Umbrella Reviews : Evidence Synthesis with Overviews of Reviews and Meta-Epidemiologic Studies

"This book is an ideal guide to umbrella reviews, overviews of reviews, and meta-epidemiologic studies for evidence synthesis. Research is conducted at different levels: primary research consists of original studies while secondary research comprises qualitative reviews, systematic reviews, and meta-analyses. Recently, a novel further level of research has been introduced, based on the analysis and pooling of reviews and meta-analysis. This book is the first to focus solely on this new type of research design, which permits a comprehensive and powerful synthesis of scientific evidence in medicine as well as in many other fields in order to inform decision-making. All aspects are covered, including review design and registration, the searching, abstracting, appraisal, and synthesis of evidence, the appraisal of moderators and confounders, and state of the art reporting. Case studies in a range of medical specialties are then presented. The hands-on approach of the book, written by a multinational team of experts, will enable the reader to interpret and independently conduct umbrella reviews." -- Font no determinada Foreword Acknowledgments References Contents Part I: Umbrella Reviews in the Evidence Hierarchy 1: Introduction References 2: Evidence Hierarchy 2.1 Introduction 2.2 Unsystematic Observations 2.3 Physiologic and Mechanistic Studies 2.4 Case Reports 2.5 Case-Control and Cross-Sectional Studies 2.6 Cohort Studies 2.7 Randomised Trials 2.8 Systematic Reviews and Meta-analyses Conclusions References 3: From Qualitative Reviews to Umbrella Reviews 3.1 Introduction 3.2 Definitions 3.3 From Single Studies (Primary Research) to ‘Specific’ Reviews (Traditional Secondary Research) 3.3.1 Primary Research and Secondary Research Relationship 3.3.2 Knowledge Synthesis 3.4 From ‘Specific’ or ‘Traditional’ Reviews to ‘More General’ or ‘Broad’ Reviews 3.4.1 Comparative Strengths of Different Evidence Synthesis Methods 3.4.2 Comparative Weaknesses of Different Evidence Synthesis Methods References 4: Umbrella Reviews, Overviews of Reviews, and Meta-epidemiologic Studies: Similarities and Differences 4.1 Introduction 4.2 Umbrella Reviews 4.3 Overviews of Reviews 4.3.1 Definition and Method of Conduct 4.3.2 Examples from the Literature 4.4 Meta-Epidemiology 4.4.1 Definition, Purpose, and Classification 4.4.2 Meta-Epidemiology in the Literature 4.5 Similarities and Differences Conclusion References Part II: Sound Design, Conduct, and Reporting 5: Designing the Review 5.1 Introduction 5.2 Terminology 5.3 Overview Team/Organizational Issues 5.4 Scope/Objective 5.5 Title 5.6 Background 5.7 Eligibility Criteria for Inclusion/Exclusion of Studies 5.7.1 Participants 5.7.2 Interventions/Comparisons 5.7.3 Outcomes 5.7.4 Study Design 5.8 Search for Studies to Be Included in the Overview 5.9 Study Selection 5.10 Data Collection 5.10.1 Data Collection at the Level of the Review, the Primary Studies, and the Authors 5.10.2 Basic Data to Exclude from Each Included Systematic Review 5.11 Assessment of Methodological Limitations (“Quality”) 5.11.1 Limitations at the Level of the Primary Studies 5.11.2 Limitations at the Level of the Systematic Reviews 5.11.3 Quality of the Overall Body of Evidence 5.12 Research Synthesis 5.12.1 Qualitative (Narrative) Synthesis of the Included Reviews 5.12.2 Semiquantitative Synthesis of the Included Reviews 5.12.3 Dealing with Overlapping and Discordant Reviews 5.12.4 Quantitative Synthesis of Review Results 5.13 Presentation of Findings 