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.
Introduction to meta-analysis (1612_MA_workshop)Ahmed Negida
Chapter 1: Introduction to Meta-analysis
- From the 1612 MA Workshop that will be held on 11th, December, 2016 at Dokki, Giza, Egypt
- Workshop instructor: Mr. Ahmed Negida, MBBCh candidate
Introduction to meta-analysis (1612_MA_workshop)Ahmed Negida
Chapter 1: Introduction to Meta-analysis
- From the 1612 MA Workshop that will be held on 11th, December, 2016 at Dokki, Giza, Egypt
- Workshop instructor: Mr. Ahmed Negida, MBBCh candidate
Basics of Systematic Review and Meta-analysis: Part 3Rizwan S A
A 4 part lecture series on the basics of Systematic Review and Meta-analysis, Part 3 discusses the software needed and analytical techniques used for this purpose.
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
A systematic review uses systematic and explicit methods to identify, select, critically appraise, and extract and analyze data from relevant research [Higgins & Green 2011].
Summary slides for "Systematic Review and Meta-Analysis Course for Healthcare Professionals", January 8-9, 2013, King Abdullah Medical City, Makkah, Saudi Arabia
http://KAMCResearch.org
Critical Appraisal of systematic review and meta analysis articlesDr. Majdi Al Jasim
Critique of systematic review and meta analysis articles
This presentation is made to educate health care provide rs on how to do critical appraisal of systematic review and meta analysis articles
Basics of Systematic Review and Meta-analysis: Part 3Rizwan S A
A 4 part lecture series on the basics of Systematic Review and Meta-analysis, Part 3 discusses the software needed and analytical techniques used for this purpose.
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
A systematic review uses systematic and explicit methods to identify, select, critically appraise, and extract and analyze data from relevant research [Higgins & Green 2011].
Summary slides for "Systematic Review and Meta-Analysis Course for Healthcare Professionals", January 8-9, 2013, King Abdullah Medical City, Makkah, Saudi Arabia
http://KAMCResearch.org
Critical Appraisal of systematic review and meta analysis articlesDr. Majdi Al Jasim
Critique of systematic review and meta analysis articles
This presentation is made to educate health care provide rs on how to do critical appraisal of systematic review and meta analysis articles
. 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.
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Thesis Statement for students diagnonsed withADHD.ppt
Introduction to Systematic Review & Meta-Analysis
1.
2. Assoc. Prof. Dr.
Hasanain Faisal Ghazi
• MBChB (University of Baghdad)
Master & PhD (UKM, Malaysia)
• Publication:
89 Full papers (56 in SCOPUS)
H Index = 11
• Published Systematic Review & Meta
Analysis (7)
• Editor in Chief, Global Journal of Public
Health Medicine.
@AP_Dr_Hasanain_Faisal_Ghazi 2
4. Evidence-based medicine
• Is the process of systematically reviewing, appraising, and using
clinical research findings to aid the delivery of optimum clinical care
to patients.
Clinical
Judgment
Relevant
scientific
evidences
Patient values
& preferences
EBM
5. Definition
• A systematic review summarises the results of available carefully
designed healthcare studies (controlled trials) and provides a high
level of evidence on the effectiveness of healthcare
interventions. Judgments may be made about the evidence and inform
recommendations for healthcare.
Reference: https://consumers.cochrane.org/what-systematic-review
@AP_Dr.Hasanain_Ghazi
6. SR & MA
• A systematic review answers a defined research question by
collecting and summarising all empirical evidence that fits pre-
specified eligibility criteria.
• A meta-analysis is the use of statistical methods to summarise the
results of these studies.
@AP_Dr.Hasanain_Ghazi
7. WHAT IS SYSTEMATIC REVIEW
• Focus on specific question
• use explicit , pre-planned scientific methods to:
1. Identify
2. Select
3. Appraise
4. Summarize similar but separate studies
@AP_Dr.Hasanain_Ghazi
8. Must Have
• clearly stated objectives with pre-defined eligibility criteria for studies
• explicit, reproducible methodology
• a systematic search that attempts to identify all studies
• assessment of the validity of the findings of the included studies (e.g.
risk of bias)
• systematic presentation, and synthesis, of the characteristics and
findings of the included studies
@AP_Dr.Hasanain_Ghazi
10. TRADITIONAL NARRATIVE REVIEW
• No standard format
• No specific methods for selecting and appraising
• Quantitively synthesis rarely used to integrate information from
multiple studies
@AP_Dr.Hasanain_Ghazi
11. SR Steps
1. Gather your team
2. Develop protocol
3. Data collection, locate and screen
@AP_Dr.Hasanain_Ghazi
12. 4. abstract data , appraise risk of Bias
5. synthesis findings and interpret
6. report writing
7. update
@AP_Dr.Hasanain_Ghazi
13. META ANALYSIS
• Is an OPTIONAL component of systematic review.
