Systematic Review & Course outline. Lecture (20%) Class discussion & tutorial (30%)

Size: px
Start display at page:

Download "Systematic Review & Course outline. Lecture (20%) Class discussion & tutorial (30%)"

Transcription

1 Systematic Review & Meta-analysisanalysis Ammarin Thakkinstian, Ph.D. Section for Clinical Epidemiology and Biostatistics Faculty of Medicine, Ramathibodi Hospital Tel: , Fax: Lecture (20%) Review methods Meta-analysis Course outline Class discussion & tutorial (30%) Review topics Assignments (50%) 1

2 Topics Score Due Date Assignment I: - Initiating review topic - Literature review o Background & rationale, o Formulate a review question & objectives 15% Feb 26, 2009 Assignment II: Locate and select studies - Define inclusion & exclusion criteria 12.5% Mar 6, Search terms and strategies - Identifying studies - Selecting studies Assignment III: - Design o Data extraction forms o Quality or risk of bias assessment 12.5% Mar 13, Perform data extraction & assess quality of studies Assignment IV: - Data analysis plan 15% Mar 20, Dummy tables & figures Assignment V: Data analysis 20% April 17, 2009 Assignment VI: Writing up paper (as a manuscript) - Presentation (verbal) 5% May 7, Submit paper 25% May 8, 2009 Systematic review Review methodology Pooling methods: meta-analysis Dichotomous outcome Continuous outcome 2

3 Systematic review A review that has been prepared using a systematic approach to minimise biases and random error Rationale Tool for health care worker Tool for health care worker, researchers, consumers, and also policy maker who want to keep up with the evidence that is accumulating in their field 3

4 Rationale More objective appraisal of the evidence than traditional narrative reviews - Narrative review: subjective, selection bias, limitation of single or few studies, unhelpful descriptions, e.g., no clear evidence, a weak relationship, a strong relationship. - Systematic review: more transparent appraisal, allow reader to replicate, quantitative conclusion. Meta-analysis: Rationale Estimates treatment effects Leading to reduces probability of false negative results (increase power of test) Potentially to a more timely introduction of effective treatments. 4

5 Rationale Exploratory analyses: subgroups of patients who are likely to respond particularly well to a treatment (or the reverse) may generate promising new research questions to be addressed in future studies. Systematic review may demonstrate the lack of adequate evidence and thus identify area where further studies are needed Terminology Systematic review Overview Meta-analysis Research synthesis Summarizing Pooling 5

6 Review Methodology Good Rationale Clearly state research question Objective Identify relevant studies/locate studies Explicitly describe inclusion & exclusion criteria of studies Data extraction: study factor, outcome Data analysis Results Discussion Review proposal Introduction & background Research question/objective Review methods Locating studies Selecting studies Inclusion/exclusion criteria Data extraction Quality/risk assessment Data analysis Results Discussion 6

7 Rationale Why do we need to perform the review How were results of previous individual and review study (if any) Positive results Negative results Methodologic issues Sample size/power of test Narrative reviews? Selective bias Pooling effect sizes? Quality of the studies 7

8 Good research question Evidence-base Medicine (EBM) Patient Intervention Comparator Outcome PICO 8

9 Research question Is there association between VDR and BMD/osteoporosis in women? To compare rates of osteoporosis in women with BB with bb genotypes Is Rosiglitazone higher risk of developing myocardial infarction compare with Metformin in diabetic patients? To compare incidence of MI between diabetic patients received Rosiglitazone and Metformin Locate studies 1. Defines source of database MEDLINE to present Over 16 million references Since 2005, between 2,000-4,000 completed references are added each day Tuesday through Saturday Cover 5200 worldwide journals in 40 languages - Uses medical subject heading (MeSH) for index - Includes biomedicine and health science journals - English abstracts for 79% on references - 90% are English language articles - 47% of journals covered are published in the US - PubMed available free of charge From 9

10 Defines source of databases EMBASE - Over 12 million records from 1974-present - More than 600,000 records added annually - Covers over 4,800 active peer-reviewed journals published in 70 countries/ 30 languages - uses EMTREE for indexing - includes English abstracts for 80% of references - daily update, within two weeks of receipt of the original journal - Produced by Elsevier, no free version available Defines source of database The Cochrane Controlled Trials Register (CCTR) ClinicalTrials.gov HUGE NET Review Reference lists Hand searching of key journals Personal communication with expert in the field 10

11 Locate studies 2. Define the software & version used for searching - PubMed - OVID version Silver Platter National Center for Biotechnology Information 11

12 National Center for Biotechnology Information 12

13 13

14 3. Defines searching terms Specify period of searching Plan for update searching Combinations of search terms Intervention: treatment/study factor Outcome of interest Comparator* Patient 14

15 Example VDR& BMD/Osteoporosis(J Bone Miner Res. 2004;19(3): ) 1. vitamin D receptor or VDR (MeSH) 2. genotype(s) or allele(s) or polymorphism(s) (MeSH) 3. bone mineral density or BMD or bone density (MeSH) 4. low bone mineral density or low density (textword) 5. osteoporosis (MeSH) 6. fracture (MeSH) 7. 1 and 2 and and 2 and and 2 and and 2 and 6 Selecting studies Clearly define inclusion & exclusion criteria Inclusion criteria Type of subjects Treatment or exposure or gene Comparator (if needed) Outcome Study design randomized controlled trial, observational studies (cohort, case-control, cross-sectional study) Full paper 15

16 Languages English, French, others Restrictions due to sample size or other criteria Multiple publications of the same studies, choose the recent one or the one has provided d more completeness of data Exclusion Incompleteness of information Contact authors at least two times for incomplete data Not the outcome of interest Review studies Narrative review Systematic review Not comparative studies No control group 16

