Decisive Tools In Clinical Practice
The clinical field, the scenario for health professionals, is a complex space that equally requires a concise, timely, and structured performance.
The actions carried out in it are as varied as they are relevant and range from health recommendations, the intentional search for risk factors, screening tests, diagnostic methods, and treatments to prognoses on specific illnesses.
Due to the importance of all these activities, their execution must be supported by a vast body of constantly updated scientific evidence.
The clinical practice guidelines and care protocols, which ultimately dictate the clinical actions of nurses, doctors, and specialists, summarize a high degree of evidence and are the product of numerous systematic reviews and meta-analyses.
What Are Systematic Reviews And Meta-Analyses?
By definition, systematic reviews are the narrative synthesis of all available data aimed at answering a specific question. While meta-analyses consist of the statistical integration of the results of various independent studies, which can be combined, to determine a global effect. Not in all systematic reviews it is appropriate to carry out a meta-analysis.
Systematic reviews and meta-analyses, according to the pyramid of scientific evidence, are studies that provide the best available evidence, as long as they are carried out meticulously, using a clear and rigorous methodology.
They are secondary studies since their unit of analysis is primary studies, but they are considered original research because they seek to answer a research question through the scientific method.
Today it is common to find reviews in any database, but it must be stressed that not all reviews are systematic. Systematic reviews make use of precise methods to reduce bias in the selection, abstraction, presentation, interpretation, and reporting of evidence.
For their part, non-systematic reviews are contributions prepared by experts, which offer a general description or extensive summary of a particular topic, where they do not usually make the methodology used explicit, making them susceptible to bias. Distinguishing the nature of the reviews is of paramount importance in interpreting the results that are presented with caution.
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Systematic reviews and meta-analyses reveal the advantages of individual or primary studies. For example, their reading saves considerable time, provides reliable evidence, resolves inconsistencies between studies, identifies gaps or potential areas where more and better research is needed, establishes when a question has been fully answered and explores differences between studies.
These advantages not only strengthen clinical practice, but are crucial in decision-making, in the creation of public health policies, in teaching, and as catalysts in research.
To conduct a quality systematic review and meta-analysis the following elements must be considered:
- Authors. Have the participation of at least two authors, skilled in the topic to be investigated, but also with some experts in the methodology of systematic reviews.
- Protocol. It details the methodological plan to follow to identify, evaluate and synthesize all the findings regarding the topic of interest. This is prepared before the review and it is important to register it and publish it on the corresponding platforms.
- Review question. The review begins with a well-structured question, which may contain the PICO components (population, intervention, comparison, and outcomes /results) in the case that interventions are being studied, or PECO, if exposures are being studied.
- Search strategy. An extensive and rigorous search strategy must be developed, which is reproducible. The recommendation is to cover various digital and print data sources, as well as gray literature, preferably without language restrictions.
- Selection criteria. Specific inclusion and exclusion criteria are established beforehand, which will simplify the search for studies.
- Bias assessment. It is a decisive element that allows knowing the risk of bias in each one of the studies included in the review. It is extremely useful to consider the validity of the findings and to be able to explain the effects found.
- Synthesis. Contains narrative synthesis (qualitative) and meta-analysis (quantitative summary of effects).
To Keep In Mind.
Cochrane is an international collaboration group that seeks to generate the best evidence in health, carrying out high-quality systematic reviews and meta-analyses and developing methodological instruments that support their performance.
Although carrying out a systematic review is not a difficult process, it does require considerable time, a lot of teamwork, and the use of the best methodological instruments, so whenever possible, it is advisable to follow the guidelines and manuals developed.
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