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Introduction to EIDM and Systematic Reviews
The document provides an overview of evidence-informed decision making and systematic reviews, emphasizing the integration of best research evidence with clinical expertise and patient values. It outlines the steps in evidence-based practice, the importance of evidence synthesis, and various types of reviews, including narrative, scoping, rapid, and systematic reviews. Additionally, it discusses the systematic review process, including preparation, selection of studies, data extraction, and synthesis while highlighting the need for transparency and minimizing bias.
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Introduction to EIDM and Systematic Reviews
- 1. kcochrane@kemri.go.ke / www.kenya.cochrane.org IntroductionTo Evidence Informed Decision Making and Systematic Reviews: @CochraneKenya Lilian M. Mayieka Kenya Medical Research institute Cochrane Kenya
- 2. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Evidence is anything used to determine or demonstrate the truth of an assertion. Scientific evidence: Evidence which serves to either support or counter a Scientific Theory or hypothesis – Accumulated through observations of phenomena which occurs in the natural world or laboratory experiments
- 3. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Necessity of Falsifiability All swans are white All bachelors are unmarried
- 4. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Evidence Based Practices (EBP) EBP is the integration of best available research evidence with clinical expertise and patient values to deliver optimal care, Best research means clinically relevant patient centered research studies
- 5. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Evidence Based Decision Making Isn't new Babylonians Isralites 1. 10 days trial to determine the healthier diet 2. The Biblical times The famous 1747 scurvy trial Dr. James Lind treated twelve scurvy patients on the HMS Salisbury with different remedies. The group given oranges and lemons recovered the fastest. This finding was published in Lind's "Treatise on Scurvy" in 1753.
- 6. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Modern time Evidence Based Decision Making Isn't new "Crossing the Quality Chasm: A New Health System for the 21st Century" It emphasizes six aims for healthcare: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The report highlights the need for systemic changes, including the adoption of new technologies, better use of data, and more coordinated care to bridge the gap between current healthcare practices and optimal care.
- 7. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Steps in evidence based practice Critically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice) Tracking down the best evidence with which to answer that question Converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc) into an answerable question Evaluating our effectiveness and efficiency in executing Steps 1-4 and seeking ways to improve them both for next time Integrating the critical appraisal with our clinical expertise and with our patient's unique biology, values and circumstances
- 8. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Generation of Primary research Synthesis of relevant evidence Evidence reaches policy makers Policy makers value evidence and use it in decision making Policy makers implement largescale change Flow of Evidence from Generation to Implementation
- 9. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya The evidence Ecosystem
- 10. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya The evidence Ecosystem Evidence generation Evidence Synthesis Evidence Translation Regulatory Culture Economy Social Politics
- 11. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Putting evidence into Practice Process
- 12. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Hierarchy of Evidence
- 13. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Evidence Synthesis The use of techniques to combine multiple sources of data- Clinical or observational, to comprehensively understand their findings. What is it & Why do we need it
- 14. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya • Making sense of research • Same question – different answers from studies • Coping with information overload • Millions of new articles, grey literature, internet – cope by relying on literature reviews to stay up to date • Justification of future research • What gaps in knowledge the proposed research intends to fill • Facilitating access to relevant research • Avoiding publication biases • Better accountability • Many effective treatments (alternatives) • Costs (avoiding waste) Why is Evidence Synthesis Important
- 15. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya What is a review • A review is a summary or synthesis of the results or conclusions of more than one study • Several types of reviews available, eg: • Narrative reviews • Scoping reviews • Rapid reviews • Systematic reviews • Reviews differ by rationale, methodological rigor and risk of bias • A good review should be a readable summary of ALL the evidence, unbiased, transparent, replicable and up-to-date
- 16. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Narrative Review • Summaries of evidence on a given topic usually written by an expert in the field. • Typically, involve informal and subjective methods to collect and interpret information • Problems with narrative reviews • Personal bias • Publication bias • Language bias • Small sample size
- 17. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Scoping Reviews A type of knowledge synthesis that uses a systematic and iterative approach to identify and synthesize an existing or emerging body of literature on a given topic Aim is to map the body of literature on a topic area.
- 18. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Rapid Review A form of knowledge synthesis that accelerates the process of conducting a systematic review through streamlining or omitting specific methods to produce evidence for stakeholders in a timely and resource-efficient manner shorten the process by: Limited scope of review question Limiting search by years, databases, language and sources beyond electronic searches Single rather than two reviewers for some review steps (eg title and abstract review, full text review, methodological quality assessment and data extraction process) Limited risk of bias assessment Qualitative summary rather than meta-analysis Fast-tracking of PROSPERO registration
- 19. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Systematic Review • “A review in which bias has been reduced by : • the systematic identification • Critical appraisal • Synthesis, and, • If relevant, statistical aggregation • of all relevant studies on a specific topic according to a predetermined and explicit method.”
- 20. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Main elements of a systematic review • Pre-specified protocol • Clearly focussed question • Pre-determined selection criteria • Detailed description of search strategy • Explanation of types of evidence included and excluded • Critical examination of quality of included studies • Transparent process for synthesising and interpreting findings • Kept up-to-date
- 21. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Preparing for a Systematic Review • Any review project requires three components: • Review question: defines your destination • Review protocol: details your proposed route and activities • Review team • Will continually consult the review question and protocol in the systematic review process • Review question—clear, well-defined, appropriate, manageable and relevant to outcomes • Beware that both review question and protocol may take longer than you think. • A review team helps to minimize bias
- 22. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Preparing for a Systematic Review • Aim of review protocol: • To describe current evidence • To identify the review question • To outline/pre-specify methods to be used to answer review question • What studies will be included and excluded? • How (exactly) will each stage be conducted? • What are the primary and secondary outcomes of interest? • Needs to be registered (to avoid duplication of efforts) - PROSPERO • Journals often require a protocol registration number before publishing systematic reviews
- 23. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya PROSPERO Registration • Search for ongoing reviews • Register planned review online (& update as work progresses) • Avoids duplication of reviews
- 24. kcochrane@kemri.go.ke / www.kenya.cochrane.org@CochraneKenya Systematic Review Process • Review question • Has 4 components (PICO) • Search for studies • Need a search strategy • Search more than one database • No restriction with language, publication status • Consider contacting experts, reference lists • Selecting studies • At least two authors screen studies independently • Use the inclusion criteria developed from the review question (PICO) • In two stages (titles and abstracts, full text papers) • Can be done electronically (eg Covidence) • Risk of bias assessment • Use a validated tool, eg Cochrane risk of bias tool
- 25. kcochrane@kemri.go.ke / www.kenya.cochrane.org Systematicreview process • kcochrane@kemri.go.ke / www.kenya.cochrane.org @CochraneKenya • Data extraction • Need a (piloted) data abstraction sheet • Sone by at least 2 authors • Be systematic • Resolve disagreement • Data analysis/synthesis • Develop analysis plan at protocol stage • If data is not combinable, describe qualitatively • If data is combinable, consider meta-analysis • Use software (eg Revman, Stata, Met-analyst) • Establish presence of heterogeneity • Summary of the findings (use GRADE methodology) • Report writing • Structured report • Include a plain language summary