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Research > Week 11 - Meta-Analysis and Meta-Synthesis > Flashcards

Week 11 - Meta-Analysis and Meta-Synthesis Flashcards

1
Q

what is scoping reviews

A

a preliminary review of research to clarify the range and nature of evidence, often to refine future research questions and to support the design of a future SR or to generate evidence supporting additional research needed on a topic.

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2
Q

what is a narrative review

A

a summary of research on a topic, less rigorous than SR

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3
Q

what is rapid review

A

a streamlined and rapid approach for synthesizing evidence, no statistics, often performed in weeks as a rapid update to critical areas or trends in clinical practice (raises HCP awareness of critical developments)

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4
Q

what is umbrella review

A

review of reviews (Cochrane calls them overview of reviews), where the unit of analysis is a published literature review and are used to manage information overload

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5
Q

what is integrative reviews

A

a form of review that is broader in nature and inclusion experimental and non-experimental research (i.e. empirical or theoretical) to more fully understand a phenomena of interest. Uses more diverse data sources and wide ranges of inquiry with variable methodologies and outcomes.

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6
Q

what are living SRs

A

published as new research becomes available in rapid formats, (i.e.: online only) containing evidence summaries from using automated methods of information retrieval and extraction

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7
Q

what are next generation SRs

A

individual patient-level meta-analysis (i.e. from Clinical Trial data from multiple trials)

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8
Q

what are network SRs

A

common in comparative effectiveness research because it allows you to ask questions beyond the intent of the original CTs. Involves the collection of direct and indirect evidence for alternative interventions even if they were not directly tested for in the original CTs.

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9
Q

what are SR-MAs

A

a rigorous and intensive review of research findings on an RQ using systematic sampling, data collection, statistical data analysis procedures, and requires a formal protocol, various literature rating and charting/graphing tools, stats programs, 1-2 years and several team members.

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10
Q

what are the basic forms of systemic reviews

A
  • scooping review

- narrative literature review

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11
Q

what are the special types of systemic reviews

A
  • Rapid reviews
  • Overview of reviews (umbrella review)
  • Integrative reviews (popular in nursing)
  • Living SRs
  • Next-generation SRs
  • SRs and Meta-analyses
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12
Q

what is PRISMA

A
  • preferred reporting items for systematic reviews and meta-analyses:
  • Standard way to report how you use the literature, demonstrating the comprehensiveness of your research
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13
Q

what is an example of PRISMA framework

A

if there is no SR-MA, we won’t use the intervention, but if it’s low-cost and low hassle to implement with minimal harms, possible modest therapeutic benefit, why not?

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14
Q

what is a systemic review

A
  • A rigorous synthesis of research findings on an RQ, using systematic sampling, data collection, and data analysis procedures and a formal protocol; QUANT or QUAL; considered strongest form of evidence
  • PICOT format
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15
Q

is quant or qual more popular with systemic reviews

A
  • QUANT: Very popular as EBP-EBM movements blossom and flourish d/t:
  • Provides a reliable picture of the available evidence more than any single study,
  • Provides increased statistical power and more precise results about impacts of an intervention on an outcome,
  • Clarifies gaps in knowledge and where additional research is needed,
  • Resolves conflicting evidence across studies, integrates information for decisions
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16
Q

what are the three types of systemic reviews

A
  • meta-analysis
  • metasynthesis
  • mixed studies review
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17
Q

what is the type meta-analysis

A
  • SRs that combine and analyze findings of multiple quantitative studies on a topic
  • Typically a therapeutic intervention*
  • Uses sophisticated statistical techniques, to provide a summary finding across studies
  • Allows for creation and use of a common metric or summary statistic to present an overall analysis of the effect of an intervention across all included studies
  • Metrics can be displayed in a plot
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18
Q

what is the type metasynthesis

A
  • Interpretive translation of abstract phenomena produced by integrating findings from multiple qualitative studies
  • Qualitative evidence syntheses (QESs)
  • SR of qualitative evidence focused on particular aspects of an intervention, phenomenon, or program, i.e. barriers to participation, satisfaction with treatment
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19
Q

