Systematic Review/ Meta Analysis

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Process of A SR: Step 6-7 How will authors sometimes weigh the material

based on the average estimate of the effect, makes it so bad articles do not impact the results as much

How do qualitative analysis (SR) determine the words?

based on the count and quality of the articles

Review articles are typically

biased

Why are inconclusive findings useful?

clinical often misled by the results of one study that agrees with their philosophy -they search for an article they agree with and it might just be an atypical result for an intervention

Where can you find the least bias and most expensive SR/MA?

cochrane collaboration

Process of A SR: Step 1 Cochrane and other systematic reviews often compare the intervention to several "________" conditions

comparison

Process of A SR: Step 1 PICO become what for a SA (3)

inclusion criteria exclusion criteria search terms

Common SR results 1. What findings are common?

inconclusive findings

How is a SR unbias?

it includes ALL articles

Process of A SR: Step 5 How does the systematic review become bias when you only use articles that only include ONE outcome measure

just because the study doesn't use the same outcome/units doesn't mean the study is worse. SR become bias because the conclusion of it might not be true.

Process of A SR: Step 2 and 3 Define the _______ ______

literature search (search terms)

What is expert opinion?

lowest quality clinical experience, guidelines, review articles

What is it called when it is approtiate to combine the results from different studies and settings?

meta analysis

results are represented statically

meta analysis

Systematic Review -What about the quality of articles used in a systematic review?

quality of individual articles is extensively analysis -you know if they are using low quality articles. low quality would be consider a 2A not 1a because the quality of articles is low.

Process of A SR: Step 6-7 1. Scales are used to score the

quality of the studies (internal validity)

Process of A SR: Step 6-7 Must review articles for

quality/ internal validity

Dimensionless measures nominal or ordinal outcome measures

relative risk or odds ratio

Review Articles- Traditional Approach lack of description of the organized approach to gathering....

relevant literature data

Process of A SR: Step 4 Avoidance of selective ________ bias

reporting

Process of A SR: Step 5 After searching the articles the author will

retrieve/ screen articles

Process of A SR: Step 6-7 Use a scale to

review each article

An inconclusive result or negative SR may cause a PT to

review their practice patterns -start question why they are using their methods

Heterogeneity in studies happens because (2)

sample characteristics- inclusion/exclusion, baseline function/disability methodology- length of follow up, handling of data

authors choosing not to include certain RCT results for publication

selective reporting

Heterogeneity in studies

show significant differences between studies

Process of A SR: Step 5 How can outcome be very specific in a SR?

some require a consistent outcome measure for all studies example cannot compare seconds to inches

Dimensionless measures interval or ratio outcome measures

standard mean difference weight mean difference

Process of A SR: Step 1 The comparison conditions include

standard of care no care competing interventions (multiple comparisons: education, treatment, no treatment)

Process of A SR: Step 6-7 Scaling is sometimes used to? Example

statistically place more emphasis on results of high quality studies example pedro and JADAD

What words do qualitative analysis (SR) use

strong, moderate, minimal evidence for/ against treatment

What is the one problems with synthesizing findings?

studies often use different outcome measures to quantity the same construct

Process of A SR: Step 8-9 What are you doing here?

synthesize/analyze the findings

Qualitative analysis=

systematic review

describes the results results will be in words "we had three articles that showed a positive effect"

systematic review

Process of A SR: Step 5 Some of the articles will not meet

the predetermine criteria

What typically determines if the study results will be synthesize statistically?

the study's heterogeneity- probably will be a SR if it has a lot of heterogeneity

What is the goal of a SR?

to synthesize results of all relevant studies that evaluate a common question to get an answer

What is the solution with different outcome measures?

transform results of each study into a dimensionless measure (SMD or WMD)

When do some authors not do Cochran Q or Chi Square test when determining heterogeneity?

when there are few studies (less than 5)

When does the author decide if it should be a SR or MA?

at the end and by looking at the data

Process of A SR: Step 4 As a reader how can you find out what authors are not reporting?

authors who are funded must publish a protocol of their study. the protocol tells what they were funded for. so all the information they were saying the were going to do.

Meta analysis improves external validity by?

pooling results from across settings (acute, day rehab, SNF)

a bunch of low quality RCT=

poor systematic review

To avoid publication bias what can you do?

"Grey literature" search for articles that haven't been published

Narrative Review - ______ or _____ topic -No _______ ________ required of studies included in review - There is no reason to include...... -Was is not reported? - Do not know how? -_______ and or level of ______ of studies included in review

- GENERAL or FOCUSED topic -No SPECIFIC CRITERIA required of studies included in review - There is no reason to include ARTICLES THAT DO NOT AGREE WITH YOU -Was is not reported.. SEARCH AND SELECTION METHODS - Do not know how? THEY GOT THE ARTICLES - QUALITY and or level of EVIDENCE of studies included in review

Review Articles- Traditional Approach -_______ review - ______ opinion -_____ statement -________ review statements

- UNSYSTEMATIC review - EXPERT opinion - CONSENSUS statement -NARRATIVE review statement

The specific search and selection methods with a systematic review -tells you what search terms were used to... -would allow you to.....

