系統性文獻回顧及統合分析介紹 - chimei.org.tw

1 1 Outline Steps for systematic reviewSteps for systematic review Data analysis, present and interpret resultsData analysis, present and interpret results : 3 Number of publications about metaNumber of publications about meta--analysisanalysis systematic review or evidencesystematic review or evidence--based medicinebased medicine text word text word systematic reviewsystematic review medical subject (MESH) heading medical subject (MESH) heading evidenceevidence--based medicinebased medicine and and metameta--analysisanalysisas topicas topic publication type as publication type as metameta--analysisanalysis Lin PC et al.

2 FIP 2008, Lin PC et al. FIP 2008, PIPI--PP--022022501050205030504050505060 5070508050before 1988198819891990199119921993199419951996 1997199819992000200120022003200420052006 20074 (systematic review and meta-analysis)5 What is metaWhat is meta--analysis?analysis? Systematic reviewSystematic review a clearly stated set of a clearly stated set of objectivesobjectiveswith with prepre--defined eligibility defined eligibility criteria for studiescriteria for studies an an explicit, explicit, reproduciblereproduciblemethodologymetho dology a a systematicsystematicsearchsearchthat attempts to that attempts to identify identify allallstudiesstudiesthat that would meet the eligibility criteriawould meet the eligibility criteria an an assessment of the assessment of the validityvalidityof the findings of the included of the findings of the included studies, for example through the assessment of risk of biasstudies, for example through the assessment of risk of bias a a systematicsystematicpresentation, and synthesispresentation, and synthesis, of the.

3 Of the characteristics and findings of the included studiescharacteristics and findings of the included studies MetaMeta--analysisanalysis statistical procedurestatistical procedurefor combining data from independent for combining data from independent studiesstudiesCochrane Handbook for Systematic Reviews of InterventionsCochrane Handbook for Systematic Reviews of InterventionsVersion [updated March Version [updated March 2011]. The Cochrane Collaboration, 2011. Available from ]. The Cochrane Collaboration, 2011. Available from 6 Ann Intern Med. 2011;155 to conduct a metaHow to conduct a meta--analysisanalysis 1996: QUOR1996: QUOROOMM quality of reporting metaquality of reporting meta--analysisanalysis 2009/7: PRISMA Ann Intern Med 2009; 151(4):2642009/7: PRISMA Ann Intern Med 2009; 151(4):264--99 Preferred reporting items for systematic reviews and metaPreferred reporting items for systematic reviews and meta--analysisanalysis Avoiding publication bias, language bias or outcome Avoiding publication bias, language bias or outcome measure etc.

4 72011/9/302010/11/188 QUORQUOROOMML ancet 1999; 354:1896-900 Potentially relevant RCTsPotentially relevant RCTsidentified identified and screened for retrieval (n= and screened for retrieval (n= ------))RCTs retrieved for RCTs retrieved for more detailed more detailed evaluationevaluation(n= (n= ------))Potentially appropriate RCTsPotentially appropriate RCTsto be to be included in the metaincluded in the meta--analysis (n= analysis (n= ----))RCTs includedRCTs includedin metain meta--analysis analysis (n= (n= ------))With usable informationWith usable informationby by outcome (n= outcome (n= ------))RCTs excluded, with RCTs excluded, with reasons (n= reasons (n= ------))RCTs excluded, with RCTs excluded, with reasons (n= reasons (n= ------))RCTs excluded from metaRCTs excluded from meta--analysis, with reasons (n= analysis, with reasons (n= ------))RCTs withdrawn, by outcome, RCTs withdrawn, by outcome, with reasons (n= with reasons (n= ------))Progress through the Progress through the stages of a metastages of a meta--analysis for RCTsanalysis for RCTs2011/9/3092010/11/1892010/09/0491020 10/11/18102010/09/041011 HowHowto conduct a metato conduct a meta--analysisanalysis Steps for systematic reviewSteps for systematic review Formulate review questionFormulate review question Define inclusion and exclusion criteriaDefine inclusion and exclusion criteria Locate studiesLocate studies Select studiesSelect studies Extract dataExtract data Assess study qualityAssess study quality Data analysis, present and interpret resultsData analysis, present and interpret resultsEgger M et al.