what is the type mixed studies review

A
  • Standard are evolving weekly, monthly

- Area of intense debate, no formal consensus, agreement

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20
Q

what are the broad steps to conducting an SR

A
  • Assess need for a SR
  • Assemble the SR team and resources
  • Formulate the research question (PICOT)
  • Define eligibility criteria (inclusion/exclusion) for the primary studies
  • Prepare a protocol for the review
  • Search for and retrieve primary studies
  • Select studies for inclusion in the review
  • Assess study quality
  • Extract data, analyze and synthesize the data
  • Interpret data and evaluate the degree of confidence in the results
  • Write the findings in a systematic review report
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21
Q

what is PROSPERO

A

an international database of prospectively registered systematic reviews in health and social care, welfare, public health, education, crime, justice, and international development, where there is a health-related outcome. Key features from the review protocol are recorded and maintained as a permanent record

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22
Q

what is the aim of PROSPERO

A

to provide a comprehensive listing of systematic reviews registered at inception to help avoid duplication and reduce opportunity for reporting bias by enabling comparison of the completed review with what was planned in the protocol

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23
Q

what are needed for preliminary groundwork

A
  • assess need for SR
  • review team
  • review auspices
  • computer software
  • schedule
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24
Q

who can be on the review team

A
  • 2-3 Reviewers (tiebreaker)
  • Librarian or IS
  • Content, methodologic, stats experts
  • Advisory Group
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25
Q

who is part of the review auspices

A

Independent or group? (fed, non-profit, Cochrane)

26
Q

what kind of software is needed?

A
  • Text mining (SWIFT-Review, TERMINE)
  • Screening (Covidence, Rayyan, DistillerSR)
  • Citation management (EndNote, RefWorks, Mendeley
  • Data extraction (DistillerSR)
  • SPSS, SAS for meta-analyses
  • JBI SUMARI; CC RevMan
27
Q

what does the schedule look like

A
  • Project Management

- Documentation Forms (Excel, Google Sheets, Google Forms) and Tools (DistillerSR, Covidence)

28
Q

what do you do when conducting an SR

A
  • formulate RQ
  • define study eligibility criteria
  • prepare the review protocol
  • search/screen for primary studies
29
Q

what should happen when formulating your RQ

A
  • All team members should approve RQ

- May involve significant iterations, refinement, contributions from many stakeholders

30
Q

how do you define study eligibility criteria

A
  • Study participants
  • Intervention/influence
  • Study design
  • Other criteria
31
Q

what do you need for preparing the review protocol

A

Title, team, schedule, RQ’s, background, eligibility criteria, search strategy, review methods, assessment of confidence in findings, registration with CC or JBI

32
Q

what is publication bias

A

A bias resulting from the tendency that journals-Editors select studies with primarily significant, and thus ‘interesting’ results

33
Q

what is dissemination bias

A

A bias resulting from the profile of a study’s findings that is dependent on the strength or direction of the findings (becomes the dominant voice in a debate)

34
Q

what do you do when evaluating studies

A

-Study quality and bias levels
-Various scoring tools for study design, evidence
CC, JBI, Rayyan, GRADE, EBP appraisal tools, etc
Variable cost, complexity
-Assessing quality and bias; creating a final evidence summary table

35
Q

what is the GRADE criteria

A
  • Risk of bias
  • Inconsistent results
  • Indirectness of evidence
  • Imprecision
  • Publication bias
  • Large effect
  • Dose-response gradient
  • Implausible confounders
36
Q

explain the two step process of GRADE

A

1-Grading each study individually;

2-Overall recommendation is made to use/not use the intervention in addition to the strength (strong, weak)

37
Q

what is the fixed effect model

A

model in which studies are assumed to be estimating a single true effect; a pooled effect estimate is calculated under the assumption that observed variation b/t studies is due to chance

38
Q

what is the random effect model

A

model in which studies are not assumed to be measuring the same overall effect, but rather different, yet related effects; often preferred to a fixed effect model when there is extensive statistical heterogeneity.

