This document introduces key concepts in systematic reviews and meta-analysis from a health care perspective. It discusses terminology, standards from the Institute of Medicine for conducting rigorous systematic reviews, and challenges in synthesizing the large volume of existing research evidence. Key steps in conducting a systematic review are outlined, including assessing the quality and risk of bias of individual studies and addressing heterogeneity. Standards for evaluating the overall strength of evidence from the body of literature are also presented.
This workshop is meant to be an introduction to the systematic review process. Further information about systematic reviews was available through a research guide. http://libguides.ucalgary.ca/content.php?pid=593664
This document provides an overview of how to conduct a systematic review. It begins by defining what a systematic review is and why they are important for evidence-based practice. It then outlines the key steps in conducting a systematic review, including formulating an answerable question using PICO(T), performing a comprehensive literature search, selecting studies and extracting data in an unbiased manner, critically appraising the evidence, and synthesizing the data. The document emphasizes that systematic reviews need to follow a structured, systematic process and make all methods explicit to minimize bias. It also discusses challenges that can arise in systematic reviews like database, publication, and language biases.
A systematic review is a literature review focused on answering a specific question by identifying, appraising, selecting, and synthesizing high-quality research evidence relevant to that question. It follows a rigorous methodology to overcome bias, including formulating a research question, conducting a comprehensive literature search, applying inclusion/exclusion criteria, assessing study quality, and analyzing results. The results are often combined using meta-analysis to provide a quantitative summary of effects across multiple studies.
This document provides an overview of implementation research. It defines implementation research as using strategies to introduce or change evidence-based health interventions in real world contexts. Implementation research is a multidisciplinary field that seeks to understand and close the gap between evidence and practice. The document discusses conceptual frameworks, methods, outcomes and evidence used in implementation research. It describes both qualitative and quantitative research designs that can be used, including descriptive, analytic, experimental and mixed methods approaches.
Observational studies should be considered for inclusion in comparative effectiveness reviews to fill gaps in evidence from randomized controlled trials. Gaps may exist due to populations, interventions, comparators, outcomes, timing, or settings not covered by trials. Reviewers should assess whether observational studies can validly address review questions by considering potential biases, clinical context, and availability of comparison groups. While observational studies are generally not suitable for assessing benefits due to biases, they are important for evaluating harms since these are often inadequately assessed in randomized trials.
Jan Hrabal: Evaluation of medical information quality #bcs2015KISK FF MU
Talk given at the BOBCATSSS 2015 conference - http://www.bobcatsss2015.com/.
The paper deals with the concept of quality of health-related information in the internet environment. It brings definitions of indicators of medical information quality, which are set into the methodics for evaluation of medical information quality on Czech websites. The methodics is divided in two parts: one for non-expert sources in common online environment designed for laymen and one extended version designed for experts, which includes also criteria for evaluation of research papers and reviews.
This document provides an overview of evidence-based periodontics. It discusses the need for evidence-based decision making to reduce variations in clinical practice. The advantages of an evidence-based approach are that it is objective, scientifically sound, patient-focused, and incorporates clinical expertise. The process of evidence-based decision making involves framing questions, searching for and appraising evidence from various sources and levels, evaluating outcomes, and implementing decisions. Key aspects include assessing evidence critically and avoiding changes to pre-established hypotheses.
This workshop is meant to be an introduction to the systematic review process. Further information about systematic reviews was available through a research guide. http://libguides.ucalgary.ca/content.php?pid=593664
This document provides an overview of how to conduct a systematic review. It begins by defining what a systematic review is and why they are important for evidence-based practice. It then outlines the key steps in conducting a systematic review, including formulating an answerable question using PICO(T), performing a comprehensive literature search, selecting studies and extracting data in an unbiased manner, critically appraising the evidence, and synthesizing the data. The document emphasizes that systematic reviews need to follow a structured, systematic process and make all methods explicit to minimize bias. It also discusses challenges that can arise in systematic reviews like database, publication, and language biases.
A systematic review is a literature review focused on answering a specific question by identifying, appraising, selecting, and synthesizing high-quality research evidence relevant to that question. It follows a rigorous methodology to overcome bias, including formulating a research question, conducting a comprehensive literature search, applying inclusion/exclusion criteria, assessing study quality, and analyzing results. The results are often combined using meta-analysis to provide a quantitative summary of effects across multiple studies.
This document provides an overview of implementation research. It defines implementation research as using strategies to introduce or change evidence-based health interventions in real world contexts. Implementation research is a multidisciplinary field that seeks to understand and close the gap between evidence and practice. The document discusses conceptual frameworks, methods, outcomes and evidence used in implementation research. It describes both qualitative and quantitative research designs that can be used, including descriptive, analytic, experimental and mixed methods approaches.
Observational studies should be considered for inclusion in comparative effectiveness reviews to fill gaps in evidence from randomized controlled trials. Gaps may exist due to populations, interventions, comparators, outcomes, timing, or settings not covered by trials. Reviewers should assess whether observational studies can validly address review questions by considering potential biases, clinical context, and availability of comparison groups. While observational studies are generally not suitable for assessing benefits due to biases, they are important for evaluating harms since these are often inadequately assessed in randomized trials.
Jan Hrabal: Evaluation of medical information quality #bcs2015KISK FF MU
Talk given at the BOBCATSSS 2015 conference - http://www.bobcatsss2015.com/.
The paper deals with the concept of quality of health-related information in the internet environment. It brings definitions of indicators of medical information quality, which are set into the methodics for evaluation of medical information quality on Czech websites. The methodics is divided in two parts: one for non-expert sources in common online environment designed for laymen and one extended version designed for experts, which includes also criteria for evaluation of research papers and reviews.
This document provides an overview of evidence-based periodontics. It discusses the need for evidence-based decision making to reduce variations in clinical practice. The advantages of an evidence-based approach are that it is objective, scientifically sound, patient-focused, and incorporates clinical expertise. The process of evidence-based decision making involves framing questions, searching for and appraising evidence from various sources and levels, evaluating outcomes, and implementing decisions. Key aspects include assessing evidence critically and avoiding changes to pre-established hypotheses.
This document provides an overview of evidence-based orthodontics. It defines evidence-based orthodontics as integrating the best available research evidence with clinical expertise and patient values. The need for evidence-based orthodontics is that it allows practitioners to provide the currently best care available to patients. Evidence-based orthodontic practice differs from traditional practice by regularly accessing new evidence, identifying risk factors, and providing continuous, patient-centered, and efficient care. Systematic reviews are used to summarize research evidence in an unbiased manner to inform clinical decision making.
