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Hurley JC. Visualizing and diagnosing spillover within randomized concurrent controlled trials through the application of diagnostic test assessment methods. BMC Med Res Methodol 2024; 24:182. [PMID: 39152400 PMCID: PMC11328391 DOI: 10.1186/s12874-024-02296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/24/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Spillover of effect, whether positive or negative, from intervention to control group patients invalidates the Stable Unit Treatment Variable Assumption (SUTVA). SUTVA is critical to valid causal inference from randomized concurrent controlled trials (RCCT). Spillover of infection prevention is an important population level effect mediating herd immunity. This herd effect, being additional to any individual level effect, is subsumed within the overall effect size (ES) estimate derived by contrast-based techniques from RCCT's. This herd effect would manifest only as increased dispersion among the control group infection incidence rates above background. METHODS AND RESULTS The objective here is to explore aspects of spillover and how this might be visualized and diagnosed. I use, for illustration, data from 190 RCCT's abstracted in 13 Cochrane reviews of various antimicrobial versus non-antimicrobial based interventions to prevent pneumonia in ICU patients. Spillover has long been postulated in this context. Arm-based techniques enable three approaches to identify increased dispersion, not available from contrast-based techniques, which enable the diagnosis of spillover within antimicrobial versus non-antimicrobial based infection prevention RCCT's. These three approaches are benchmarking the pneumonia incidence rates versus a clinically relevant range, comparing the dispersion in pneumonia incidence among the control versus the intervention groups and thirdly, visualizing the incidence dispersion within summary receiver operator characteristic (SROC) plots. By these criteria there is harmful spillover effects to concurrent control group patients. CONCLUSIONS Arm-based versus contrast-based techniques lead to contrary inferences from the aggregated RCCT's of antimicrobial based interventions despite similar summary ES estimates. Moreover, the inferred relationship between underlying control group risk and ES is 'flipped'.
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Affiliation(s)
- James C Hurley
- Melbourne Medical School, University of Melbourne, Ballarat, Australia.
- Internal Medicine Service, Ballarat Health Services, Grampians Health, PO Box 577, Ballarat, 3353, Australia.
- Ballarat Clinical School, Deakin University, Ballarat, Australia.
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Løvsletten PO, Wang X, Pitre T, Ødegaard M, Veroniki AA, Lunny C, Tricco AC, Agoritsas T, Vandvik PO. A systematic survey of 200 systematic reviews with network meta-analysis (published 2020-2021) reveals that few reviews report structured evidence summaries. J Clin Epidemiol 2024; 173:111445. [PMID: 38942177 DOI: 10.1016/j.jclinepi.2024.111445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVES To map whether and how systematic reviews (SRs) with network meta-analysis (NMA) use presentation formats to report (a) structured evidence summaries - here defined as reporting of effects estimates in absolute effects with certainty ratings and with a method to rate interventions across one or more outcome(s) - and (b) NMA results in general. STUDY DESIGN AND SETTING We conducted a systematic survey, searching MEDLINE (Ovid) for SRs with NMA published between January 1, 2020, and December 31, 2021. We planned to include a random sample of publications, with predefined mechanisms in place for saturation, and included SRs that met prespecified quality criteria and extracted data on presentation formats that reported: (a) estimates of effects, (b) certainty of the evidence, or (c) rating of interventions. RESULTS The 200 eligible SRs, from 158 unique Journals, utilized 1133 presentation formats. We found structured evidence summaries in 10 publications (5.0%), with 3 (1.5%) reporting structured evidence summaries across all outcomes, including benefits and harms. Sixteen of the 133 SRs (11.7%) reporting dichotomous outcomes included estimates of absolute effects. Seventy-six SRs (38.0%) reported both benefits and harms and 26 SRs (13.0%) reported certainty ratings in presentation formats, 20 (76.9%) used Grading of Recommendations Assessment, Development and Evaluation and 6 (23.1%) used Confidence In Network Meta-analysis. Surface Under the Cumulative Ranking Curve was the most common method to rate interventions (69 SRs, 34.5%). NMA results were most often reported using forest plots (108 SRs, 54.0%) and league tables (93 SRs, 46.5%). CONCLUSION Most SRs with NMA do not report structured evidence summaries and only rarely do such summaries include reporting of both benefits and harms; those that do offer effective user-friendly communication and provide models for optimal NMA presentation practice.