5.14 Limitations 5.15 Considerations for Meta-epidemiological Studies Conclusions References 6: Registering the Review 6.1 Introduction 6.2 Why Register a Protocol 6.3 Registration Options 6.4 Reviews of Reviews in PROSPERO 6.5 Registering a Review of Reviews on PROSPERO 6.5.1 Completing Methods Fields for a Review of Reviews 6.5.1.1 Review Question and Title 6.5.1.2 Searches 6.5.1.3 Condition, PICO and Context 6.5.1.4 Types of Reviews 6.5.1.5 Data Extraction 6.5.1.6 Quality Assessment 6.5.1.7 Data Synthesis and Subgroup Analyses 6.5.1.8 Dissemination 6.6 Practicalities of Registration Conclusion References 7: Searching Evidence 7.1 Introduction 7.2 Identifying Studies for Inclusion in Traditional Systematic Reviews versus Identifying Reviews for Inclusion in Umbrella Reviews 7.3 Sources to Use to Identify Reviews for Inclusion in Umbrella Reviews 7.3.1 Cochrane Database of Systematic Reviews (CDSR): http://www.thecochranelibrary.com/ 7.3.2 Health Technology Assessment (HTA) Database: http://www.crd.york.ac.uk/CRDWeb/ 7.3.3 Campbell Library: http://www.campbellcollaboration.org/lib/ 7.3.4 The Database of Promoting Health Effectiveness Reviews (DoPHER): http://eppi.ioe.ac.uk/webdatabases/Intro.aspx?ID=2 7.3.5 Health Systems Evidence: http://www.mcmasterhealthforum.org/hse/ 7.3.6 The JBI Database of Systematic Reviews and Implementation Reports: http://joannabriggslibrary.org/index.php/jbisrir 7.3.7 3ie Systematic Review Database: http://www.3ieimpact.org/en/evidence/systematic-reviews/ 7.3.8 PROSPERO: http://www.crd.york.ac.uk/prospero/ 7.3.9 Social Care Online: http://www.scie-socialcareonline.org.uk/ 7.3.10 The Medion Database: http://www.mediondatabase.nl/ 7.3.11 Epistemonikos: http://www.epistemonikos.org/ 7.3.12 TRIP: http://www.tripdatabase.com/ 7.3.13 Sumsearch: http://sumsearch.org/ 7.3.14 Guideline Collections 7.3.14.1 The National Guidelines Clearinghouse (NGC): http://www.guideline.gov/index.aspx 7.3.14.2 The National Institute for Health and Care Excellence (NICE) Website: https://www.nice.org.uk/guidance 7.3.14.3 Scottish Intercollegiate Guidelines Network (SIGN): http://www.sign.ac.uk/ 7.3.15 Using Bibliographic Databases Such as MEDLINE and Embase 7.3.16 McMaster University’s Hedges Project: http://hiru.mcmaster.ca/hiru/HIRU_Hedges_home.aspx 7.3.17 McMaster’s Health Evidence Website: http://www.healthevidence.org/default.aspx 7.3.18 Other Websites: https://sites.google.com/a/york.ac.uk/issg-search-filters-resource/home 7.4 Summary References 8: Abstracting Evidence 8.1 Introduction 8.2 Collection of Review Data 8.3 Collection of Study Data 8.4 Troubleshooting Conclusion References 9: Appraising Evidence 9.1 Introduction 9.2 Tools to Evaluate Quality of Individual Studies 9.3 Tools to Inform Reporting of Systematic Reviews 9.4 Tools to Appraise the Quality of Systematic Reviews 9.5 Tools to Appraise the Quality of Network Meta-analyses Conclusions References 10: Statistical Models for Overviews of Reviews 10.1 Introduction 10.2 Basic Model 10.3 Bayesian Approach to Statistical Analysis of Umbrella Review 10.4 Generalized Least-Squares Approach to Umbrella Review 10.5 Practical Example: The Effects of Topical Antibiotics for Chronically Discharging Ears with Underlying Eardrum Perforations 10.6 Inconsistency Within a Umbrella Review 10.7 Results from Bayesian Analysis 10.8 Results from Generalized Least-Squares Analysis 10.9 Network Meta-analysis of Example Data 10.10 Discussion Appendix 10.1: WinBUGS Code of Umbrella Review Appendix 10.2: Stata Codes for Statistical Analysis of Umbrella Reviews References 11: Bayesian Approach