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Presentation of Findings

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Presentation of Findings. Prepared for: The Agency for Healthcare Research and Quality (AHRQ), Training Modules for Systematic Reviews Methods Guide, www.ahrq.gov
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Presentation of Findings

This figure presents an overview of the steps in the systematic review process. The first step, the preparation of the topic, requires refinement of the topic and development of an analytic framework. The second step is to search for and select studies for inclusion, which involves identifying study eligibility criteria, searching for relevant studies, and selecting evidence for inclusion. The third step involves extracting data from individual studies. The fourth step is to analyze and synthesize studies, which involves assessing the quality of individual studies, assessing applicability, presenting findings in tables, synthesizing quantitative data, and grading the strength of evidence. The final step is to report the systematic review. This module focuses on the presentation of findings in tables.
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Systematic Review Process Overview

Keywords: systematic process overview
Learning Objectives. To understand the goals of presenting systematic review data in tables that summarize data across studies. To become familiar with approaches to graphical presentations of findings not synthesized through statistical or meta-analytic techniques.
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Learning Objectives

Keywords: data tables | graphical presentation
Organizing and Reporting Findings. Once the evidence tables are completed, there is an enormous (sometimes overwhelming) amount of data yet to synthesize. Various types of heterogeneity may preclude a quantitative synthesis (e.g., meta-analysis). Synthesizing heterogeneous studies by using tables (nonquantitative synthesis) can capture underlying similarities to support conclusions. Making sense of the data requires good tabular presentation, in addition to clear organization and writing of the text.
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Organizing and Reporting Findings

Keywords: analytic framework | key question | inclusion criteria | exclusion criteria | evidence table
Why Not Meta-analysis? Even studies meeting the same inclusion criteria can vary. Clinical heterogeneity—variation in the study population, interventions, and outcomes. Methodological heterogeneity—variation in study design. Statistical heterogeneity—variation in observed treatment effect (for trials). Many factors can contribute to variation in seemingly similar studies. Some examples are evolving diagnostic criteria, evolving diseases, differences in baseline characteristics, and differences in care. Not all studies can (or should) be combined statistically. Various statistical models are useful for identifying the level of heterogeneity between studies.
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Why Not Meta-analysis?

Keywords: heterogeneity | variation | statistical models
Solution. Nonquantitative synthesis using tables that summarize data across studies. Use of evidence maps to provide an overview of the data.
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Solution

Keywords: summary table | heterogeneity | systematic review | Evidence-based Practice Center
PICOTS. Population: primary populations of interest are followed by subpopulations. Intervention: hierarchy of interventions may reflect most common to least common. Comparator: where multiple comparisons are made, one might present the more “usual” decision first. Outcome: a hierarchy of outcomes may reflect higher to lower acuity or target outcomes followed by collateral ones; harms are generally presented last. Timing: short term generally precedes long term. Setting: an intervention may be available in various settings (e.g., inpatient or outpatient).
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PICOTS

Keywords: PICOTS | PICOS
Combining Studies. Evidence tables are the first step to summarization, but each evidence table represents the data in only one study. Incorporating multiple studies into a single table allows entire subsets of the literature to be summarized and compared (e.g., by key question or study design). Summary tables and evidence maps are two approaches with which information about individual studies and results are combined.
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Combining Studies

Keywords: evidence table | data | summary table | evidence map
Summary Tables (I). Combine data from multiple studies to illustrate trends in the data. May be focused on describing study characteristics, results, or both. Can be designed to include characteristics of all included studies. Examples: funding sources, assessment method, country of study. Can be designed for subsets of included studies. Examples: summary tables for randomized controlled trials, prevalence studies, harms/side effects, outcomes for specific treatments.
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Summary Tables (I)

Keywords: summary table | evidence table
Summary Tables (II). Simplified entry (one row) for each study. Table columns may include, for example: PICOTS (may be listed in table title or headers). Methodological quality. Applicability. Study size (weight). Magnitude of effect. A single study may be represented in multiple summary tables (e.g., different outcomes).
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Summary Tables (II)

Keywords: summary table
Example: Summary Table of Study Characteristics. This table includes five columns listing the locations from which the populations originated, and rows listing the type of population, assessment method, conditions assessed, and funding source. Numbers are entered into the table to provide a count of the characteristics listed in the rows per country (United States) or region (Europe, Asia, or other).
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Example: Summary Table of Study Characteristics

Keywords: summary table | key question | study design
Example: Presentation of Data by Outcome and Age. This table includes 17 columns listing the specific health outcomes examined in concert with vitamin D intake, including body weight, cancer, immune function clinical exposures, all-cause mortality, hypertension, and blood pressure. Rows parse the results into different life stages and indicate the total number of unique studies per outcome, the number of randomized controlled trials per outcome, and the number of systematic reviews per outcome.
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Example: Summary Table as High-Level Map

Keywords: summary table | evidence map
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