Introduction to EIDM and Systematic Reviews

Discover the foundations of evidence-informed decision-making with our introductory slides on "Introduction to EIDM and Systematic Reviews." This presentation covers:

1) The principles and importance of Evidence-Informed Decision Making (EIDM)
2) An overview of systematic reviews and their role in EIDM
3) Steps in conducting a systematic review, from protocol development to data synthesis
4) Key methodologies and best practices for systematic reviews
5) Examples of how systematic reviews inform policy and practice
6) Tools and resources for conducting and utilizing systematic reviews

Ideal for researchers, policymakers, and practitioners new to EIDM and systematic reviews, these slides provide a comprehensive introduction to these essential concepts. Empower your decision-making process with rigorous evidence from systematic reviews.

1. [email protected] / www.kenya.cochrane.org
Introduction To Evidence Informed Decision
Making and Systematic Reviews:
@CochraneKenya
Lilian M. Mayieka
Kenya Medical Research institute
Cochrane Kenya

2. [email protected] / www.kenya.cochrane.org @CochraneKenya
Evidenceisanythingusedtodetermineordemonstratethetruthofanassertion.
Scientificevidence:EvidencewhichservestoeithersupportorcounteraScientificTheory
orhypothesis–Accumulatedthroughobservationsofphenomenawhichoccursinthe
naturalworldorlaboratoryexperiments

3. [email protected] / www.kenya.cochrane.org @CochraneKenya
Necessity of Falsifiability
All swans are white
All bachelors are
unmarried

4. [email protected] / www.kenya.cochrane.org @CochraneKenya
Evidence Based Practices (EBP)
EBPistheintegrationofbest
availableresearchevidencewith
clinicalexpertiseandpatientvalues
todeliveroptimalcare,
Bestresearchmeansclinically
relevantpatientcenteredresearch
studies

5. [email protected] / www.kenya.cochrane.org @CochraneKenya
Evidence Based Decision Making Isn't new
Babylonians Isralites
1.
10 days trial to determine the healthier
diet
2.
The Biblical times
The famous 1747 scurvy trial
Dr.JamesLindtreatedtwelvescurvypatientsontheHMS
Salisburywithdifferentremedies.Thegroupgivenoranges
andlemonsrecoveredthefastest.Thisfindingwaspublished
inLind's"TreatiseonScurvy"in1753.

6. [email protected] / www.kenya.cochrane.org @CochraneKenya
Modern time Evidence Based Decision Making Isn't new
"Crossing the Quality Chasm:A New Health System for the 21st
Century"
It emphasizes six aims for healthcare: safety, effectiveness, patient-centeredness,
timeliness, efficiency, and equity.
The report highlights the need for systemic changes, including the adoption of new
technologies, better use of data, and more coordinated care to bridge the gap
between current healthcare practices and optimal care.

7. [email protected] / www.kenya.cochrane.org @CochraneKenya
Steps in evidence based practice
Critically appraising that evidence
for its validity (closeness to the
truth), impact (size of the effect),
and applicability (usefulness in our
clinical practice)
Tracking down the best evidence with
which to answer that question
Converting the need for information (about
prevention, diagnosis, prognosis, therapy,
causation, etc) into an answerable question
Evaluating our effectiveness and
efficiency in executing Steps 1-4 and
seeking ways to improve them both for
next time
Integrating the critical appraisal
with our clinical expertise and
with our patient's unique
biology, values and
circumstances

8. [email protected] / www.kenya.cochrane.org @CochraneKenya
Generation
of Primary
research
Synthesis of
relevant
evidence
Evidence
reaches
policy
makers
Policy
makers value
evidence
and use it in
decision
making
Policy
makers
implement
largescale
change
Flow of Evidence from Generation to Implementation

9. [email protected] / www.kenya.cochrane.org @CochraneKenya
The evidence Ecosystem

10. [email protected] / www.kenya.cochrane.org @CochraneKenya
The evidence Ecosystem
Evidence generation
Evidence Synthesis Evidence Translation
Regulatory
CultureEconomy
Social
Politics

11. [email protected] / www.kenya.cochrane.org @CochraneKenya
Putting evidence into Practice Process

12. [email protected] / www.kenya.cochrane.org @CochraneKenya
Hierarchy of Evidence

13. [email protected] / www.kenya.cochrane.org @CochraneKenya
Evidence Synthesis
The use of techniques to combine multiple sources of data-Clinical or observational, to comprehensively
understand their findings.
What is it & Why do we need it

14. [email protected] / www.kenya.cochrane.org @CochraneKenya
•Making sense of research
•Same question –different answers from studies
•Coping with information overload
•Millions of new articles, grey literature, internet –
cope by relying on literature reviews to stay up to
date
•Justification of future research
•What gaps in knowledge the proposed research
intends to fill
•Facilitating access to relevant research
•Avoiding publication biases
•Better accountability
•Many effective treatments (alternatives)
•Costs (avoiding waste)
Why is Evidence Synthesis Important

