Review Article: The Flagship of Evidence-Based Medicine

2021 ◽  
pp. 153473462199563
Author(s):  
Miltos K. Lazarides ◽  
Irene-Zacharo Lazaridou ◽  
Nikolaos Papanas
Keyword(s):  
Systematic Reviews ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Evidence Based ◽  
Relevant Evidence ◽  
Quantitative Studies ◽  
Current State ◽  
Scoping Reviews ◽  
Based Medicine

Global literature is ever-growing and physicians rely on it for evidence-based decision making. Review articles summarize available literature and provide the current state of knowledge on a given topic. Various review types exist, the main ones being narrative and systematic reviews. The former are based on studies selected in an undefined manner. They express the authors’ opinions of a given topic, lack a systematic search, and are prone to bias. By contrast, the latter represent an unbiased synthesis of knowledge on a particular topic and attempt to offer all relevant evidence. A systematic review may include a meta-analysis, which combines the results of quantitative studies using statistical techniques to provide a more precise summary of the evidence. With a dramatic increase in literature complexity, new “next-generation” types of reviews emerged to improve the quality of evidence synthesis: network meta-analysis, umbrella review, and meta-analysis of individual patient data, among others. Finally, scoping reviews are a special type, conducted as precursors to systematic reviews aiming to reveal specific knowledge gaps in a given subject.

scholarly journals Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management: Part 6. Systematic Reviews and Meta-Analyses of Observational Studies

2008 ◽  
Vol 5;12 (5;9) ◽  
pp. 819-850
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Observational Studies ◽  
Meta Analysis ◽  
Evidence Based ◽  
Confounding Bias ◽  
Meta Analyses ◽  
Based Medicine

Observational studies provide an important source of information when randomized controlled trials (RCTs) cannot or should not be undertaken, provided that the data are analyzed and interpreted with special attention to bias. Evidence-based medicine (EBM) stresses the examination of evidence from clinical research and describes it as a shift in medical paradigm, in contrast to intuition, unsystematic clinical experience, and pathophysiologic rationale. While the importance of randomized trials has been created by the concept of the hierarchy of evidence in guiding therapy, much of the medical research is observational. The reporting of observational research is often not detailed and clear enough with insufficient quality and poor reporting, which hampers the assessment of strengths and weaknesses of the study and the generalizability of the mixed results. Thus, in recent years, progress and innovations in health care are measured by systematic reviews and meta-analyses. A systematic review is defined as, “the application of scientific strategies that limit bias by the systematic assembly, clinical appraisal, and synthesis of all relevant studies on a specific topic.” Meta-analysis usually is the final step in a systematic review. Systematic reviews and meta-analyses are labor intensive, requiring expertise in both the subject matter and review methodology, and also must follow the rules of EBM which suggests that a formal set of rules must complement medical training and common sense for clinicians to integrate the results of clinical research effectively. While expertise in the review methods is important, the expertise in the subject matter and technical components is also crucial. Even though, systematic reviews and meta-analyses, specifically of RCTs, have exploded, the quality of the systematic reviews is highly variable and consequently, the opinions reached of the same studies are quite divergent. Numerous deficiencies have been described in methodologic assessment of the quality of the individual articles. Consequently, observational studies can provide an important complementary source of information, provided that the data are analyzed and interpreted in the context of confounding bias to which they are prone. Appropriate systematic reviews of observational studies, in conjunction with RCTs, may provide the basis for elimination of a dangerous discrepancy between the experts and the evidence. Steps in conducting systematic reviews of observational studies include planning, conducting, reporting, and disseminating the results. MOOSE, or Meta-analysis of Observational Studies in Epidemiology, a proposal for reporting contains specifications including background, search strategy, methods, results, discussion, and conclusion. Use of the MOOSE checklist should improve the usefulness of meta-analysis for authors, reviewers, editors, readers, and decision-makers. This manuscript describes systematic reviews and meta-analyses of observational studies. Authors frequently utilize RCTs and observational studies in one systematic review; thus, they should also follow the reporting standards of the Quality of Reporting of Meta-analysis (QUOROM) statement, which also provides a checklist. A combined approach of QUOROM and MOOSE will improve reporting of systematic reviews and lead to progress and innovations in health care. Key words: Observational studies, evidence-based medicine, systematic reviews, metaanalysis, randomized trials, case-control studies, cross-sectional studies, cohort studies, confounding bias, QUOROM, MOOSE

