Narrative and Systemic Review

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T or F: Appraisal methods are used to evaluate included articles

False - they are not used

The % variability across studies that is due to heterogeneity and not chance

I2 test

Narrative review is considered to be ____ literature

tertiary

T or F: Systematic reviews define their search strategy (mesh, key words, limits, etc.)

true

T or F: Systematic reviews have a rigorous critical appraisal of studies that are included

true

Statistical analysis is done to complement ___ ____

visual analysis

What tests can be done to see if the studies combined were similar or consistent?

visual assessment of forest plot statistical testing - cochran Q (x2), I2 difference between studies or heterogeneity

What is the point of no difference for continuous data?

0

What is the point of no difference for discrete data?

1

How should the studies in a meta-analysis be selected? What kind of bias is this?

Based on methods - not results! Selection

How does one assesss a study for risk of bias?

Blind manner and completed by more than one person independently, to then be compared

What is the leading resource for systematic reviews?

Cochrane database of systematic reviews (CDSR)

What are the best tests (2) for the random effects model?

DerSimonian and Lard test

T or F: Meta-analysis overcomes bias

F

T or F: Meta-analysis increases sample size resulting in a decrease in power and precision

F --- increases power

What test is best for descriptive statistics?

I^2

How do qualitative and quantitative systematic reviews differ?

In the analysis of the data - statistics

How is publication bias assessed?

Inverted funnel plot

What is the most-common test for the fixed effects model?

Mantel-Haenszel test

These can help answer a clinical question that is currently unanswered by small RCTs

Meta-analysis

These take less time and they are less costly than a large RCT

Meta-analysis

what is another name for quantitative review?

Meta-analysis

Outcome is predicted according to 1 or more explanatory variables

Meta-regression

Outcome variable is effect estimate and the explanatory variables are study characteristics that might influence the effect size

Meta-regression

What are the 2 types of review articles?

Narrative Systematic

What does a P value > 0.05 suggest when assessing a publication bias?

No publication bias

T or F: meta-analysis can establish statistical significance with studies that have conflicting results

T

PRISMA stands for:

Preferred reporting items for systematic reviews and meta-analyses

Studies with a positive result will more likely be published than those with a negative result

Publication bias

What do asymmetrical inverted funnel plots suggest?

Publication bias

What are the 2 types of systematic reviews?

Qualitative Quantitative

Data is pooled Qualitative or quantitative

Quantitative (Meta-analysis)

T or F: SR can increase power to detect rare events

T - reduce need for large expensive trials

(SR/Narrative) cannot reduce systematic error

SR

____ can look for differences in effect among subgroups

SR

What do gaps in inverted funnel plots mean?

Small studies favoring the control are missing

Compares estimates of treatment effects for different subgroups or study types

Subgroup analysis

Meta-analysis is a: narrative review or a systematic review?

Systematic

Focuses on a specific topic and attempt to answer a specific question

Systematic reviews (SR)

Has a predefined research methodology

Systematic reviews (SR)

T of F: Poor studies lead to poor SR

T

T of F: Simple average would give each study equal weight which is incorrect

T

T or F: The focus of a meta-analysis is more narrow than that of a narrative review

T

T or F: Weighing gives more emphasis to studies that provide more precise estimate of effect size

T

Why should a search be detailed and include the dates and limits?

To allow one to duplicate it

What is the purpose of having 2 or more investigators participate in decisions in the systematic review process ?

To reduce error and guard against observation/interpretation bias

T or F: Narrative reviews include bias

True - the author usually supports their own hypothesis and excludes those that do not

Is publication bias a key concern for SR? why?

YES Because depends on thorough search of both published and unpublished studies to represent the population of completed studies

Does an author need to report how they assessed risk of bias?

Yes

What is the traditional test for heterogeneity?

cochran's Q (chi-squared)

Mean difference and standardized mean difference are used for ____ data

continuous

A search should be 2 things:

detailed exhaustive

Odds ratio and risk ratio is used for ____ data

discrete

critical appraisal relates to the ____ criteria. These define __.

eligibility pico

PICO is a form of: (a) internal validity (b) external validity

external validity

T or F: Pooling data is acceptable when studies are different

false - this would not make sense

T or F: Narrative review use mostly a scientific approach to how the review is conducted

false --- less scientific

T or f: In a narrative review, the search strategy along with the studies included and excluded must ALWAYS be mentioned and described

false --- not always

"What is the best estimate of the treatment effect" fixed / random effects model

fixed

considers only within-study variability fixed / random effects model

fixed

Assumes one true effect size

fixed effects model

This can be a source of unpublished literature (ex: conference abstracts, thesis)

grey lit

Random effects model incorporates _____

heterogeneity

What does a low p value <0.10 indicate? is pooling appropriate?

heterogeneity and source of heterogeneity should be explored - pooling is not appropriate

If studies are not similar enough to be pooled, they are: homozygous vs heterozygous

heterozygous

For a fixed effects model, ___ is assumed

homoegenity

What does a high p value > 0.10 indicate? is pooling appropriate?

homogeneity and increases confidence that the studies can be pooled

If studies are similar enough to be pooled, they are: homozygous vs heterozygous

homozygous

searching for unpublished information is important to avoid____ __

publication bias

(Narrative/Qualitative and or Meta) - variable and subjective; has new data produced

meta

(Narrative/Qualitative and or Meta) have statistically evaluated results

meta-analysis

This is a general summary on a given topic that does not need to answer a specific question

narrative review

Fixed effects model gives a (narrower/wider) CI than random model

narrower

Having 2 or more investigators participate in decisions in the systematic review process

observation bias

Enables the author to search for the studies for inclusion and enable the reader to apply the info

pico/eligibility

statistical summary of the data

pooled estimate

27-item checklist and flow diagram

prisma

A checklist containing a minimal list of items relevant when report systematic reviews

prisma

a standard way for authors to prepare the manuscript of trial findings for complete and transparent reporting

prisma

(Narrative/Qualitative and or Meta) have a predefined strategy that is explicit and comprehensive

qual/meta-analysis

(Narrative/Qualitative and or Meta) includes unpublished literature

qual/meta-analysis

A narrative synthesis of the data is a _____ SR

qualitative

Data is not pooled Qualitative or quantitative

qualitative

Systematic reviews can be either ___ or ___

qualitative or quantitative

A synthesis of the data with statistical analysis is a _____ SR

quantitative (meta-analysis)

"what is the average treatment effect" fixed / random effects model

random

assumes true effect size could vary from study to study

random effects model

considers both between study and within study variability fixed / random effects model

random effects model

Summaries and analyses of available information

review articles

What are the 3 types of biases in systematic reviews?

selection observation publication

Studies for systematic reviews are chosen based on specific criteria and not results to avoid ____ ____

selection bias

Determines how sensitive the results are to changes in the way meta-analysis was conducted

sensitivity analysis

_________ ___ _ is used when studies have different endpoints to measure the same clinical outcomes

standardized mean difference


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