Periodontal Research: Basics and beyond – Part II (Ethical issues, sampling, ...naseemashraf2
This document summarizes key ethical and methodological considerations in periodontal research. It discusses issues like obtaining informed consent, maintaining participant confidentiality, and having research approved by an ethics committee. It also covers topics like study design, sampling methods, bias, outcome measures, and evaluating diagnostic tests. Proper planning of these elements is important for generating meaningful, valid and ethical study results.
· Reflect on the four peer-reviewed articles you critically apprai.docxVannaJoy20
· Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
· Consider the best method of disseminating the results of your presentation to an audience.
The Assignment: (Evidence-Based Project)
Part 4: Recommending an Evidence-Based Practice Change
Create an 8- to 9-slide
narrated PowerPoint presentation in which you do the following:
· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
· Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
· Add a lessons learned section that includes the following:
· A summary of the critical appraisal of the peer-reviewed articles you previously submitted
· An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)
Zeinab Hazime
Nurs 6052
10/16/2022
Evaluation Table
Use this document to complete the
evaluation table requirement of the Module 4 Assessment,
Evidence-Based Project, Part 3A: Critical Appraisal of Research
Full
APA formatted citation of selected article.
Article #1
Article #2
Article #3
Article #4
Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T.
(2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews.
BMJ Quality & Safety, 29(10), 1-2.
Alanazi, A. (2020). The effect of computerized physician order entry on mortality rates in pediatric and neonatal care setting: Meta-analysis.
Informatics in Medicine
Unlocked, 19, 100308. https.
This document outlines the steps involved in conducting a systematic review and meta-analysis on the prevalence of elder abuse. It discusses how 52 studies from around the world were analyzed using comprehensive meta-analysis software. The key findings were that the pooled prevalence of elder abuse was 15.7%. While systematic reviews have strengths like being comprehensive and transparent, they also have limitations such as reliance on the quality of primary studies and risk of publication bias.
Level of Evidence- Dina Hudiya Nadana Lubis.pptxdina410715
This document provides an overview of different types of evidence and study designs used to assess levels of evidence in healthcare research. It defines level of evidence as a hierarchical system used to assess the quality and strength of research findings. Randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies are described as primary sources of evidence, while systematic reviews and meta-analyses are secondary sources. The advantages and disadvantages of each study design are summarized in a table. Systematic reviews synthesize existing evidence through a structured process, while meta-analyses conduct quantitative analyses to derive summary effect sizes. Expert opinion is also discussed as a source of evidence.
This document provides an overview of critical appraisal of randomized controlled trials (RCTs). It defines critical appraisal as carefully examining research to assess its trustworthiness and relevance. RCTs are described as the gold standard for clinical trials, where participants are randomly allocated to groups that receive either a treatment or a control. Key factors to examine in appraising an RCT are described, including sample size, eligibility criteria, baseline characteristics, randomization, blinding, follow-up of participants, data collection, presentation of results, and applicability to local populations. Advantages of critical appraisal and RCTs include providing a systematic way to assess research validity and improving practice, while disadvantages include taking time and not always finding clear answers.
This document summarizes a journal club presentation about critically appraising papers on dental therapy. It discusses key questions to consider when evaluating randomized controlled trials and systematic reviews relating to new therapeutic interventions. These include whether patient allocation was randomized, all patients were accounted for, blinding was used, groups were similar at outset, clinically important outcomes were assessed, and results can be applied to patients. It also reviews criteria for assessing systematic reviews, such as whether a clear question was asked, inclusion criteria were appropriate, search was comprehensive, study validity was evaluated, and findings were combined correctly.
This document outlines and provides examples of 8 specific types of quantitative research designs: 1) clinical trials, 2) evaluation research, 3) outcome research, 4) operational research, 5) methodological research, 6) secondary data research, 7) meta-analysis, and 8) ecological studies. Each type is defined and an example is given to illustrate how that particular design is used in research.
. Evidence-based dentistry (EBD) is the integration and interpretation of the available current research evidence, combined with personal experience. It allows dentists, as well as academics researchers, to keep update of the new developments and to make decisions that should improve their clinical practice.
This document discusses systematic reviews and their usefulness for busy dental practitioners. It introduces the problem of information overload for clinicians trying to stay up to date. Systematic reviews provide a solution by synthesizing large amounts of research into concise summaries. The key features that make systematic reviews reliable include having a clearly defined clinical question, conducting a comprehensive search for relevant studies, using explicit criteria to include/exclude studies, assessing study validity, analyzing inconsistencies, appropriately combining findings, and conclusions supported by evidence. Systematic reviews offer clinicians summaries of the best available evidence to inform patient care decisions.
This document discusses evidence-based periodontology and decision making. It defines evidence-based periodontology as applying evidence-based healthcare to periodontology by integrating the best available evidence with clinical practice. The document outlines the steps of evidence-based periodontology, including asking questions using the PICO format, searching for and appraising evidence from systematic reviews and clinical practice guidelines, and applying the evidence to clinical decisions. It also discusses tools for critically assessing evidence, such as considering different levels of evidence and ensuring temporality between causes and effects.
This document provides an overview of critical appraisal and how to appraise a cohort study. It discusses the key elements of cohort studies, including their use in identifying environmental and lifestyle factors that influence health outcomes. The document also provides a sample cohort study paper and the CASP checklist for appraising cohort studies. It addresses appraising elements like selection of study participants, measurement of exposures, follow-up, and consideration of confounding factors.
Can systematic reviews help identify what works and why?Carina van Rooyen
This document discusses systematic reviews (SRs) as a tool to evaluate the impact of development interventions. It notes calls from funders to demonstrate what works using evidence-based approaches. While randomized controlled trials (RCTs) are often advocated, SRs are presented as a way to overcome some of RCTs' limitations. The document summarizes a SR conducted by the authors on the impact of microfinance in sub-Saharan Africa. It took a pragmatic approach, including a variety of study designs and developing a causal pathway to understand impact. The SR found microfinance has the potential to benefit the poor but also identified challenges, calling for more and better evaluations.