17 Selecting studies Merge studies identified from databases using reference manager (e.g. Endnote) Remove duplicates Two reviewers independently select studies Screen title/abstract to remove non-relevant studies base on eligibility criteria Access full papers Examine other sources of studies Contact t author if needed d Final decision Perform searching every 3 months while doing a review 17

18 Thakkinstian et al. Meta-analysis of molecular association studies: vitamin D receptor gene polymorphisms and BMD as a case study. J Bone Miner Res 2004;19(3): Any observational study (cohort, case-control, and cross-sectional study), regardless of sample size, which determined the difference in mean BMD according to the VDR genotype, or tested t the association between osteoporosis or fracture and the VDR genotypes and which fulfilled the following criteria: 18

19 VDR & BMD/Osteoporosis - The BMD measurements were performed at lumbar spine or hip by Dual Energy X-ray Absorptiometry (DEXA) or Dual Photon Absorptiometry (DPA) method. - sufficient details: mean and SD of BMD, and number of subjects for each VDR genotype, and frequencies of genotype among case and control group were reported for dichotomous outcomes VDR & BMD/Osteoporosis Participants were adult women who were either pre- or post menopausal. Study factor & outcome Bsm/Apa/Taq/Fok BMD/Osteoporosis 19

20 Data extraction (DE) At least two reviewers Design DEF, pilot, & revise DEF The article Study ID, Author, Year & source of publication The study characteristics Type of studies subjects ethnicity, it Adults vs children Postmenopause, premenopause study design (RCT, CS, CC, CrS) Methods used/criteria for measuring outcomes Patients DE (cont.) Demographic and clinical features of study's participants that might affect outcomes mean age, gender, BMI, smoking, underlying diseases T bl f t d f t /i t ti Table of study factors/interventions versus outcomes 20

21 DE (cont.) Dichotomous outcome Frequencies between study factor/intervention vs outcome Group Disease Yes No N I Rx (Exp+) a b n1 a/n1 Placebo (Exp-) c d n2 c/n2 - OR (95% CI), RR (95% CI), HR (95% CI) DE (cont.) Continuous outcome n, mean (95% CI) Group n mean SD A n 1 mean 1 SD 1 B n 2 mean 2 SD 2 21

22 Risk of bias in individual studies Quality Assessment (QA) Consider internal & external validity RCT Risk of bias (cont.) TC Chalmers From Egger M, Smith GD, Altman DG. Systematic reviews in health care: Meta-analysis in context. London: BMJ Books, Jadad s quality assessment scale The Cochrane Collaboration s tool for assessing risk of bias 2009 Preferred reports of items for systematic review and meta-analysis-prisma guideline 22

23 Domain Description Review authors judgement Sequence generation. Describe the method used to generate the allocation sequence in sufficient detail to allow an assessment of whether h it should produce comparable groups. Was the allocation sequence adequately generated? Allocation concealment. Describe the method used Was allocation to conceal the allocation adequately sequence in sufficient concealed? detail to determine whether intervention allocations could have been foreseen in advance of, or during, enrolment. Blinding of participants, Describe all measures used, Was knowledge of personnel and outcome if any, to blind study the allocated assessors Assessments should participants and personnel be made for each main outcome from knowledge of which intervention adequately prevented (or class of outcomes). intervention a participant during the study? received. Provide any information relating to whether the intended blinding was effective. Incomplete outcome data Assessments should be made for each main outcome (or class of outcomes). Describe the completeness of outcome data for each main outcome, including attrition and exclusions from the analysis. State whether attrition and exclusions were reported, the numbers in each intervention group (compared with total randomized participants), reasons for attrition/exclusions where reported, and any reinclusions in analyses performed by the review authors. Were incomplete outcome data adequately addressed? 23

24 Selective outcome reporting. State how the possibility of selective outcome reporting was examined by the review authors, and what was found. Are reports of the study free of suggestion of selective outcome reporting? Other sources of bias. State any important concerns Was the study about bias not addressed in apparently free of other the other domains in the tool. If particular questions/entries were pre-specified in the review s protocol, responses should be provided for each question/entry. Trial methodology Statistical analysis problems that could put it at a high risk of bias? Premature trial termination Post-randomization exclusion Unbalance baseline characteristics Adequately describe methods of data analysis -use per-protocol analysis, modified ITT Observational studies Thakkinstian A, D'Este DEsteC, Eisman J, Nguyen T, Attia J. Meta-analysis of molecular association studies: vitamin D receptor gene polymorphisms and BMD as a case study. J Bone Miner Res 2004;19:

25 Criteria A. Representativeness of cases - Consecutive/randomly selected from cases population with clearly defined random frame - Consecutive/randomly selected from cases population without clearly defined random frame or with extensively inclusion criteria - Not describe method of selection B. Representativeness of controls - Consecutive/randomly drawn from area (ward/community) as cases with the same criteria - Consecutive/randomly drawn from different area as cases - Not describe Score Criteria C. Ascertainment of osteoporosis/fracture - Clearly described objective criteria of diagnosis of osteoporosis/osteoporotic fracture with proving diagnosis, e.g. measure BMD using DEXA, X-ray for fracture - Diagnosis of osteoporosis/osteoporotic fracture by patients history - Not describe D. Ascertainment of control - Controls were proved that they were not osteoporosis/osteoporotic p fracture, i.e. measured BMD - Only mentioned that controls were subjects who were not osteoporosis/osteoporotic fracture without proving - Not describe Score

26 Criteria E. Ascertainment of VDR examination - Genotyping done under blind condition - Unblind or not mention F. Data analysis HWE: - Checking goodness of fit in control group with appropriate statistics - Checking goodness of fit of HWE in case & control group, or using inappropriate statistics - Not mentioned G. Association assessment: - Appropriate statistic used with adjusting for confounders e.g. logistic regression, or matched case-control design - Appropriate statistic used without adjusting - Inappropriate statistic Score Criteria Score H. Response rate - Response rates for both group are the 2 same or different between groups 5% - Response rates are different between 1 5% - 10% - Response rates are different 10% or 0 more, or not mention about response rates Total 15 26

