Summary slides for "Systematic Review and Meta-Analysis Course for Healthcare Professionals", January 8-9, 2013, King Abdullah Medical City, Makkah, Saudi Arabia http://KAMCResearch.org

1. Systematic Review & Meta-Analysis Course
January 8-9, 2013
“Summary Slides”
SohailBajammal, MBChB, MSc, FRCSC, PhD(c)
SohaElmorsy, MD, PhD, MSc
KAMCResearch
research@kamc.med.sa
KAMCResearch.org

3. Acknowledgements
Big Thank You
 KAMC Research Center
 Dr. DoaaAbdelmotey
 Dr. RawanIkram
 Ms. RaniaFelemban
 KAMC CPD Administration
 Ms. Huda Altalhi
 Ms. NisreenAlhazmi
 Johnny Fagyan
 Eng. Mohammad Alqethami
 Mr. MazinJizani
 Mr. Mohammad Alabbasi

4. How to Conduct
a Systematic Review/Meta-Analysis
1. Ask Research Question
2. Search the Literature
3. Select the Studies
4. Appraise the Studies
5. Extract the Data
6. Summarize the Data
7. Reporting

5. Systematic Review & Meta-Analysis
Definitions & Importance
 A systematic review:a review of a clearly formulated question that
uses systematic and explicit methods to identify, select, and
critically appraise relevant research, and to collect and analyze
data from the studies that are included in the review.
 Statistical methods (meta-analysis) may or may not be used to
analyze and summarize the results of the included studies.
 Meta-analysis:the use of
statistical techniques in a
systematic review to
integrate the results of
included studies.
Cochrane Collaboration Definition
DiCenso A, Bayley L, Haynes RB. Accessing preappraised evidence: fine-tuning the 5S model
into a 6S model. ACP Journal Club, 2009

6. Types of Reviews
Narrative Systematic
Feature
“Review Article” Review Study
Question Broad Focused
Sources and Search Not usually specified Comprehensive
Selection Not usually specified Criterion based selection
Appraisal Variable Rigorous appraisal
Synthesis Often qualitative Often quantitative
Inferences Sometimes evidence based Usually evidence based

7. 1. Ask Research Question
P • Population
I • Intervention
C • Comparator
O • Outcome
S • Study design
T • Time frame

8. 2. Search the Literature
 Strategy
 Keywords (synonyms & spellings) &MeSH: for each concept of the PICOS
 Combine terms within concept with OR
 Combine between concepts with AND
 Multiple sources
 Published:
 Electronic Databases (time frame): MEDLINE, EMBASE, Cochrane, CINAHL, AMED
 Hand Search: Journals, Reference lists of included studies
 Unpublished (grey literature): authors/experts, conference proceedings,
companies, trials registry
 Process
 Done by at least 2 reviewers, assess agreement & solve disagreement
 Documentation of every step

9. Hands-on PubMed Search
Develop a Search STRATEGY
• Keywords
• MeSH terms
• Publication Type
• Automatic Term Mapping
• Limits: Dates, Languages, Species, Ages
• Advanced Search & History

10. 3. Select the Studies
 2 reviewers apply inclusion/exclusion criteria:
 Screening of titles & abstract
 Assessment of full text for eligibility
 Final inclusion of studies
 Remove duplicate publications
 Record reasons for exclusion
 Assess agreement (kappa)

11. 4. Appraise the Studies
 2 reviewers assess for risk of bias in included studies:
 Scoring scales: e.g., Jadad, Detsky (not recommended by
PRISMA or Cochrane)
 Domains: random sequence generation, allocation
concealment, blinding, loss of follow-up
 Resolve disagreement by consensus or third reviewer
 What to do with poor quality studies?
 ? Exclude
 ? Sensitivity analysis
 ? Weighting in meta-analysis

12. 5. Extract the Data
Data
 Pilot the extraction form Extraction
Form
 2 reviewers Quality
Study Outcome
Assessment
Characteristics Measures
Criteria
 Consider e-form
Study Study Quality Study
Characteristics Criteria Outcomes

13. 6. Summarize the Data
 Qualitative (systematic review)
 Quantitative (meta-analysis)
 When to do a meta-analysis?
 Choice of summary statistics
 Dichotomous outcome: OR, RR, RD
 Continuous outcome: mean difference, weighted or standardized
 Time to event: HR
 Fixed effects or Random effects
 Forest plot
 Heterogeneity testing
 Funnel plot
 Sensitivity analysis
 Subgroup analysis

14. Hands-on RevMan Exercise

15. 7. Reporting

16. Other Activities by KAMCResearch
KAMCResearch