scholarly journals REGISTERING AND REPORTING SYSTEMATIC REVIEWS

2021 ◽  
Vol 1 (2) ◽  
pp. 122-126
Author(s):  
Pallavi Patro ◽  
Durga Prasanna Misra
Keyword(s):  
Systematic Reviews ◽  
Observational Studies ◽  
Meta Analysis ◽  
Future Research ◽  
Evidence Based ◽  
Extensive Literature ◽  
Literature Searches ◽  
Review Question ◽  
Based Medicine

Systematic reviews are considered as the highest rung in the ladder of evidence-based medicine. They are bound by a pre-defined structure and requirement for extensive literature searches, when compared with the more liberal format of narrative reviews. Systematic review protocols should ideally be pre-registered to avoid duplication or redundancy. After defining clear review question(s), thorough literature searches form the basis of systematic reviews. Presentation of results should be qualitative or quantitative (meta-analysis) if the data is homogenous enough to permit pooling across multiple studies. Quality of individual studies by Cochrane risk of bias 2 tool for interventional studies and other suitable scales for observational studies, as well as appropriate assessment of publication bias are recommended. Certainty of outcomes should be assessed by the GRADE profiler. Finally, systematic reviews should conclude with recommendations for future research, based on their findings.

scholarly journals Evidence-Based Interventional Pain Management: Principles, Problems, Potential and Applications

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 329-356
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Clinical Practice ◽  
Pain Management ◽  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Randomized Trials ◽  
Evidence Synthesis ◽  
Evidence Based ◽  
Interventional Pain Management ◽  
Based Medicine

Background: The past decade has been marked by unprecedented interest in evidencebased medicine (EBM) and a focus upon the use of innovative methods and protocols to provide valid and reliable information for and about healthcare. Thus (it is at least purported that), healthcare decisions are increasingly being based upon research-derived evidence, rather than on expert opinion or clinical experience alone. But this quest for evidence to support clinical practice also compels the question of whether the methods employed to acquire information, the ranking of information that is acquired, and the prudent use of this information are sound enough to actually sustain the validity of an evidence-based paradigm in practice. Moreover, it is becoming apparent that the scope, depth, and applicability of available evidence to effectively and ethically guide the myriad of situational decisions in clinical practice is not uniform across all medical fields or disciplines. In particular, comprehensive evidence synthesis or complete guidelines for clinical decision-making in interventional pain management remain relatively scarce. EBM is defined as the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. Thus, the practice of EBM requires the integration of individual clinical expertise with the best available external evidence from systematic research. To arrive at evidence-based medical decisions all valid and relevant evidence should be considered alongside randomized controlled trials, patient preferences, and resources. Objective: To describe principles of EBM, and the methods and relative utility of evidence synthesis in interventional pain management. Description: This review provides 1) an understanding of evidence-based medicine, 2) an overview of issues related to evaluating the quality of individual studies, analyses, narrative, and systematic reviews, 3) discussion of factors affecting the strength and value(s) of evidence, 4) analysis of specific reviews of interventional techniques, and finally, 5) the utility and purpose of guidelines in interventional pain management. Conclusion: Interpreting and understanding evidence synthesis, systematic reviews and other analytic literature is a difficult task. It is crucial for pain physicians to understand the goals, principles, and process(es) of EBM so as to meaningfully improve its application(s). This knowledge affords better insight into not only the analytic reviews in interventional pain management provided herein, but ultimately allows future information to be selected, evaluated, and used with prudence in technically competent, ethically sound medical practice. Key words: Interventional pain management, interventional techniques, evidence-based medicine, evidence synthesis, pragmatic or practical clinical trials, randomized trials, observational studies, non-randomized trials, systematic reviews, quality of evidence