27 Net work Cochrane collaboration RCT Diagnostic studies 27

28 28

29 29

30 Statistical analysis Unit of analysis is study NOT subject Describe how data will be pooled OR, RR, RD, HR Mean Heterogeneity Test Degree (I 2 ) Explore source(s) of heterogeneity Meta-regression Sub-group analysis Publication bias Graph Test Software P value 30

31 Dummy tables Table 1. study s characteristics Table 2. cross-tabulate table Treatment vs primary outcome Treatment effects & 95% CI Pooled treatment effects Table 3. cross-tabulate table of subgroup Table 4. cross-tabulate table of 2 nd outcome Dummy figures Figure 1. Flow chart of selection of studies Figure 2. Forest plot of 1 st outcome Figure 3. Forest plot of 2 nd outcome 31

Systematic reviews and meta-analyses of observational studies (MOOSE): Checklist.

Systematic reviews and meta-analyses of observational studies (MOOSE): Checklist. Systematic reviews and meta-analyses of observational studies (MOOSE): Checklist. MOOSE Checklist Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease:

More information

Robert M. Jacobson, M.D. Department of Pediatric and Adolescent Medicine Mayo Clinic, Rochester, Minnesota

Robert M. Jacobson, M.D. Department of Pediatric and Adolescent Medicine Mayo Clinic, Rochester, Minnesota How to Conduct a Systematic Review: A Workshop 24 th Annual Primary Care Research Methods & Statistics Conference, San Antonio, Texas Saturday, December 3, 2011 Robert M. Jacobson, M.D. Department of Pediatric

More information

Instrument for the assessment of systematic reviews and meta-analysis

Instrument for the assessment of systematic reviews and meta-analysis Appendix II Annex II Instruments for the assessment of evidence As detailed in the main body of the methodological appendix (Appendix II, "Description of the methodology utilised for the collection, assessment

More information

The QUOROM Statement: revised recommendations for improving the quality of reports of systematic reviews

The QUOROM Statement: revised recommendations for improving the quality of reports of systematic reviews The QUOROM Statement: revised recommendations for improving the quality of reports of systematic reviews David Moher 1, Alessandro Liberati 2, Douglas G Altman 3, Jennifer Tetzlaff 1 for the QUOROM Group

More information

School of Dentistry. What is a systematic review?

School of Dentistry. What is a systematic review? School of Dentistry What is a systematic review? Screen Shot 2012-12-12 at 09.38.42 Where do I find the best evidence? The Literature Information overload 2 million articles published a year 20,000 biomedical

More information

Controlled Trials. Spyros Kitsiou, PhD

Controlled Trials. Spyros Kitsiou, PhD Assessing Risk of Bias in Randomized Controlled Trials Spyros Kitsiou, PhD Assistant Professor Department of Biomedical and Health Information Sciences College of Applied Health Sciences University of

More information

USDA Nutrition Evidence Library: Systematic Review Methodology

USDA Nutrition Evidence Library: Systematic Review Methodology USDA Nutrition Evidence Library: Systematic Review Methodology Julie E. Obbagy, PhD, RD USDA Center for Nutrition Policy & Promotion Meeting #2 October 17, 2016 The National Academies of Sciences, Engineering,

More information

Meta-analyses: analyses:

Meta-analyses: analyses: Meta-analyses: analyses: how do they help, and when can they not? Lee Hooper Senior Lecturer in research synthesis & nutrition l.hooper@uea.ac.uk 01603 591268 Aims Systematic Reviews Discuss the scientific

More information

Evidence Based Medicine

Evidence Based Medicine Course Goals Goals 1. Understand basic concepts of evidence based medicine (EBM) and how EBM facilitates optimal patient care. 2. Develop a basic understanding of how clinical research studies are designed

More information

Appendix 2 Quality assessment tools. Cochrane risk of bias tool for RCTs. Support for judgment

Appendix 2 Quality assessment tools. Cochrane risk of bias tool for RCTs. Support for judgment Appendix 2 Quality assessment tools Cochrane risk of bias tool for RCTs Item Judgment (H/L/Unclear) Random sequence generation (selection bias) Allocation concealment (selection bias) Blinding of participants

More information

Introduction to systematic reviews/metaanalysis

Introduction to systematic reviews/metaanalysis Introduction to systematic reviews/metaanalysis Hania Szajewska The Medical University of Warsaw Department of Paediatrics hania@ipgate.pl Do I needknowledgeon systematicreviews? Bastian H, Glasziou P,

More information

Critical Appraisal of a Meta-Analysis: Rosiglitazone and CV Death. Debra Moy Faculty of Pharmacy University of Toronto

Critical Appraisal of a Meta-Analysis: Rosiglitazone and CV Death. Debra Moy Faculty of Pharmacy University of Toronto Critical Appraisal of a Meta-Analysis: Rosiglitazone and CV Death Debra Moy Faculty of Pharmacy University of Toronto Goal To provide practitioners with a systematic approach to evaluating a meta analysis

More information

Systematic Reviews. Simon Gates 8 March 2007

Systematic Reviews. Simon Gates 8 March 2007 Systematic Reviews Simon Gates 8 March 2007 Contents Reviewing of research Why we need reviews Traditional narrative reviews Systematic reviews Components of systematic reviews Conclusions Key reference

More information

Supporting information for Systematic review reveals limitations of studies evaluating health-related quality of life after potentially curative

Supporting information for Systematic review reveals limitations of studies evaluating health-related quality of life after potentially curative Supporting information for Systematic review reveals limitations of studies evaluating health-related quality of life after potentially curative treatment for esophageal cancer Supplement Material 1 Supplement