This document provides an overview of research methods and designs. It discusses qualitative and quantitative research methods, with qualitative focusing on lived experiences and meanings and quantitative focusing on numerical data. It also discusses different types of study designs, including observational studies like cross-sectional and longitudinal, and experimental designs like clinical and community trials. Experimental research allows investigators to actively alter variables to evaluate relationships, while considering factors like the purpose of the study, strength of evidence desired, time and resources available, and ethics.
Cochrane Health Promotion Antony Morgan Explor MeetSonia Groisman
This document discusses NICE's role in providing public health guidance in the UK and some issues related to evaluating evidence on health inequalities. It describes NICE's process for developing guidance, which involves scoping topics, reviewing evidence, and making recommendations. However, it notes some limitations, such as a lack of evidence on effective interventions to reduce health inequalities and conceptual gaps in understanding the causes of inequalities. It argues NICE needs to improve its methods for evaluating evidence on inequalities, including getting the right review questions, considering different types of evidence, and better conceptual frameworks for analyzing causes of inequalities.
1
Methods and Statistical Analysis
Name xxx
United State University
Course xxx
Professor xxxx
Date xxx
The Evaluative Criteria
The process of analyzing a healthcare plan to see if it meets its goals takes some time. Because it promotes an evidence-based approach, assessment is crucial in practice consignment. Evaluation can be used to assess the effectiveness of the research. It helps determine what changes could be recommended to improve service delivery and the study's persuasiveness. An impact evaluation analyzes the intervention's direct and indirect, positive and negative, planned and unplanned consequences. If an evaluation fails to deliver fresh recognition regularly, it may result in inaccurate results and conclusions. A healthcare practitioner can utilize the indicators or variables to evaluate programs and determine whether they are legal or not (Dash et al., 2019). The variables are also used to assess if the mediation is on track to meet its objectives and obligations. Participation rates, prevalence, and individual behaviors are among the measures to be addressed.
Individual behaviors are actions taken by individuals to improve their health. People have been denied the assistance and resources they seek because of ethics and plans. In addition, different people have varied perspectives about pressure ulcers treatment. Relevance refers to how the study may contribute to a worthwhile cause (Li et al., 2019). Quality variables give statistics on the precariously rising service consignment while also attempting to provide information on the part of the care that may be changed. The participation rate refers to the total number of people participating in the study.
On the other hand, individuals may be unable to engage in the study due to a lack of cultural knowledge and ineffective consent processes. The overall number of persons in a population who have a health disease at a given time is referred to as prevalence (Li et al., 2019). Although prevalence shows the rate at which new facts arrive, it aids in determining the suitable, complete outcome-positive prestige of people.
Research Approaches
The word "research approaches" refers to techniques and procedures to draw general conclusions concerning data collection, analysis, and explanation methods. In my research, I'll employ both quantitative and qualitative methods. A qualitative research technique will reveal deterrents and hindrances to practicing change by rationalizing the reasons behind specific demeanors (Li et al., 2019). Qualitative research will collect and evaluate non-numerical data to comprehend perspectives or opinions. It will also be utilized to learn everything there is to know about a subject or to develop new research ideologies.
The quantitative method focuses on goal data and statistical or numerical analysis of data collected through a questionnaire. In the healthcare field, quantitative research may develop and execute new or enhanced work meas ...
This document discusses study eligibility criteria and how to set criteria for systematic reviews. It explains that criteria should be tied to the review questions and consider population, intervention, outcomes, timing, and setting. Criteria can be broad to explore what is known or narrow to focus on specific questions, and finding the right balance is important. The document provides examples of how criteria choices can impact applicability and bias reviews by including or excluding certain studies.
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.
Introduction to Parasitology and Protozoa .pptShahriarHabib4
This document provides an introduction to parasitology. It states that more than 50% of living organisms are parasitic at some stage of their life cycle. Parasites are studied because they provide unique biological examples not found in free-living organisms and have medical, veterinary, and economic importance. Some key points made include that humans host many parasite species that are major causes of disease globally, and parasites can have significant impacts on public health like reducing life expectancy and causing millions of child deaths annually from effects like malnutrition. The document also provides classifications of protozoa and helminths, and discusses aspects of their life cycles and impacts on human hosts.
Shigella, Klebsiella, Proteus, and Pseudomonas are important Gram-negative bacilli that can cause disease. They are non-motile, non-lactose fermenting bacteria that do not produce gas from glucose or hydrogen sulfide. Virulence is determined by surface properties, invasiveness, and toxins. Shigella is highly invasive and produces Shiga toxin. Klebsiella commonly causes pneumonia and urinary tract infections. Proteus can cause urinary tract infections due to urease production. Pseudomonas aeruginosa is an opportunistic pathogen known for antibiotic resistance and ability to cause various infections.
This document provides an overview of evidence-based orthodontics. It defines evidence-based orthodontics as integrating the best available research evidence with clinical expertise and patient values. The need for evidence-based orthodontics is that it allows practitioners to provide the currently best care available to patients. Evidence-based orthodontic practice differs from traditional practice by regularly accessing new evidence, identifying risk factors, and providing continuous, patient-centered, and efficient care. Systematic reviews are used to summarize research evidence in an unbiased manner to inform clinical decision making.
Periodontal Research: Basics and beyond – Part II (Ethical issues, sampling, ...naseemashraf2
This document summarizes key ethical and methodological considerations in periodontal research. It discusses issues like obtaining informed consent, maintaining participant confidentiality, and having research approved by an ethics committee. It also covers topics like study design, sampling methods, bias, outcome measures, and evaluating diagnostic tests. Proper planning of these elements is important for generating meaningful, valid and ethical study results.
· Reflect on the four peer-reviewed articles you critically apprai.docxVannaJoy20
· Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
· Consider the best method of disseminating the results of your presentation to an audience.
The Assignment: (Evidence-Based Project)
Part 4: Recommending an Evidence-Based Practice Change
Create an 8- to 9-slide
narrated PowerPoint presentation in which you do the following:
· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
· Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
· Add a lessons learned section that includes the following:
· A summary of the critical appraisal of the peer-reviewed articles you previously submitted
· An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)
Zeinab Hazime
Nurs 6052
10/16/2022
Evaluation Table
Use this document to complete the
evaluation table requirement of the Module 4 Assessment,
Evidence-Based Project, Part 3A: Critical Appraisal of Research
Full
APA formatted citation of selected article.
Article #1
Article #2
Article #3
Article #4
Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T.
(2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews.
BMJ Quality & Safety, 29(10), 1-2.
Alanazi, A. (2020). The effect of computerized physician order entry on mortality rates in pediatric and neonatal care setting: Meta-analysis.
