E, selenium, either alone or in different combinations, for the
prevention of lung cancer and lung cancer mortality in healthy
people.
3. There is some evidence that the use of beta‐carotene supplements
could be associated with a small increase in lung cancer incidence
and mortality in smokers or persons exposed to asbestos.
4. Single study that included 7627 women and found a higher risk of
lung cancer incidence for those taking vitamin C but not for total
cancer incidence, but that effect was not seen in males or when the
results for males and females were pooled.
116
118. AUTHOR CONCLUSION
1. 19 randomised studies (2728 participants) of concurrent chemoradiotherapy versus
radiotherapy alone were included.
2. Chemoradiotherapy significantly reduced overall risk of death (HR 0.71, 95% CI 0.64 to
0.80; I2 0%; 1607 participants) and overall progression‐free survival at any site (HR 0.69,
95% CI 0.58 to 0.81; I2 45%; 1145 participants).
3. Incidence of acute oesophagitis, neutropenia and anaemia were significantly increased
with concurrent chemoradiation.
4. 6 trials (1024 patients) of concurrent versus sequential chemoradiation were included.
5. A significant benefit of concurrent treatment was shown in overall survival (HR 0.74,
95% CI 0.62 to 0.89; I2 0%; 702 participants). This represented a 10% absolute survival
benefit at 2 years.
6. More treatment‐related deaths (4% vs 2%) were reported in the concurrent arm
without statistical significance (RR 2.02, 95% CI 0.90 to 4.52; I2 0%; 950 participants).
7. There was increased severe oesophagitis with concurrent treatment (RR 4.96, 95%CI
2.17 to 11.37; I2 66%; 947 participants).
118
120. AUTHOR CONCLUSION
1. Main results
A. There was no difference between the treatment interventions and
the control groups in preventing a first seizure in participants with
brain tumors.
B. The risk of an adverse event was higher for those on antiepileptic
drugs than for participants not on antiepileptic drugs (NNH 3; RR
6.10, 95% CI 1.10 to 34.63; P = 0.046).
1. Authors' conclusions
A. The evidence is neutral, neither for nor against seizure prophylaxis,
in people with brain tumors. These conclusions apply only for the
antiepileptic drugs phenytoin, phenobarbital, and divalproex
sodium.
B. The decision to start an antiepileptic drug for seizure prophylaxis is
ultimately guided by assessment of individual risk factors and
careful discussion with patients. 120
122. AUTHOR CONCLUSION
1. Treatment of cancer is increasingly effective but is associated with short and
long term side effects.
2. Oral and gastrointestinal side effects, including oral candidiasis, remain a major
source of illness despite the use of a variety of agents to treat them
3. Ten trials involving 940 patients, satisfied the inclusion criteria and are
included in this review. Drugs absorbed from the gastrointestinal (GI) tract were
beneficial in eradication of oral candidiasis compared with drugs not absorbed
from the GI tract (three trials: RR = 1.29, 95% confidence interval (CI) 1.09 to
1.52), however there was significant heterogeneity.
4. A drug absorbed from the GI tract, ketoconazole, was more beneficial than
placebo in eradicating oral candidiasis (one trial: RR = 3.61, 95% CI 1.47 to
8.88).
5. Clotrimazole, at a higher dose of 50 mg was more effective than a lower 10 mg
dose in eradicating oral candidiasis, when assessed mycologically (one trial: RR
= 2.00, 95% CI 1.11 to 3.60).
122
135. FATHER- FATHER IN LAW
MOTHER- MOTHER IN LAW
SISTER- SISTER IN LAW
SON- SON IN LAW
135
ROLE OF WIFE?
CHOOSE WISELY
136. Large number of studies – need to synthesise & summarise
136
Source: Banzi et al. J of Med Internet Res;
2010,12 (3) adapted from Haynes RB. Evid
Based Med 2006;11(6):162-164.
Source: Evidence-based Nursing
http://ebp.lib.uic.edu/nursing/node/12