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Using Evidence Maps in SRDR to Efficiently Plan Systematic Reviews - - PowerPoint PPT Presentation

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Using Evidence Maps in SRDR to Efficiently Plan Systematic Reviews Center for Evidence-Based Medicine School of Public Health Brown University Ethan Balk, MD MPH Bryant Smith, MPH CPH SRDR is being developed and maintained by the Brown

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Using Evidence Maps in SRDR™ to Efficiently Plan Systematic Reviews

SRDR is being developed and maintained by the Brown EPC under contract with the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00002-I).

Center for Evidence-Based Medicine School of Public Health Brown University Ethan Balk, MD MPH Bryant Smith, MPH CPH

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Evidence Maps

A Brief Overview

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Evidence Map Definition (Katz 2003)

“A means of systematically organizing the base of evidence pertaining to a broad topic… so that the distribution, breadth, depth, methodology, and

  • verall quality of pertinent evidence is characterized

and made readily accessible.”

Katz et al. Alternative Therapies. 2003;9(4):22-30.

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Evidence Map Definition (Hetrick 2010)

“Less exhaustive yet systematic and replicable methodology that allows an understanding of the extent and distribution of evidence in a broad clinical area, highlighting both what is known and where gaps in evidence exist.”

Hetrick et al. J Eval Clin Pract. 2010;16(6):1025-30.

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Evidence Map Definition (Miake-Lye 2016)

“A systematic search of a broad field to identify gaps in knowledge and/or future research needs that presents results in a user-friendly format, often a… searchable database.”

Miake-Lye et al. Systematic Reviews 2016; 5:28.

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“Gap Map”

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3ie’s evidence map for education.

http://www.scidev.net/global/data/news/gap-maps-holes-development-evidence.html

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Features of Evidence Maps

  • Systematic process

(eg, documented search strategy, inclusion criteria)

  • Review of evidence of (usually) a broad field to

– Describe characteristics of existing evidence – Identify research gaps and future research needs

  • Briefly summarizes included studies
  • Provides data on (for example)

– PICO-D – Sample size – ± Basic study results or conclusions – (Not detailed study results; Usually not study quality)

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Bubble Plot

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Evidence Map of Mindfulness

Hempel et al. http://www.hsrd.research.va.gov/publications/esp/cam_mindfulness.cfm

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Scoping Study (Arksey 2005, O’Brien 2016)

  • Rapidly map key concepts underpinning a research area,

and sources and types of evidence available

– Extent, range, nature of research activity

  • Determine value of undertaking a full systematic review

– Eg, does literature exist? have SRs been done?

  • Summarize and disseminate research findings
  • Identify research gaps in the existing literature

– Does not address gaps due to poor quality research

Arksey et al. Int J Soc Res Method 2005;8(1):19-32. O’Brien et al. Health Serv Res 2016;16:305.

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Basic Steps

  • Mostly follow standard systematic review

process

– Identify research question – Develop protocol – Define eligibility criteria (eg, PICO-D) – Systematically search literature – Screen (select) citations (± full text articles) – Extract pertinent data – Organize, summarize, report, map results

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Map of Studies

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Decision Support Tools

Trikalinos et al. https://www.effectivehealthcare.ahrq.gov/ehc/products/529/2029/cancer-decision-support-tools-report-141223.pdf

(black = included in a systematic review)

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How Differs from Systematic Review

  • Usually covers a broader field / range of questions than a SR
  • Eligibility criteria may be more expansive (inclusive) than a SR
  • May be based on citations/abstracts only (not full text)

→ incomplete extraction of outcome list and analyses

  • Omits details of study methodology, eligibility criteria,

participant and intervention characteristics, etc.

  • Omits study quality / risk of bias assessment
  • Usually omits extraction of (detailed) study results or

conclusions

– May include directionality, statistical significance, etc.

  • Less time/resource intensive than SR of same topic/scope
  • Categorizes existing literature more than summarize findings

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Example Evidence Map

  • Omega-3 fatty acids (n-3 FA) and Cardiovascular disease (CVD)

– Used to describe breadth and types of evidence to scope a systematic review update

  • What is the efficacy or association of n-3 FA (EPA, DHA, EPA+DHA,

DPA, SDA, ALA, or total n-3 FA) exposures in reducing CVD

  • utcomes (incident CVD events, including all-cause death, CVD

death, nonfatal CVD events, new diagnosis of CVD, peripheral vascular disease, CHF, major arrhythmias, and hypertension diagnosis) and specific CVD risk factors (BP, key plasma lipids)?

– Without known CVD (primary prevention) – At high risk for CVD (primary prevention) – With known CVD (secondary prevention) – Other subpopulations – Interactions with CVD and diabetes drugs

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Omega-3 Fatty Acids and CVD

  • Literature search (and existing SRs) yielded 462 articles

that met basic eligibility criteria:

– Adults (healthy, at CVD risk, with CVD) – Comparison of n-3 FA intake (as food or supplement) with other n- 3 FA or other level of intake (including “placebo”) – Association of baseline n-3 FA intake or biomarker with future CVD event – CVD events (1 year follow-up), BP/Cholesterol (4 week follow-up) – RCTs (for comparisons) Prospective longitudinal observational studies

  • Needed to constrain literature review given resource

and time constraints, but also to create a searchable database for others to use for future reviews

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A Priori Approach to Limit Scope

  • Goal was to capture “best”, “most generalizable”

evidence for each specific topic to address most important key questions

  • Planned to select largest, longest follow-up, most

generalizable studies for each specific topic – Wanted to prioritize larger studies with longer follow-up duration or that reported interaction analyses of interest