to Evidence Synthesis 11.1 Introduction 11.2 The Case of Binary Data 11.2.1 Bayesian Model Selection Problems Conclusion References 12: Appraising Between-Study Homogeneity, Small-Study Effects, Moderators, and Confounders 12.1 Introduction 12.2 Approaches for Assessing the Between-Study Heterogeneity 12.2.1 Graphical Representation of the Between-Study Heterogeneity 12.2.1.1 Forest Plot 12.2.1.2 Galbraith Plots 12.2.1.3 L’Abbé Plot 12.2.1.4 Baujat Plot 12.2.2 Statistical Tests for the Evaluation of the Between-Study Variance 12.2.2.1 Cochran Q-Statistic 12.2.2.2 Generalized Q-Statistic 12.2.2.3 Cochran Q-Statistic Adjusted for Small-Study Effects 12.2.3 Statistical Measures to Quantify Between-Study Variance 12.2.3.1 H2 Index 12.2.3.2 I2 Index I2 Index Based on Cochran Q-Statistic I2 Index Based on Generalized Q-Statistic 12.2.3.3 R2 Index 12.2.3.4 D2 Index 12.2.3.5 G2 Index 12.2.4 Estimating the Between-Study Variance 12.2.4.1 Approaches for the Between-Study Variance Point Estimate Method of Moments Estimators DerSimonian and Laird (DL) Paule and Mandel (PM) Maximum Likelihood Estimators Maximum Likelihood (ML) Restricted Maximum Likelihood (REML) Bayes Estimators Full Bayes (FB) 12.3 Possible Causes and Approaches to Deal with Heterogeneity 12.4 Methods to Appraise Small-Study Effects 12.4.1 Graphical Representation of Small-Study Effects 12.4.2 Tests for Small-Study Effects and Selection Bias 12.4.2.1 Funnel Plot-Based Tests 12.4.3 Adjusting Intervention Effect Estimates for Small-Study Effects 12.4.3.1 Trim-and-Fill Method 12.4.3.2 Selection Models 12.4.3.3 Extrapolation Methods 12.5 Moderators and Confounders 12.6 Discussion References 13: State-of-the-Art Reporting 13.1 Introduction 13.2 Reporting Checklist 13.2.1 Title and Abstract 13.2.1.1 Title 13.2.1.2 Structured Summary 13.2.2 Introduction 13.2.2.1 Rationale 13.2.2.2 Objectives 13.2.3 Methods 13.2.3.1 Protocol and Registration 13.2.3.2 Criteria for Considering Reviews for the Overview 13.2.3.3 Information Sources 13.2.3.4 Search Strategy 13.2.3.5 Review Selection 13.2.3.6 Additional Searches to Identify Other Relevant Primary Studies 13.2.3.7 Data Extraction and Management 13.2.3.8 Data Items 13.2.3.9 Assessment of Methodological Quality of Included Reviews 13.2.3.10 Data Synthesis 13.2.4 Results 13.2.4.1 Review Selection 13.2.4.2 Review Characteristics 13.2.4.3 Assessment of Methodological Quality of Included Reviews 13.2.4.4 Syntheses of Results 13.2.5 Discussion 13.2.5.1 Summary of Evidence 13.2.5.2 Limitations 13.2.5.3 Conclusions 13.2.5.4 Funding 13.3 Conclusion References Part III: Case Studies 14: Case Study of Allied Health and Complementary and Alternate Medicine 14.1 Introduction 14.2 What Are Allied Health and Complementary and Alternate Therapies? 14.3 Case Studies of Allied Health and Complementary and Alternate Medicine 14.3.1 Case Study 1: Massage Therapy 14.3.2 Case Study 2: Exercise 14.3.3 Case Study 3: Spinal Manipulation 14.3.4 Case Study 4: Acupuncture 14.4 Discussion Conclusion References 15: Case Study in Dentistry 15.1 Introduction 15.2 Definitions 15.3 Overviews of Systematic Reviews in Dentistry 15.3.1 The Case of Periimplantitis Treatment 15.3.2 The Case of Animal Research in Dentistry 15.3.3 Can Periodontitis Affect the Survival of Dental Implants? 