• A statistical analysis which combines the results of several
independent studies considered by the analyst to be combinable
(Huque, 1988).
@AP_Dr.Hasanain_Ghazi
14. What meta analysis can help
• Assess strength of evidence
To determine whether an effect exists in a particular direction
• Combine results quantitively
To obtain a single summary result
• Investigate heterogeneity
To examine reasons for different results among studies
@AP_Dr.Hasanain_Ghazi
15. Addressing same question?
• What is the effect of interferon therapy in hepatitis C?
• Size of effect might be higher when participants are older, more
educated or healthier than others
• Different forms of interferon
• Different interferon doses
• Different viral subtypes of hepatitis C
@AP_Dr.Hasanain_Ghazi
16. WHEN TO DO MA??
• When more than 1 study has estimated a treatment effect or
association.
• When the difference in study characteristics are unlikely to effect
treatment effect.
• When the treatment effect have been measured and reported in similar
ways (or when data available) .
@AP_Dr.Hasanain_Ghazi
17. WHO IS DOING SYS. REV.
• Independent authors
• Cochrane collaboration
• Group interested in policy
• Business
@AP_Dr.Hasanain_Ghazi
18. Who is using Sys Rev
• Individual doctors and researchers
• Patient and consumers
• Guidelines producers
• Policy makers
@AP_Dr.Hasanain_Ghazi
19. IOM standers for systematic reviews
• Initiating a systematic review
• Establish a review team
• Manage bias and conflict of interest of the review team
• Ensure stakeholder input
• Manage bias and conflict of interest of those providing input
• Formulate the topic
• Develop the protocol
• Submit the protocol for peer review
• Make protocol publicly available
@AP_Dr.Hasanain_Ghazi
20. Formulate the Topic
• Confirm the need for a new review
• Develop an analytic framework
• Use a standard format to articulate each question of interest For
example, PICO(TS)
• State a rationale for each question
• Refine each question
@AP_Dr.Hasanain_Ghazi
21. Formulating the Question in a Systematic
Review
• “The most important maxim for data analysis to heed, and one which
many statisticians have shunned is this: ‘far better an approximate
answer to the right question, which is often vague, than an exact
answer to the wrong question, which can always be made precise.’”
@AP_Dr.Hasanain_Ghazi
22. Ways Similar Studies May Differ
• Patient population
• Inclusion and exclusion criteria
• Exposure definition/intervention composition, dose, timing
• Comparison group/controls
• Management protocol(co interventions) for trials
• Outcome definition(follow-up time, cause-specific mortality)
• Quality of design and execution
• Analysis
@AP_Dr.Hasanain_Ghazi
23. Components of well-structured question
• P patients or population
• I intervention/ exposure
• C comparison groups (s)
• O outcome
@AP_Dr.Hasanain_Ghazi
24. Type of people
• Define condition or disease, including explicit diagnostic criteria
• Population and setting of interest (age, race, sex, community, hospital,
outpatient)
@AP_Dr.Hasanain_Ghazi
25. Type of risk factors
• Timing of exposure
• Route of administration
• Dose of intensity
• Duration of exposure or therapy
@AP_Dr.Hasanain_Ghazi
26. Type of comparison group
• For trials :
• Placebo
• Standard therapy
• No treatment
• For epidemiological STUDIES
• No exposure
• Non-cases (hospital, neighborhood, etc)
@AP_Dr.Hasanain_Ghazi
27. Types of outcome
• Criteria of defining
• Important to consumers, providers
• Unpublished data
@AP_Dr.Hasanain_Ghazi
28. Well constructed and answerable clinical
question
• For preschool children with mild to moderate visual acuity
impairment, are glasses and patching effective in improving visual
acuity, compared with glasses alone or no treatment ?
@AP_Dr.Hasanain_Ghazi
29. Some groups add TS to PICO
• T= TIMING (Duration of minimum of follow up)
• S= sitting (primary care, specialty, inpatients )
@AP_Dr.Hasanain_Ghazi
30. • Effectiveness best answered with RCT
• Harm best answered with RCT but usually more practical to use
observational data (rare events, occurring after follow-up complete in
an RCT)
@AP_Dr.Hasanain_Ghazi
32. RESEARCH QUESTION
IS Drug therapy associated with long term morbidity and mortality in older
persons with moderate hypertension?
