| Date post: | 30-Jun-2015 |
| Category: |
Education |
| Upload: | health-evidence |
| View: | 174 times |
| Download: | 0 times |
Making friends with systematic reviews:
Be comfortable assessing quality & interpreting forest plots in 90 minutes!
March 31, 2014
Maureen Dobbins RN, PhDKara DeCorby, MSc
McMaster University
Disclosure of Commercial Support
CFPC Conflict of Interest
Presenter Disclosure
Presenter: Maureen Dobbins
Relationships with commercial interests:
• Grants/Research Support: None• Speakers Bureau/Honoraria: None• Consulting Fees: None• Other: None
Today’s Objectives
1. To refresh EIDM knowledge and skill
2. To become familiar with systematic reviews
3. To identify the parts of a forest plot
4. To learn and practice how to read forest plots
5. To increase comfort with critical appraisal criteria and how to assess review quality
3
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Model of EIDM in Public Health
4
CommunityHealth Issues,Local Context
ResearchEvidence
Public HealthResources
Community and Political Preferences
and Actions
Public HealthExpertise
National Collaborating Centre for Methods and Tools. (2012). A Model for Evidence‐Informed Decision‐Making in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf.
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Evidence-informed public health
5
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
National Collaborating Centre for Methods and Tools. STEPS in Evidence‐Informed Public Health in Evidence‐Informed Public Health. Retrieved February 10, 2013. From http://www.nccmt.ca/eiph/index‐eng.html
Hierarchy of Evidence
6
Electronic systems, such as clinical decision aids.
Outline of management options for a given health issue; incorporate highest quality and most synthesized research.
Summarize the findings and implications of high quality systematic reviews.
Rigorous summary of primary research relevant to a particular focused question.
Brief summary of results and implications of Single, high-quality studies.
Related to a particular focused question.
Systems
Single studies
Syntheses
Synopses of syntheses
Summaries
Synopses of single studies
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Dicenso, Alba, Bayley, Liz, & Haynes, R. Brian. (2009a). Accessing pre‐appraised evidence: fine‐tuning the 5S model into a 6S model. Evidence‐Based Nursing, 12(4), 99‐101.DiCenso, Alba, Bayley, Liz, & Haynes, R. Brian. (2009b). ACP Journal Club. Editorial: Accessing preappraised evidence: fine‐tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6), JC3‐2, JC3‐3
Systematic Review• A synthesis or summary of single
studies on a health topic
• A formalized (systematic), transparent, scientific process
• Multiple reviewers involved
7
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Steps of a systematic review
1. Stating the objectives of the research
2. Defining eligibility criteria for studies to be included
3. Searching for (all) potentially eligible studies
4. Applying eligibility criteria
5. Assembling the most complete dataset feasible
6. Analyzing this dataset, using statistical synthesis and sensitivity analyses, if appropriate and possible
7. Preparing a structured report of the research.8
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Anatomy of a systematic review
• Introduction (background, objectives)
• Methods (search strategy, analytic approach)
• Results (studies included, data, statistical results)
• Discussion (interpretation, applicability, limitations, future research)
• Appendices (data analyses) 9
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Ekeland,E., Heian,F., & Hagen,K.B. (2005). Can exercise improve self esteem in children and young people? A systematic review of randomised controlled trials. British Journal of Sports Medicine, 39(11), 792‐798.
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Appraising a systematic review
1. Clearly focused question?
2. Inclusion / exclusion criteria?
3. Thorough search?
4. Appropriate search timeframe?
5. Level of evidence described?
11
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Appraising a review, continued
6. Quality of included evidence described?
7. Methods transparent?
8. Appropriate to combine?
9. Results weighted?
10.Conclusions believable?
12
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Critical Appraisal
Do I trust the findings and can I use the research in my setting?
13
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Critical Appraisal
- Identify study type
- Identify CA tool
- Conduct appraisal
14
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Critical AppraisalType of study (appropriate tool)
Summary/ Guideline(AGREE tool)Brouwers, M., et al. (2010)
Systematic review (HE tool)Health Evidence. (2013)
Single study – RCT, cohort, case control, qualitative (CASP tools)Public Health Resource Unit (2006)
15
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Summary:
• What is EIDM?
• What is a systematic review?
• What are the processes and parts of a review?
• How do I read a forest plot?
• How do I assess quality of a review (critical appraisal)?
16
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Questions?
17
Objectives -- EIDM – Systematic reviews -- Forest plots -- Critical Appraisal -- Summary -- Questions
Additional Resources
• HE Practice Tools: http://www.healthevidence.org/practice-tools.aspx
• NCCMT Online Learning Modules: http://www.nccmt.ca/modules/index-eng.html
– Intro to EIDM; – Searching for Research Evidence in PH
18
References• Brouwers, M., Kho, M.E., Browman, G.P., Burgers, J.S., Cluzeau, F., Feder, G., Fervers, B.,
Graham, I.D., Grimshaw, J., Hanna, S., Littlejohns, P., Makarski, J., Zitzelsberger, L. for the AGREE Next Steps Consortium. (2010). AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Canadian Medical Association Journal, 182(18), e839-e842. doi:10.1503/cmaj.090449
• Dicenso, Alba, Bayley, Liz, & Haynes, R. Brian. (2009a). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence-Based Nursing, 12(4), 99-101.
• DiCenso, Alba, Bayley, Liz, & Haynes, R. Brian. (2009b). ACP Journal Club. Editorial: Accessing preappraised evidence: fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6), JC3-2, JC3-3
• Ekeland,E., Heian,F., & Hagen,K.B. (2005). Can exercise improve self esteem in children and young people? A systematic review of randomised controlled trials. British Journal of Sports Medicine, 39(11), 792-798.
• Health Evidence. Quality assessment tool: Review articles. http://www.healthevidence.org/documents/our-appraisal-tools/QA_tool&dictionary_18.Mar.2013.pdf . 2013. McMaster Univerisity.
• National Collaborating Centre for Methods and Tools. (2012). A Model for Evidence-Informed Decision-Making in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf.
• National Collaborating Centre for Methods and Tools. STEPS in Evidence-Informed Public Health in Evidence-Informed Public Health. Retrieved February 10, 2014 From http://www.nccmt.ca/eiph/index-eng.html
• Public Health Resource Unit (2006). The Critical Skills Appraisal Programme: making sense of evidence. Public Health Resource Unit, England. Retrieved from: http://www.casp-uk.net/19