15.3.4 Use of Systemic Antimicrobials for Treating Periodontitis 15.3.5 Root Coverage Procedures 15.3.6 Search Strategies Used in SRs 15.3.7 Methodological Tools in SRs 15.3.8 Reporting Abstracts of SRs 15.3.9 Reporting Funding Source in SRs 15.3.10 The Case of Economic Evaluation in Dentistry Conclusion References 16: Case Study in Neonatology 16.1 Introduction 16.2 Recognising Risk for Mechanical Ventilation 16.3 Antenatal Preparation for Delivery: Prevention of Preterm Birth (Table 16.3) 16.3.1 Tocolytics for Threatened Preterm Labour 16.3.2 Tocolytics for Women with Preterm Premature Rupture of Membranes (PPROM) 16.3.3 Antibiotics for Women with PPROM 16.3.4 Asymptomatic Women at Risk of Preterm Birth 16.3.5 Progesterone 16.3.6 Cervical Cerclage 16.3.7 Summary 16.4 Antenatal Preparation for Delivery: Maturation of the Foetus (Table 16.3) 16.4.1 Antenatal Corticosteroids 16.4.2 Repeat Doses of Antenatal Corticosteroids 16.5 Preventing Respiratory Morbidity at Term Gestation (Table 16.3) 16.5.1 Induction of Labour for Improving Birth Outcomes for Women at or beyond Term 16.6 Postnatal Respiratory Support Strategies for Avoiding Mechanical Ventilation in Preterm Infants (Table 16.4) 16.6.1 Continuous Positive (or Negative) Airway Pressure Support 16.6.2 Nasal Intermittent Positive Pressure Ventilation 16.7 Non-invasive Surfactant Strategies in Preterm Infants for Preventing Mechanical Ventilation (Table 16.4) 16.7.1 Nebulised Surfactant 16.7.2 Laryngeal Mask Airway Surfactant Administration 16.7.3 Thin Catheter-Delivered Surfactant 16.8 Intubation and Surfactant Strategies for Minimising Mechanical Ventilation (Table 16.5) 16.8.1 Premedication and Techniques of Intubation 16.8.2 Early Versus Delayed Surfactant 16.8.3 Prophylactic Versus Delayed Selective Surfactant 16.8.4 Pre- Versus Post-ventilatory Surfactant in Preterm Infants 16.8.5 Multiple versus Single Doses of Exogenous Surfactant in Preterm Infants 16.9 Surfactant in Full-Term/Near-Term Infants (Table 16.5) 16.9.1 Surfactant for Meconium Aspiration Syndrome 16.10 Minimising Mechanical Ventilation and Its Side Effects for Ventilated Infants (Table 16.6) 16.10.1 Analgesia, Sedation and Neuromuscular Blockade of Ventilated Newborn Infants 16.10.1.1 Midazolam 16.10.1.2 Morphine 16.10.1.3 Neuromuscular Blockade 16.11 Minimising Side Effects of Conventional Ventilation (Table 16.6) 16.11.1 Inspiratory Time and Rate 16.11.2 Synchronised Ventilation 16.11.3 Volume-Targeted Ventilation versus Pressure- 16.12 Minimising Side Effects of High-Frequency Oscillation Ventilation (HFOV) (Table 16.6) 16.12.1 Preterm Infants 16.12.2 Term Infants 16.13 Pulmonary Vasodilators in Infants with Lung Disease (Table 16.6) 16.13.1 Nitric Oxide in Preterm Infants 16.13.2 Nitric Oxide in Term Infants 16.13.3 Sildenafil in Term Infants with Pulmonary Hypertension 16.14 Strategies for Facilitating Extubation and Avoiding Reintubation (Table 16.7) 16.14.1 Methylxanthines 16.14.2 Ventilation Settings Prior to Extubation 16.14.3 Extubation to Respiratory Support 16.14.4 Corticosteroids in Preterm Infants with Lung Disease 16.14.4.1 Early ( 7 Days) Postnatal Corticosteroids for Chronic Lung Disease in Preterm Infants 16.14.5 Diuretics in Preterm Infants with Lung Disease 16.15 Oxygen Targeting in Newborn Infants (Table 16.6) 16.15.1 At Resuscitation for Term Infants 16.15.2 At Resuscitation for Preterm Infants 16.15.3 Early Saturation Targeting in Preterm Infants 16.15.4 Late Saturation Targeting in Preterm Infants 16.15.5 Summary Conclusion References 17: Case Study in Nursing 17.1 Introduction 17.2 Case Study 1: Handover and Nursing 17.2.1 Synopsis 17.2.1.1 Introduction 17.2.1.2 Methods 17.2.1.3 Results 17.2.1.4 Conclusion 17.2.2 Introduction 17.2.3 Objective 17.2.4 Methods 17.2.4.1 Inclusion Criteria 17.2.4.2 Exclusion Criteria 17.2.4.3 Quality Assessment 17.2.4.4 Data Analysis 17.2.5 Result 17.2.6 Discussion 