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Affiliation(s)
- Per Olav Løvsletten
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway; Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Xiaoqin Wang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; University of Ottawa Heart Institute Research Corporation, Ottawa, Ontario, Canada
| | - Tyler Pitre
- Department of Respirology, University of Toronto, Toronto, Ontario, Canada
| | - Marte Ødegaard
- Library of Medicine and Science, University of Oslo Library, University of Oslo, Oslo, Norway
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Ontario, Toronto, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Ontario, Toronto, Canada; Cochrane Hypertension Group and the Therapeutics Initiative, University of British Columbia, Vancouver, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Ontario, Toronto, Canada; Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's School of Nursing. Queen's University, Kingston, Ontario, Canada; Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Agoritsas
- Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; MAGIC Evidence Ecosystem Foundation, Oslo, Norway
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway; Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway; MAGIC Evidence Ecosystem Foundation, Oslo, Norway
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Stogiannis D, Siannis F, Androulakis E. Heterogeneity in meta-analysis: a comprehensive overview. Int J Biostat 2024; 20:169-199. [PMID: 36961993 DOI: 10.1515/ijb-2022-0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/10/2023] [Indexed: 03/26/2023]
Abstract
In recent years, meta-analysis has evolved to a critically important field of Statistics, and has significant applications in Medicine and Health Sciences. In this work we briefly present existing methodologies to conduct meta-analysis along with any discussion and recent developments accompanying them. Undoubtedly, studies brought together in a systematic review will differ in one way or another. This yields a considerable amount of variability, any kind of which may be termed heterogeneity. To this end, reports of meta-analyses commonly present a statistical test of heterogeneity when attempting to establish whether the included studies are indeed similar in terms of the reported output or not. We intend to provide an overview of the topic, discuss the potential sources of heterogeneity commonly met in the literature and provide useful guidelines on how to address this issue and to detect heterogeneity. Moreover, we review the recent developments in the Bayesian approach along with the various graphical tools and statistical software that are currently available to the analyst. In addition, we discuss sensitivity analysis issues and other approaches of understanding the causes of heterogeneity. Finally, we explore heterogeneity in meta-analysis for time to event data in a nutshell, pointing out its unique characteristics.
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Affiliation(s)
| | - Fotios Siannis
- Department of Mathematics, National and Kapodistrian University, Athens, Greece
| | - Emmanouil Androulakis
- Mathematical Modeling and Applications Laboratory, Section of Mathematics, Hellenic Naval Academy, Piraeus, Greece
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Luo R, Wang Y, Li R, Ma Y, Chen H, Zhang J, Shen J. Laser therapy decreases oral leukoplakia recurrence and boosts patient comfort: a network meta-analysis and systematic review. BMC Oral Health 2024; 24:469. [PMID: 38632580 PMCID: PMC11025167 DOI: 10.1186/s12903-024-04179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Oral leukoplakia (OLK) is a prevalent precancerous lesion with limited non-pharmacological treatment options. Surgery and various lasers are the mainstay of treatment; however, their relative efficacy and optimal choice remain unclear. This first network meta-analysis compared the effects of different lasers and surgical excision on post-treatment recurrence and comfort in OLK patients. METHODS We searched four databases for relevant randomized controlled trials (RCTs) up to April 2023. The primary outcome was post-treatment recurrence, and secondary outcomes included intraoperative hemorrhage and postoperative pain scores. The Cochrane Risk of Bias tool was used to assess the study quality. Meta-analysis and network meta-analysis were employed to determine efficacy and identify the optimal intervention. RESULTS A total of 11 RCTs including 917 patients and 1138 lesions were included. Er,Cr:YSGG laser treatment showed significantly lower recurrence rates compared to CO2 laser (OR: 0.04; 95% CI: 0.01-0.18), CO2 laser with margin extension (OR: 0.06; 95% CI: 0.01-0.60), Er:YAG laser (OR: 0.10; 95% CI: 0.03-0.37), electrocautery (OR: 0.03; 95% CI: 0.00-0.18), and standard care (OR: 0.08; 95% CI: 0.02-0.33). Er,Cr:YSGG laser also ranked the best for reducing recurrence, followed by standard care and CO2 laser combined with photodynamic therapy (PDT). Er:YAG and Er:Cr:YSGG lasers minimized bleeding and pain, respectively. None of the interventions caused severe adverse effects. CONCLUSION For non-homogeneous OLK, Er:YAG, Er:Cr:YSGG, and CO2 laser combined with PDT offer promising alternatives to surgical excision, potentially reducing recurrence and improving patient comfort. Further high-quality RCTs are necessary to confirm these findings and determine the optimal laser-PDT combination for OLK treatment.