Informatics in Medicine
Unlocked, 19, 100308. https.
This document outlines the steps involved in conducting a systematic review and meta-analysis on the prevalence of elder abuse. It discusses how 52 studies from around the world were analyzed using comprehensive meta-analysis software. The key findings were that the pooled prevalence of elder abuse was 15.7%. While systematic reviews have strengths like being comprehensive and transparent, they also have limitations such as reliance on the quality of primary studies and risk of publication bias.
Level of Evidence- Dina Hudiya Nadana Lubis.pptxdina410715
This document provides an overview of different types of evidence and study designs used to assess levels of evidence in healthcare research. It defines level of evidence as a hierarchical system used to assess the quality and strength of research findings. Randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies are described as primary sources of evidence, while systematic reviews and meta-analyses are secondary sources. The advantages and disadvantages of each study design are summarized in a table. Systematic reviews synthesize existing evidence through a structured process, while meta-analyses conduct quantitative analyses to derive summary effect sizes. Expert opinion is also discussed as a source of evidence.
This document provides an overview of critical appraisal of randomized controlled trials (RCTs). It defines critical appraisal as carefully examining research to assess its trustworthiness and relevance. RCTs are described as the gold standard for clinical trials, where participants are randomly allocated to groups that receive either a treatment or a control. Key factors to examine in appraising an RCT are described, including sample size, eligibility criteria, baseline characteristics, randomization, blinding, follow-up of participants, data collection, presentation of results, and applicability to local populations. Advantages of critical appraisal and RCTs include providing a systematic way to assess research validity and improving practice, while disadvantages include taking time and not always finding clear answers.
This document summarizes a journal club presentation about critically appraising papers on dental therapy. It discusses key questions to consider when evaluating randomized controlled trials and systematic reviews relating to new therapeutic interventions. These include whether patient allocation was randomized, all patients were accounted for, blinding was used, groups were similar at outset, clinically important outcomes were assessed, and results can be applied to patients. It also reviews criteria for assessing systematic reviews, such as whether a clear question was asked, inclusion criteria were appropriate, search was comprehensive, study validity was evaluated, and findings were combined correctly.
This document outlines and provides examples of 8 specific types of quantitative research designs: 1) clinical trials, 2) evaluation research, 3) outcome research, 4) operational research, 5) methodological research, 6) secondary data research, 7) meta-analysis, and 8) ecological studies. Each type is defined and an example is given to illustrate how that particular design is used in research.
. Evidence-based dentistry (EBD) is the integration and interpretation of the available current research evidence, combined with personal experience. It allows dentists, as well as academics researchers, to keep update of the new developments and to make decisions that should improve their clinical practice.
This document discusses systematic reviews and their usefulness for busy dental practitioners. It introduces the problem of information overload for clinicians trying to stay up to date. Systematic reviews provide a solution by synthesizing large amounts of research into concise summaries. The key features that make systematic reviews reliable include having a clearly defined clinical question, conducting a comprehensive search for relevant studies, using explicit criteria to include/exclude studies, assessing study validity, analyzing inconsistencies, appropriately combining findings, and conclusions supported by evidence. Systematic reviews offer clinicians summaries of the best available evidence to inform patient care decisions.
This document discusses evidence-based periodontology and decision making. It defines evidence-based periodontology as applying evidence-based healthcare to periodontology by integrating the best available evidence with clinical practice. The document outlines the steps of evidence-based periodontology, including asking questions using the PICO format, searching for and appraising evidence from systematic reviews and clinical practice guidelines, and applying the evidence to clinical decisions. It also discusses tools for critically assessing evidence, such as considering different levels of evidence and ensuring temporality between causes and effects.
This document provides an overview of critical appraisal and how to appraise a cohort study. It discusses the key elements of cohort studies, including their use in identifying environmental and lifestyle factors that influence health outcomes. The document also provides a sample cohort study paper and the CASP checklist for appraising cohort studies. It addresses appraising elements like selection of study participants, measurement of exposures, follow-up, and consideration of confounding factors.
Can systematic reviews help identify what works and why?Carina van Rooyen
This document discusses systematic reviews (SRs) as a tool to evaluate the impact of development interventions. It notes calls from funders to demonstrate what works using evidence-based approaches. While randomized controlled trials (RCTs) are often advocated, SRs are presented as a way to overcome some of RCTs' limitations. The document summarizes a SR conducted by the authors on the impact of microfinance in sub-Saharan Africa. It took a pragmatic approach, including a variety of study designs and developing a causal pathway to understand impact. The SR found microfinance has the potential to benefit the poor but also identified challenges, calling for more and better evaluations.
This document provides an overview of research methods and designs. It discusses qualitative and quantitative research methods, with qualitative focusing on lived experiences and meanings and quantitative focusing on numerical data. It also discusses different types of study designs, including observational studies like cross-sectional and longitudinal, and experimental designs like clinical and community trials. Experimental research allows investigators to actively alter variables to evaluate relationships, while considering factors like the purpose of the study, strength of evidence desired, time and resources available, and ethics.
Cochrane Health Promotion Antony Morgan Explor MeetSonia Groisman
This document discusses NICE's role in providing public health guidance in the UK and some issues related to evaluating evidence on health inequalities. It describes NICE's process for developing guidance, which involves scoping topics, reviewing evidence, and making recommendations. However, it notes some limitations, such as a lack of evidence on effective interventions to reduce health inequalities and conceptual gaps in understanding the causes of inequalities. It argues NICE needs to improve its methods for evaluating evidence on inequalities, including getting the right review questions, considering different types of evidence, and better conceptual frameworks for analyzing causes of inequalities.
1
Methods and Statistical Analysis
Name xxx
United State University
Course xxx
Professor xxxx
Date xxx
The Evaluative Criteria
The process of analyzing a healthcare plan to see if it meets its goals takes some time. Because it promotes an evidence-based approach, assessment is crucial in practice consignment. Evaluation can be used to assess the effectiveness of the research. It helps determine what changes could be recommended to improve service delivery and the study's persuasiveness. An impact evaluation analyzes the intervention's direct and indirect, positive and negative, planned and unplanned consequences. If an evaluation fails to deliver fresh recognition regularly, it may result in inaccurate results and conclusions. A healthcare practitioner can utilize the indicators or variables to evaluate programs and determine whether they are legal or not (Dash et al., 2019). The variables are also used to assess if the mediation is on track to meet its objectives and obligations. Participation rates, prevalence, and individual behaviors are among the measures to be addressed.
