Professional Documents
Culture Documents
META-ANALYSIS=results of trials
are combined statistically
Traditional Reviews
- summary of evidence and recommendations
- usually, broad-gauged questions
“management of the diabetic patients”
- experts know the literature
have the actual practice
- But
lack structure
articles are cited but
personal experience and
conventional wisdom
strength of original researches
not known
Shorthand Indicators of Quality
1. prestige of journal
2. author
3. currency/latest
4. number of articles for and
against a given point
5. design # of RCTs
SYSTEMATIC REVIEWS AND
META-ANALYSES
COMPREHENSIVE
SYSTEMATIC
OBJECTIVE
Systematic Reviews
- rigorous reviews of specific questions
- useful in addressing a single, focused
question
Ex:
Effect Aspirin in prevention of cardiovascular
events
Effect Statin treatment in prevention of
cardiovascular events
Systematic Reviews
- rigorous reviews of specific questions
- useful in addressing a single, focused
question
Ex:
ACE inhibitors of CHF
skin adhesives vs. sutures for superficial
lacerations
Elements of Systematic Reviews
1. Define the clinical question.
2. Identify all completed studies of the question,
published and unpublished.
3. Select the studies that meet high standards for
scientific validity.
4. Look for evidence of bias in the studies
selected.
5. Describe the scientific quality of the studies.
Elements of Systematic Reviews
• patient
• intervention
• follow-ups
• outcomes
2 General approaches in pooling study
results
3. Fixed-effect Model
All studies are asking similar questions
4. Random-effects Model
Studies are asking somewhat different but
related questions
Figure 12.5
Summary Effect
Cumulative Meta-Analysis
- another way of looking at same
information
- new survey effect age and confidence
calculated each time results of the study
become available
Fig. 12.7
Advantages and Risk of Combining
Studies
• Advantage:
- can do subgroup analysis
- detecting rare events
• Disadvantage:
- may give misleading impression
Advantages Combining Studies
• Advantage:
- can do subgroup analysis
- detecting rare events
• Ask – Focused Clinical Question
• Appraise