Systematic Review：系统综述.ppt

* * * Determine effect estimates in key subgroups (e.g. based on gender, race/ethnicity or age) Identify (through meta-regression) the sources of heterogeneity in prior studies * Although meta-analysis is most widely known in biomedical settings for its application to clinical trials, the technique can also be used to synthesize/analyze other study designs: * * * * Usually the best if systematic reviews and meta-analyses are conducted by teams that include investigators with both methodologic and content expertise. * * * * * * Background give rationale for systematic review as well as importance of research question * * * * Reviewers must determine which studies are relevant and suitable for inclusion in the systematic review. As noted before, it is crucial that the criteria for study selection be determined ahead of time to the extent possible, so investigators cannot, for example, decide to exclude certain types of studies that do not show a positive result. The specific inclusion criteria will depend on the study question. * * * Consider assessment by more than 1 reviewer * * * * Always assess selection and allocation bias, blinding and handling of patient attrition * * * Before deciding which approach to take, it is important to tabulate the findings from the studies and examine heterogeneity (i.e. diversity of studies). * * * * These issues should be included in the discussion and recommendations section of a systematic review: * Search strategy example Risch et al. JAMA 2010 Step 5 Quality appraisal Principles of quality appraisal Quantitative studies Internal Validity allocation bias, confounding, attrition, statistical analysis, intervention integrity, withdrawals and dropouts External Validity (generalizability or applicability) Are there quality appraisal tools? QUORUM for trials Moher et al. Improving the quality of reports of meta-analyses of randomized controlled trials: The QUORUM statement. Lancet 1999;354:1896-1900 MOOSE for o