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Affiliation(s)
- Rui Luo
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China
| | - Yanan Wang
- Tianjin Medical University, Tianjin, 300070, China
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, Hospital of Stomatological, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China
| | - Ruixin Li
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, Hospital of Stomatological, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China
| | - Yanan Ma
- School of Stomatology, Weifang Medical University, Weifang, 261053, China
| | - Haitao Chen
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, Hospital of Stomatological, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China
| | - Jian Zhang
- School of Stomatology, Hospital of Stomatology, Tianjin Medical University, 12 Observatory Road, Tianjin, 300070, China.
| | - Jun Shen
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
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Rao KN, Rajguru R, Dange P, Vetter D, Triponez F, Nixon IJ, Randolph GW, Mäkitie AA, Zafereo M, Ferlito A. Lower Rates of Hypocalcemia Following Near-Infrared Autofluorescence Use in Thyroidectomy: A Meta-Analysis of RCTs. Diagnostics (Basel) 2024; 14:505. [PMID: 38472977 DOI: 10.3390/diagnostics14050505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Iatrogenic injury of the parathyroid glands is the most frequent complication after total thyroidectomy. OBJECTIVE To determine the effectiveness of near-infrared autofluorescence (NIRAF) in reducing postoperative hypocalcemia following total thyroidectomy. METHODS PubMed, Scopus, and Google Scholar databases were searched. Randomised trials reporting at least one hypocalcemia outcome following total thyroidectomy using NIRAF were included. RESULTS The qualitative data synthesis comprised 1363 patients from nine randomised studies, NIRAF arm = 636 cases and non-NIRAF arm = 637 cases. There was a statistically significant difference in the overall rate of hypocalcemia log(OR) = -0.7 [(-1.01, -0.40), M-H, REM, CI = 95%] and temporary hypocalcemia log(OR) = -0.8 [(-1.01, -0.59), M-H, REM, CI = 95%] favouring the NIRAF. The difference in the rate of permanent hypocalcemia log(OR) = -1.09 [(-2.34, 0.17), M-H, REM, CI = 95%] between the two arms was lower in the NIRAF arm but was not statistically significant. CONCLUSIONS NIRAF during total thyroidectomy helps in reducing postoperative hypocalcemia. Level of evidence-1.