Individual behaviors are actions taken by individuals to improve their health. People have been denied the assistance and resources they seek because of ethics and plans. In addition, different people have varied perspectives about pressure ulcers treatment. Relevance refers to how the study may contribute to a worthwhile cause (Li et al., 2019). Quality variables give statistics on the precariously rising service consignment while also attempting to provide information on the part of the care that may be changed. The participation rate refers to the total number of people participating in the study.
On the other hand, individuals may be unable to engage in the study due to a lack of cultural knowledge and ineffective consent processes. The overall number of persons in a population who have a health disease at a given time is referred to as prevalence (Li et al., 2019). Although prevalence shows the rate at which new facts arrive, it aids in determining the suitable, complete outcome-positive prestige of people.
Research Approaches
The word "research approaches" refers to techniques and procedures to draw general conclusions concerning data collection, analysis, and explanation methods. In my research, I'll employ both quantitative and qualitative methods. A qualitative research technique will reveal deterrents and hindrances to practicing change by rationalizing the reasons behind specific demeanors (Li et al., 2019). Qualitative research will collect and evaluate non-numerical data to comprehend perspectives or opinions. It will also be utilized to learn everything there is to know about a subject or to develop new research ideologies.
The quantitative method focuses on goal data and statistical or numerical analysis of data collected through a questionnaire. In the healthcare field, quantitative research may develop and execute new or enhanced work meas ...
This document discusses study eligibility criteria and how to set criteria for systematic reviews. It explains that criteria should be tied to the review questions and consider population, intervention, outcomes, timing, and setting. Criteria can be broad to explore what is known or narrow to focus on specific questions, and finding the right balance is important. The document provides examples of how criteria choices can impact applicability and bias reviews by including or excluding certain studies.
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.
Introduction to Parasitology and Protozoa .pptShahriarHabib4
This document provides an introduction to parasitology. It states that more than 50% of living organisms are parasitic at some stage of their life cycle. Parasites are studied because they provide unique biological examples not found in free-living organisms and have medical, veterinary, and economic importance. Some key points made include that humans host many parasite species that are major causes of disease globally, and parasites can have significant impacts on public health like reducing life expectancy and causing millions of child deaths annually from effects like malnutrition. The document also provides classifications of protozoa and helminths, and discusses aspects of their life cycles and impacts on human hosts.
Shigella, Klebsiella, Proteus, and Pseudomonas are important Gram-negative bacilli that can cause disease. They are non-motile, non-lactose fermenting bacteria that do not produce gas from glucose or hydrogen sulfide. Virulence is determined by surface properties, invasiveness, and toxins. Shigella is highly invasive and produces Shiga toxin. Klebsiella commonly causes pneumonia and urinary tract infections. Proteus can cause urinary tract infections due to urease production. Pseudomonas aeruginosa is an opportunistic pathogen known for antibiotic resistance and ability to cause various infections.
BACTERIAL PHYSIOLOGY AND BACTERIAL GENETICS.pptxShahriarHabib4
Bacterial physiology and genetics were discussed. Key points include:
1) Bacteria grow through an orderly increase in constituents and multiply through cell division. Growth is measured by a growth curve with four phases: lag, log, stationary, and decline.
2) Bacteria require nutrients, temperature, oxygen levels, and other environmental factors for growth.
3) Genetic variations occur through mutations, conjugation, transduction, and transformation. Plasmids and transposons allow horizontal gene transfer.
4) Staining techniques like Gram staining and acid-fast staining are used to differentiate bacteria based on cell wall structure.
Antibodies and immunoglobulins are glycoproteins produced by plasma cells in response to antigens. Antibodies are immunoglobulins that can bind to specific antigens, while not all immunoglobulins are antibodies. There are five classes of immunoglobulins - IgG, IgM, IgA, IgE, and IgD - that have different structures and roles in the immune system, such as activating complement pathways or binding to mast cells. Class switching allows B cells to change the class of antibodies they produce in response to signals from T cells and cytokines. Monoclonal antibodies produced from a single B cell clone are important tools in diagnostics and therapies.
Viruses are the smallest infectious agents that are obligate intracellular parasites. They contain either DNA or RNA, but not both, and are surrounded by a protein coat. Viruses replicate inside host cells using the cell's machinery. The viral replication cycle involves adsorption, penetration, uncoating, biosynthesis of viral components, assembly, maturation, and release. Viruses do not undergo binary fission like bacteria but instead use a complex replication process within the host cell.
This document provides information on the classification, morphology, cultural characteristics, diagnosis, virulence factors, and clinical significance of Rickettsia, Chlamydia, Mycoplasma, Legionella, and Gardnerella. Key points include:
- Rickettsia, Chlamydia, and Legionella are obligate intracellular parasites. Mycoplasma and Gardnerella are closely adapted parasites that can colonize cell surfaces.
- Diseases caused include typhus, Rocky Mountain spotted fever, psittacosis, lymphogranuloma venereum, trachoma, and Legionnaire's disease.
- Diagnosis involves staining, culture, and serological tests. Treatment involves antibiotics
This document provides an overview of basic bacteriology and bacterial structure. It discusses the differences between prokaryotic and eukaryotic cells, outlines Koch's postulates and molecular Koch's postulates for identifying pathogenic bacteria. The essential structures of bacteria including the cell wall, ribosomes and plasma membrane are described. Gram-positive and Gram-negative cell wall structures are compared. Non-essential bacterial structures like capsules, flagella, pili and plasmids are also summarized.
Burkholderia pseudomallei is the bacterium that causes melioidosis, a potentially fatal infectious disease. It was first identified in 1911 in Burma but has since been recognized as an emerging disease in many tropical and subtropical regions. While rates of reported cases have increased with greater recognition and diagnostic capabilities, the true global incidence is estimated to be much higher, with many cases going undetected. The bacterium is a motile, facultative intracellular pathogen that resides in soil and water in endemic areas. Its complex genome allows it to survive intracellularly and cause severe illness. Proper diagnosis relies on clinical awareness, laboratory identification, and surveillance efforts to distinguish true emergence from increasing recognition of the disease.
