Systematic reviews and meta-analysis of prognosis research studies

2019 ◽  
pp. 208-244
Author(s):  
Richard D Riley ◽  
Karel GM Moons ◽  
Thomas PA Debray ◽  
Douglas G Altman ◽  
Gary S Collins
Keyword(s):  
Prognostic Factor ◽  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Relevant Information ◽  
Included Study ◽  
Prognosis Research ◽  
Meta Analyses ◽  
Research Studies

Systematic reviews and meta-analyses identify, evaluate, and summarize prognosis research studies and their findings. The chapter provides a guide to the key components and methods for conducting a systematic review and meta-analysis for each of the four types of prognosis studies. The CHARMS checklist is introduced as a guide to identifying clear review objectives and design, and to extracting the relevant information from each included study. Many existing prognosis studies are at high risk of bias, because (for example) of selective recruitment and reporting. Tools for examining quality of studies are discussed—the QUIPS for prognostic factor research and PROBAST for prognostic model research. The statistical principles of meta-analysis are described, and the key statistics that can be synthesized are outlined. Challenges are identified, such as the potential for publication bias and substantial heterogeneity in published prognostic factor cut points and methods of prognostic factor measurement. Despite these challenges the chapter emphasizes the crucial importance of prognosis reviews for evidence-based guidelines and clinical decision making.

scholarly journals Comparative Effectiveness Research: Using Systematic Reviews and Meta-Analyses to Synthesize Empirical Evidence

2011 ◽  
Vol 25 (3) ◽  
pp. 191-209 ◽  
Author(s):  
Maria C. Katapodi ◽  
Laurel L. Northouse
Keyword(s):  
Systematic Reviews ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Research Question ◽  
Alternative Methods ◽  
Evidence Based ◽  
Effectiveness Research ◽  
Meta Analyses ◽  
Research Studies

The increased demand for evidence-based health care practices calls for comparative effectiveness research (CER), namely the generation and synthesis of research evidence to compare the benefits and harms of alternative methods of care. A significant contribution of CER is the systematic identification and synthesis of available research studies on a specific topic. The purpose of this article is to provide an overview of methodological issues pertaining to systematic reviews and meta-analyses to be used by investigators with the purpose of conducting CER. A systematic review or meta-analysis is guided by a research protocol, which includes (a) the research question, (b) inclusion and exclusion criteria with respect to the target population and studies, © guidelines for obtaining relevant studies, (d) methods for data extraction and coding, (e) methods for data synthesis, and (f ) guidelines for reporting results and assessing for bias. This article presents an algorithm for generating evidence-based knowledge by systematically identifying, retrieving, and synthesizing large bodies of research studies. Recommendations for evaluating the strength of evidence, interpreting findings, and discussing clinical applicability are offered.

scholarly journals Review of Systematic Reviews on Acute Procedural Pain in Children in the Hospital Setting

2008 ◽  
Vol 13 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Jennifer Stinson ◽  
Janet Yamada ◽  
Alison Dickson ◽  
Jasmine Lamba ◽  
Bonnie Stevens
Keyword(s):  
Systematic Reviews ◽  
Acute Pain ◽  
Clinical Decision Making ◽  
Hospital Setting ◽  
Clinical Decision ◽  
Future Research ◽  
Hospitalized Children ◽  
Assessment Measure ◽  
Cochrane Database ◽  
Meta Analyses

BACKGROUND: Acute pain is a common experience for hospitalized children. Despite mounting research on treatments for acute procedure-related pain, it remains inadequately treated.OBJECTIVE: To critically appraise all systematic reviews on the effectiveness of acute procedure-related pain management in hospitalized children.METHODS: Published systematic reviews and meta-analyses on pharmacological and nonpharmacological management of acute procedure-related pain in hospitalized children aged one to 18 years were evaluated. Electronic searches were conducted in the Cochrane Database of Systematic Reviews, Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Two reviewers independently selected articles for review and assessed their quality using a validated seven-point quality assessment measure. Any disagreements were resolved by a third reviewer.RESULTS: Of 1469 published articles on interventions for acute pain in hospitalized children, eight systematic reviews met the inclusion criteria and were included in the analysis. However, only five of these reviews were of high quality. Critical appraisal of pharmacological pain interventions indicated that amethocaine was superior to EMLA (AstraZeneca Canada Inc) for reducing needle pain. Distraction and hypnosis were nonpharmacological interventions effective for management of acute procedure-related pain in hospitalized children.CONCLUSIONS: There is growing evidence of rigorous evaluations of both pharmacological and nonpharmacological strategies for acute procedure-related pain in children; however, the evidence underlying some commonly used strategies is limited. The present review will enable the creation of a future research plan to facilitate clinical decision making and to develop clinical policy for managing acute procedure-related pain in children.

