Literature Review for Meta-

analysis
Objective
s
How to formulate a question for meta-analysis

How to test the feasibility for a question

How to run a database search for a question

How to screen articles using ENDNOTE

Data Extraction

Risk of bias assessment

 PRISM
Guideline
A
s
 PRISM
guideline
A
s
Choosing a
Topic
• Experience in a field.
• Current focus. The topic of a recent trial in a big journal (e.g NEJM) is fair game.
• Do a review of prior studies or meta-analyses done on the topic.
• Talking to mentors.
Testing a topics
feasibility
• Do not use an idea that is too broad
• Preferable number is 10-20 studies
• Ideal to run a MeSH only search at Pubmed to see the feasilibility of topic at hand
 WHAT IS A SYSTEMATIC REVIEW?

 A review of a clearly formulated question that uses

systematic and explicit methods to identify, select, and
critically appraise relevant research, and to collect and
analyse data from the studies that are included in the
review. http://www.cochrane.org/glossary/5#term423/ (accessed 19.11.14)

 To complete such a review we must prepare, conduct, and

record a very comprehensive search strategy based
upon a very definite research question.
WHY DO WE NEED SYSTEMATIC SEARCH STRATEGIES?

 A high-quality literature search is essential for an SR – the

goal is to capture every relevant study

 It is from the search results that data is gathered for

analysis and evidence identified

 Failure to locate important studies can significantly

affect results and findings

 It is important to report your search strategy so your

methodology can be reproduced
 BEING SYSTEMATIC WITH YOUR
SEARCH STRATEGY
• Do not use an idea that is too broad
• Preferable number is 10-20 studies
• Ideal to run a MeSH only search at Pubmed to see the feasilibility of topic at hand
Comprehensive database
search to find all the
relevant studies
• Formulating a scientific question
• Need an exclusion and inclusion Problem Intervention Comparison Outcomes Study
criteria Type
 • Pubmed
• Embase

Different • Cochrane
• Clinicaltrials.gov
databases • Web of Science
• Scopus
• CINAHL
Pubmed

• Using Advanced search

• Create search queries for individually for each term from P, I, C, O, S by using OR
• Need to search with and without MeSH terms
• Combine the PICOS together using AND
• Run the search and save your search results in an ENDNOTE file
• Atrial Fibrillation ≠ Atrial-Fibrillation
• Atrial Fibrillation ≠ Atrial Fibrillations
• AtrialFibrillation ≠ Atrial Fibrillation
• Atrial Fibrillation = Fibrillation, Atrial
Embase

• PICO search tab

• Use the broadest search term and then narrow it down. You can use
Emtree to help you to find the search query
• Tip: You can go through prior meta-analyses or literature reviews to
make sure you do not miss an important study
• Show results
• You can then export results in an ENDNOTE file
Cochran
e
• Using Search Manager
• MeSH –> “look up” –> “Add/Edit”
• Add terms with and without MeSH
• Combine P results with OR and so on
• Combine PICOS results with AND
• Download the results in ENDNOTE
• Download trials, reviews, etc. They are downloaded
separately
Clinicaltrials.go
v
• You cannot add all the keywords and you cannot combine them using
AND, OR
• You can only write important words
• Try using the broader terms and then narrow it down
• Download to make an ENDNOTE file
Web of
Science
• Atrial Fibrillation = Atrial Fibrillations
• Atrial Fibrillation ≠ Atrial-Fibrillation
• Advanced search -> Field Tags “using TS” to find keywords in Topic.
• Combine P terms with OR and so on
• Combine PICOS terms with AND
• Download results – you can download 500 results in one file. You may
need to create more than 1 files
Combining all results
in ENDNOTE
• Pool all the results in one ENDNOTE file to create a Master
library
• Dividing and screening the library
• Sending copies or divisions of a library to other members of
a team using .enlx file
• Never work on .enlx file. Always open it to make a working
.enl and .data file and work on the .enl file.
Screenin
g• Studies should then be de-duplicated
• All the remaining studies in the library should be screened for relevance
• May need to make further subgroups in ENDNOTE
• Can be done in one or two cycles
• Goal is to weed out irrelevant studies, studies with same cohort, literature
reviews, letters to editors etc
Data
Extraction
• Need to create a data extraction tool on excel
• Best way is to go through the important studies or good prior meta-analyses to
see what type of data was collected
• Keep in mind your inclusion and exclusion criteria
• This step is important to make sure uniform data collection for all studies
• You may have to go through several studies before the extraction tool is ready
• Make sure you collect baseline characteristics as well
Recheckin
g
• Once collected, data needs to be rechecked and errors corrected
Risk of Bias
Assessment
• While rechecking or extraction, it is good to make an assessment of risk
of bias in studies
• ROB Cochrane tool for trials and interventions, while Newcastle Ottawa
scale for observational studies etc
• Ideally it should be done by one or two team members and can be
done
while rechecking or prior to data extraction
 Risk of
Bias
Assessment
– ROB tool
at
Cochrane
Take
Home
Points
• Query Formation on different
databases
• Screening and extracting
ENDNOTE libraries
Thank
You