Training on
Systematic Review and Meta-analysis
For Debre Markos University academic staffs
BY
Molla Yigzaw(MPH, Ass,t Professor)
Gedefaw Diress(MPH, Ass,t Professor)
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Brain storming questions
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What is evidence based practice in different discipline ?
What is evidence based practice in Public Health?
What is evidence based practice in clinical setting?
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Point 1
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Evidence-based practice is the integration of the best
available research with expertise opinion in the context
of target population characteristics, culture and
preferences.
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Why integration of evidence is needed?
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The results of a single study are never going to
provide the complete answer to a question in most
practices
Even, different studies may provide different answers
to the same question
If so what…….???
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Why integration of evidence is needed?
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So, information from multiple studies is often needed to
inform a particular decision
To move towards this we need to review the literature
more widely and synthesize evidence
How?
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2: Methods of review articles
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How can we review articles?
1. Narrative reviews
2. Systematic review
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1. Narrative reviews
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Summarized the literature on a topic in a subjective
manner
often including significant author biases
Generally do not provide a quantitative summary of
the literature
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2. Systematic review
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It adhere to a well-defined set of methodological
principles.
Uses structured and transparent process
allowsthe reader to gauge the quality of the review
process and the potential for bias
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3: comparison between SR &NR
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What is Meta-analysis?
Meta-analysis is a particular type of systematic review,
one in which the results are summarized in a quantitative
manner
A good meta-analysis should include a qualitative
appraisal of the literature in addition to a quantitative
summation.
Meta-analysis and systematic review
Now let us start new topic
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Steps of Systematic Review
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Steps of systematic review
Planning
I. Searching for existing reviews/protocols
Itis a preliminary search to see if others have done a review
or are working towards a review on a similar topic.
Eliminate duplication
Help you identify/finalise a review question.
Planning
II. Develop systematic review protocol
describes the stages of systematic review process.
Usually includes
Objective
review question
Research group
search strategy
Methods
inclusion/exclusion criteria
quality assessment
procedures for data extraction and data synthesis
timeline
Planning
III. Registration
Systematic reviews protocols are often registered in registries at
the protocol stage.
Avoid duplication
Reduce opportunity for reporting bias by enabling comparison of
the completed review with what was planned in the protocol.
Example PROSPERO
https://www.crd.york.ac.uk/prospero/#loginpage
Basic systematic review
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Step 1
Formulating or developing a research question and
inclusion criteria
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Defining the question
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The most important step in the process of reviewing evidence is
clarifying the topic and the nature of questions to be answered by
the review
Broad questions vs narrow questions
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Defining the question
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Broad questions
asked to review what is generally known about a problem or topic
are often used in a scoping review to provide a thorough
understanding of the problem or topic
Example : What types of programs can build mental resilience among
student nurses?
Narrow questions
Usually covers a specific topic
Helps define the key terms used in searching databases
In patients undergoing a surgical biopsy (P), how does mindfulness
meditation (I) compared with hypnosis (C) affect the use of pain killers (O)
in the first 24 hours after the biopsy (T)
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Defining the question
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What will guide question definition?
target condition
patient population
context
Intervention
outcomes of interest,
target audience,
standards of evidence
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Characteristics of well-focused questions:
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1. Disease/risk factors defined in precise terms.
2. Type of study population (adult, pediatric, etc) specified.
3. Type of intervention/exposure/diagnostic procedure specified.
4. Outcomes of interest well defined. Hard health outcomes are
preferable to surrogate outcomes.
5. Target audience considered.
6. Question based on evidence model.
7. Type of evidence specified.
8. Clear inclusion/exclusion criteria.
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Framework for Resaerch questions
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Framework for Resaerch questions
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Framework for Research questions
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Framework for Resaerch questions
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Question Development
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Verify that the question has not already been addressed
(i.e. search protocols and systematic review reports )
Aim is to provide a framework for the development and
conduct of the review
A good question supports the review, a poor question risks
confounding the review
A good question responds to identified priorities and
needs
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Other technique
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Other question framework technique
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SPICE : useful for qualitative research topics
evaluating the outcomes of a service, project, or
intervention
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Formulate research question using
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PICO model
Population or patients
The most important characteristics, including:
Disease or condition
Stage, severity
Demographic factors of the population (e.g. age,
gender, ethnicity)
Socioeconomic factors
the setting (e.g. hospital, community etc)
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Formulate research question
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Intervention (or “Exposure”):
Type of intervention or exposure
Dose, duration, timing, route, etc.
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Formulate research question
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Comparator or control group:
Absence of risk or treatment
Passive (placebo, no treatment, standard care, or a
waiting list control)
Active (variation of the intervention, a drug, or kind
of therapy)
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Formulate research question
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Outcomes
Identify the primary outcome/s in order to reach a clinically relevant
conclusion
Secondary outcomes may be required
Risk or protective
Dichotomous or continuous
Type: mortality, morbidity, quality of life, etc
Outcomes should be stated neutrally, covering benefits and adverse
effects
Avoid use of surrogate outcomes unless clearly reasoned in the
background
Consider how the type and timing of outcome measurements impacts
on outcome measurement
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Formulate research question
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Type of study:
RCTs
Cohort
Case-control
Cross-sectional
All
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Example
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Example
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