More information

GRADE. Grading of Recommendations Assessment, Development and Evaluation. British Association of Dermatologists April 2018

GRADE. Grading of Recommendations Assessment, Development and Evaluation. British Association of Dermatologists April 2018 GRADE Grading of Recommendations Assessment, Development and Evaluation British Association of Dermatologists April 2018 Previous grading system Level of evidence Strength of recommendation Level of evidence

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews Prophylactic cranial irradiation in patients with non-small-cell lung cancer: a systematic review and meta-analysis of randomized controlled

More information

SUPPLEMENTARY DATA. Supplementary Figure S1. Search terms*

SUPPLEMENTARY DATA. Supplementary Figure S1. Search terms* Supplementary Figure S1. Search terms* *mh = exploded MeSH: Medical subject heading (Medline medical index term); tw = text word; pt = publication type; the asterisk (*) stands for any character(s) #1:

More information

Zhengtao Liu 1,2,3*, Shuping Que 4*, Lin Zhou 1,2,3 Author affiliation:

Zhengtao Liu 1,2,3*, Shuping Que 4*, Lin Zhou 1,2,3 Author affiliation: Dose-response Relationship of Serum Uric Acid with Metabolic Syndrome and Non-alcoholic Fatty Liver Disease Incidence: AMeta-analysis of Prospective Studies Zhengtao Liu 1,2,3*, Shuping Que 4*, Lin Zhou

More information

Learning objectives. Examining the reliability of published research findings

Learning objectives. Examining the reliability of published research findings Examining the reliability of published research findings Roger Chou, MD Associate Professor of Medicine Department of Medicine and Department of Medical Informatics and Clinical Epidemiology Scientific

More information

Learning from Systematic Review and Meta analysis

Learning from Systematic Review and Meta analysis Learning from Systematic Review and Meta analysis Efficacy and Safety of Antiscabietic Agents: A Systematic Review and Network Meta analysis of Randomized Controlled Trials KUNLAWAT THADANIPON, MD 4 TH

More information

Meta Analysis. David R Urbach MD MSc Outcomes Research Course December 4, 2014

Meta Analysis. David R Urbach MD MSc Outcomes Research Course December 4, 2014 Meta Analysis David R Urbach MD MSc Outcomes Research Course December 4, 2014 Overview Definitions Identifying studies Appraising studies Quantitative synthesis Presentation of results Examining heterogeneity

More information

Guidelines for Writing and Reviewing an Informed Consent Manuscript From the Editors of Clinical Research in Practice: The Journal of Team Hippocrates

Guidelines for Writing and Reviewing an Informed Consent Manuscript From the Editors of Clinical Research in Practice: The Journal of Team Hippocrates Guidelines for Writing and Reviewing an Informed Consent Manuscript From the Editors of Clinical Research in Practice: The Journal of Team Hippocrates 1. Title a. Emphasize the clinical utility of the

More information

Systematic Reviews and Meta- Analysis in Kidney Transplantation

Systematic Reviews and Meta- Analysis in Kidney Transplantation Systematic Reviews and Meta- Analysis in Kidney Transplantation Greg Knoll MD MSc Associate Professor of Medicine Medical Director, Kidney Transplantation University of Ottawa and The Ottawa Hospital KRESCENT

More information

Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright 2017 University of York.

Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright 2017 University of York. A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling Brown

More information

Critical appraisal: Systematic Review & Meta-analysis

Critical appraisal: Systematic Review & Meta-analysis Critical appraisal: Systematic Review & Meta-analysis Atiporn Ingsathit MD.PhD. Section for Clinical Epidemiology and biostatistics Faculty of Medicine Ramathibodi Hospital Mahidol University What is a

More information

Standards for the reporting of new Cochrane Intervention Reviews

Standards for the reporting of new Cochrane Intervention Reviews Methodological Expectations of Cochrane Intervention Reviews (MECIR) Standards for the reporting of new Cochrane Intervention Reviews 24 September 2012 Preface The standards below summarize proposed attributes

More information

Alcohol interventions in secondary and further education

Alcohol interventions in secondary and further education National Institute for Health and Care Excellence Guideline version (Draft for Consultation) Alcohol interventions in secondary and further education NICE guideline: methods NICE guideline Methods

More information

ARCHE Risk of Bias (ROB) Guidelines

ARCHE Risk of Bias (ROB) Guidelines Types of Biases and ROB Domains ARCHE Risk of Bias (ROB) Guidelines Bias Selection Bias Performance Bias Detection Bias Attrition Bias Reporting Bias Other Bias ROB Domain Sequence generation Allocation

More information

Workshop: Cochrane Rehabilitation 05th May Trusted evidence. Informed decisions. Better health.

Workshop: Cochrane Rehabilitation 05th May Trusted evidence. Informed decisions. Better health. Workshop: Cochrane Rehabilitation 05th May 2018 Trusted evidence. Informed decisions. Better health. Disclosure I have no conflicts of interest with anything in this presentation How to read a systematic

More information

Systematic Reviews and Meta-analysis

Systematic Reviews and Meta-analysis Systematic Reviews and Meta-analysis Introduction to Clinical Research: A Two-week Intensive Course July 22, 2014 Sonal Singh, MD, MPH Assistant Professor Key messages Systematic reviews (SR) summarize

More information

Structural Approach to Bias in Meta-analyses

Structural Approach to Bias in Meta-analyses Original Article Received 26 July 2011, Revised 22 November 2011, Accepted 12 December 2011 Published online 2 February 2012 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/jrsm.52 Structural

More information

Standards for the conduct and reporting of new Cochrane Intervention Reviews 2012

Standards for the conduct and reporting of new Cochrane Intervention Reviews 2012 Methodological Expectations of Cochrane Intervention Reviews (MECIR) s for the conduct and reporting of new Cochrane Intervention Reviews 2012 Booklet Version 2 September 2013 1 Preface Cochrane Reviews

