A Stepwise Approach to Systematic Reviews and Meta-analyses of Endovascular Interventions

The accrual of clinical studies poses important challenges to researchers and practitioners, especially in the field of endovascular therapy, where patient, lesion, technique, and device subtleties abound. Systematic reviews and meta-analyses may prove particularly fruitful in such settings by increasing statistical precision and bolstering external validity if the evidence base on a specific topic is consistent or by highlighting important discrepancies in the opposite scenario. However, mastering the correct approach to systematic review and meta-analysis is challenging for careful readers or for those interested in conducting such an evidence synthesis exercise. The present article highlights a stepwise approach to systematic reviews and meta-analyses, focusing on endovascular interventions, which will prove useful to anyone reading or wishing to synthesize the evidence base on endovascular topics to optimize decision making or shape future research efforts.

Download Full-text

Mapping Host-Related Correlates of Influenza Vaccine-Induced Immune Response: An Umbrella Review of the Available Systematic Reviews and Meta-Analyses

Vaccines ◽

10.3390/vaccines7040215 ◽

2019 ◽

Vol 7 (4) ◽

pp. 215 ◽

Cited By ~ 5

Author(s):

Alexander Domnich ◽

Ilaria Manini ◽

Giovanna Elisa Calabrò ◽

Chiara de Waure ◽

Emanuele Montomoli

Keyword(s):

Influenza Vaccine ◽

Systematic Reviews ◽

Evidence Synthesis ◽

Meta Analysis ◽

Health Condition ◽

Vitamin D Supplementation ◽

Umbrella Review ◽

Related Factors ◽

Ready Availability ◽

Meta Analyses

Seasonal influenza is the leading infectious disease in terms of its health and socioeconomic impact. Annual immunization is the most efficient way to reduce this burden. Several correlates of influenza vaccine-induced protection are commonly used, owing to their ready availability and cheapness. Influenza vaccine-induced immunogenicity is a function of host-, virus- and vaccine-related factors. Host-related factors constitute the most heterogeneous group. The objective of this study was to analyze the available systematic evidence on the host factors able to modify influenza vaccine-induced immunogenicity. An umbrella review approach was undertaken. A total of 28 systematic reviews/meta-analyses were analyzed—these covered the following domains: intravenous drug use, psychological stress, acute and chronic physical exercise, genetic polymorphisms, use of pre-/pro-/symbiotics, previous Bacillus Calmette–Guérin vaccination, diabetes mellitus, vitamin D supplementation/deficiency, latent cytomegalovirus infection and various forms of immunosuppression. In order to present effect sizes on the same scale, all possible meta-analyses were re-performed and cumulative evidence synthesis ranking was carried out. The meta-analysis was conducted separately on each health condition category and virus (sub)type. A total of 97 pooled estimates were used in order to construct an evidence-based stakeholder-friendly map. The principal public health implications are discussed.

Download Full-text

Network meta-analyses in reproductive medicine: challenges and opportunities

Human Reproduction ◽

10.1093/humrep/deaa126 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1723-1731

Author(s):

Rui Wang ◽

Anna Lene Seidler ◽

Lisa Askie ◽

Robert J Norman ◽

Siladitya Bhattacharya ◽

...

Keyword(s):

Reproductive Medicine ◽

Evidence Synthesis ◽

Meta Analysis ◽

Indirect Evidence ◽

Future Research ◽

Challenges And Opportunities ◽

Recent Addition ◽

Simultaneous Comparisons ◽

Multiple Treatments ◽

Meta Analyses

Abstract Network meta-analysis allows researchers to synthesise both direct and indirect evidence, thus enabling simultaneous comparisons of multiple treatments. A relatively recent addition to evidence synthesis in reproductive medicine, this approach has become increasingly popular. Yet, the underlying assumptions of network meta-analyses, which drive the validity of their findings, have been frequently ignored. In this article, we discuss the strengths and limitations of network meta-analyses. In addition, we present an overview of published network meta-analyses in reproductive medicine, summarize their challenges and provide insights into future research opportunities.

