Académique Documents
Professionnel Documents
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CHRIS REDMAN
ALEX SANCHEZ-VIVAR
Presentation Overview
• Disadvantages
– time consuming
– not always any easy answers or what you hoped to find
– dispiriting if ‘good’ evidence is lacking i.e. little / poor
research done
Critical appraisal
Reviews
Systematic reviews
Rationale for systematic reviews
• Information overload
• Publication bias
• Missing link
– Inhalation of hexamethonium (comment by Clark et al, 2001)
Sources of systematic reviews
• Comprehensive search
– Databases
– Conference proceedings
– Hand searching
– Grey literature (reports, research registers)
– Foreign language
– Follow-up references
– Contacting experts/authors
• Publication bias – unpublished studies
• Explicit
Select and Assess Studies
• Checklists/scoring systems
What do the findings mean?
• P-values
• Confidence intervals
Using statistics
• If a CI for an RR or OR includes 1
(the line of no effect)
then we are unable to demonstrate statistically
significant difference between the two groups
What is a meta-analysis?
• BestBETs CA database
– http://www.bestbets.org/cgi-bin/browse.pl?~show=appraisal
References
• Funnel plots
– Bias in meta-analysis detected by a simple, graphical test.
Egger M, et al BMJ 1997 (315):629-634
– The case of the misleading funnel plot. Lau J, et al. BMJ
2006 (333):597-600
• Heterogeneity
– What is heterogeneity and is it important? Fletcher J BMJ
2007;334:94-6
The label tells you what the comparison and
outcome of interest are
Conventional
and cumulative
meta-analysis of
33 trials of
intravenous
streptokinase
for acute
myocardial
infarction.