systematic reviews: meta-analysis and meta-synthesis

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systematic reviews: meta-analysis and meta-synthesis
2013-12-05 23:30:07
3215 final
3215 final
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  1. research integration and synthesis
    The systematic and rigorous integration and synthesis of evidence is a cornerstone of EBP.

    Impossible to develop “best practice” guidelines, protocols, and procedures without organizing and evaluating research evidence through a systematic review
  2. systematic review
    is a review that methodically integrates research evidence about specific research question using careful sampling and data collection procedures that are spelled out in advance in a protocol
  3. forms of systematic reviews
    • meta-analysis
    • metasynthesis
  4. meta-analysis
    • statistical integration of results used to compute common effect size. effect sixes are averaged across studies, yielding not only information about the existence of a relationship between variable in many studies but also an estimate of its magnitude across studies
    • it is the pinnacle of traditional evidence hierarchies
  5. metasynthesis
    • theoretical integration and interpretation of qualitative findings
    • are products that are more than the sum of the parts - they offer new insights and interpretation of findings
  6. meta-analysis advantages
    Objectivity—statistical integration eliminates bias in drawing conclusions when results in different studies are at odds.

    Increased power—reduces the risk of a type II error compared to a single study
  7. criteria for meta-analysis in systematic review
    Research question or hypothesis should be essentially identical across studies.–The “fruit” problem—don’t combine apples and oranges!

    Must be a sufficient knowledge base—must be enough studies of acceptable quality

    Results can be varied but not totally at odds.
  8. Steps in a Meta-Analysis
    Problem formulation: Delineate research question or hypothesis to be tested.

    Design of meta-analysis: Identify sampling criteria for studies to be included.

    Search for evidence in literature: Develop and implement a search strategy.

    Evaluation of study quality: Locate and screen sample of studies meeting the criteria.

    Extract and encode data for analysis.

    Calculate effects.

    Data analysis
  9. Evaluating Study Quality
    • Meta-analysts must make decisions about
    • handling study quality
  10. approaches to evaluating study quality
    • –Omit low-quality studies (e.g., in
    • intervention studies, non-RCTs).

    –Give more weight to high-quality studies.

    • –Analyze low- and high-quality studies to
    • see if effects differ (sensitivity
    • analyses).
  11. Metasynthesis:Some Ongoing Debates
    Whether to exclude low-quality studies

    Whether to integrate studies based in multiple qualitative traditions

    Various typologies and approaches; differing terminology
  12. Metasynthesis:Steps
    Similar to meta-analysis in many ways

    –Formulate problem.

    • –Decide on design: selection criteria,
    • search strategy.

    –Search for data in the literature.

    –Evaluation of study quality.

    –Extract data for analysis.

    –Data analysis and interpretation