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Systematic Review

Two reviewers independently Reliability of data extraction - Compare results and resolve discrepancies by discussion or third party Step 6. Data analysis and synthesis - Narrative synthesis if meta-analysis not appropriate - Meta-analysis if studies are sufficiently similar

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41 views

Systematic Review

Two reviewers independently Reliability of data extraction - Compare results and resolve discrepancies by discussion or third party Step 6. Data analysis and synthesis - Narrative synthesis if meta-analysis not appropriate - Meta-analysis if studies are sufficiently similar

Uploaded by

Sri setia yuliawati
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Systematic Review

Linlin Lindayani, PhD


Systematic Review (SR)

• Clearly stated objectives with pre-defined eligibility criteria for


studies
• Explicit, reproducible methodology
• A systematic search that attempts to identify all studies
• Assessment of the validity of the findings of the included studies
(e.g. risk of bias)
• Systematic presentation, and synthesis, of the characteristics and
findings of the included studies
Advantages

• Greater transparency
• Detect and reduce biases and random errors
• Replicability
• Resolve controversy between conflicting studies
• Identify gaps in current research
• Provide reliable basis for decision making
• Less expensive and quicker to conduct the new studies
• Ensure the justification for further research
Criticisms/Limitation
• Results may still be inconclusive
• Combining results from different types of studies, treatments, etc. is
not always appropriate
• Require updating (often by time of publication)
• May not include all studies
– Non-English; Grey literature; Early literature
• Quality assessment can still be subjective
Categories
• Integrative systemic review
A systematic review that does not have a summary statistics.
• Meta-analysis
A statistical approach to synthesizing the results of a number of
studies that produces a larger sample size and thus greater power
to determine the true magnitude of an effect.
• Meta-synthesis (meta-summary)
Narrative analysis of a number of independent qualitative studies
and text
Questions for yourself before
you start

• Do I have a clearly defined clinical question with established


inclusion and exclusion criteria?
• Do I have a team of at least three people assembled?
• Do I have time to go through as many search results as we might
find?
• Do I have resources to get foreign-language articles
appropriately translated? (Note that exclusion of foreign-
language articles is an inherent bias.)
• Do I have the statistical resources to analyze and pool data?
Conducting and Writing a Systematic Review
Types of research

• Intervention reviews
• Diagnostic test accuracy reviews
– Instruments/test accuracy
– Summary ROC curve (sROC)
– Diagnostic odds ratios (dOR)
• Risk factors reviews
– Observational studies (cohort study)
– Polled point estimator of association
Steps in SR

1. Formulate a topic/ the research question


2. Develop a written protocol (plan)
3. A comprehensive and reproducible
4. literature searching strategy
5. Unbiased selection and abstraction process
6. Critical appraisal
7. Data analysis and synthesis (may include meta-analysis)
8. Interpretation of results
Develop PICOT question
P : Populasi/ Pasien/Masalah

I : Intervensi/eksposure/issue of
interest
C : Intervensi pembanding/
kelompok pembanding
O : Outcomes/hasil-hasil yang
diharapkan
T : Time frame (batas waktu)/jenis
penelitian
Purpose

• To summarize
• To evaluate
Step 2.
Develop a written protocol
• Inclusion & Exclusion criteria
– Characteristics of subjects (study), treatment modalities, outcome
measures…
– Search strategy (key word, database)
• Quality of studies? Rating score
• Data extraction (reliability)
• Data analysis
Step 3
Literature search strategies

• Recommended:

•PubMed
• https://www.ncbi.nlm.nih.gov/pubmed/?term=HIV+AND+Preventio
n
• PubMed
• Clinical Queries (Old Version)
• Special Queries
• MeSH Database
• Buscar en MEDLINE con PubMed
• PubMed - enhanced search
• Ovid databases (Medline, EMBASE, PsycINFO, AMED)
• EBSCO CINAHL
• Decide keyword
Limiter

• Limit searches to specific criteria such as format, language,


publication date, and periodical title
• Full Text – limit results to articles with full text
• Peer Reviewed – limit search results to articles from peer-reviewed
journals
• Serial Title – enter a journal/magazine name to limit results to
articles only from that title
Step 5. Critical appraisal

• Two independent reviewers should involve in.


• Study quality: internal & external validity Internal validity
– Minimization of method bias in a study
• External validity
– Generalizability of the conclusions of a trial to the other
populations
• Criteria for appraise: based on research methodology
Tools for Critical Appraisal

• Modified Jadad scale (Methodological Quality Score)


• Critical Appraisal Skills Programme (CASP), Public Health Resource
Unit, Institute of Health Science, Oxford.
• The Cochrane Collaboration’s tool for assessing risk of bias for RCT
CASP Checklists

• CASP Checklists
• CASP Systematic Review Checklist
• CASP Qualitative Checklist
• CASP Randomized Controlled Trial Checklist
• CASP Case Control Checklist
• CASP Cohort Study Checklist
• CASP Clinical Prediction Rule Checklist
• CASP Diagnostic Checklist
• CASP Economic Evaluation Checklist
Data extraction

• Source – citation and contact details


• Eligibility – confirm eligibility for review
• Methods – study design, concerns about bias
• Participants – total number, setting, diagnostic criteria
• Interventions – total number of intervention groups
• Outcomes – outcomes and time points
• Results – for each outcome of interest: sample size, etc
• Miscellaneous – funding source, etc

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