More information

Systematic Reviews and Meta-analysis in Aquatic therapy

Systematic Reviews and Meta-analysis in Aquatic therapy Systematic Reviews and Meta-analysis in Aquatic therapy Prof. Daniel Daly Ben Waller PT, MSc 2nd European Congress on Evidence Based Aquatic Therapy Wednesday 15th April 2015 Systematic Review A systematic

More information

SYSTEMATIC REVIEW: AN APPROACH FOR TRANSPARENT RESEARCH SYNTHESIS

SYSTEMATIC REVIEW: AN APPROACH FOR TRANSPARENT RESEARCH SYNTHESIS SYSTEMATIC REVIEW: AN APPROACH FOR TRANSPARENT RESEARCH SYNTHESIS A Case Study By Anil Khedkar, India (Masters in Pharmaceutical Science, PhD in Clinical Research Student of Texila American University)

More information

GRADE. Grading of Recommendations Assessment, Development and Evaluation. British Association of Dermatologists April 2014

GRADE. Grading of Recommendations Assessment, Development and Evaluation. British Association of Dermatologists April 2014 GRADE Grading of Recommendations Assessment, Development and Evaluation British Association of Dermatologists April 2014 Previous grading system Level of evidence Strength of recommendation Level of evidence

More information

GATE CAT Intervention RCT/Cohort Studies

GATE CAT Intervention RCT/Cohort Studies GATE: a Graphic Approach To Evidence based practice updates from previous version in red Critically Appraised Topic (CAT): Applying the 5 steps of Evidence Based Practice Using evidence about interventions

More information

Effect of Intermittent versus Chronic Calorie Restriction on Tumor Incidence: A

Effect of Intermittent versus Chronic Calorie Restriction on Tumor Incidence: A Supplementary Information for: Effect of Intermittent versus Chronic Calorie Restriction on Tumor Incidence: A Systematic Review and Meta-Analysis of Animal Studies Running title: Intermittent vs. chronic

More information

What is the Cochrane Collaboration? What is a systematic review?

What is the Cochrane Collaboration? What is a systematic review? 1 What is the Cochrane Collaboration? What is a systematic review? Archie Cochrane (1909-1988) It is surely a great criticism of our profession that we have not organised a critical summary, by specialty

More information

American Journal of Internal Medicine

American Journal of Internal Medicine American Journal of Internal Medicine 2016; 4(3): 49-59 http://www.sciencepublishinggroup.com/j/ajim doi: 10.11648/j.ajim.20160403.12 ISSN: 2330-4316 (Print); ISSN: 2330-4324 (Online) The Effect of Dose-Reduced

More information

Cochrane Bone, Joint & Muscle Trauma Group How To Write A Protocol

Cochrane Bone, Joint & Muscle Trauma Group How To Write A Protocol A p r i l 2 0 0 8 Cochrane Bone, Joint & Muscle Trauma Group How To Write A Protocol This booklet was originally produced by the Cochrane Renal Group to make the whole process of preparing a protocol as

More information

Osteodensitometry in primary and secondary osteoporosis

Osteodensitometry in primary and secondary osteoporosis Osteodensitometry in primary and secondary osteoporosis Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) Research question The main goal of the present research was the assessment

More information

Background: Traditional rehabilitation after total joint replacement aims to improve the muscle strength of lower limbs,

Background: Traditional rehabilitation after total joint replacement aims to improve the muscle strength of lower limbs, REVIEWING THE EFFECTIVENESS OF BALANCE TRAINING BEFORE AND AFTER TOTAL KNEE AND TOTAL HIP REPLACEMENT: PROTOCOL FOR A SYSTEMATIC RE- VIEW AND META-ANALYSIS Background: Traditional rehabilitation after

More information

Meta-Analyses: Considerations for Probiotics & Prebiotics Studies

Meta-Analyses: Considerations for Probiotics & Prebiotics Studies Meta-Analyses: Considerations for Probiotics & Prebiotics Studies Daniel J. Tancredi, PhD Associate Professor in Residence Department of Pediatrics UC Davis School of Medicine Objectives Provide an overview

More information

Determinants of quality: Factors that lower or increase the quality of evidence

Determinants of quality: Factors that lower or increase the quality of evidence Determinants of quality: Factors that lower or increase the quality of evidence GRADE Workshop CBO, NHG and Dutch Cochrane Centre CBO, April 17th, 2013 Outline The GRADE approach: step by step Factors

More information

Page: 1 / 5 Produced by the Centre for Reviews and Dissemination Copyright 2018 University of York

Page: 1 / 5 Produced by the Centre for Reviews and Dissemination Copyright 2018 University of York Weight management using a meal replacement strategy: meta and pooling analysis from six studies Heymsfield S B, van Mierlo C A, van der Knaap H C, Heo M, Frier H I CRD summary The review assessed partial

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews Percutaneous access for endovascular aortic aneurysm repair: a systematic review and meta-analysis Shahin Hajibandeh, Shahab Hajibandeh,

More information

Methodological standards for the conduct of new Cochrane Intervention Reviews Version 2.3, 02 December 2013

Methodological standards for the conduct of new Cochrane Intervention Reviews Version 2.3, 02 December 2013 Methodological Expectations of Cochrane Intervention Reviews (MECIR) Methodological standards for the conduct of new Cochrane Intervention Reviews Version 2.3, 02 December 2013 Jackie Chandler, Rachel

More information

Continuous update of the WCRF-AICR report on diet and cancer. Protocol: Breast Cancer. Prepared by: Imperial College Team

Continuous update of the WCRF-AICR report on diet and cancer. Protocol: Breast Cancer. Prepared by: Imperial College Team Continuous update of the WCRF-AICR report on diet and cancer Protocol: Breast Cancer Prepared by: Imperial College Team The current protocol for the continuous update should ensure consistency of approach