Download Full-text

Improving the transparency of meta-analyses with interactive web applications

BMJ evidence-based medicine ◽

10.1136/bmjebm-2019-111308 ◽

2020 ◽

pp. bmjebm-2019-111308

Author(s):

Thomas P Ahern ◽

Richard F MacLehose ◽

Laura Haines ◽

Deirdre P Cronin-Fenton ◽

Per Damkier ◽

...

Keyword(s):

Quality Assessment ◽

Web Applications ◽

Evidence Synthesis ◽

Meta Analysis ◽

Cancer Recurrence ◽

Quality Criteria ◽

Future Research ◽

Summary Estimate ◽

Specific Association ◽

Meta Analyses

Increased transparency in study design and analysis is one proposed solution to the perceived reproducibility crisis facing science. Systematic review and meta-analysis—through which individual studies on a specific association are ascertained, assessed for quality and quantitatively combined—is a critical process for building consensus in medical research. However, the conventional publication model creates static evidence summaries that force the quality assessment criteria and analytical choices of a small number of authors onto all stakeholders, some of whom will have different views on the quality assessment and key features of the analysis. This leads to discordant inferences from meta-analysis results and delayed arrival at consensus. We propose a shift to interactive meta-analysis, through which stakeholders can take control of the evidence synthesis using their own quality criteria and preferred analytic approach—including the option to incorporate prior information on the association in question—to reveal how their summary estimate differs from that reported by the original analysts. We demonstrate this concept using a web-based meta-analysis of the association between genetic variation in a key tamoxifen-metabolising enzyme and breast cancer recurrence in tamoxifen-treated women. We argue that interactive meta-analyses would speed consensus-building to the degree that they reveal invariance of inferences to different study selection and analysis criteria. On the other hand, when inferences are found to differ substantially as a function of these choices, the disparities highlight where future research resources should be invested to resolve lingering sources of disagreement.

Download Full-text

The differential efficacy of systemic therapy: a protocol for a systematic review and meta-analysis

10.21203/rs.3.rs-1074984/v1 ◽

2021 ◽

Author(s):

Niels Braus ◽

Rebecca von Oepen ◽

Nina Immel ◽

Johanna Wichmann ◽

Christian Frankman ◽

...

Keyword(s):

Systematic Reviews ◽

Systemic Therapy ◽

Literature Search ◽

Meta Analysis ◽

Social Systems ◽

Future Research ◽

Controlled Trials ◽

Cochrane Central Register ◽

System Functioning ◽

Meta Analyses

Abstract Background: Systemic therapy is a widespread evidence-based psychotherapy approach. Its main goal revolves around the concept of viewing mental symptoms within the context of social systems (e.g., families, couples). Systematic reviews and meta-analyses have confirmed that systemic therapy significantly reduces symptom severity of DSM- or ICD-diagnosed patients. This meta-analysis aims to investigate the differential efficacy of systemic therapy, taking into account moderators (e.g., allegiance, adherence) and outcomes (system functioning) not considered in previous meta-analytical investigations.Methods: To conduct a comprehensive literature search, we will optimize search strategies from previous systematic reviews on systemic therapy. The search strategy presented in this protocol has improved the precision and sensitivity by using an iterative validation and optimization process. We will conduct the literature search in multiple electronic databases (PsycInfo, Pubmed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)). We will include all randomized controlled trials that report quantitative outcomes for symptom change and/or system functioning. For the calculations, we will conduct a Bayesian meta-analysis for the outcomes based on a random-effects model, a Bayesian meta-regression for the moderators, and Bayesian subgroup analysis for disorder-specific differences.Discussion: Understanding the differential efficacy of systemic therapy is essential for the conceptualization, performance, and analysis of future research and therapeutic practice. This meta-analysis faces potential limitations associated with the definition of systemic therapy, as well as methodological problems in systemic therapy research.

Download Full-text

An Overview of Systematic Reviews and Meta-Analyses on Acupuncture for Post-Acute Stroke Dysphagia

Geriatrics ◽

10.3390/geriatrics4040068 ◽

2019 ◽

Vol 4 (4) ◽

pp. 68 ◽

Cited By ~ 1

Author(s):

Zi-Yu Tian ◽

Xing Liao ◽

Ying Gao ◽

Shi-Bing Liang ◽

Chong-Yang Zhang ◽

...

