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EBM Quiz 4: Systematic Review
systematic review
12
Anatomy
Graduate
04/06/2011

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Term
A systematic review is any type of synthesis of ___ on a topic that has been prepared using strategies to minimize ___.
Definition
- synthesis of evidence
- using strategies to minimize errors
Term
Individual studies in a systematic review may be combined statistically using ___ ____, or may be described ___.
Definition
- combined statistically using meta-analysis
- described qualitatively
Term
steps of a systematic review:
Definition
- identify studies> review for relevance
- relevant studies> evaluate methodological quality> extract data> analyze data> draw conclusions
Term
What are the 4 S's of EBM and describe each?
Definition
- Studies: original published articles in journals
- Synthesis: Cochrane reviews
- Synopses: evidence based journal extracts
- Systems: compuertized decision report system (CDSS)
Term
The "trickle down" of knowledge to practice:
Definition
unsound research> sound research> Systematic reviews and CATs> Synopses> Systems> aware, acceptable, applicable, acted on, agreed to, adhered to
Term
In finding studies for a systematic review and meta-analysis, all relevant studies should be included, __ and ___.
Definition
- published and unpublished
Term
__ __ with systematic review and meta-analysis is analogous to __ __ in experimental and observational studies.
Definition
- Publication bias
- Selection bias
Term
Publication bias can be detected ___ by a __ __. Often times __ __ and __ __ indicate this. Publication bias can also be determined ___ by calculating the __ __ __.
Definition
- graphically by a funnel diagram
- large studies and positive results
- statistically "fail-safe-N"
Term
A meta-analysis is a ___ ___ that combines or integrates the results from several independent studies. The purpose is to reach conclusions or address questions that were not possible on the basis of __ investigations. This has largely replaced ___ __ in __ ___.
Definition
- statistical analysis
- single
- largely replaced review articles in clinical journals
Term
Why have meta-analysis studies largely replaced review articles in clinical journals?
Definition
- they present quantitative data
- more objective than qualitative reviews
- may allow greater insight into variation in results among studies
Term
History of Meta-analysis. Glass first coined the term in "__ __ _ ___" in 1976. He addressed four categories of criticism of meta-analysis including:
Definition
- "the analysis of analyses"
4 problems:
- apples and oranges problem
- use of poor studies
- selection publication bias
- lumpy non-independent data
Term
funnel plot is a scatterplot of treatment effect against a measure of study size. It is used primarily as a visual aid to detecting bias or systematic heterogeneity. A symmetric inverted funnel shape arises from a ‘well-behaved’ data set, in which publication bias is unlikely. An asymmetric funnel indicates a relationship between treatment effect and study size. This suggests the possibility of either publication bias or a systematic difference between smaller and larger studies (‘small study effects’). Asymmetry can also arise from use of an inappropriate effect measure. Whatever the cause, an asymmetric funnel plot leads to doubts over the appropriateness of a simple meta-analysis and suggests that there needs to be investigation of possible causes.

A variety of choices of measures of ‘study size’ is available, including total sample size, standard error of the treatment effect, and inverse variance of the treatment effect (weight). Sterne and Egger have compared these with others, and conclude that the standard error is to be recommended.[3] When the standard error is used, straight lines may be drawn to define a region within which 95% of points might lie in the absence of both heterogeneity and publication bias.[3]
Definition
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