This document summarizes research into Zika virus infection of human testicular cells. It found that Sertoli cells, which support sperm production, are highly permissive to Zika virus infection. The virus depends on the Axl receptor to infect Sertoli cells and causes massive changes to the cells' gene expression. It also found that the secreted protein FGF2 facilitates viral replication and that inhibiting FGF2 or its receptor reduces infection. The research demonstrates Sertoli cells' role in prolonged viral shedding and identifies potential immunodiagnostic markers and therapeutic approaches to disrupt sexual transmission of Zika virus.
HPV is a virus that can cause cervical cancer. Dr. Umme Shahera, an assistant professor in the Department of Virology at BSMMU, wrote about HPV. She thanked the reader for their time.
This document summarizes the work of three teams revising the M39 standard on antibiograms. Team 1 is reviewing and expanding the current M39 document. Team 2 is defining antimicrobial resistance surveillance programs and providing three approaches. Team 3 is discussing how to incorporate data from automated susceptibility testing instruments, laboratory information systems, and electronic health records into antibiograms. The teams will draft their sections and submit a completed draft for review at the next meeting in January 2019. Companion articles on each section will also be written.
A study considered 437 individuals for eligibility based on age, of which 38 met inclusion criteria. From a contact list of 5409 unvaccinated individuals, 40 were included in the study after meeting criteria and not being duplicate entries. The study involved collecting samples from participants at three time points, with some dropping out between points due to refusal, getting vaccinated, or testing positive for COVID antibodies. In total, 35 participants completed the study and underwent statistical analysis.
06-04-2024 - NYC Tech Week - Discussion on Vector Databases, Unstructured Data and AI
Round table discussion of vector databases, unstructured data, ai, big data, real-time, robots and Milvus.
A lively discussion with NJ Gen AI Meetup Lead, Prasad and Procure.FYI's Co-Found
Natural Language Processing (NLP), RAG and its applications .pptxfkyes25
1. In the realm of Natural Language Processing (NLP), knowledge-intensive tasks such as question answering, fact verification, and open-domain dialogue generation require the integration of vast and up-to-date information. Traditional neural models, though powerful, struggle with encoding all necessary knowledge within their parameters, leading to limitations in generalization and scalability. The paper "Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks" introduces RAG (Retrieval-Augmented Generation), a novel framework that synergizes retrieval mechanisms with generative models, enhancing performance by dynamically incorporating external knowledge during inference.
Learn SQL from basic queries to Advance queriesmanishkhaire30
Dive into the world of data analysis with our comprehensive guide on mastering SQL! This presentation offers a practical approach to learning SQL, focusing on real-world applications and hands-on practice. Whether you're a beginner or looking to sharpen your skills, this guide provides the tools you need to extract, analyze, and interpret data effectively.
Key Highlights:
Foundations of SQL: Understand the basics of SQL, including data retrieval, filtering, and aggregation.
Advanced Queries: Learn to craft complex queries to uncover deep insights from your data.
Data Trends and Patterns: Discover how to identify and interpret trends and patterns in your datasets.
Practical Examples: Follow step-by-step examples to apply SQL techniques in real-world scenarios.
Actionable Insights: Gain the skills to derive actionable insights that drive informed decision-making.
Join us on this journey to enhance your data analysis capabilities and unlock the full potential of SQL. Perfect for data enthusiasts, analysts, and anyone eager to harness the power of data!
#DataAnalysis #SQL #LearningSQL #DataInsights #DataScience #Analytics
The Building Blocks of QuestDB, a Time Series Databasejavier ramirez
Talk Delivered at Valencia Codes Meetup 2024-06.
Traditionally, databases have treated timestamps just as another data type. However, when performing real-time analytics, timestamps should be first class citizens and we need rich time semantics to get the most out of our data. We also need to deal with ever growing datasets while keeping performant, which is as fun as it sounds.
It is no wonder time-series databases are now more popular than ever before. Join me in this session to learn about the internal architecture and building blocks of QuestDB, an open source time-series database designed for speed. We will also review a history of some of the changes we have gone over the past two years to deal with late and unordered data, non-blocking writes, read-replicas, or faster batch ingestion.
06-04-2024 - NYC Tech Week - Discussion on Vector Databases, Unstructured Data and AI
Discussion on Vector Databases, Unstructured Data and AI
https://www.meetup.com/unstructured-data-meetup-new-york/
This meetup is for people working in unstructured data. Speakers will come present about related topics such as vector databases, LLMs, and managing data at scale. The intended audience of this group includes roles like machine learning engineers, data scientists, data engineers, software engineers, and PMs.This meetup was formerly Milvus Meetup, and is sponsored by Zilliz maintainers of Milvus.
1. Introduction to
Systematic Review and
Meta-Analysis:
A Health Care Perspective
Sally C. Morton
Department of Biostatistics
University of Pittsburgh
Methods for Research Synthesis:
A Cross-Disciplinary Approach, October 2013
2. Cross-Disciplinary Communication
From the Healthcare
Systematic Review World
• Terminology
• Institute of Medicine (IOM) standards for
systematic reviews
–Quality of individual studies
–Heterogeneity
–Strength of the body of evidence
Research Synthesis, Morton, 10/13, 2
3. How Did We Get Here?
“The Evidence Paradox” (Sean Tunis):
• 18,000+ RCTs published each year
• Tens of thousands of other clinical studies
• Systematic reviews routinely conclude that:
“The available evidence is of poor quality
and therefore inadequate to inform
decisions of the type we are interested
in making.”
Research Synthesis, Morton, 10/13, 3
4. Terminology
Systematic Review (SR): 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
Meta-analysis (MA): Use of statistical
techniques in an SR to integrate the results of
included studies to conduct statistical
inference
Adapted from the Cochrane Collaboration Glossary Research Synthesis, Morton, 10/13, 4
5. Key Points
MAs
Research Synthesis, Morton, 10/13, 5
1. MA should not be used as a synonym for SR
2. An MA should be done in the context of an SR
3. “An MA should not be assumed to always be an
appropriate step in an SR. The decision to conduct
an MA is neither purely analytical nor statistical in
nature.”