Keyword(s):

Acute Stroke ◽

Systematic Reviews ◽

Primary Outcome ◽

Acupuncture Treatment ◽

Meta Analysis ◽

Future Research ◽

Randomized Controlled ◽

Overview Of Systematic Reviews ◽

Meta Analyses

Background: Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Conflicting results from different SRs necessitated an overview to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this condition. The aim was to evaluate methodological quality and summarizing the evidence for important outcomes. Methods: Seven databases were searched for SRs and/or meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). Results: Searches yielded 382 SRs, 31 were included. The quality of 22 SRs was critically low, five SRs were low, and four Cochrane SRs were moderate when evaluated by AMSTAR2. A total of 17 SRs reported 85.2–96.3% of PRISMA items. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. Conclusion: Currently, evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is of a low quality. The type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research.

Download Full-text

Systematic reviews and meta-analysis in nutrition research

British Journal Of Nutrition ◽

10.1017/s0007114519002241 ◽

2019 ◽

Vol 122 (11) ◽

pp. 1279-1294 ◽

Cited By ~ 4

Author(s):

George A. Kelley ◽

Kristi S. Kelley

Keyword(s):

Systematic Reviews ◽

Meta Analysis ◽

Technical Information ◽

Major Elements ◽

Future Research ◽

High Quality ◽

Nutrition Research ◽

Production And Consumption ◽

Different Types ◽

Meta Analyses

AbstractThere exists an ever-increasing number of systematic reviews, with or without meta-analysis, in the field of nutrition. Concomitant with this increase is the increased use of such to guide future research as well as both practice and policy-based decisions. Given this increased production and consumption, a need exists to educate both producers and consumers of systematic reviews, with or without meta-analysis, on how to conduct and evaluate high-quality reviews of this nature in nutrition. The purpose of this paper is to try and address this gap. In the present manuscript, the different types of systematic reviews, with or without meta-analyses, are described as well as the description of the major elements, including methodology and interpretation, with a focus on nutrition. It is hoped that this non-technical information will be helpful to producers, reviewers and consumers of systematic reviews, with or without meta-analysis, in the field of nutrition.

Download Full-text

An Overview of Systematic Reviews and Meta Analyses on Acupuncture for Post-Acute Stroke Dysphagia

10.20944/preprints201910.0135.v1 ◽

2019 ◽

Author(s):

Zi-Yu Tian ◽

Xing Liao ◽

Ying Gao ◽

Shi-Bing Liang ◽

Chong-Yang Zhang ◽

...

Keyword(s):

Acute Stroke ◽

Systematic Reviews ◽

Primary Outcome ◽

Meta Analysis ◽

Future Research ◽

Overview Of Systematic Reviews ◽

Registration Number ◽

Meta Analyses ◽

Quality Type

Background: Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Due to conflicting results an overview of SRs to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this disease was conducted. Methods: Seven databases were searched for SRs and/or Meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). Results: 31 SRs were identified. Quality of 22 SRs was critically low, 5 SRs were low, and 4 Cochrane SRs were moderate when evaluated by AMSTAR2. 17 SRs reported 85.2-96.3% items of PRISMA. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. Conclusion: Currently evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is low quality. Type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research. PROSPERO REGISTRATION NUMBER: CRD42019134163

Download Full-text

The REPRISE Project: Protocol for an Evaluation of Reproducibility and Replicability in Syntheses of Evidence

10.21203/rs.3.rs-150893/v1 ◽

2021 ◽

Author(s):

Matthew J Page ◽

David Moher ◽

Fiona M Fidler ◽

Julian PT Higgins ◽

Sue E Brennan ◽

...

Keyword(s):

