Course catalogue doctoral education - VT20

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Title How to conduct systematic reviews and meta-analyses
Course number 2790
Programme Folkhälsovetenskap
Language English
Credits 3.0
Date 2020-04-20 -- 2020-05-06
Responsible KI department Institutionen för mikrobiologi, tumör- och cellbiologi
Specific entry requirements Students need to have basic knowledge of biostatistics (corresponding to KIs Basic Course in Medical Statistics or Biostatistics I) and it is recommended to have basic knowledge in epidemiology (corresponding to Epidemiology I course).
Purpose of the course Meta-analyses are becoming the gold standard method of reviewing and summarising the scientific literature, and they have contributed greatly to the current body of scientific knowledge. This course aims to introduce the concepts and procedures of systematic reviews and meta-analyses, and will help applicants to get started with their own study.
Intended learning outcomes At the end of the course the students should be able to: 1) Understand and demonstrate the value, principles and the different concepts related to systematic reviews and meta-analyses, in particular compared to other types of studies (incl. narrative reviews, original research); 2) Identify the strengths, limitations and pitfalls of systematic reviews and meta-analysis; 3) Independently formulate study hypotheses, and plan and generate a study protocol to perform a systematic review and meta-analysis, justifying the selection of the eligible studies and statistical methodology; 4) Apply basic methods of meta-analyses; 5) Critically reflect on other students individual project work and provide feedback in a scientifically constructive way (peer-review); 6) Interpret and critically evaluate scientific studies relevant to the course content.
Contents of the course The course is designed for PhD students, in particular those who are at an early stage of their research education, and those with an interest in conducting systematic reviews and meta-analysis. The content of the course is as follows: 1) Basic concepts in systematic reviews and meta-analyses, 2) strengths, problems and limitations of systematic reviews and meta-analyses, 3) How to write a study protocol for a systematic review, 4) How to perform a systematic literature search (including a practical seminar organised by Karolinska Institutet library), 5) Data-extraction and quality assessment of included studies, 6) Statistical methods used in meta-analyses and interpretation, 7) Examination. This is a hands-on course, covering theoretical concepts and discussion of strengths, limitations and problems of systematic reviews and meta-analyses. We will also discuss publication guidelines, strategies to identify eligible studies, quality assessment of research papers, how to use Endnote to facilitate the systematic search, Excel for data-management, and different statistical methods and programs.
Teaching and learning activities Interactive lectures, seminars, individual article review, group discussions, practical sessions (one on systematic literature search, one on statistical methods) and homework tasks will be used. The course focuses on active learning, i.e. putting knowledge into practice and critically reflecting upon the knowledge, rather than memorising facts. Therefore, much of the focus of the course is on the individual project where students are required to develop a full study protocol including several important aspects covered in the lectures, peer assessment, article reviews and group discussions. Students will also peer-review each other's projects and this will form the basis for the final examination seminar. Throughout the course, the students will work on an individual project and will have to peer-review the project of another student. Further, students will critically review and discuss relevant scientific articles. There will be several group discussions with other students and experienced teachers, with a focus on peer-assessment (discussing each other's projects), and the lectures are interactive allowing for critical discussions.
Compulsory elements Compulsory attendance includes the scheduled lectures and seminars (i.e. full first week of the course + exam). One is required to come well prepared for each seminar (see reading list). Absence will need to be replaced by individual assignments following discussion with the course co-ordinator, e.g. article reviews, with written or oral follow-up. Attendance is also compulsory for the examination, which includes discussion of the study protocol of each student + opposition for another student.
Examination 1) Individual project work: To develop a written comprehensive yet concise study protocol including several important aspects as discussed during the course; 2) Peer-review of other students' projects followed by an oral presentation of their own project and opposition of other students projects during the group examination; 3) Critically review scientific articles relevant to the course content. To pass the course, the student has to show that all intended learning outcomes have been reached.
Literature and other teaching material Course literature (mandatory)

1. Berlin JA, Golub RM. Meta-analysis as evidence: Building a better pyramid. JAMA 2014:312(6):603-605. PubMed PMID: 25117128. Before course starts.

2. Systematic Reviews in Health Care: Meta-analysis in context (2nd edition, 2008, Egger et al BMJ publishing group):
(http://ije.oxfordjournals.org.proxy.kib.ki.se/content/31/3/697.1)
(free online as e-book via KI library)
Chapter 1: Introduction: Before course starts
Chapter 3: Problems and limitations in conducting systematic reviews: Before 2nd day of course
Chapter 9: Why and how sources of heterogeneity should be investigated: Before 4th day of course

3. Karolinska Institutet library: practical information on how to conduct systematic literature searches: https://kib.ki.se/en/search-evaluate/systematic-reviews: Before 2nd day of the course

4. PRISMA: http://www.prisma-statement.org/ (flowchart, checklist and PRISMA statement: Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009 Oct;62(10):1006-12. doi: 10.1016/j.jclinepi.2009.06.005. Epub 2009 Jul 23. PubMed PMID: 19631508). Before 2nd day of the course.