SRs
6. 1. Develop a focused research question
2. Define inclusion/exclusion criteria
3. Select the outcomes for your review
4. Find the studies
5. Abstract the data
6. Assess quality of the data
7. Explore data (heterogeneity)
8. Synthesize the data descriptively and inferentially via
meta-analysis if appropriate
9. Summarize the findings
Steps of a Systematic Review
Research Synthesis, Morton, 10/13, 6
7. A standard is a process, action,
or procedure for performing
SRs that is deemed essential to
producing scientifically valid,
transparent, and reproducible
results
Systematic Review Standards
Research Synthesis, Morton, 10/13, 7
8. IOM Report on Standards for SRs (2011)
Committee Charge: Recommend
methodological standards for SRs of
comparative effectiveness research
(CER) on health and health care
• Assess potential methodological
standards that would assure
objective, transparent, and
scientifically valid SRs of CER
• Recommend a set of
methodological standards for
developing and reporting
such SRs
Research Synthesis, Morton, 10/13, 8
9. Committee Methodology
• Available research evidence
• Expert guidance from:
— Agency for Healthcare Research and Quality (AHRQ) Effective
Health Care Program
— Centre for Reviews and Dissemination (CRD)
— Cochrane Collaboration
— Grading of Recommendations Assessment,
Development and Evaluation (GRADE) Working Group
— Preferred Reporting Items for
Systematic Reviews and Meta-analyses (PRISMA)
• Committee’s assessment criteria:
Research Synthesis, Morton, 10/13, 9
o Acceptability (credibility)
o Applicability (generalizability)
o Efficiency
o Patient-centeredness
o Scientific rigor
o Timeliness
o Transparency
21 standards
and 82 elements
recommended
10. Research Synthesis, Morton, 10/13, 10
IOM standards are categorized into four subgroups:
• Initiating an SR
• Finding and assessing individual studies
• Synthesizing the body of evidence
• Reporting SRs
11. Buscemi et al., 2006 – “Single extraction was faster,
but resulted in 21.7% more mistakes.”
AHRQ – Ensure quality control mechanism; usually
through use of independent researchers to assess studies
for eligibility. Pilot testing is particularly important if
there is not dual-review screening.
CRD – Good to have more than one researcher to help
minimize bias and error at all stages of the review.
Parallel independent assessments should be conducted to
minimize the risk of errors.
Cochrane – At least two people, independently. Process
must be transparent, and chosen to minimize biases and
human error. Research Synthesis, Morton, 10/13, 11
12. “Collectively the standards and elements present a daunting
task. Few, if any, members of the committee have participated
in an SR that fully meets all of them. Yet the evidence and
experience are strong enough that it is impossible to ignore
these standards or hope that one can safely cut corners. The
standards will be especially valuable for SRs of high-stakes
clinical questions with broad population impact, where the use
of public funds to get the right answer justifies careful
attention to the rigor with which the SR is conducted.
Individuals involved in SRs should be thoughtful about all of
the standards and elements, using their best judgment if
resources are inadequate to implement all of them, or if some
seem inappropriate for the particular task or question at hand.
Transparency in reporting the methods actually used and the
reasoning behind the choices are among the most important of
the standards recommended by the committee.”
Research Synthesis, Morton, 10/13, 12
13. IOM Standards Regarding
Study Quality and Heterogeneity
STANDARD 3.6
Critically appraise each study
3.6.1 Systematically assess the risk of bias, using predefined criteria
3.6.2 Assess the relevance of the study’s populations, interventions,
and outcome measures
3.6.3 Assess the fidelity of the implementation of interventions
STANDARD 4.2
Conduct a qualitative synthesis
4.2.4 Describe the relationships between the characteristics of the
individual studies and their reported findings and patterns
across studies
STANDARD 4.4
If conducting a meta-analysis, then do the following:
4.4.2 Address the heterogeneity among study effects
14. Why Assess the Quality of Individual Studies?
• Combining poor quality studies may lead to biased,
and therefore, misleading , pooled estimates
• Assessment of quality can be controversial and lead
to its own form of bias
• Variety of methods exist including the Cochrane risk
of bias tool
• Assessing quality of observational studies is very
difficult
Research Synthesis, Morton, 10/13, 14
15. Domain Description Review authors’ judgement
1. Sequence generation.
Describe the method used to
generate the allocation sequence in
sufficient detail to allow an
assessment of whether it should
produce comparable groups.
Was the allocation sequence
adequately generated?
2. Allocation concealment.
Describe the method used to
conceal the allocation sequence in
sufficient detail to determine
whether intervention allocations
could have been foreseen in
advance of, or during, enrolment.
Was allocation adequately
concealed?
3. Blinding of participants,
personnel and outcome
assessors
Describe all measures used, if any,
to blind study participants and
personnel from knowledge of which
intervention a participant received.
Provide any information relating to
whether the intended blinding was
effective.
Was knowledge of the allocated
intervention adequately
prevented during the study?
Cochrane Risk of Bias Tool
Research Synthesis, Morton, 10/13, 15
16. Domain Description Review authors’ judgment
4. Incomplete outcome data
Describe the completeness of
outcome data for each main
outcome, including attrition and
exclusions from the analysis. State
whether attrition and exclusions were
reported, the numbers in each
intervention group (compared with
total randomized participants),
reasons for attrition/exclusions where
reported, and any re-inclusions in
analyses performed by the review
authors.
Were incomplete outcome data
adequately addressed?
5. Selective outcome reporting
State how the possibility of selective
outcome reporting was examined by
the review authors, and what was
found.
Are reports of the study free of
suggestion of selective outcome
reporting?
6. Other sources of bias
State any important concerns about
bias not addressed in the other
domains in the tool.
If particular questions/entries were
pre-specified in the review’s protocol,
responses should be provided for
each question/entry.
Was the study apparently free of
other problems that could put it at
a high risk of bias?
Research Synthesis, Morton, 10/13, 16
18. “Heterogeneity is Your Friend” (J. Berlin)
Fruit salad may, or may not, be tasty and
interesting
Which are the apples and oranges, and
how do they differ? Research Synthesis, Morton, 10/13, 18
19. Definitions of Heterogeneity
From a Health Care Perspective
Different types of heterogeneity:
• Clinical heterogeneity (diversity): Variability in
participants, interventions and outcomes
• Methodological heterogeneity (diversity):
Variability in study design and risk of bias
• Statistical heterogeneity: Variability in treatment
effects, resulting from clinical and/or
methodological diversity
• Statistical heterogeneity is present if the observed
treatment effects are more different from each
other than would be expected due to chance alone
Research Synthesis, Morton, 10/13, 19
20. Discuss Clinical/Methodological or
“Substantive” Heterogeneity
Prior To Analysis
• Think first: Are included studies similar with respect to
treatment effect? Study design, subjects, treatments, etc.
may affect results.
