Professional Documents
Culture Documents
http://www.cochrane-handbook.org/
What is a systematic review?
http://www.cochrane-handbook.org/
What is a meta-analysis?
Literature/narrative/critical review:
Vary in quality
Require updating (often by time of publication)
May not include all studies
o Non-English
o Grey literature
o Early literature
Quality assessment can still be subjective
Why are systematic reviews needed?
Mostly
o A substantive question
o Several primary studies
o Uncertainty
Can be of
o RCTs (randomised controlled trials) of intervention (vaccine,
drug, behaviour)
e.g. MMR, clot busters, exercise after stroke
o Observational studies
e.g. Birth weight and IQ, IQ and mortality, WMH and
morbidity/mortality
Hierarchy of evidence
RCTs or observational studies
RCTs
o gold standard for interventions
o Minimise bias
o Exposed/unexposed groups are comparable
o Bigger is better
http://www.cochrane-handbook.org/
RCTs or observational studies
Observational studies
o The majority of studies
o When RCTs are not ethical/feasible/done
o Need clarity about design ?filter by method
o What search techniques are appropriate?
o Concern about bias, confounding (bigger not always
better)
o Difficult to combine different study designs
o May require original data
o Meta-analysis can be spuriously precise and misleading
http://www.cochrane-handbook.org/
Introduction to Cochrane
Cochrane collaboration
o Cochrane Reviews (>4,000) registered
o Identify, appraise and synthesise research-
based evidence and present it in accessible
format; regularly updated
o Focus on interventions
o Outstanding general resource
http://www.cochrane-handbook.org/
Introduction to Campbell Collaboration
http://www.campbellcollaboration.org/
Introduction to EPPI-Centre
Evidence for Policy and Practice Information and Co-
ordinating Centre
Systematic reviews of public policy
o Education, health promotion, employment, social care,
criminal justice
Online evidence library
Methods, tools and databases (quantitative and
qualitative)
EPPI-Centre (March 2007) EPPI-Centre methods for
conducting systematic reviews. London: EPPI-Centre,
Social Science Research Unit, Institute of Education,
University of London.
http://eppi.ioe.ac.uk/
Introduction to PROSPERO
http://www.crd.york.ac.uk/PROSPERO/
Introduction to EQUATOR
http://www.equator-network.org/
Introduction to EQUATOR
1. Define a question
2. Search the literature
3. Assess the studies
4. Combine the results
5. Put the findings in context
How to do a systematic review?
1. Define a question
2. Search the literature
3. Assess the studies
4. Combine the results
5. Put the findings in context
How to do a systematic review?
1. Define a question
2. Search the literature
3. Assess the studies
4. Combine the results (Geoff Der)
5. Put the findings in context
Presenting and assessing results
Reported
Section/topic # Checklist item
on page #
Risk of bias across studies 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective
reporting within studies).
Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating
which were pre-specified.
RESULTS
Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at
each stage, ideally with a flow diagram.
Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and
provide the citations.
Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12).
Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each
intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
Synthesis of results 21 Present results of each meta-analysis done, including confidence intervals and measures of consistency.
Risk of bias across studies 22 Present results of any assessment of risk of bias across studies (see Item 15).
Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]).
DISCUSSION
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to
key groups (e.g., healthcare providers, users, and policy makers).
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of
identified research, reporting bias).
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research.
FUNDING
Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the
systematic review.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097.
doi:10.1371/journal.pmed1000097
For more information, visit: www.prisma-statement.org.
Page 2 of 2
Putting the results in context
http://www.dcn.ed.ac.uk/dcn/default.asp
Division of Clinical Neurosciences (DCN), especially Prof Joanna Wardlaw
www.ccace.ed.ac.uk
The work was supported by The University of Edinburgh Centre for Cognitive Ageing
and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing
Initiative (G0700704/84698). Funding from the BBSRC, EPSRC, ESRC and MRC is
gratefully acknowledged.