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Affiliation(s)
- Karthik N Rao
- Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur 492099, India
- Sri Shankara Cancer Hospital and Research Center, Bangalore 560004, India
| | - Renu Rajguru
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur 492099, India
| | - Prajwal Dange
- Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur 492099, India
| | - Diana Vetter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland
| | - Frederic Triponez
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Iain J Nixon
- Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh EH3 9YL, UK
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki University Hospital, 00014 Helsinki, Finland
| | - Mark Zafereo
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX 77005, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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Stokke Hunskaar B, Løvsletten PO, Muller A, Vandvik PO. Interpretation and use of a decision support tool for multiple treatment options: a combined randomised controlled trial and survey of medical students. BMJ Evid Based Med 2024; 29:29-36. [PMID: 37833036 PMCID: PMC10850623 DOI: 10.1136/bmjebm-2023-112370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES To investigate medical students' ability to interpret evidence, as well as their self-assessed understandability, perceived usefulness and preferences for design alternatives in an interactive decision support tool, displaying GRADE evidence summaries for multiple treatment options (Making Alternative Treatment CHoices Intuitive and Trustworthy, MATCH-IT). DESIGN A combined randomised controlled trial and survey. Participants were presented with a clinical scenario and randomised to one of two versions of the MATCH-IT tool (A/B), instructed to explore the evidence and decide on a recommendation. Participants answered a questionnaire assessing interpretation, treatment recommendation self-assessed understandability and perceived usefulness before exposure to the other MATCH-IT version and asked questions on design preferences. SETTING Online lecture in an evidence-based medicine (EBM) introductory course. PARTICIPANTS 149 third-year medical students. 52% (n=77) had 6 months of clinical training and 48% (n=72) had preclinical training only. INTERVENTIONS The MATCH-IT tool version A uses colour coding to categorise interventions by magnitude and direction of effects and displays all outcomes in a table on entry. Version B has no colour coding, and the user must decide which outcomes to display in the table. MAIN OUTCOME MEASURES Interpretation of evidence, treatment recommendation, perceived usefulness and understandability, preference for format and design alternatives. RESULTS 82.5% (n=123) of medical students correctly answered ≥4 out of 5 multiple choice questions assessing interpretation of data. 75.8% (n=114) of students made a treatment recommendation in accordance with an expert panel for the same clinical scenario. 87.2% (n=130) found the tool understandable while 91.9% perceived the tool as useful in addressing the clinical scenario. CONCLUSION Medical students with no prior training in EBM can interpret and use the MATCH-IT tool. Certain design alternatives were preferred but had no bearing on interpretation of evidence or understandability of the tool.
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Affiliation(s)
- Birk Stokke Hunskaar
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Per Olav Løvsletten
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
- Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Ashley Muller
- Norwegian Centre for Addiction Research, University of Oslo Faculty of Medicine, Oslo, Norway
- Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
| | - Per Olav Vandvik
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
- Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Norway
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Perivoliotis K, Chatzinikolaou C, Symeonidis D, Tepetes K, Baloyiannis I, Tzovaras G. Comparison of ointment-based agents after excisional procedures for hemorrhoidal disease: a network meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2023; 408:401. [PMID: 37837466 DOI: 10.1007/s00423-023-03128-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Efficient postoperative pain control is important after hemorrhoidal surgery. Although several locally applied medications have been used, current evidence regarding the optimal strategy is still conflicting. This network meta-analysis assessed analgesic efficacy and safety of the various topical medications in patients submitted to excisional procedures for hemorrhoids. METHODS The present study followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The last systematic literature screening was performed at 15 June 2023. Comparisons were based on a random effects multivariate network meta-analysis under a Bayesian framework. RESULTS Overall, 26 RCTs and 2132 patients were included. Regarding postoperative pain, EMLA cream (surface under the cumulative ranking curve (SUCRA) 80.3%) had the highest ranking at 12-h endpoint, while aloe vera cream (SUCRA 82.36%) scored first at 24 h. Metronidazole ointments had the highest scores at 7 and 14 days postoperatively. Aloe vera had the best analgesic profile (24-h SUCRA 84.8% and 48-h SUCRA 80.6%) during defecation. Lidocaine (SUCRA 87.9%) displayed the best performance regarding overall morbidity rates. CONCLUSIONS Due to the inconclusive results and several study limitations, further RCTs are required.