More information

GATE: Graphic Appraisal Tool for Epidemiology picture, 2 formulas & 3 acronyms

GATE: Graphic Appraisal Tool for Epidemiology picture, 2 formulas & 3 acronyms GATE: Graphic Appraisal Tool for Epidemiology 1991-2015 1 picture, 2 formulas & 3 acronyms 1 GATE: Graphic Appraisal Tool for Epidemiology Graphic Architectural Tool for Epidemiology Graphic Approach To

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews Closed reduction methods for acute anterior shoulder dislocation [Cochrane Protocol] Kanthan Theivendran, Raj Thakrar, Subodh Deshmukh,

More information

Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma

Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma ril 2014 Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma FINAL COMPREHENSIVE RESEARCH PLAN June 2015 Study Team: Systematic Review Unit FINAL COMPREHENSIVE RESEARCH PLAN: Systematic

More information

Evidence Based Medicine

Evidence Based Medicine Hamadan University of medical sciences School of Public Health Department of Epidemiology Evidence Based Medicine Amin Doosti-Irani, PhD in Epidemiology 10 March 2017 a_doostiirani@yahoo.com 1 Outlines

More information

Copyright GRADE ING THE QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS NANCY SANTESSO, RD, PHD

Copyright GRADE ING THE QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS NANCY SANTESSO, RD, PHD GRADE ING THE QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS NANCY SANTESSO, RD, PHD ASSISTANT PROFESSOR DEPARTMENT OF CLINICAL EPIDEMIOLOGY AND BIOSTATISTICS, MCMASTER UNIVERSITY Nancy Santesso,

More information

CHECK-LISTS AND Tools DR F. R E Z A E I DR E. G H A D E R I K U R D I S TA N U N I V E R S I T Y O F M E D I C A L S C I E N C E S

CHECK-LISTS AND Tools DR F. R E Z A E I DR E. G H A D E R I K U R D I S TA N U N I V E R S I T Y O F M E D I C A L S C I E N C E S CHECK-LISTS AND Tools DR F. R E Z A E I DR E. G H A D E R I K U R D I S TA N U N I V E R S I T Y O F M E D I C A L S C I E N C E S What is critical appraisal? Critical appraisal is the assessment of evidence

More information

Downloaded from:

Downloaded from: Arnup, SJ; Forbes, AB; Kahan, BC; Morgan, KE; McKenzie, JE (2016) The quality of reporting in cluster randomised crossover trials: proposal for reporting items and an assessment of reporting quality. Trials,

More information

Empirical evidence on sources of bias in randomised controlled trials: methods of and results from the BRANDO study

Empirical evidence on sources of bias in randomised controlled trials: methods of and results from the BRANDO study Empirical evidence on sources of bias in randomised controlled trials: methods of and results from the BRANDO study Jonathan Sterne, University of Bristol, UK Acknowledgements: Tony Ades, Bodil Als-Nielsen,

More information

Appendix A: Literature search strategy

Appendix A: Literature search strategy Appendix A: Literature search strategy The following databases were searched: Cochrane Library Medline Embase CINAHL World Health organisation library Index Medicus for the Eastern Mediterranean Region(IMEMR),

More information

Problem solving therapy

Problem solving therapy Introduction People with severe mental illnesses such as schizophrenia may show impairments in problem-solving ability. Remediation interventions such as problem solving skills training can help people

More information

Methodological standards for the conduct of new Cochrane Intervention Reviews Version 2.1, 8 December 2011

Methodological standards for the conduct of new Cochrane Intervention Reviews Version 2.1, 8 December 2011 Methodological Expectations of Cochrane Intervention Reviews (MECIR) Methodological standards for the conduct of new Cochrane Intervention Reviews Version 2.1, 8 December 2011 Jackie Chandler, Rachel Churchill,

More information

Appendix Document A1: Search strategy for Medline (1960 November 2015)

Appendix Document A1: Search strategy for Medline (1960 November 2015) Appendices: Appendix Document A1: Search strategy for Medline (1960 November 2015) Appendix Table A1: Detailed Risk of Bias Table Appendix Figure A1: Funnel plot Appendix Figure A2: Sensitivity analysis

More information

Component of CPG development ILAE Recommendation Document Identifying topic and developing clinical. S3 research question

Component of CPG development ILAE Recommendation Document Identifying topic and developing clinical. S3 research question S1: Summary of recommendations for developing Clinical Practice Guidelines Minimum CPG development requirements (where resources are more limited) are bolded. When full resources are available, every recommendation

More information

Evidence-Based Review Process to Link Dietary Factors with Chronic Disease Case Study: Cardiovascular Disease and n- 3 Fatty Acids

Evidence-Based Review Process to Link Dietary Factors with Chronic Disease Case Study: Cardiovascular Disease and n- 3 Fatty Acids Evidence-Based Review Process to Link Dietary Factors with Chronic Disease Case Study: Cardiovascular Disease and n- 3 Fatty Acids Alice H. Lichtenstein, D.Sc. Gershoff Professor of Nutrition Science and

More information

CONSORT 2010 checklist of information to include when reporting a randomised trial*

CONSORT 2010 checklist of information to include when reporting a randomised trial* CONSORT 2010 checklist of information to include when reporting a randomised trial* Section/Topic Title and abstract Introduction Background and objectives Item No Checklist item 1a Identification as a

More information

Pneumococcal polysaccharide vaccines: Systematic review and meta-analysis of randomised controlled efficacy trials

Pneumococcal polysaccharide vaccines: Systematic review and meta-analysis of randomised controlled efficacy trials Pneumococcal polysaccharide vaccines: Systematic review and meta-analysis of randomised controlled efficacy trials Pippa Scott, Anke Huss, Matthias Egger Institute of Social & Preventive Medicine (ISPM)

