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Unpublished (grey literature): authors/experts, conference proceedings,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