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Affiliation(s)
| | | | - Dimitrios Symeonidis
- Department of Surgery, University Hospital of Larissa Viopolis, 41110, Larissa, Greece
| | - Konstantinos Tepetes
- Department of Surgery, University Hospital of Larissa Viopolis, 41110, Larissa, Greece
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa Viopolis, 41110, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa Viopolis, 41110, Larissa, Greece
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Freeman SC, Saeedi E, Ordóñez-Mena JM, Nevill CR, Hartmann-Boyce J, Caldwell DM, Welton NJ, Cooper NJ, Sutton AJ. Data visualisation approaches for component network meta-analysis: visualising the data structure. BMC Med Res Methodol 2023; 23:208. [PMID: 37715126 PMCID: PMC10502971 DOI: 10.1186/s12874-023-02026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Health and social care interventions are often complex and can be decomposed into multiple components. Multicomponent interventions are often evaluated in randomised controlled trials. Across trials, interventions often have components in common which are given alongside other components which differ across trials. Multicomponent interventions can be synthesised using component NMA (CNMA). CNMA is limited by the structure of the available evidence, but it is not always straightforward to visualise such complex evidence networks. The aim of this paper is to develop tools to visualise the structure of complex evidence networks to support CNMA. METHODS We performed a citation review of two key CNMA methods papers to identify existing published CNMA analyses and reviewed how they graphically represent intervention complexity and comparisons across trials. Building on identified shortcomings of existing visualisation approaches, we propose three approaches to standardise visualising the data structure and/or availability of data: CNMA-UpSet plot, CNMA heat map, CNMA-circle plot. We use a motivating example to illustrate these plots. RESULTS We identified 34 articles reporting CNMAs. A network diagram was the most common plot type used to visualise the data structure for CNMA (26/34 papers), but was unable to express the complex data structures and large number of components and potential combinations of components associated with CNMA. Therefore, we focused visualisation development around representing the data structure of a CNMA more completely. The CNMA-UpSet plot presents arm-level data and is suitable for networks with large numbers of components or combinations of components. Heat maps can be utilised to inform decisions about which pairwise interactions to consider for inclusion in a CNMA model. The CNMA-circle plot visualises the combinations of components which differ between trial arms and offers flexibility in presenting additional information such as the number of patients experiencing the outcome of interest in each arm. CONCLUSIONS As CNMA becomes more widely used for the evaluation of multicomponent interventions, the novel CNMA-specific visualisations presented in this paper, which improve on the limitations of existing visualisations, will be important to aid understanding of the complex data structure and facilitate interpretation of the CNMA results.
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Affiliation(s)
- Suzanne C Freeman
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK.
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK.
| | - Elnaz Saeedi
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clareece R Nevill
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola J Cooper
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - Alex J Sutton
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
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Vilsmeier JK, Kossmeier M, Voracek M, Tran US. The fraternal birth-order effect as a statistical artefact: convergent evidence from probability calculus, simulated data, and multiverse meta-analysis. PeerJ 2023; 11:e15623. [PMID: 37609443 PMCID: PMC10441532 DOI: 10.7717/peerj.15623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 06/01/2023] [Indexed: 08/24/2023] Open
Abstract
The fraternal-birth order effect (FBOE) is a research claim which states that each older brother increases the odds of homosexual orientation in men via an immunoreactivity process known as the maternal immune hypothesis. Importantly, older sisters supposedly either do not affect these odds, or affect them to a lesser extent. Consequently, the fraternal birth-order effect predicts that the association between the number of older brothers and homosexual orientation in men is greater in magnitude than any association between the number of older sisters and homosexual orientation. This difference in magnitude represents the main theoretical estimand of the FBOE. In addition, no comparable effects should be observable among homosexual vs heterosexual women. Here, we triangulate the empirical foundations of the FBOE from three distinct, informative perspectives, complementing each other: first, drawing on basic probability calculus, we deduce mathematically that the body of statistical evidence used to make inferences about the main theoretical estimand of the FBOE rests on incorrect statistical reasoning. In particular, we show that throughout the literature researchers ascribe to the false assumptions that effects of family size should be adjusted for and that this could be achieved through the use of ratio variables. Second, using a data-simulation approach, we demonstrate that by using currently recommended statistical practices, researchers are bound to frequently draw incorrect conclusions. And third, we re-examine the empirical evidence of the fraternal birth-order effect in men and women by using a novel specification-curve and multiverse approach to meta-analysis (64 male and 17 female samples, N = 2,778,998). When analyzed correctly, the specific association between the number of older brothers and homosexual orientation is small, heterogenous in magnitude, and apparently not specific to men. In addition, existing research evidence seems to be exaggerated by small-study effects.