More information

The role of Randomized Controlled Trials

The role of Randomized Controlled Trials The role of Randomized Controlled Trials Dr. Georgia Salanti Lecturer in Epidemiology University of Ioannina School of Medicine Outline Understanding study designs and the role of confounding Observational

More information

Comparative Effectiveness Research Collaborative Initiative (CER-CI) PART 1: INTERPRETING OUTCOMES RESEARCH STUDIES FOR HEALTH CARE DECISION MAKERS

Comparative Effectiveness Research Collaborative Initiative (CER-CI) PART 1: INTERPRETING OUTCOMES RESEARCH STUDIES FOR HEALTH CARE DECISION MAKERS Comparative Effectiveness Research Collaborative Initiative (CER-CI) PART 1: INTERPRETING OUTCOMES RESEARCH STUDIES FOR HEALTH CARE DECISION MAKERS HEALTH EVIDENCE FOR DECISION MAKING: ASSESSMENT TOOL

More information

Results. NeuRA Treatments for internalised stigma December 2017

Results. NeuRA Treatments for internalised stigma December 2017 Introduction Internalised stigma occurs within an individual, such that a person s attitude may reinforce a negative self-perception of mental disorders, resulting in reduced sense of selfworth, anticipation

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews Effectiveness of collaborative care in patients with combined physical disorders and depression or anxiety disorder: a systematic review

More information

EVIDENCE DETECTIVES December 28, 2005 Edward Amores, M.D. Reviewed and edited by P. Wyer, M.D. Part I Question Formulation

EVIDENCE DETECTIVES December 28, 2005 Edward Amores, M.D. Reviewed and edited by P. Wyer, M.D. Part I Question Formulation EVIDENCE DETECTIVES December 28, 2005 Edward Amores, M.D. Reviewed and edited by P. Wyer, M.D. Part I Question Formulation Clinical Scenario Quite often in the Pediatric ED and at times in the adult ED

More information

Cochrane Breast Cancer Group

Cochrane Breast Cancer Group Cochrane Breast Cancer Group Version and date: V3.2, September 2013 Intervention Cochrane Protocol checklist for authors This checklist is designed to help you (the authors) complete your Cochrane Protocol.

More information

PROGRAMMA DELLA GIORNATA

PROGRAMMA DELLA GIORNATA PROGRAMMA DELLA GIORNATA si riprendono i concetti della volta precedente compiti dati da fare a casa si richiama il programma del corso 1.1.1. Studi integrativi 1.1.2. Revisioni sistematiche 1.1.4.1. TEST

More information

Cochrane Pregnancy and Childbirth Group Methodological Guidelines

Cochrane Pregnancy and Childbirth Group Methodological Guidelines Cochrane Pregnancy and Childbirth Group Methodological Guidelines [Prepared by Simon Gates: July 2009, updated July 2012] These guidelines are intended to aid quality and consistency across the reviews

More information

Other potential bias. Isabelle Boutron French Cochrane Centre Bias Method Group University Paris Descartes

Other potential bias. Isabelle Boutron French Cochrane Centre Bias Method Group University Paris Descartes Other potential bias Isabelle Boutron French Cochrane Centre Bias Method Group University Paris Descartes 1 Outlines RoB tool for specific design Cross over trial Cluster randomized controlled trials Mono

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews Drug-eluting balloon angioplasty versus non-stenting balloon angioplasty for peripheral arterial disease of the lower limbs [Cochrane Protocol]

More information

Guidelines for Reporting Non-Randomised Studies

Guidelines for Reporting Non-Randomised Studies Revised and edited by Renatus Ziegler B.C. Reeves a W. Gaus b a Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Great Britain b Biometrie und Medizinische Dokumentation,

More information

Alectinib Versus Crizotinib for Previously Untreated Alk-positive Advanced Non-small Cell Lung Cancer : A Meta-Analysis

Alectinib Versus Crizotinib for Previously Untreated Alk-positive Advanced Non-small Cell Lung Cancer : A Meta-Analysis Showa Univ J Med Sci 30 2, 309 315, June 2018 Original Alectinib Versus Crizotinib for Previously Untreated Alk-positive Advanced Non-small Cell Lung Cancer : A Meta-Analysis Ryo MANABE 1, Koichi ANDO

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews Preventing falls and associated mortality in older people: an umbrella review of systematic reviews Mukesh Dherani, Stefanie Buckner, Daniel

More information

Introductory: Coding

Introductory: Coding Introductory: Coding Sandra Jo Wilson Editor, Education Coordinating Group Associate Director, Peabody Research Institute Research Assistant Professor, Dept. of Special Education Vanderbilt University,

More information

Supplement DS1 Search strategy. EMBASE Search Strategy

Supplement DS1 Search strategy. EMBASE Search Strategy British Journal of Psychiatry doi: 10.1192/bjp.bp.111.106666 Vitamin D deficiency and depression in adults: systematic review and meta-analysis Rebecca E. S. Anglin, Zainab Samaan, Stephen D. Walter and

More information

The Cochrane Collaboration, the US Cochrane Center, and The Cochrane Library

The Cochrane Collaboration, the US Cochrane Center, and The Cochrane Library The Cochrane Collaboration, the US Cochrane Center, and The Cochrane Library Kay Dickersin, PhD Association for Population/Family Planning Libraries & Information Centers International Boston, Ma 30 March

More information

Results. NeuRA Hypnosis June 2016

Results. NeuRA Hypnosis June 2016 Introduction may be experienced as an altered state of consciousness or as a state of relaxation. There is no agreed framework for administering hypnosis, but the procedure often involves induction (such

More information

Network Meta-Analysis of the Efficacy of Acupuncture, Alpha-blockers and Antibiotics on