5. Introduction to meta-analysis. (2009, Borenstein et al) (free online as e-book via KI library) (http://onlinelibrary.wiley.com.proxy.kib.ki.se/book/10.1002/9780470743386)
Part 3 - Fixed-effect versus random-effects models (complete): Before 3rd day of course
Part 4 - Heterogeneity: chapter 15,16: Before 3rd day of course
Part 9 - Meta-analysis in context (complete): Before 5th day of the course

6. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer Review of Electronic Search Strategies: 2015 guideline statement. J Clin Epidemiol. 2016 Jul;75:40-6. http://www.sciencedirect.com/science/article/pii/S0895435616000585: Before 3rd day of course: Checklist to be used for journal club and examination (opposition)

7. PRISMA-P: http://www.prisma-statement.org/Extensions/Protocols.aspx

8. Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and
susceptibility to bias in observational studies in epidemiology: a systematic
review and annotated bibliography. Int J Epidemiol. 2007 Jun;36(3):666-76. Epub
2007 30. Review. PubMed PMID: 17470488. Before 4th day of course


To read for literature seminar on the third day of course (mandatory):

1. Kung J, Chiappelli F, Cajulis OO, Avezova R, Kossan G, Chew L, Maida CA.From Systematic Reviews to Clinical Recommendations for Evidence-Based Health Care: Validation of Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) for Grading of Clinical Relevance. Open Dent J. 2010 Jul 16;4:84-91. doi: 10.2174/1874210601004020084. PMID: 21088686 (Checklist to be used to discuss articles)

2. Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CC, Day RO, McLachlan AJ, Ferreira ML. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015 Mar 31;350:h1225. doi: 10.1136/bmj.h1225. PMCID: PMC4381278. PMID: 25828856.

3. De Bruijn KM, Arends LR, Hansen BE, Leeflang S, Ruiter R, van Eijck CH. Systematic review and meta-analysis of the association between diabetes mellitus and incidence and mortality in breast and colorectal cancer. Br J Surg. 2013 Oct;100(11):1421-9. doi: 10.1002/bjs.9229. Review. PubMed PMID: 24037561.


Suggested reading (optional)

1. Cochrane handbook (free online) (http://handbook.cochrane.org/)

2. Systematic Reviews. CRDs guidance for undertaking reviews in health care (2009). Centre for Reviews and Dissemination, University of York. ISBN 978-1-900640-47-3. www.york.ac.uk/inst/crd/index_guidance.htm (free to download online): discussion of different types of systematic reviews (clinical tests, public health interventions)

3. Brusselaers N. How to teach the fundamentals of meta-analyses. Ann Epidemiol. 2015 Dec;25(12):948-54. doi: 10.1016/j.annepidem.2015.08.004. Epub 2015 Aug 28: contains lots of tips on how to conduct systematic reviews and meta-analysis. PMID: 26454416

4. Stroup DF, Thacker SB, Olson CM, Glass RM, Hutwagner L. Characteristics of meta-analyses related to acceptance for publication in a medical journal. J Clin Epidemiol. 2001 Jul;54(7):655-60. PMID: 11438405.

5. Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F, Niu Y, Du L. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015 Feb;8(1):2-10. doi: 10.1111/jebm.12141. (especially appendix is useful!) PMID: 25594108

6. Borenstein et al: Common mistakes in meta-analyses and how to avoid them. https://www.meta-analysis-workshops.com/pages/paperseries.php?utm_source=iContact&utm_medium=email&utm_campaign=Meta-Analysis&utm_content=Common+Mistakes+Part+1 (explanation on I-square, heterogeneity, fixed/random effect models)

7. Ioannidis J 2017, Next-generation systematic reviews: prospective meta-analysis, individual-level data, networks and umbrella reviews. Br J Sports Med. 2017 Feb 21. pii: bjsports-2017-097621. PMID: 28223307
Number of students 18 - 25
Selection of students Selection will be based on 1) the relevance of the course syllabus for the applicant's doctoral project (according to written motivation), 2) start date of doctoral studies (priority given to earlier start date). Since a basic understanding of biostatistics is required, and a basic understanding of epidemiology is recommended, please state relevant experience.
More information All lectures and seminars will be organised at KI Solna campus. The first week is the most intense week, with lectures and workshops every day. The second week the student is expected to work on their individual study protocol, and we organise an "open office" on Wednesday before lunch, so all students can receive 1-to-1 feedback, for which attendance is not mandatory (although previous years almost all students attended). The exam will take place during the last day of the course (Wednesday whole morning) for which attendance is mandatory (in exceptional circumstances presence through Skype may be permitted). Please notify the course leader if you cannot attend one or more of the sessions during the first week. Absence will need to be replaced by individual assignments following discussion with the course leader.
Additional course leader
Latest course evaluation Course evaluation report
Course responsible Nele Brusselaers
Institutionen för mikrobiologi, tumör- och cellbiologi
0761516212
nele.brusselaers@ki.se

CTMR - Nobelsvag 16 - KISolna

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Stockholm
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