• P = older persons with moderate hypertension
• I= drug therapy
• C= not stated ( presumably any intervention other than named drug therapy
• O= long term morbidity and mortality
@AP_Dr.Hasanain_Ghazi
34. Major databases
• Major bibliographic databases for RCT
• Medline/Pubmed
• EMBASE
• Cochrane central register for controlled trials
• National and regional databases
• Subject specific datbases
• CINAHL
• PsychINFO
• OTSeeker
@AP_Dr.Hasanain_Ghazi
36. Register of ongoing trials
• www.clinicaltrials.gov
• www.centerwatch.com
• www.controlles-trials.com
• WHO Portal
@AP_Dr.Hasanain_Ghazi
37. Break into concepts
• P POPULATION
• I INTERVENTION
• C COMPARISON
• O OUTCOME
@AP_Dr.Hasanain_Ghazi
38. @AP_Dr.Hasanain_Ghazi
Patients with choroidal neovascularization associated with age related macular degeneration, do
intravitreal injections of Lucentis , when compared with Avastin , prevent vision loss?
Individuals with choroidal neovascularization associated with
age related macular degeneration
Lucentis (Ranibizumab)
Avastin
Change in visual acuity or visual field
P
I
C
O
39. • START WITH GENERAL FORMAT:
• (Population OR synonym #1 OR synonym #2) AND
• (Intervention OR synonym #1 OR synonym #2) AND
• (Comparison OR synonym #1 OR synonym #2) AND
• (Outcome OR synonym #1 OR synonym #2) AND
• Add study type filters
@AP_Dr.Hasanain_Ghazi
42. • WHEN DID THE SEARCH
• Month/year
• Where you searched
• Electronic databases
• Hand searches
• Trial registers
• Internet
• bibliographies
@AP_Dr.Hasanain_Ghazi
43. • How you searched
• Strategies
• What you found
• PRISMA flow diagram
@AP_Dr.Hasanain_Ghazi
48. ELEMENTS OF STUDY QUALITY THAT CAN
BE ASSESSED BY READING STUDY REPORT
• INTERNAL VALIDITY
• EXTERNAL VALIDITY
• RELEVANCE, ORIGINALITY
• ETHICS
@AP_Dr.Hasanain_Ghazi
51. • A meta-analysis is a survey in which the results of the studies included
in the review are statistically similar and are combined and analysed as
if they were one study.
@AP_Dr.Hasanain_Ghazi
52. PLANNING THE ANALYSIS
• Results of meta analysis can be very misleading if suitable attention
has not been given to:
• Formulate the review question
• Specify eligibility criteria
• Identify, select and critically appraise studies
• Collect appropriate data
• Decide what would be meaningful to analyze
@AP_Dr.Hasanain_Ghazi
53. • Systematic review contain analysis of the primary studies
• Qualitative: structured summary, description , and discussion of the
studies characteristics that may affect the cumulative evidence
• Quantitative: involves statistical analysis( meta-analysis)
@AP_Dr.Hasanain_Ghazi
54. A general framework for synthesis
• What is the direction of effect (association )
• What is the size of effect?
• Is the effect consistent across studies ?
• What is the strength of evidence for the effect ?
@AP_Dr.Hasanain_Ghazi
55. What is meta analysis
• An optional component of systematic review
• Definition:
• The statistical analysis of a large collection of analysis results from
individual studies for the purpose of integrating the findings (Glass 1976)
• The statistical analysis which combines the results of several independent
studies considered by the analyst to be combinable (Huque, 1988)
@AP_Dr.Hasanain_Ghazi
57. Reference : Hoffman, J. I. E. (2015). Meta-analysis. Biostatistics for Medical and Biomedical
Practitioners, 645–653. doi:10.1016/b978-0-12-802387-7.00036-
58. • Typical figure of response to some new treatment. The dots are the
mean log odds ratio, and the horizontal lines indicate 95% confidence
limits. Figures in the right-hand column are the weights assigned to
each study; the studies are often arranged in descending weights. The
solid vertical line at 0 indicates no difference between the groups, and
the dashed vertical line indicates the pooled average. Some figures
include the numbers of subjects in each group.
@AP_Dr.Hasanain_Ghazi
59. Note on interpretation
• The results of meta-analysis (estimate and confidence interval ) as any
other study must be interpreted in the context of a clinically important
effect size
• Statistically significant result may not be clinically important
• Results that is not statistically significant may still be compatible with
a clinically important effect
@AP_Dr.Hasanain_Ghazi
60. Why we do meta analysis
@AP_Dr.Hasanain_Ghazi
1. Increase power and precision (detect effect as statistically significant)
2. Quantify effect sizes and their uncertainty
Reduce problems of interpretation due to sampling variation
3. Assess homogeneity / heterogenicity of results
4. Answer questions not posed by individual studies
61. CONCLUSION
• Systematic review is essential for healthcare
• Meta analysis is an optional thing in SR
• SR should be done in team
@AP_Dr.Hasanain_Ghazi
62. • Cochrane is a British
international charitable
organisation formed to
organise medical research
findings to facilitate
evidence-based choices
about health interventions
involving health
professionals, patients and
policy makers. It includes
53 review groups that are
based at research
institutions worldwide
@AP_Dr.Hasanain_Ghazi