5 Egger M et al. Systematic Reviews in Health Care: MetaSystematic Reviews in Health Care: Meta--analysis in analysis in context. BMJ, 2rd edition 2005context. BMJ, 2rd edition 200512 HowHowto conduct a metato conduct a meta--analysisanalysis Steps for systematic reviewSteps for systematic review Formulate review questionFormulate review question Define inclusion and exclusion criteriaDefine inclusion and exclusion criteria Locate studiesLocate studies Search strategy (reproducible)Search strategy (reproducible) Key words Key words MeSH termsMeSH terms Databases Databases PubMed or MedlinePubMed or Medline EMBASEEMBASE CINHALCINHAL PEDroPEDro Conference abstract (dependent)Conference abstract (dependent) Reference lists of the identified articlesReference lists of the identified articles Hand searchHand search Registered centersRegistered centers13 RCT RCT International Clinical Trials Registry PlatformInternational Clinical Trials Registry Platform(ICTRP)(ICTRP)

6 James Lind Library Lind Library Lind Library James Lind Library CochraneCochraneCollaborationCollaborati on Iain ChalmerIain Chalmer ((fair test)fair test) 14 RCT RCT The Cochrane Central Register of Controlled Trials (Clinical The Cochrane Central Register of Controlled Trials (Clinical TrialsTrials))

7 CENTRALCENTRAL MEDLINEMEDLINE EMBASEEMBASE 3/53/5 MEDLINEMEDLINE Cochrane Review GroupsCochrane Review Groups US US Cochrane CenterCochrane Center Cochrane LibraryCochrane Library The Society for Clinical TrialsThe Society for Clinical Clinical TrialsClinical Trials ; ; IRBIRB 16 HowHowto conduct a metato conduct a meta--analysisanalysis Steps for systematic reviewSteps for systematic review Formulate review questionFormulate review question Define inclusion and exclusion criteriaDefine inclusion and exclusion criteria Locate studiesLocate studies Select studiesSelect studies At least 2 reviewers At least 2 reviewers independentlyindependentlyevaluated each evaluated each identified study and abstracted relevant characteristics identified study and abstracted relevant characteristics Contact authorsContact authorsfor the unpublished data for the unpublished data 17 HowHowto conduct a

8 Metato conduct a meta--analysisanalysis Steps for systematic reviewSteps for systematic review Formulate review questionFormulate review question Define inclusion and exclusion criteriaDefine inclusion and exclusion criteria Locate studiesLocate studies Select studiesSelect studies Extract dataExtract data Assess study qualityAssess study quality Prepare tables comparing studies with respect to:Prepare tables comparing studies with respect to: Authors, YearAuthors, Year PPatients (setting)atients (setting) IInterventionntervention CComparisonomparison OOutcome (results)utcome (results) Study qualityStudy quality2011/9/3018 Quality Quality of included studiesof included studies Scale (score) approachScale (score) approach Jadad scaleJadad scale Chalmers TCChalmers TC ------------------ Components approachComponents approach Scales or components?Scales or components?Health Technol Assess.

9 1999;3(12):i-iv, 1-98212010/11/1821222010/11/1822 Study quality Study quality Jadad scoreJadad scoreModified from Controlled Clin Trials. 1996; 17:1-1223 BMJ. 2008 Jun 14;336(7657):1359-6124 Aliment Pharmacol Ther 2002; 16: 1623 conduct a metato conduct a meta--analysisanalysis Steps for systematic reviewSteps for systematic review Formulate review questionFormulate review question Define inclusion and exclusion criteriaDefine inclusion and exclusion criteria Locate studiesLocate studies Select studiesSelect studies Extract dataExtract data Assess study qualityAssess study quality Data analysis, present and interpret resultsData analysis, present and interpret resultsHowHowto conduct a metato conduct a meta--analysisanalysis Data analysis, present and interpret resultsData analysis, present and interpret results Systematic review or metaSystematic review or meta--analysisanalysisMoher D et al.

10 Arch Pediatr Adolesc Med 1998;152:915-20 HowHowto conduct a metato conduct a meta--analysisanalysis Data analysis, present and interpret resultsData analysis, present and interpret results Systematic review or metaSystematic review or meta--analysisanalysis Treatment effect (effect size)Treatment effect (effect size) Continuous data: standardized (differences in means)Continuous data: standardized (differences in means) Dichotomous dataDichotomous data Difference scale: risk differenceDifference scale: risk difference Ratio scale: odds ratio, risk ratio (hazard ratio)Ratio scale: odds ratio, risk ratio (hazard ratio) Point estimate (forest plot) or cumulative forest plotPoint estimate (forest plot) or cumulative forest plot28 Calculation of RR (relative risk, risk ratio) Experimental event rate (EER) = a/(a+b) Experimental event rate (EER) = a/(a+b) Control event rate (CER) = c/(c+d)Control event rate (CER) = c/(c+d) RR= EER/CER= (a/a+b)/(c/c+d)RR= EER/CER= (a/a+b)/(c/c+d)TreatmentEventPositiveNeg ativeExposed (experimental)abNot exposed cd29 Calculation of OR (odds ratio.)