Systematic Reviews ◽

Meta Analysis ◽

Educational Interventions ◽

Outcome Data ◽

Future Research ◽

Review Study ◽

Meta Analyses ◽

Data Analytic ◽

Completeness Of Reporting ◽

Selection Of

Abstract Background: Investigations of transparency, reproducibility and replicability in science have been directed largely at individual studies. It is just as critical to explore these issues in syntheses of studies, such as systematic reviews, given their influence on decision making and future research. We aim to explore various aspects relating to the transparency, reproducibility and replicability of several components of systematic reviews with meta-analysis of the effects of health, social, behavioural and educational interventions.Methods: The REPRISE (REProducibility and Replicability In Syntheses of Evidence) project consists of four studies. We will evaluate the completeness of reporting and sharing of review data, analytic code and other materials in a random sample of 300 systematic reviews of interventions published in 2020 (Study 1). We will survey authors of systematic reviews to explore their views on sharing review data, analytic code and other materials and their understanding of and opinions about replication of systematic reviews (Study 2). We will then evaluate the extent of variation in results when we (a) independently reproduce meta-analyses using the same computational steps and analytic code (if available) as used in the original review (Study 3), and (b) crowdsource teams of systematic reviewers to independently replicate a subset of methods (searches for studies, selection of studies for inclusion, collection of outcome data, and synthesis of results) in a sample of the original reviews; 30 reviews will be replicated by one team each and two reviews will be replicated by 15 teams (Study 4). Discussion: The REPRISE project takes a systematic approach to determine how reliable systematic reviews of interventions are. We anticipate that results of the REPRISE project will inform strategies to improve the conduct and reporting of future systematic reviews.

Download Full-text

Systematic reviews and meta-analysis

10.1093/med/9780198816805.003.0038 ◽

2021 ◽

pp. 193-206

Author(s):

Nandi Siegfried ◽

Lawrence Mbuagbaw

Keyword(s):

Systematic Reviews ◽

Evidence Synthesis ◽

Meta Analysis ◽

Research Question ◽

Similar Data ◽

Inaccurate Information ◽

Healthcare Decision Making ◽

Scoping Reviews ◽

Meta Analyses

Systematic reviews play an important role in healthcare decision-making. When conducted correctly, they provide up-to-date, comprehensive, and replicable summaries of evidence. Authors of systematic reviews are expected to develop a protocol that outlines the research question and key methodological features of their review. A comprehensive and exhaustive search should be conducted, followed by screening to capture studies that meet the prespecified inclusion criteria. Once the relevant studies have been identified, data will be extracted, using a dedicated tool that permits the review authors to confirm the eligibility of the study and collect information on its design, risk of bias, and results. Sufficiently similar data may be pooled using meta-analytic techniques or synthesized narratively. A summary of the overall quality of evidence for each outcome is an essential component of a systematic review. The main concerns with systematic reviews are (1) selection bias: systematic exclusion of relevant studies due to publication status or language; (2) indexing bias: failure to identify relevant studies because they are not indexed accurately; and (3) information bias: missing or inaccurate information in the included studies. Other approaches to evidence synthesis include mapping the evidence with scoping reviews; conducting overviews of systematic reviews; using individual patient data; conducting network meta-analyses for multiple comparisons; conducting rapid reviews when evidence is needed urgently; synthesis of diagnostic accuracy data; and synthesis of qualitative data. Systematic reviews often inform clinical guidelines and require careful planning and execution by teams with content and methodological expertise.

Download Full-text

Research synthesis: Systematic reviews and meta-analyses

Practical Psychiatric Epidemiology ◽

10.1093/med/9780198735564.003.0014 ◽

2020 ◽

pp. 237-254

Author(s):

Marianna Purgato ◽

Giovanni Ostuzzi ◽

Corrado Barbui

Keyword(s):

Mental Health Professionals ◽

Systematic Reviews ◽

Meta Analysis ◽

Scientific Evidence ◽

Analytical Techniques ◽

Evidence Base ◽

Multiple Treatment ◽

Innovative Methods ◽

Meta Analyses ◽

Based Medicine

In everyday clinical practice, the choice of the best treatment to be delivered to each individual patient should be based on the integration of three main aspects: the patient’s psychopathological status, the clinical experience, and the best scientific knowledge available about efficacy and safety of interventions. The approach that integrates these three aspects is known as evidence-based medicine. The aim of this chapter is to describe the main methodological characteristics of what constitutes an evidence base, in order to assist mental health professionals in the compelling world of scientific evidence. We present randomized controlled trials as a tool for evaluating efficacy and tolerability of treatments, systematic reviews of randomized trials, and meta-analysis, a statistical approach that allows the calculation of a weighted pooled estimate of treatment efficacy and tolerability. Finally, two innovative methods to statistically summarize data using meta-analytical techniques are described: individual patient data meta-analysis and multiple treatment meta-analysis.

Download Full-text