highest level of evidence in clinical research

1. Dr Sridevi NH
MBBS (MD)
Community medicine
Chikmagalur

2. Learners objectives
1. To list the steps involved in the systematic review.
2. To interpret the meta analysis and systematic
review.

3. Contents
 Introduction
 Methodology
 Forest plot & funnel plot
 Bias in systematic review and meta-analysis
 Strengths and limitations
 Summary
 References

4. Introduction
 In 1904, Karl Pearson collated data from several studies
of typhoid which was used to aggregate the outcomes of
multiple clinical studies.
 A systematic review is a scientific tool that can be used to
appraise, summarise, and communicate the results and
implications of otherwise unmanageable quantities of
research.
 “Meta-analysis" was coined by Gene V. Glass

6. Need for the study
 There are now more than 15 million citations in
MEDLINE (4800 medical journals), with 10,000 to
20,000 new citations added each week
 These studies often vary in their design;
methodological quality; population studied; and the
intervention, test, or condition considered.

7. Methodology
1. Protocol & Review question
2. Define inclusion and exclusion criteria
3. Develop search strategy and locate studies.
4. Select studies
5. Data abstraction from each studies

8. 6. Analyse and interpret results( meta-analysis)
7. Writing the findings.
8. Disseminate findings.

9. Elder abuse prevalence in community
settings: a systematic
review and meta-analysis
 Protocol: The study protocol was registered with
PROSPERO, number CRD42015029197.

10.  Inclusion criteria: community-based studies that
provided estimates of abuse prevalence at a national or
sub-national level
 Studies that included participants that were aged 60
years and older
 Exclusion criteria: studies that were reviews,
conference proceedings, or used qualitative methods
only; studies that focused exclusively on self-neglect or
homicide; and studies that concentrated only on
institutional abuse or on specific subpopulations.

11. screened for
relevant studies
searched
additional web-
based platforms
14 academic
databases pub
med , EMBASE,
medline

13. Meta-analysis
 The 52 studies selected for meta-analysis were
geographically diverse and included 28 countries
 WHO region of the western Pacific: 5
 Southeast Asia region:5
 Region of the America:15
 European region: 25
 Eastern Mediterranean region: 2
 All analyses were done using Comprehensive Meta-
Analysis software (CMA version 3.9)

14.  Findings : The pooled prevalence rate for overall
elder abuse was 15·7%.
 Disseminate findings: The findings of this study
strengthen the case for global action to expand
efforts for preventing and supporting victims of
abuse.

15. Forest plot

16. Bias
 English language bias
 Database bias
 Publication bias
 Citation bias

17. Funnel plot

18. Strengths
 Physicians can make better clinical decisions since it
is a highest level of evidence.
 Transparent .
 Comprehensive search strategy.
 Provide a more precise estimate of effect since
overall sample is increased.

19.  Delay between research discoveries and
implementation of effective diagnostic and
therapeutic strategies may be reduced.

20. Limitations
 Reliability depends on the reliability of the primary
studies.
 Publication bias/ selection bias.
 Failure to asses the methodological flaws in the
primary studies.

22. Summary
 Like all types of research, systematic reviews and
meta-analyses have both potential strengths and
weaknesses.
 Systematic reviews have become a basis for
financing health technologies. And also published
guidelines are based on systematic reviews of
available data.

23. Learners objectives
1. To list the steps involved in the systematic review.
2. To interpret the meta analysis and systematic
review.

24. Thank you

25. References
1. Leon gordis. Meta-analysis: Epidemiology. Elsvier 5th edition.360-361
2. Jimmy Volmink and Mike Clarke. Systematic reviews and meta-analysis
Oxford Textbook of global public health: oxford 6th edition 599-611
3. Przemylaw rys. review articles, systematic reviews and meta-analyses:
which can be trusted? polskie archiwum medycyny wewnętrznej 2009;
119 (3) 148-154
4. Yongjie Yon. Elder abuse prevalence in community settings: a
systematic review and meta-analysis Lancet Glob Health 2017; 5:
e147–56
5. S green. Systematic reviews and meta-analysis E v i d e n c e - B a s e
d M e d i c i n e A n d H e a l t h c a r e Singapore Med J 2005 Vol 46(6)
: 270-74