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Affiliation(s)
- Johannes K. Vilsmeier
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Michael Kossmeier
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Martin Voracek
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ulrich S. Tran
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
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South E, Rodgers M. Data visualisation in scoping reviews and evidence maps on health topics: a cross-sectional analysis. Syst Rev 2023; 12:142. [PMID: 37587522 PMCID: PMC10433592 DOI: 10.1186/s13643-023-02309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Scoping reviews and evidence maps are forms of evidence synthesis that aim to map the available literature on a topic and are well-suited to visual presentation of results. A range of data visualisation methods and interactive data visualisation tools exist that may make scoping reviews more useful to knowledge users. The aim of this study was to explore the use of data visualisation in a sample of recent scoping reviews and evidence maps on health topics, with a particular focus on interactive data visualisation. METHODS Ovid MEDLINE ALL was searched for recent scoping reviews and evidence maps (June 2020-May 2021), and a sample of 300 papers that met basic selection criteria was taken. Data were extracted on the aim of each review and the use of data visualisation, including types of data visualisation used, variables presented and the use of interactivity. Descriptive data analysis was undertaken of the 238 reviews that aimed to map evidence. RESULTS Of the 238 scoping reviews or evidence maps in our analysis, around one-third (37.8%) included some form of data visualisation. Thirty-five different types of data visualisation were used across this sample, although most data visualisations identified were simple bar charts (standard, stacked or multi-set), pie charts or cross-tabulations (60.8%). Most data visualisations presented a single variable (64.4%) or two variables (26.1%). Almost a third of the reviews that used data visualisation did not use any colour (28.9%). Only two reviews presented interactive data visualisation, and few reported the software used to create visualisations. CONCLUSIONS Data visualisation is currently underused by scoping review authors. In particular, there is potential for much greater use of more innovative forms of data visualisation and interactive data visualisation. Where more innovative data visualisation is used, scoping reviews have made use of a wide range of different methods. Increased use of these more engaging visualisations may make scoping reviews more useful for a range of stakeholders.
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Affiliation(s)
- Emily South
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD UK
| | - Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD UK
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Nakagawa S, Yang Y, Macartney EL, Spake R, Lagisz M. Quantitative evidence synthesis: a practical guide on meta-analysis, meta-regression, and publication bias tests for environmental sciences. ENVIRONMENTAL EVIDENCE 2023; 12:8. [PMID: 39294795 PMCID: PMC11378872 DOI: 10.1186/s13750-023-00301-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/23/2023] [Indexed: 09/21/2024]
Abstract
Meta-analysis is a quantitative way of synthesizing results from multiple studies to obtain reliable evidence of an intervention or phenomenon. Indeed, an increasing number of meta-analyses are conducted in environmental sciences, and resulting meta-analytic evidence is often used in environmental policies and decision-making. We conducted a survey of recent meta-analyses in environmental sciences and found poor standards of current meta-analytic practice and reporting. For example, only ~ 40% of the 73 reviewed meta-analyses reported heterogeneity (variation among effect sizes beyond sampling error), and publication bias was assessed in fewer than half. Furthermore, although almost all the meta-analyses had multiple effect sizes originating from the same studies, non-independence among effect sizes was considered in only half of the meta-analyses. To improve the implementation of meta-analysis in environmental sciences, we here outline practical guidance for conducting a meta-analysis in environmental sciences. We describe the key concepts of effect size and meta-analysis and detail procedures for fitting multilevel meta-analysis and meta-regression models and performing associated publication bias tests. We demonstrate a clear need for environmental scientists to embrace multilevel meta-analytic models, which explicitly model dependence among effect sizes, rather than the commonly used random-effects models. Further, we discuss how reporting and visual presentations of meta-analytic results can be much improved by following reporting guidelines such as PRISMA-EcoEvo (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Ecology and Evolutionary Biology). This paper, along with the accompanying online tutorial, serves as a practical guide on conducting a complete set of meta-analytic procedures (i.e., meta-analysis, heterogeneity quantification, meta-regression, publication bias tests and sensitivity analysis) and also as a gateway to more advanced, yet appropriate, methods.