scholarly journals Meta-analyses in paediatric surgery are often fragile: implications and consequences

2021 ◽  
Vol 37 (3) ◽  
pp. 363-367
Author(s):  
Arne Schröder ◽  
Oliver J. Muensterer ◽  
Christina Oetzmann von Sochaczewski
Keyword(s):  
Clinical Decision Making ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Clinical Decision ◽  
Paediatric Surgery ◽  
Fragility Index ◽  
Level Of Evidence ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Surgical Condition

Abstract Purpose Meta-analyses occupy the highest level of evidence and thereby guide clinical decision-making. Recently, randomised-controlled trials were evaluated for the robustness of their findings by calculating the fragility index. The fragility index is the number of events that needs to be added to one treatment arm until the statistical significance collapses. We, therefore, aimed to evaluate the robustness of paediatric surgical meta-analyses. Methods We searched MEDLINE for paediatric surgical meta-analyses in the last decade. All meta-analyses on a paediatric surgical condition were eligible for analysis if they based their conclusion on a statistically significant meta-analysis. Results We screened 303 records and conducted a full-text evaluation of 60 manuscripts. Of them, 39 were included in our analysis that conducted 79 individual meta-analyses with significant results. Median fragility index was 5 (Q25–Q75% 2–11). Median fragility in relation to included patients was 0.77% (Q25–Q75% 0.29–1.87%). Conclusion Paediatric surgical meta-analyses are often fragile. In almost 60% of results, the statistical significance depends on less than 1% of the included population. However, as the fragility index is just a transformation of the P value, it basically conveys the same information in a different format. It therefore should be avoided.

scholarly journals Critical appraisal and meta-analysis of biological variation estimates for kidney related analytes

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Niels Jonker ◽  
Berna Aslan ◽  
Beatriz Boned ◽  
Fernando Marqués-García ◽  
Carmen Ricós ◽  
...  
Keyword(s):  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Biological Variation ◽  
Plasma Albumin ◽  
Literature Searches ◽  
Global Estimates ◽  
Correct Application ◽  
Meta Analyses

AbstractObjectiveKidney markers are some of the most frequently used laboratory tests in patient care, and correct clinical decision making depends upon knowledge and correct application of biological variation (BV) data. The aim of this study was to review available BV data and to provide updated BV estimates for the following kidney markers in serum and plasma; albumin, creatinine, cystatin C, chloride, potassium, sodium and urea.ContentRelevant studies were identified from a historical BV database as well as by systematic literature searches. Retrieved publications were appraised by the Biological Variation Data Critical Appraisal Checklist (BIVAC). Meta-analyses of BIVAC compliant studies with similar design were performed to deliver global estimates of within-subject (CVI) and between-subject (CVG) BV estimates. Out of the 61 identified papers, three received a BIVAC grade A, four grade B, 48 grade C, five grade D grade and one was not appraised as it did not report numerical BV estimates. Most studies were identified for creatinine (n=48). BV estimates derived from the meta-analysis were in general lower than previously reported estimates for all analytes except urea. For some measurands, BV estimates may be influenced by age or states of health, but further data are required.SummaryThis review provides updated global BV estimates for kidney related measurands. For all measurands except for urea, these estimates were lower than previously reported.OutlookFor the measurands analyzed in this review, there are sufficient well-designed studies available to publish a trustworthy estimate of BV. However, for a number of newly appearing kidney markers no suitable data is available and additional studies are required.

scholarly journals Methods for the Development of Healthcare Practice Recommendations Using Systematic Reviews and Meta-Analyses

2021 ◽  
Vol 12 ◽  
Author(s):  
Thomas Platz
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Systematic Reviews ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Practice Recommendations ◽  
Meta Analyses