Network Meta-Analysis of the Efficacy of Acupuncture, Alpha-blockers and Antibiotics on Network Meta-Analysis of the Efficacy of Acupuncture, Alpha-blockers and Antibiotics on Chronic Prostatitis/Chronic Pelvic Pain Syndrome Zongshi Qin, Jiani Wu, Jinhui Tian, Jing Zhou, Yali Liu, Zhishun

More information

Confounding Bias: Stratification

Confounding Bias: Stratification OUTLINE: Confounding- cont. Generalizability Reproducibility Effect modification Confounding Bias: Stratification Example 1: Association between place of residence & Chronic bronchitis Residence Chronic

More information

Z-drugs and risk of falls and fractures: A systematic review and metaanalysis

Z-drugs and risk of falls and fractures: A systematic review and metaanalysis Originally submitted to academic advisory board: February 2015 Revised: September 2017 Z-drugs and risk of falls and fractures: A systematic review and metaanalysis - Protocol Nir Treves, Amichai Perlman,

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews Review title and timescale 1 Review title Give the working title of the review. This must be in English. Ideally it should state succinctly

More information

Research Synthesis and meta-analysis: themes. Graham A. Colditz, MD, DrPH Method Tuuli, MD, MPH

Research Synthesis and meta-analysis: themes. Graham A. Colditz, MD, DrPH Method Tuuli, MD, MPH Research Synthesis and meta-analysis: themes Graham A. Colditz, MD, DrPH Method Tuuli, MD, MPH Today Course format Goals, competencies Overview of themes for the class SRMA M19-551 Course Format Lectures»

More information

Appendix. TABLE E-1 Search Terms

Appendix. TABLE E-1 Search Terms Page 1 Appendix TABLE E-1 Search Terms Category Search Terms* Disease (Chronic) osteomyelitis, osteitis, bone infection Antibiotics Gentamicin, vancomycin, anti-infective agent, (local) antibiotics Properties

More information

Change in 28 HRQL outcomes after open surgery, open surgery combined, and minimally invasive surgery at 3, 6, 9, and 12 months follow-up.

Change in 28 HRQL outcomes after open surgery, open surgery combined, and minimally invasive surgery at 3, 6, 9, and 12 months follow-up. Supporting information for Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer. Online Resource 1 Online Resource 2 Online Resource

More information

Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials(review)

Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials(review) Cochrane Database of Systematic Reviews Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials (Review) Anglemyer A, Horvath HT, Bero L Anglemyer

More information

Evidence-based Laboratory Medicine: Finding and Assessing the Evidence

Evidence-based Laboratory Medicine: Finding and Assessing the Evidence Find Assess Decide Evidence-based Laboratory Medicine: Finding and Assessing the Evidence Pieter Vermeersch, M.D. Ph.D. Laboratory Medicine, UZ Leuven November 18th 2008 Introduction Archie Cochrane (1908-1988)

More information

Introduzione al metodo GRADE

Introduzione al metodo GRADE Introduzione al metodo GRADE Atto Billio MD, MSc EBHC Ematologia e TMO-Bolzano Gruppo linee guida SIE Critique of EBM De-emphasizes patient values Doesn t account for individual variation Devalues clinical

More information

Bisphosphonates and other bone agents for breast cancer(review)

Bisphosphonates and other bone agents for breast cancer(review) Cochrane Database of Systematic Reviews Bisphosphonates and other bone agents for breast cancer (Review) O Carrigan B, Wong MHF, Willson ML, Stockler MR, Pavlakis N, Goodwin A O Carrigan B, Wong MHF, Willson

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews The effect of probiotics on functional constipation: a systematic review of randomised controlled trials EIRINI DIMIDI, STEPHANOS CHRISTODOULIDES,

More information

Clinical Research Scientific Writing. K. A. Koram NMIMR

Clinical Research Scientific Writing. K. A. Koram NMIMR Clinical Research Scientific Writing K. A. Koram NMIMR Clinical Research Branch of medical science that determines the safety and effectiveness of medications, devices, diagnostic products and treatment

More information

Feng-Yi Lai, RN, MSN, Instructor Department of Nursing, Shu-Zen College of Medicine and Management, Asphodel Yang, RN, PhD, Associate Professor

Feng-Yi Lai, RN, MSN, Instructor Department of Nursing, Shu-Zen College of Medicine and Management, Asphodel Yang, RN, PhD, Associate Professor Feng-Yi Lai, RN, MSN, Instructor Department of Nursing, Shu-Zen College of Medicine and Management, Asphodel Yang, RN, PhD, Associate Professor Department of Nursing, Central Taiwan University of Science

More information

Traumatic brain injury

Traumatic brain injury Introduction It is well established that traumatic brain injury increases the risk for a wide range of neuropsychiatric disturbances, however there is little consensus on whether it is a risk factor for

More information

Critical Appraisal Series

Critical Appraisal Series Definition for therapeutic study Terms Definitions Study design section Observational descriptive studies Observational analytical studies Experimental studies Pragmatic trial Cluster trial Researcher

More information

Results. NeuRA Worldwide incidence April 2016

Results. NeuRA Worldwide incidence April 2016 Introduction The incidence of schizophrenia refers to how many new cases there are per population in a specified time period. It is different from prevalence, which refers to how many existing cases there

More information

Online Supplementary Material

Online Supplementary Material Section 1. Adapted Newcastle-Ottawa Scale The adaptation consisted of allowing case-control studies to earn a star when the case definition is based on record linkage, to liken the evaluation of case-control

More information

Introduction to Systematic Reviews

Introduction to Systematic Reviews Introduction to Systematic Reviews Madhukar Pai, MD, PhD Assistant Professor Department of Epidemiology & Biostatistics McGill University, Montreal, Canada Email: madhukar.pai@mcgill.ca Case Study 1: Egg

More information