Systematic reviews and meta-analysis

2021 ◽  
pp. 193-206
Author(s):  
Nandi Siegfried ◽  
Lawrence Mbuagbaw
Keyword(s):  
Systematic Reviews ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Research Question ◽  
Similar Data ◽  
Inaccurate Information ◽  
Healthcare Decision Making ◽  
Scoping Reviews ◽  
Meta Analyses

Systematic reviews play an important role in healthcare decision-making. When conducted correctly, they provide up-to-date, comprehensive, and replicable summaries of evidence. Authors of systematic reviews are expected to develop a protocol that outlines the research question and key methodological features of their review. A comprehensive and exhaustive search should be conducted, followed by screening to capture studies that meet the prespecified inclusion criteria. Once the relevant studies have been identified, data will be extracted, using a dedicated tool that permits the review authors to confirm the eligibility of the study and collect information on its design, risk of bias, and results. Sufficiently similar data may be pooled using meta-analytic techniques or synthesized narratively. A summary of the overall quality of evidence for each outcome is an essential component of a systematic review. The main concerns with systematic reviews are (1) selection bias: systematic exclusion of relevant studies due to publication status or language; (2) indexing bias: failure to identify relevant studies because they are not indexed accurately; and (3) information bias: missing or inaccurate information in the included studies. Other approaches to evidence synthesis include mapping the evidence with scoping reviews; conducting overviews of systematic reviews; using individual patient data; conducting network meta-analyses for multiple comparisons; conducting rapid reviews when evidence is needed urgently; synthesis of diagnostic accuracy data; and synthesis of qualitative data. Systematic reviews often inform clinical guidelines and require careful planning and execution by teams with content and methodological expertise.

scholarly journals Systematic Reviews and Meta-analysis Published in Indexed Portuguese Medical Journals: Time Trends and Critical Appraisal.

2021 ◽  
Author(s):  
Luísa Prada ◽  
Ana Prada ◽  
Miguel Antunes ◽  
Ricardo Fernandes ◽  
João Costa ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Critical Appraisal ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Measurement Tool ◽  
Medical Journals ◽  
Electronic Search ◽  
Potential Impact

Abstract Introduction:Over the last years, the number of systematic reviews published is steadily increasing due to the global interest in this type of evidence synthesis. However, little is known about the characteristics of this research published in Portuguese medical journals. This study aims to evaluate the publication trends and overall quality of these systematic reviews.Material and Methods:Systematic reviews were identified through an electronic search up to August 2020, targeting Portuguese Medical journals indexed in MEDLINE. Systematic reviews selection and data extraction were done independently by three authors. The overall quality critical appraisal using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR II) was independently assessed by three authors. Disagreements were solved by consensus.Results:Seventy systematic reviews published in 5 Portuguese medical journals were included. Most (n=57; 81,4%) were systematic reviews without meta-analysis. Until 2010, the number of systematic reviews per year increased. Since then, the number of reviews published has not remained stable and no less than 3 SRs were published per year. According to the systematic reviews’ typology, most have been predominantly conducted to assess the effectiveness of health interventions (n=28; 40,0%). General and Internal Medicine (n=26; 37,1%) was the most addressed field. Most systematic reviews (n=45; 64,3%) were rated as being of “critically low-quality”.Conclusions:There were consistent flaws in the methodological quality report of the systematic reviews included, particularly in establishing a prior protocol and not assessing the potential impact of the risk of bias on the results.Through the years, the number of systematic reviews published increased, yet their quality is suboptimal. There is a need to improve the reporting of systematic reviews in Portuguese medical journals, which can be achieved by better adherence to quality checklists/tools.Systematic review registration: INPLASY202090105