39
Q

what is sensitivity analysis

A

tests how sensitive the results of a statistical analysis are to changes in key assumptions or how the analyses were done (i.e. in MAs, tests if conclusions are sensitive to the quality of the studies included)

40
Q

which model is more stable with high heterogenenity

A

random effects

41
Q

which model is best for low heterogeneity

A

fixed or random (identical results)

42
Q

what is inverse variance method

A

common weighting method that uses the variance of the effect estimate (one divided by the square of its standard error) as the weight in calculating a weighted average of effects.

43
Q

what are the two tests of heterogenenity

A

Q test and I2 test

44
Q

what is the Q test

A

p-value w/probability of obtaining ES differences as large as if Ho were true

45
Q

what is the I2 test

A

(0-100%, >50% = moderate heterogeneity); similar to Q but adjusts for #’s of studies in the analysis

46
Q

what are the final steps of systematic review

A
  • Create evidence profile (final table)
  • Summary of Findings (SoF)
  • Present summary of findings
  • Generate remainder of written report
  • Use of tools and frameworks to generate the final format: CC, JBI, PRISMA for SRs of RCTs, MOOSE; EQUATOR
47
Q

explain qual SRs- aggregative

A

Permeable boundaries, many feature both

48
Q

explain qual SRs-aggregative

A
  • Pooling of findings
  • Fairly structured, focused
  • Exhaustive searching for high quality primary studies
  • Minimal bias, subjectivity
  • GOAL: provide direct, usable guidance for action

Typical RQ: Why do people who clearly understand the risks of smoking choose to continue to smoke?

49
Q

explain qual SRs-interpretive

A
  • Not highly structured
  • RQ evolves as the project unfolds > discovery
  • May even start as a broad research statement of purpose
  • Purposive sampling and not exhaustive searching; study quality of primary studies is not essential
  • Interpreter’s unique insights are valued
  • GOAL: attain enlightenment through new ways of understanding

Typical RQ: What is it like for smokers to lose a loved one to lung cancer?

50
Q

what is meta synthesis

A

An interpretive translation produced by integrating findings from multiple qualitative studies

51
Q

how does meta synthesis apply to nursing

A

umbrella term for qualitative synthesis, perspective; RNs have contributed the most to this field

52
Q

what are the three techniques used for meta synthesis

A
  • meta ethnography
  • metastudy
  • mestasummary
53
Q

what is meta ethnography

A

An approach to the integration of findings from qualitative studies by translating and interpreting concepts and metaphors across studies

54
Q

what is metastudy

A

A research approach involving analysis of theory, methods, and findings about qualitative research and the synthesis of these insights into new ways of thinking about the phenomena

55
Q

what is meta summary

A

A type of qual synthesis that uses quantitatively oriented methods to aggregate qualitative findings; it involves the development of a list of abstracted findings from primary studies and calculating manifest effect sizes (frequency and intensity effect size);

56
Q

what are the steps to conducting meta-synthesis

A

-Formulating the problem
-Designing a meta-synthesis
-Searching the literature for data
-Appraising study quality
-Extracting data for analysis
-Synthesizing and interpreting the data
Meta-ethnography
Deciding on the phenomenon, relevant studies
Reading and re-reading each study
Deciding on how studies are related
Translating qualitative studies
Synthesizing and interpreting translations

57
Q

what is the name of the reporting guidelines for qual SRs

A

ENTREQ

58
Q

what is meta aggregation

A

JBI method for performing an aggregative structured approach to synthesize qualitative evidence

59
Q

what makes meta aggregation different

A

-PICo (instead of PICOT) RQ
Population, phenomenon of Interest, Co-ntext
-Preliminary steps to JBI qualitative evidence synthesis
-Analysis through meta-aggregation
-Assessment of confidence
-Writing a meta-aggregation report
-GRADE-CERQual also has a competing rating tool and method

60
Q

what are the mixed methods studies review designs

A
  • Segregated design allows for 2 independent syntheses—1 qual, 1 quant, and mixed design uses both
  • Integrated design—studies grouped by RQ
  • Contingent design—coordinated series of syntheses

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