hmgt 400 part 7 resp

WATSON

The importance of a systematic review for evidence-based practice is grounded in the development of public health. Assessment of public services requires researchers to perform a systematic review to evaluate the reliability of collected evidence. Limitations occur within flawed designs. Meta-analysis supports evidence-based practices through experiences in published and unpublished reviews of healthcare systems and practices. According to Gopalakrishnan, “Systematic reviews and meta-analyses have become increasingly important in healthcare settings. Clinicians read them to keep up to date with their field and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research and some healthcare journals are moving in this direction” (Gopalakrishnan, et.al, 2013). Overcoming challenges associated with evidence-based practices could be grounded in research structure, study designs, and guidelines for collecting and analyzing data. An example of when a systemic review was a defining point in effective decision-making was outlined in a systematic literature review of burnouts within university teaching staff. Watts stated, “Using a

design method, researchers were able to address and identify key factors in its evidence-based decision-making” (Watts & Robertson, 2011).

Gopalakrishnan, S., & Ganeshkumar, P. (2013, January).  Systematic reviews and meta-analysis: Understanding the best evidence in Primary Healthcare. Journal of family medicine and primary care.                                        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894019/

Watts, J., & Robertson, N. (January 20, 2011).  Burnout in university teaching staff a systematic literature review. Educational Research, 53, 33-50. doi10.1080/00131881.2011.552235 - references - scientific research publishing.  https://www.scirp.org/reference/ReferencesPapers.aspx?ReferenceID=462313

RHONDA

Explain the importance of systematic review and meta-analysis for evidence-based practice.

Systematic reviews aim to inform and facilitate this process through research synthesis of multiple studies, enabling increased and efficient access to evidence. Systematic reviews and meta-analyses have become increasingly important in healthcare settings. Clinicians read them to keep up-to-date with their field and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research and some healthcare journals are moving in this direction.

A meta-analysis is the combination of data from several independent primary studies that address the same question to produce a single estimate like the effect of treatment or risk factor. It is the statistical analysis of a large collection of analysis and results from individual studies for the purpose of integrating the findings.  The term meta-analysis has been used to denote the full range of quantitative methods for research reviews.  Meta-analyses are studies of studies.  Meta-analysis provides a logical framework for a research review where similar measures from comparable studies are listed systematically and the available effect measures are combined wherever possible.

What are the limitations of the systematic review? How to overcome the challenges?

There are challenges with any type of research method being used.  The value of a systematic review will depend on what was done, what was found, and the clarity of the reporting.  The reporting quality of systematic reviews varies, limiting a reader’s ability to assess the strengths and weaknesses of the reviews. (Moher D, Liberati, et. al., 2009)

Systematic reviews and meta-analyses are considered the best evidence for obtaining a definitive answer to a research question but there are inherent flaws that are associated with them, such as the location and selection of the studies, heterogeneity, loss of information on important outcomes, inappropriate sub-ground analyses, conflict with new experimental data, and duplication of publication. (Gopalakrishnan, S., & Ganeshkumar, P., (2013)

Publication bias often leans toward a positive outcome, and this occurs due to inappropriate sifting of the studies, where the results are always toward significant outcomes.  Even when publication bias is assessed, there is no guarantee that systematic reviewers have assessed or interpreted it appropriately. (Moher D, Tetzlaff, et. al., 2012)

To be able to overcome certain limitations, the Cochrane reviews are currently reported in a format where at the end of each review, findings are summarized from the author’s point of view and also give an overall picture of the outcome by means of plain language summary.  This is found to be helpful in understanding the existing evidence about the topic. (Gopalakrishnan, S., & Ganeshkumar, P., (2013)

Offer an example of a situation when a systematic review and meta-analysis were one of the defining points in the decision-making process, and when without it the decision might have been incorrect. 

There was a systematic review and meta-analysis performed on psychological effects and mortality following solitary confinement in correctional settings.  The results were:

The systematic review identified 13 studies for inclusion, with a total sample of 382,440 inmates (23% having been exposed to solitary confinement). Higher quality evidence showed solitary confinement was associated with an increase in adverse psychological effects, self-harm, and mortality, especially by suicide. A meta-analysis of five studies (n = 4,517) showed a standardized mean difference of 0.45 for general psychological symptomatology, which increased to 0.51 upon outlier exclusion. Small to moderate significant effects were observed for mood, psychotic, and hostility symptoms specifically. In addition, a meta-analysis of two mortality studies (n = 243,050) showed a trend for a moderate effect for mortality by any unnatural causes (i.e., suicide, homicide, overdose, and accidents). (Luigi, M., et. al, 2020)

Analyses showed that solitary confinement is associated with the psychological deterioration of inmates. This effect appears to be beyond that of general incarceration or the presence of prior mental illness. Thus, solitary confinement may pose significant harm to inmates. Still, further studies are required to show that exposure to SC can increase the risk of post-release death. Finally, add-on treatments and alternatives to solitary confinement that could alleviate the associated psychological harm are discussed. (Luigi, M., et. al, 2020)

Without systematic review and meta-analysis in this situation, we would not have this detail in the research regarding solitary confinement and the psychological effects on the inmates in correctional institutions. 

References:

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Goldman L, Feinstein AR. Anticoagulants and myocardial infarction. The problems of pooling, drowning and floating.  Ann Intern Med. 1979;90:92–4.

Gopalakrishnan, S., & Ganeshkumar, P. (2013). Systematic Reviews and Meta-analysis: Understanding the Best Evidence in Primary Healthcare.  Journal of family medicine and primary care,  2(1), 9–14.  https://doi.org/10.4103/2249-4863.109934

Green S. Systematic reviews and meta-analysis.  Singapore Med J. 2005;46:270–3. 

Kassirer JP. Clinical trials and meta-analysis. What do they do for us?  N Engl J Med. 1992;327:273–4. 

Kavale KA, Glass GV. Meta-analysis and the integration of research in special education.  J Learn Disabil. 1981;14:531–8. 

Luigi, M., Dellazizzo, L., Giguère, C. É., Goulet, M. H., & Dumais, A. (2020). Shedding Light on "the Hole": A Systematic Review and Meta-Analysis on Adverse Psychological Effects and Mortality Following Solitary Confinement in Correctional Settings.  Frontiers in psychiatry,  11, 840.  https://doi.org/10.3389/fpsyt.2020.00840

Moher D, Liberati A, Tetzlaff J, Altman DG PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.  PLoS Med. 2009;6:e1000097. 

Ried K. Interpreting and understanding meta-analysis graphs--a practical guide.  Aust Fam Physician. 2006;35:635–8.

Sackett D, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: What it is and what it isn't.  BMJ. 1996;312:71