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Evidence Map Design

  • Designed evidence map to capture (from abstract)

– Sample size (N, N taking n-3 FA) – Study design – Population type (healthy, at risk, CVD) – Specific n-3 FA(s) (“fish oil” [EPA, DHA, DPA], SDA, ALA, total, unclear) – Biomarker study – Interaction between n-3 FA and drug – Subgroup or predictor analysis – Study duration – Specific outcome(s)

  • Based on these data, selected “most relevant” studies

à 61 RCTs (82 articles) & 37 observational (65 articles)

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Conducting the Evidence Map in SRDR: Introduction to the Systematic Review Data Repository (SRDR)

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Systematic Review Data Repository (SRDR)

  • Online, open access archive of searchable

systematic review data

– Key questions – Extraction forms – Data extracted from included studies

  • Collaborative workspace for completing the data

extraction phase of systematic reviews

– Powerful, web-based tools – Flexible options for data extraction – Platform from which a complete systematic review tool is being developed.

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System Status

  • System has been in development for 6+ years
  • Launched on June 20th 2012
  • Hosted on the Amazon Cloud (via AHRQ link)
  • Designed and maintained by the SRDR Team lead by
  • Dr. Joseph Lau at Brown University
  • SRDR is committed to a policy of open access and

data sharing. All systematic review data published to the SRDR archive are publically available under the terms of a Creative Commons license

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Value of SRDR to Systematic Reviewers

  • Open access

– Free registration, access and support

  • Useful systematic review tools

– Data extraction – Data management – Project management

  • Interaction with the systematic review community

– Contribute data to the community – Use data contributed by other review teams

  • Participate in collaborative development of SRDR

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  • Access to high quality data used in SRs
  • Minimize need to repeat expensive process, save

time, money, and resources

– Particularly when updating reviews and guidelines

  • Collaborate in development of a worldwide

resource

– Allow developers to benefit from others’ experience and expertise

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Value of SRDR to Guideline Developers

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SRDR Features

  • Free to Use
  • Searchable repository of published SR data
  • Community commenting on published data
  • Collaborative, on-line data extraction
  • Customizable data extraction forms
  • Secure database
  • Export data to MS Excel (.xlsx) and CSV files
  • Import data from MS Excel (.xlsx)
  • Supports multiple data abstraction

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Creating an Evidence Map in SRDR

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Potential Benefits of Using SRDR to Create an Evidence Map

  • Customize electronic extraction forms
  • Work collaboratively collecting data from studies

using the extraction forms

  • Export complete evidence map data-sets to

spreadsheet files (to allow analysis)

  • Share evidence map datasets with other guideline

developers by publishing them (no cost) to the publically accessible SRDR published projects page.

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Steps to Create an Evidence Map

25 Extract study data into extraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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http://srdr.ahrq.gov

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Extract study data into extraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Using the SRDR Interface: Creating a New Project

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Extract study data into extraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Extract study data into extraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Creating an Extraction Form

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Extract study data into extraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Tabs for Data Elements 30

Extraction Form Tabs

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Hypothetical Evidence Map that Used a Paper Form

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Extract study data into abstraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Adding Studies

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Extract study data into abstraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Adding Studies

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Extract study data into abstraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Adding Studies

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Extract study data into abstraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Retrieve PMID

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Extracting Data from a Study

  • Example Study…

– Garmendia F. et al. Effect of sancha inchi (plukenetia volubilis I) on the lipid profile of patients with hyperlipoproteinemia. Rev Peru Med Exp Salud Publica. 2013 Mar;30(1):148. – PubMed ID: 22241259

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Extract study data into abstraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Retrieve PMID

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Extract study data into abstraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Retrieve PMID

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Extract study data into extraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Extracting Study Data

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Extract study data into extraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Publish Data

(make publically available)

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Extract study data into extraction forms for each project Review and publish the project to SRDR’s published projects page Add eligible study records to the SRDR project Build an SRDR extraction form Enter general project information and key question(s) Create a project in SRDR

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Publish Data

(make publically available)

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SRDR Features Not Covered Here

  • Adding arm/outcome-specific questions to the form
  • Exporting data entered into Extraction forms to

query-able Microsoft Excel files

  • Assigning studies to individual project team

members

  • Uploading documents to a project so that they may

be downloaded following publication to SRDR

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http://srdr.ahrq.gov/help

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Evidence Map Exercise

  • Topic: Omega-3 fatty acids and CVD

– Intervention and observational studies

  • Enter study data from abstracts into SRDR
  • Export and analyze database (evidence map)
  • Discussion

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Data Extraction Steps

  • Go to srdr.ahrq.gov
  • Log in with your given username and password
  • Select Collaborator tab
  • Add a Study

– One study created individually – Select key question 1

  • Publications tab

– Enter PMID (Retrieve) and Save

  • Design tab

– Answer all questions and Save

  • Add 2nd study and repeat

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Exporting and Analyzing Data

  • Data Export Tool
  • Exported spreadsheet

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Discussion

  • Evidence mapping
  • How to use SRDR
  • Value of SRDR (or equivalent electronic data

extraction software)

  • Other…

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SRDR Support and Contact Info

The SRDR website contain resources to help you become familiar with the system To learn more, visit: srdr.ahrq.gov/help

  • Contact the SRDR Team with any questions or

for registration assistance

– Email: SRDR@AHRQ.HHS.gov – Phone: (401) 863-5791; 9:00am – 5:00pm ET

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Adding Arm specific questions-1

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Adding Arm specific questions-2

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Adding Arm specific questions-3

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