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Affiliation(s)
- Shinichi Nakagawa
- Evolution & Ecology Research Centre and School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, NSW, 2052, Australia.
- Theoretical Sciences Visiting Program, Okinawa Institute of Science and Technology Graduate University, Onna, 904-0495, Japan.
| | - Yefeng Yang
- Evolution & Ecology Research Centre and School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Erin L Macartney
- Evolution & Ecology Research Centre and School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Rebecca Spake
- School of Biological Sciences, Whiteknights Campus, University of Reading, Reading, RG6 6AS, UK
| | - Malgorzata Lagisz
- Evolution & Ecology Research Centre and School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
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12
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Ostinelli EG, Efthimiou O, Naci H, Furukawa TA, Leucht S, Salanti G, Wainwright L, Zangani C, De Crescenzo F, Smith K, Stevens K, Liu Q, Cipriani A. Vitruvian plot: a visualisation tool for multiple outcomes in network meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2022; 25:e65-e70. [PMID: 35613849 PMCID: PMC9811072 DOI: 10.1136/ebmental-2022-300457] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/10/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE A network meta-analysis (NMA) usually assesses multiple outcomes across several treatment comparisons. The Vitruvian plot aims to facilitate communication of multiple outcomes from NMAs to patients and clinicians. METHODS We developed this tool following the recommendations on the communication of benefit-risk information from the available literature. We collected and implemented feedback from researchers, statisticians, methodologists, clinicians and people with lived experience of physical and mental health issues. RESULTS We present the Vitruvian plot, which graphically presents absolute estimates and relative performance of competing interventions against a common comparator for several outcomes of interest. We use two alternative colour schemes to highlight either the strength of statistical evidence or the confidence in the evidence. Confidence in the evidence is evaluated across six domains (within-study bias, reporting bias, indirectness, imprecision, heterogeneity and incoherence) using the Confidence in Network Meta-Analysis (CINeMA) system. CONCLUSIONS The Vitruvian plot allows reporting of multiple outcomes from NMAs, with colourings appropriate to inform credibility of the presented evidence.
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Affiliation(s)
- Edoardo Giuseppe Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Orestis Efthimiou
- Department of Psychiatry, University of Oxford, Oxford, UK,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munchen, Germany
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Laurence Wainwright
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Caroline Zangani
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Katharine Smith
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Katherine Stevens
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Qiang Liu
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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13
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Use of mixed-type data clustering algorithm for characterizing temporal and spatial distribution of biosecurity border detections of terrestrial non-indigenous species. PLoS One 2022; 17:e0272413. [PMID: 35943971 PMCID: PMC9362945 DOI: 10.1371/journal.pone.0272413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
Appropriate inspection protocols and mitigation strategies are a critical component of effective biosecurity measures, enabling implementation of sound management decisions. Statistical models to analyze biosecurity surveillance data are integral to this decision-making process. Our research focuses on analyzing border interception biosecurity data collected from a Class A Nature Reserve, Barrow Island, in Western Australia and the associated covariates describing both spatial and temporal interception patterns. A clustering analysis approach was adopted using a generalization of the popular k-means algorithm appropriate for mixed-type data. The analysis approach compared the efficiency of clustering using only the numerical data, then subsequently including covariates to the clustering. Based on numerical data only, three clusters gave an acceptable fit and provided information about the underlying data characteristics. Incorporation of covariates into the model suggested four distinct clusters dominated by physical location and type of detection. Clustering increases interpretability of complex models and is useful in data mining to highlight patterns to describe underlying processes in biosecurity and other research areas. Availability of more relevant data would greatly improve the model. Based on outcomes from our research we recommend broader use of cluster models in biosecurity data, with testing of these models on more datasets to validate the model choice and identify important explanatory variables.