• Include in protocol: Sources of heterogeneity that you might
stratify analysis on, or that you might include as
independent variables in a meta-regression
• Do statistics later: Q statistic to test the hypothesis that the
true (population) treatment effect is equal in all studies;
and/or I-squared (I2)statistic
• Remember: Tests for heterogeneity have low statistical
power
Research Synthesis, Morton, 10/13, 20
23. • Use consistent language to summarize the conclusions of
individual studies as well as the body of evidence:
– Presenting results not sufficient
– Reviews often very long
Evidence on assessment methods is elusive
• Grading of Recommendations Assessment, Development
and Evaluation (GRADE) approach is becoming more
popular
• Anecdotal evidence that
– GRADE is difficult to apply
– GRADE is being modified for specific situations
• GRADE starts by downgrading observational studies
Research Synthesis, Morton, 10/13, 23
24. Journal of Clinical Epidemiology 66 (2013) 1105e1117
ORIGINAL ARTICLES
Interrater reliability of grading strength of evidence varies with the complexity of the
evidence in systematic reviews
Nancy D. Berkmana,*, Kathleen N. Lohra
, Laura C. Morgana
, Tzy-Mey Kuob
, Sally C. Mortonc a
Division of Social Policy, Health,
and Economics Research, RTI International (Research Triangle Institute), Research Triangle Park, NC 27709-2194, USA b
Lineburger Comprehensive Cancer Center, University of North
Carolina at Chapel Hill, 101 E. Weaver Street, Carrboro, NC, 27599, USA
c
Department of Biostatistics, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
Accepted 5 June 2013
Reliability Testing of the AHRQ EPC Approach to
Grading the Strength of Evidence in Comparative
Effectiveness Reviews
(Berkman et al., RTI/UNC EPC)
Research Synthesis, Morton, 10/13, 24
25. • Inter-rater reliability of
– 4 required domains (risk of bias; consistency;
directness; and precision) for RCTs and
observational studies separately
• 10 exercises from 2 published CER SRs on
depression and rheumatoid arthritis
– All exercises contained RCTs
– 6 exercises included one or more observational
studies
• Eleven pairs of reviewers (10 from 9 EPCs, 1 from
AHRQ) participated in each exercise
Study Design
Research Synthesis, Morton, 10/13, 25
26. Study/Design N Comparison Quality Results: Biologics vs. Oral DMARDs
TEMPO, 2005
RCT
451 ETN 25mg
twice/wk vs. MTX
Fair Remission at week 24:
DAS < 1.6: 13.0% vs. 13.6% (P = NS)
DAS28 < 2.6: 13.9% vs. 13.6% (P = NS)
Remission at week 52:
DAS <1.6: 17.5% vs. 14%, (P = NS)
DAS28 < 2.6: 17.5% vs. 17.1%, (P = NS)
PREMIER, 2006
RCT
531 ADA 40 mg
biweekly vs. MTX
20 mg/wk
Fair Clinical remission (DAS28 < 2.6) at 1 year:
23% vs. 21%, (P = 0.582†)
Listing 2006
Prospective
cohort study
1083 Biologics vs.
conventional
DMARDs
Fair Odds of achieving remission (DAS28 < 2.6) at 12
months:
Adjusted* OR, 1.95 (95% CI, 1.20-3.19); (P =
0.006)
*Adjusted for age, sex, # of previous DMARDs,
DAS28, ESR, FFbH, osteoporosis, previous txt
with cyclosporine A.
Matched pairs analysis DAS28 remission at 12
months: 24.9% vs. 12.4%, (P = 0.004)
Research Synthesis, Morton, 10/13, 26
27. Study Results
Domain or Strength
of Evidence (SOE)
Independent
Reviewer
Agreement
Reconciled
Reviewer Pair
Agreement
Bias: RCTs 0.67 (0.61,0.73) 0.65 (0.56,0.73)
Bias: Observational
studies
0.11 (0.05,0.18) 0.22 (0.13,0.32)
SOE: All studies 0.20 (0.16,0.25) 0.24 (0.14,0.34)
SOE: RCTs only 0.22 (0.17,0.28) 0.30 (0.17,0.43)
Research Synthesis, Morton, 10/13, 27
28. Study Conclusions
• Inter-rater reliability is low
• Complex evidence bases, particularly those with a
mix of randomized and observational studies, can
be extremely difficult to grade
• Dual review with adjudication of differences
improves reliability
• Additional methodological guidance needed for
reviewers
• More research is needed on reliability, and the
advantages and disadvantages of concrete rules for
determining strength of evidence
Research Synthesis, Morton, 10/13, 28
29. Final words
“To do a meta-analysis is easy,
to do one well is hard.”
- Ingram Olkin
Research Synthesis, Morton, 10/13, 29
30. Thank You
Sally C. Morton
Department of Biostatistics
Graduate School of Public Health
University of Pittsburgh
scmorton@pitt.edu
31. Are RCTs Enough?
Austin Bradford Hill Heberden Oration (1965):
“this leads directly to a related criticism of the
present controlled trial – that it does not tell the
doctor what he wants to know. It may be so
constituted as to show without any doubt that
treatment A is on the average better than
treatment B. On the other hand, that result does
not answer the practicing doctor’s question – what
is the most likely outcome when this drug is given
to a particular patient?”
Research Synthesis, Morton, 10/13, 31
35. Q Statistic – The Math
1
1
1 2
Let true treatment effect for study for 1,...,
Individual study effect is estimated by
Pooled treatment effect is estimated by
: ...
Test statistic is
i
i
K
i i
i
P P K
i
i
o K P
i
i i K
i T
wT
T
w
H
Q w
θ
θ
θ θ θ θ
=
=
=
=
= = = =
=
∑
∑
0
2
1
2
( )
and ~ with 1 degrees of freedom
K
i P
i
H
T T
Q K
χ
=
−
−
∑
I-squared is a newer
heterogeneity statistic
that measures the
percentage of variation
across studies that
cannot be explained
by chance
Research Synthesis, Morton, 10/13, 35
36. Assessment of Heterogeneity –
Proceed with Meta-analysis, or Not?
First, check your data!
Options:
• Do not do meta-analysis
• Change treatment effect measure
• Explore heterogeneity via
stratification or meta-regression
• Account for heterogeneity via
random effects model (not
advisable if heterogeneity large)
• Exclude studies (can do “leave-one-
out” or jackknife test to determine
individual study effect on
heterogeneity)
Research Synthesis, Morton, 10/13, 36