- find the articles -reproduce the search

Systematic Review - focused _____ (____) -Summary of findings from studies that meet _______ ______

- focused QUESTION (PICO) it will be very specific, patient outcome and intervention -Summary of findings from studies that meet SPECIFIC CRITERIA every article meets the criteria associated with PICO

Review Articles do not tell you how they gathered relevant literature data - there is no ____ or ____ criteria to evaluate -they might only pick articles based on their _______

- there is no INCLUSION or EXCLUSION criteria to evaluate -they might only pick articles based on their OPINION, only support their opinion.

Process of A SR: Step 6-7 1. Each article is typically review by at least _____ reviewers 2. This is to? 3. What may the reviewer do? 4. How are discrepancies between raters settled?

1. 2 2. Avoids one person opinion 3. Reach out to the author for clarification 4. By a 3rd reviewer

Process of A SR: Step 1 What are the 5 categories and the studies that would be used that the QUESTION/PICO fits into

1. diagnosis: cross sectional study 2. etiology 3. prognosis: cohort study or epidemiology 4. treatment/intervention: RCT 5.prevention

What are 5 advantages of a MA

1. increase power 2. more precise estimate of the effect (larger n) 3. quantifies the magnitude of the effect - moderate, small... 4. resolves conflicting results 5. may improve external validity

Process of A SR: Step 2 and 3 1. Define the _______ 2. Positive of being broad 3. Negative of being broad example exercise might be

1. intervention 2. lots of articles for review 3. no as specific example cardio, strength training

What are two ways systematic reviews are helpful?

1. it is imposisble to stay current with all the new research -SR help you filter out the bad articles and find the good articles 2. SR reduces the tendency to read articles that "agree" with you or that you are "looking for"

Process of A SR: Step 6-7 The scales are based off of what three things

1. methodology/ randomization 2. masking/blinding 3. reporting and treatment of missing data

Process of A SR: Step 2 and 3 1. What will the ________ population look like. 2. Consider: Will it apply to my ______

1. patient 2. setting

Process of A SR: Step 4 A comprehensive, objective, literature search 1. The data search must be _____ with (3) 2. The author must provide

1. reproduceable- phases, terms, limits 2. The date of the data search

Process of A SR: Step 2 and 3 Determining the Search Terms 1. What type of _____ are going to be included

1. studies

What are the two ways information can be synthesized?

1. systematic review 2. meta analysis

Not all SR are a

MA

What way do we evaluate SR/MA?

PRISMA

Systematic Review -Rigorous ______ and _____ methods establish prior

SEARCH and SELECTION

All MA are a

SR

What does the cochrane collaboration do?

SR/MA across health care

Meta analysis is a subgroup of

a systematic review

How does a SR reduces the tendency to read articles that "agree" with you or that you are "looking for"

an SR aim is to come out with a conclusion on a topic in an unbiased way

Process of A SR: Step 6-7 What is the purpose of scaling the quality of articles?

assure the readers the "garbage in/ garbage out" does not apply

What are three ways to search for grey literature?

contact authors for unpublished data government studies dissertation/thesis (university libraries)

Process of A SR: Step 4 A comprehensive, objective, literature search 1. What must be provided?

databases and search terms

What are two ways you can tell the Heterogeneity in a study?

degree of overlap of study confideince intervals cochran q or chi square tests

It is important to determine why Heterogeneity between the studies exist

design type, length of follow up, the way data is collected, population studied

Process of A SR: Step 10 A flow chart reporting

detailed explanation of studies and outcomes included in the results - how you found the studies (pubmed, gray search) -why articles were not included (allows the reader to determine if the author was bias)

Process of A SR: Step 4 This is when you

do a comprehensive, objective, literature search

Process of A SR: Step 5 What are the cons of using only one outcome between studies?

excludes findings from RCT that may affect the validity of the reviews conclusions

Process of A SR: Step 5 What are the pros of using only one outcome between studies?

facilitates homogeneity of the results and combing results between studies

What two CEBM reccomendations should you not use with a SR

foundational evidence expert opinion

Systematic review does NOT

give the magnitude, just provides the number of studies that agree

Consensus

group of people providing their opinion

Heterogeneity Cochran Q or Chi Square test if the results are significant=

heterogeneity

Heterogeneity Degree of overlap in the confidence intervals If there is little over lap?

heterogeneity

Results of a systematic review are

no numbers just gives the number of studies that agree overall picture

Process of A SR: Step 4 A comprehensive, objective, literature search 1. A systematic review is the best evidence but.....

not necessarily the newest evidence

Process of A SR: Step 1 State the ______/______

objective/ question PICO

Note often there are more than ______ _______ for a SR

one comparission 1. mobs vs the ex (moderate) 2. mobs vs no treatment (strong) 3. mobs with exercise vs exercise alone (weak)

If you are only pulling articles from pubmed this creates a publication bias because

only articles that show a signficant effect are publised

Review Articles -provide lots of reference to get their _______

opinion

Process of A SR: Step 5 What term on pico can be very very specific in a SR?

outcome

What is selective reporting bias?

outcomes that are measured but not reported statistically significant outcomes are more likely to be chosen by the author for reporting

What is foundational evidence?

preponderance of evidence from animals, cadaver, or bench studies

Dimensionless measures nominal or ordinal outcome measures WHAT kind of study?

prognosis study

Process of A SR: Step 4 A comprehensive, objective, literature search 1. must avoid

publication bias

The tendency for journal editors to publicize certain study findings but not others

publication bias

How do you find SR/MA

pubmed using filters


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