Evidence-based approaches to psychiatry

2017 ◽  
pp. 119-134
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Patient Experience ◽  
Meta Analysis ◽  
Psychiatric Research ◽  
Evidence Based ◽  
High Quality ◽  
Qualitative Methodologies ◽  
Meta Analyses ◽  
Based Medicine ◽  
Quality Evidence

‘Evidence-based approaches to psychiatry’ describes the application of evidence-based medicine (EBM) to psychiatric practice. The chapter covers the key processes in EBM, including the formulation of a clinically relevant question, the systematic search for high-quality evidence and the meta-analytic synthesis of data. It demonstrates how evidence-based approaches to psychiatry have led to important developments showing quantitative effects of different treatments through advanced meta-analysis of data from randomized trials. This has underpinned the development of clinical guidelines that have the aim of improving the reliability and quality of treatments that patients receive. The chapter also describes how meta-analyses should be critically reviewed, as well as their problems and limitations. Not all relevant questions in psychiatric research are susceptible to the quantitative approach offered by EBM, and the chapter also outlines how qualitative methodologies can play a key role in answering important questions related, for example, to the patient experience.

scholarly journals Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-Analyses: Lessons From a Collaborative Effort

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Victor M Lu ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Michael J Link ◽  
Fredric B Meyer ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Lessons Learned ◽  
Evidence Based ◽  
Cranial Neuralgia ◽  
The Individual ◽  
Meta Analyses ◽  
Based Medicine ◽  
Over Time

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.

Living systematic reviews: A novel mechanism for improving efficiency and quality of evidence synthesis in oncology.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 241-241
Author(s):  
Irbaz Bin Riaz ◽  
Rabbia Siddiqi ◽  
Noureen Asghar ◽  
Elizabeth Jane Cathcart-Rake ◽  
Vitaly Herasevich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Principle Investigator

241 Background: In a rapidly moving field, such as cancer immunotherapy, where immune checkpoint inhibitors (ICIs) are used across 14 different tumor types, patients may receive suboptimal treatment or even be harmed if information on toxicity is not readily translated for use in clinical practice. Every single systematic review and meta-analysis which attempted to summarize toxicity of immune checkpoint inhibitors (ICIs) quickly became outdated. A living systematic review, which is defined as a systematic review that is continually updated to incorporate relevant new evidence as it becomes available, is necessary in this situation. Methods: The process of creating a living systematic review started with the creation of a comprehensive search designed by a librarian experienced in systematic reviews in collaboration with the study’s principle investigator. Search was constantly updated every 3 months and evidence is synthesized in a series of steps (microtasks) using a combination of human and augmented intelligence. A complete infrastructure is being developed and it includes automated cumulative meta-analysis and an online reporting platform which will constantly update information for clinicians and patients in a live manner. Results: We screened 6746 studies during Sep 2018-March 2019 and identified 6746 studies and we were able to successfully maintain up-to-date toxicity estimates for immune mediated adverse events over this period while maintaining the rigor of a conventional systematic review. Eventually, we will integrate the steps of LSR into one, user-friendly, semi-automated format which can independently provide accurate estimates and feed into and support a living guidelines platform through shared Application Programing Interface (APIs). Conclusions: LSRs are feasible, efficient, and when fully developed can reduce redundancy and waste in medical research, improve the quality of evidence, reduce human effort and support living and dynamic guidelines to facilitate truly informed shared decision making.

scholarly journals Evaluating the Quality of the Iranian Systematic Reviews, Meta-Analyses, and Economic Evaluations in Healthcare from 2005 to 2015

2021 ◽  
Author(s):  
Morteza Arab-Zozani ◽  
Zahra Heidarifard ◽  
Efat Jabarpour
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Time Horizon ◽  
Meta Analysis ◽  
Economic Evaluations ◽  
Evidence Based ◽  
Economic Perspective ◽  
Meta Analyses

