reporting systematic reviews christine laine, md, mph editor, annals of internal medicine
TRANSCRIPT
Reporting Systematic Reviews
Christine Laine, MD, MPHEditor, Annals of Internal Medicine
Elements of Well-Reported Reviews Address a good question, state it
clearlyDetailed description of search,
selection, and evaluation of evidenceDigestible reporting of available
studiesThoughtful qualitative synthesis
(even if quantitative summary)Discussion that puts findings in
context
McAlister, F. A. et. al. Ann Intern Med 1999;131:947-951
Percentage of 158 review articles published in 1996 that fulfilled specific methodologic criteria
Common ProblemsToo longInsufficient detail to permit
replicationAging searchUndigestible catalog of available
evidenceWeak qualitative synthesisInadequate handling of heterogeneityLack recognition of impending
evidence
Too longFollow instructionsJudicious use of tables and
figuresProvide technical material in
appendicesVery brief introFocussed discussion
Follow PRISMA checklistTechnical appendices
Insufficient detail
Summary of evidence search and selection.
Bloomfield H E et al. Ann Intern Med 2011;154:472-482
©2011 by American College of Physicians
Advise that end date of search be 3-6 months prior to submission
Bridge searches if necessaryImportance of currency of search
can be very topic-dependent
Aging Search
Judicious use of tables and figures
Qualitative synthesis is criticalSummary evidence tables
Undigestible Catalog of Results
Synthesize the EvidenceAvoid merely listing results of individual
studies… “Smith found no effect, while Jones and
colleagues found a significant effect…”
Acknowledge quality of underlying evidence…
“Smith found no effect in a small, open, non-randomized trial. However, Jones and colleagues found a significant effect compared to placebo in a large, placebo-controlled trial…”
Summary of Evidence.
Nelson H D et al. Ann Intern Med 2009;151:727-737
©2009 by American College of Physicians
Major thromboembolic events in PST or PSM versus usual care studies.PSM = patient self-management; PST = patient self-testing.
Bloomfield H E et al. Ann Intern Med 2011;154:472-482
©2011 by American College of Physicians
Risk for bias.ITT = intention-to-treat.
Bloomfield H E et al. Ann Intern Med 2011;154:472-482
©2011 by American College of Physicians
Routinely address in methods and results
Acknowledge in discussion how heterogeneity influences conclusions
Inadequate handling of heterogeneity
Search trials registriesMention ongoing trials and
anticipated availability in discussion
Need more routine description of updating process, expiration dates
Impending Evidence
Optimizing Review Reporting
Clear question(s)Provide detail but be conciseJudicious use of tables, figures,
technical appendicesSummary evidence tablesQualitative synthesesDiscuss anticipated new evidence