Quality of healthcare can be improved when the best external evidence available is integrated in clinical decision-making in a systematic explicit manner. With the rapid expansion of clinical evidence, the opportunities for evidence-based high-quality healthcare increase. Paradoxically, the likelihood of any one person to get a complete and balanced picture of the evidence available decreases. This is especially true for rehabilitation interventions that are complex in nature and where clinical research is rather diverse. Given the complex nature of the evidence, there is a substantial risk of misinterpreting the complex information both at the level of individual sources (e.g., reports of clinical trials) and for aggregated data syntheses (e.g., systematic reviews and meta-analyses). These risks are inherent in these sources themselves and are in addition related to the methodological expertise necessary to make valid use of the evidence for clinical decision-making. Taken together, there is a great demand for systematic structured guidance from evidence to clinical decision. This methodology paper describes a structured process for the development and report of evidence-based clinical practice recommendations that uses systematic reviews and meta-analyses as evidence source. It provides a comprehensive framework with specific requirements for the development group, the formulation of the healthcare question addressed, the systematic search for the evidence, its critical appraisal, the extraction and the outcome-centered presentation of the evidence, the rating of its quality, strengths and weaknesses, any further considerations relevant for decision-making, and an explicit recommendation statement along with its justification, implementation, and resource aspects. The suggested methodology uses international standards in evidence synthesis, critical appraisal of systematic reviews, rating the quality of evidence, characteristics of recommendations, and guideline development as developed by Cochrane, GRADE (Grading of Recommendations Assessment, Development and Evaluation), AMSTAR (A MeaSurement Tool to Assess systematic Reviews), and AGREE (Appraisal of Guidelines for REsearch & Evaluation). An added distinctive feature of the methodology is to focus on the most up-to-date, most valid evidence and hence to support the development of valid practice recommendations in an efficient way. Practice recommendations generated by such a valid methodology would be generally applicable and promote evidence-based clinical practice globally.

scholarly journals Systematic reviews and meta-analyses in animal health, performance, and on-farm food safety: a scoping review

2019 ◽  
Vol 20 (2) ◽  
pp. 116-127 ◽  
Author(s):  
Rachael Vriezen ◽  
Jan M. Sargeant ◽  
Ellen Vriezen ◽  
Mark Reist ◽  
Charlotte B. Winder ◽  
...  
Keyword(s):  
Food Safety ◽  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Animal Health ◽  
Companion Animals ◽  
Performance Outcomes ◽  
And Performance ◽  
Meta Analyses ◽  
On Farm

AbstractSystematic reviews and meta-analyses are used to summarize and interpret evidence for clinical decision-making in human health. The extent of the application of these methods in veterinary medicine and animal agriculture is unknown. The goal of this scoping study was to ascertain trends in the publication of systematic reviews and meta-analyses examining animal health, animal performance, and on-farm food safety. Online databases were searched for reviews published between 1993 and 2018 that focused on relevant outcomes in domestic livestock, companion animals, or wildlife species. In total 1787 titles and abstracts underwent data characterization. Dairy cattle, fish, and pigs were the most common target commodity groups. Few articles investigated both health and performance outcomes (only health: n = 418; only performance: n = 701; both health and performance: n = 103). Most of the reviews (67.6%, n = 1208/1787) described a meta-analysis but did not state in the title or abstract that a systematic review was also conducted, which is potentially problematic. Adherence to reporting guidelines is recommended for all systematic reviews and meta-analyses. For research areas with many reviews, an evidence repository is recommended. For less well-reviewed areas, additional investigation may be necessary to identify the reasons for the lack of synthesis research.

scholarly journals Side effects of acetazolamide: a systematic review and meta-analysis assessing overall risk and dose dependence

2020 ◽  
Vol 7 (1) ◽  
pp. e000557 ◽  
Author(s):  
Christopher N Schmickl ◽  
Robert L Owens ◽  
Jeremy E Orr ◽  
Bradley A Edwards ◽  
Atul Malhotra
Keyword(s):  
Side Effects ◽  
Clinical Decision Making ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Dose Dependence ◽  
Total Daily Dose ◽  
Effect Estimate ◽  
Moderate Quality ◽  
Meta Analyses