15. [email protected] / www.kenya.cochrane.org @CochraneKenya
What is a review
•A review is a summary or synthesis of the results or conclusions of more than one
study
•Several types of reviews available, eg:
•Narrative reviews
•Scoping reviews
•Rapid reviews
•Systematic reviews
•Reviews differ by rationale, methodological rigor and risk of bias
•A good review should be a readable summary of ALLthe evidence, unbiased,
transparent, replicable and up-to-date

16. [email protected] / www.kenya.cochrane.org @CochraneKenya
Narrative Review
•Summaries of evidence on a given topic usually
written by an expert in the field.
•Typically, involve informal and subjective methods to
collect and interpret information
•Problems with narrative reviews
•Personal bias
•Publication bias
•Language bias
•Small sample size

17. [email protected] / www.kenya.cochrane.org @CochraneKenya
Scoping Reviews
Atype of knowledge synthesis that uses a systematic
and iterative approach to identify and synthesize an
existing or emerging body of literature on a given topic
Aim is to map the body of literature on a topic area.

18. [email protected] / www.kenya.cochrane.org @CochraneKenya
Rapid Review
A form of knowledge synthesis that accelerates the process of conducting a systematic review
through streamlining or omitting specific methods to produce evidence for stakeholders in a
timely and resource-efficient manner
shorten the process by:
Limited scope of review question
Limiting search by years, databases, language and sources beyond electronic searches
Single rather than two reviewers for some review steps (egtitle and abstract review, full
text review, methodological quality assessment and data extraction process)
Limited risk of bias assessment
Qualitative summary rather than meta-analysis
Fast-tracking of PROSPERO registration

19. [email protected] / www.kenya.cochrane.org @CochraneKenya
Systematic Review
•“A review in which biashas been reduced by :
•the systematic identification
•Critical appraisal
•Synthesis, and,
•If relevant, statistical aggregation
•of all relevant studies on a specific topic according to a
predetermined and explicit method.”

20. [email protected] / www.kenya.cochrane.org @CochraneKenya
Main elements of a systematic review
•Pre-specifiedprotocol
•Clearly focussedquestion
•Pre-determinedselection criteria
•Detaileddescription of search strategy
•Explanation of types of evidence included and excluded
•Critical examination of qualityof included studies
•Transparentprocess for synthesising and interpreting findings
•Kept up-to-date

21. [email protected] / www.kenya.cochrane.org @CochraneKenya
Preparing for a Systematic Review
•Any review project requires three components:
•Review question: defines your destination
•Review protocol: details your proposed route and activities
•Review team
•Will continually consult the review question and protocol in the
systematic review process
•Review question—clear, well-defined, appropriate, manageable
and relevant to outcomes
•Beware that both review question and protocol may take longer
than you think.
•A review team helps to minimize bias

22. [email protected] / www.kenya.cochrane.org @CochraneKenya
Preparing for a Systematic Review
•Aim of review protocol:
•To describe current evidence
•To identify the review question
•To outline/pre-specify methods to be used to answer review question
•What studies will be includedand excluded?
•How (exactly) will each stage be conducted?
•What are the primary and secondary outcomes of interest?
•Needs to be registered (to avoid duplication of efforts) -PROSPERO
•Journals often require a protocol registration number before publishing
systematic reviews

23. [email protected] / www.kenya.cochrane.org @CochraneKenya
PROSPERO Registration
•Search for ongoing reviews
•Register planned review online (& update as work progresses)
•Avoids duplication of reviews

24. [email protected] / www.kenya.cochrane.org @CochraneKenya
Systematic Review Process
•Review question
•Has 4 components (PICO)
•Search for studies
•Need a search strategy
•Search more than one database
•No restriction with language, publication status
•Consider contacting experts, reference lists
•Selecting studies
•At least two authors screen studies independently
•Use the inclusion criteria developed from the review question (PICO)
•In two stages (titles and abstracts, full text papers)
•Can be done electronically (egCovidence)
•Risk of bias assessment
•Use a validated tool, egCochrane risk of bias tool

25. [email protected] / www.kenya.cochrane.org
Systematic review process
•[email protected] / www.kenya.cochrane.org
@CochraneKenya
•Data extraction
•Need a (piloted) data abstraction sheet
•Sone by at least 2 authors
•Be systematic
•Resolve disagreement
•Data analysis/synthesis
•Develop analysis plan at protocol stage
•If data is not combinable, describe qualitatively
•If data is combinable, consider meta-analysis
•Use software (egRevman, Stata, Met-analyst)
•Establish presence of heterogeneity
•Summary of the findings (use GRADE methodology)
•Report writing
•Structured report
•Include a plain language summary