17.2.6.1 Special Context (Ambulance to Emergency Department) 17.2.6.2 Tools and Intervention to Improve Handover Process 17.2.6.3 Handover Content 17.2.7 Conclusion 17.3 Case Study 2: E-Learning in Nursing Education in Academic Fields 17.3.1 Synopsis 17.3.1.1 Introduction 17.3.1.2 Method 17.3.1.3 Results 17.3.1.4 Conclusions 17.3.2 Introduction 17.3.3 Objective 17.3.4 Methods 17.3.4.1 Search Strategy 17.3.4.2 Inclusion Criteria 17.3.4.3 Exclusion Criteria 17.3.4.4 Quality Appraisal 17.3.5 Result 17.3.6 Population 17.3.7 Methodology 17.3.8 Evaluation 17.3.9 Conclusion 17.3.10 Limitations and Strengths References 18: Case Study in Orthopedics 18.1 Introduction 18.1.1 General Assumptions 18.1.2 Why Was this Umbrella Review Needed? 18.1.3 Terminology and Methodological Issues: The Report as a Case Study within this Methods Handbook 18.2 Methodology and Reporting 18.2.1 The Case Study on Adolescent Idiopathic Scoliosis: Report of the Umbrella Review 18.2.2 Background 18.2.2.1 Description of the Health Problem 18.2.2.2 Screening and Nonsurgical Management 18.2.2.3 National and International Guidelines and Recommendations 18.2.3 Methods 18.2.3.1 Inclusion and Exclusion Criteria 18.2.3.2 Search Strategy 18.2.3.3 Study Selection 18.2.3.4 Scope of the Systematic Reviews 18.2.3.5 Types of Outcomes 18.2.3.6 Data Extraction, Methodological Quality, and Level of Evidence Assessment Data Extraction Methodological Quality Levels of Evidence 18.2.4 Results 18.2.4.1 Description of Included Reviews/Quantity of Research Available 18.2.4.2 Methodological Quality of Included Reviews/Quality Assessment 18.2.4.3 Levels of Evidence of the Included Reviews 18.2.5 Discussion 18.2.5.1 Brief Summary of Evidence from Included Reviews 18.2.5.2 Screening 18.2.5.3 Scoliosis-Specific Exercises (SSE) 18.2.5.4 Manual Therapies 18.2.5.5 Bracing 18.2.5.6 Quality Analyses 18.2.5.7 Limitations of the Study 18.2.6 Conclusions: What this Study Adds 18.2.6.1 Methodological Considerations 18.2.6.2 Conclusions of Case Study Issue 18.2.6.3 Implications for Practice 18.2.6.4 Conclusions and Implications for Research 18.3 Additional Details References 19: Case Study in Prevention 19.1 Introduction 19.2 Methods: Step by Step 19.2.1 Designing the Research Question 19.2.2 Search Strategy 19.2.3 Study Selection 19.2.4 Data Extraction 19.2.5 Methodological Quality and Evidence Level Assessment 19.2.6 Registration and Ethical Aspects 19.3 Results: Synthesizing the Available Evidence References 20: Case Study of Public Health 20.1 Introduction 20.2 Health Inequalities and the Social Determinants of Health 20.3 Case Studies in Health Inequalities and the Social Determinants of Health 20.3.1 Case Study 1: Transport and Health [9] 20.3.2 Case Study 2: Housing and Health [10] 20.3.3 Case Study 3: Health-Care Service Quality [11] 20.3.4 Case Study 4: Equity in Health-Care Services [12] 20.3.5 Case Study 5: Workplace Health [13] 20.3.6 Case Study 6: Wider Determinants of Health [2] 20.4 Discussion Conclusion References Part IV: Implementation and Further Research 21: Moving from Evidence to Action 21.1 Introduction 21.2 When Search for Umbrella Review Is Needed 21.3 How to Correctly Appraise 21.4 How to Correctly Grade References 22: Avenues for Further Research 22.1 Preface and Foreword 22.2 Standardized Terms and Definition(s) Needed 22.3 Balancing the Needs of Different Users 22.4 Registration 22.5 Database of Overviews 22.6 Methods: One Size Fits All? 22.7 Reporting and Quality Assessment 22.8 Conflicts/Declaration of Interests 22.9 Presenting Results Conclusions References 23: Conclusion References