IntroductionAcetazolamide (AZM) is used for various conditions (eg, altitude sickness, sleep apnoea, glaucoma), but therapy is often limited by its side effect profile. Our objective was to estimate the risk of commonly reported side effects based on meta-analyses. We hypothesised that these risks are dose-dependent.MethodsWe queried MEDLINE/EMBASE (Medical Literature Analysis and Retrieval System Online/Excerpta Medica dataBASE) up until 04/10/2019, including any randomised placebo-controlled trial in which adults received oral AZM versus placebo reporting side effects. Eligibility assessment was performed by two independent reviewers. Data were abstracted by one reviewer who verified key entries at a second time point. For side effects reported by >3 studies a pooled effect estimate was calculated, and heterogeneity assessed via I2; for outcomes reported by >5 studies effect modification by total daily dose (EMbyTDD; <400 mg/d, 400–600 mg/d, >600 mg/d) was assessed via meta-regression. For pre-specified, primary outcomes (paraesthesias, taste disturbances, polyuria and fatigue) additional subgroup analyses were performed using demographics, intervention details, laboratory changes and risk of bias.ResultsWe included 42 studies in the meta-analyses (Nsubjects=1274/1211 in AZM/placebo groups). AZM increased the risk of all primary outcomes (p<0.01, I2 ≤16% and low-to-moderate quality of evidence for all)—the numbers needed to harm (95% CI; nStudies) for each were: paraesthesias 2.3 (95% CI 2 to 2.7; n=39), dysgeusia 18 (95% CI 10 to 38, n=22), polyuria 17 (95% CI 9 to 49; n=22), fatigue 11 (95% CI 6 to 24; n=14). The risk for paraesthesias (beta=1.8 (95% CI 1.1 to 2.9); PEMbyTDD=0.01) and dysgeusia (beta=3.1 (95% CI 1.2 to 8.2); PEMbyTDD=0.02) increased with higher AZM doses; the risk of fatigue also increased with higher dose but non-significantly (beta=2.6 (95% CI 0.7 to 9.4); PEMbyTDD=0.14).DiscussionThis comprehensive meta-analysis of low-to-moderate quality evidence defines risk of common AZM side effects and corroborates dose dependence of some side effects. These results may inform clinical decision making and support efforts to establish the lowest effective dose of AZM for various conditions.

scholarly journals Review of published systematic reviews and meta-analyses on COVID-19

2020 ◽  
Author(s):  
Ezzeldin Ibrahim ◽  
Nasrien E Ibrahim
Keyword(s):  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Treatment Guidelines ◽  
Clinical Manifestations ◽  
Clinical Decision ◽  
Rapid Spread ◽  
The World ◽  
Scientific Accuracy ◽  
Meta Analyses ◽  
And Control

Purpose: The rapid spread of the COVID-19 pandemic has prompted researchers from all over the world to share their experience. The results were numerous reports with variable quality. The latter has provided an impetus to examine all published meta-analyses and systematic reviews on COVID-19 to date to examine available evidence. Methods: Using predefined selection criteria, a literature search identified 43 eligible meta-analyses and/or systematic reviews. Results: Most (N=17) studies addressed clinical manifestations and associated comorbidity, 6 studies addressed clinical manifestations in pregnant women and younger individuals, 8 studies addressed diagnostic data, 9 studies addressed various interventions, and 9 studies addressed prevention and control. The number of studies included in the various systemic reviews and meta-analyses ranged from 2 to 89. While there were some similarities and consistency for some findings, e.g. the relation between comorbidities and disease severity, we also noted occasionally conflicting data. Conclusion: As more data are collected from patients infected with COVID-19 all over the world, more studies will undoubtedly be published and attention to scientific accuracy in the performance of trials must be exercised to inform clinical decision-making and treatment guidelines.

scholarly journals Psychometric properties and use of the DEMQOL suite of instruments in research: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041318
Author(s):  
Matthias Hoben ◽  
Stephanie A Chamberlain ◽  
Hannah M O'Rourke ◽  
Brittany Elliott ◽  
Shovana Shrestha ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Poor Quality ◽  
Included Study ◽  
Primary Data ◽  
Public Health Issue ◽  
People With Dementia ◽  
Research Studies

IntroductionDementia is a public health issue and a major risk factor for poor quality of life among older adults. In the absence of a cure, enhancing health-related quality of life (HRQoL) of people with dementia is the primary goal of care. Robust measurement of HRQoL is a prerequisite to effective improvement. The DEMQOL suite of instruments is considered among the best available to measure HRQoL in people with dementia; however, no review has systematically and comprehensively examined the use of the DEMQOL in research and summarised evidence to determine its feasibility, acceptability and appropriateness for use in research and practice.Methods and analysisWe will systematically search 12 electronic databases and reference lists of all included studies. We will include systematically conducted reviews, as well as, quantitative and qualitative research studies that report on the development, validation or use in research studies of any of the DEMQOL instruments. Two reviewers will independently screen all studies for eligibility, and assess the quality of each included study using one of four validated checklists appropriate for different study designs. Discrepancies at all stages of the review will be resolved by consensus. We will use descriptive statistics (frequencies, proportions, ranges), content analysis of narrative data and vote counting (for the measures of association) to summarise the data elements. Using narrative synthesis, we will summarise what is known about the development, validation, feasibility, acceptability, appropriateness and use of the DEMQOL. Our review methods will follow the reporting and conduct guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.Ethics and disseminationEthical approval is not required as this project does not involve primary data collection. We will disseminate our findings through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42020157851.

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