Context: The number of studies on health is increasing rapidly worldwide and in Iran. Systematic review studies, meta-analyses, and economic evaluation are of great importance in evidence-based decision making because of their standing in the evidence-based pyramid. The purpose of this study was to evaluate the reporting and methodological quality of Iranian systematic reviews, meta-analysis studies and economic evaluations on healthcare. Evidence Acquisition: PubMed and Scopus databases were searched to find considered studies, including systematic reviews, meta analyses and economic evaluations published from 2005 to 2015. Because of the high volume of review studies, 10% of all systematic reviews and meta-analyses were selected as a random sample. Also, all economic evaluations were included. Articles were evaluated using checklists, including PRISMA, AMSTAR and QHES with a maximum score of 27, 11 and 100, respectively. The quality score for each criterion as well as the epidemiological and descriptive characteristics of all articles was determined. Data were analyzed using SPSS V. 16 software. Results: After searching the databases, 1084 systematic reviews and meta-analyses were obtained, 10% of which were included in the study. A total of 41 economic evaluations were also included. The mean scores of systematic reviews and meta-analyses based on PRISMA and AMSTAR checklists were 17.04 (5.35) and 5.42 (1.97), respectively, and 68.21 (12.44) for economic evaluations based on QHES. Only three systematic reviews and meta-analysis articles had recorded protocols and 85% of the studies included the terms “systematic review” and “meta-analysis” in their titles. Only one study had been updated. In addition, 81% of the systematic reviews and meta-analyses were published in specialized journals and 47% in Iranian journals. Financial resources and conflict of interests had been mentioned in 33% and 66% of the studies, respectively. Of the selected studies, 60% had evaluated the quality of the articles and 35% of the studies had assessed publication bias. In economic evaluations, 56% had used CEA analysis, 22% CUA analysis, 12% CBA analysis, and one study had used CMA analysis. Of these studies, 54% were model-based health economic studies and 12% were trial-based. The economic perspective was the health care system in most studies. Forty-four percent of the studies had a short time horizon of one year or less, whereas 33% had a lifetime horizon. Moreover, 68% of the studies showed sensitivity analysis and only 5 included the magnitude and direction of the bias. Conclusions: Overall, the reporting and methodological quality of the selected studies were estimated at a moderate level. Based on these results, it is recommended to adopt strategies to reduce preventable errors in studies. Having a primary plan and protocol and registering it as a systematic review can be an important factor in improving the quality of studies. Economic evaluations should also focus on issues, such as economic perspective, time horizon, available bias, and sensitivity analysis.

scholarly journals How to carry out a literature search for a systematic review: a practical guide

2018 ◽  
Vol 24 (2) ◽  
pp. 74-82 ◽  
Author(s):  
Lauren Z. Atkinson ◽  
Andrea Cipriani
Keyword(s):  
Literature Search ◽  
Search Strategy ◽  
Evidence Synthesis ◽  
Published Data ◽  
Evidence Based ◽  
List Type ◽  
Relevant Evidence ◽  
Search Terms ◽  
Based Medicine ◽  
Published Research

SUMMARYPerforming an effective literature search to obtain the best available evidence is the basis of any evidence-based discipline, in particular evidence-based medicine. However, with a vast and growing volume of published research available, searching the literature can be challenging. Even when journals are indexed in electronic databases, it can be difficult to identify all relevant studies without an effective search strategy. It is also important to search unpublished literature to reduce publication bias, which occurs from a tendency for authors and journals to preferentially publish statistically significant studies. This article is intended for clinicians and researchers who are approaching the field of evidence synthesis and would like to perform a literature search. It aims to provide advice on how to develop the search protocol and the strategy to identify the most relevant evidence for a given research or clinical question. It will also focus on how to search not only the published but also the unpublished literature using a number of online resources.LEARNING OBJECTIVES•Understand the purpose of conducting a literature search and its integral part of the literature review process•Become aware of the range of sources that are available, including electronic databases of published data and trial registries to identify unpublished data•Understand how to develop a search strategy and apply appropriate search terms to interrogate electronic databases or trial registriesDECLARATION OF INTERESTNone.

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