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14
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Aisbett J, Drinkwater EJ, Quarrie KL, Woodcock S. Applying generalized funnel plots to help design statistical analyses. Stat Pap (Berl) 2022. [DOI: 10.1007/s00362-022-01322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractResearchers across many fields routinely analyze trial data using Null Hypothesis Significance Tests with zero null and p < 0.05. To promote thoughtful statistical testing, we propose a visualization tool that highlights practically meaningful effects when calculating sample sizes. The tool re-purposes and adapts funnel plots, originally developed for meta-analyses, after generalizing them to cater for meaningful effects. As with traditional sample size calculators, researchers must nominate anticipated effect sizes and variability alongside the desired power. The advantage of our tool is that it simultaneously presents sample sizes needed to adequately power tests for equivalence, for non-inferiority and for superiority, each considered at up to three alpha levels and in positive and negative directions. The tool thus encourages researchers at the design stage to think about the type and level of test in terms of their research goals, costs of errors, meaningful effect sizes and feasible sample sizes. An R-implementation of the tool is available on-line.
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15
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Purssell E, Gould D. Undertaking qualitative reviews in nursing and education - A method of thematic analysis for students and clinicians. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, McKenzie JE. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372:n160. [PMID: 33781993 PMCID: PMC8005925 DOI: 10.1136/bmj.n160+10.1136/bmj.n160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
The methods and results of systematic reviews should be reported in sufficient detail to allow users to assess the trustworthiness and applicability of the review findings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was developed to facilitate transparent and complete reporting of systematic reviews and has been updated (to PRISMA 2020) to reflect recent advances in systematic review methodology and terminology. Here, we present the explanation and elaboration paper for PRISMA 2020, where we explain why reporting of each item is recommended, present bullet points that detail the reporting recommendations, and present examples from published reviews. We hope that changes to the content and structure of PRISMA 2020 will facilitate uptake of the guideline and lead to more transparent, complete, and accurate reporting of systematic reviews.
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Affiliation(s)
- Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Isabelle Boutron
- Université de Paris, Centre of Epidemiology and Statistics (CRESS), Inserm, F 75004 Paris, France
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Cynthia D Mulrow
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States; Annals of Internal Medicine
| | - Larissa Shamseer
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
| | - Julie Glanville
- York Health Economics Consortium (YHEC Ltd), University of York, York, UK
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada; Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Canada; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Denver, Denver, Colorado, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Elizabeth W Loder
- Division of Headache, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States; Head of Research, The BMJ, London, UK
| | - Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Luke A McGuinness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lesley A Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James Thomas
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Epidemiology Division of the Dalla Lana School of Public Health and the Institute of Health Management, Policy, and Evaluation, University of Toronto, Toronto, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Vivian A Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Penny Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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17
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Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, McKenzie JE. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ : BRITISH MEDICAL JOURNAL 2021. [DOI: 10.1136/bmj.n160 10.1136/bmj.n160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, McKenzie JE. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372:n160. [PMID: 33781993 PMCID: PMC8005925 DOI: 10.1136/bmj.n160] [Citation(s) in RCA: 3335] [Impact Index Per Article: 1111.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Isabelle Boutron
- Université de Paris, Centre of Epidemiology and Statistics (CRESS), Inserm, F 75004 Paris, France
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Cynthia D Mulrow
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States; Annals of Internal Medicine
| | - Larissa Shamseer
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
| | - Julie Glanville
- York Health Economics Consortium (YHEC Ltd), University of York, York, UK
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada; Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Canada; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Denver, Denver, Colorado, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Elizabeth W Loder
- Division of Headache, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States; Head of Research, The BMJ, London, UK
| | - Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Luke A McGuinness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lesley A Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James Thomas
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Epidemiology Division of the Dalla Lana School of Public Health and the Institute of Health Management, Policy, and Evaluation, University of Toronto, Toronto, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Vivian A Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Penny Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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19
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Nikolakopoulou A, Chaimani A. More than words: Novel visualizations for evidence synthesis. Res Synth Methods 2020; 12:2-3. [PMID: 33350097 DOI: 10.1002/jrsm.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Adriani Nikolakopoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anna Chaimani
- Université de Paris, Center of Research in Epidemiology and Statistics (CRESS-U1153), Inserm, Paris, France.,Cochrane France, Paris, France
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20
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Papakonstantinou T, Nikolakopoulou A, Egger M, Salanti G. Meta-analysis as a system of springs. Res Synth Methods 2020; 12:20-28. [PMID: 33264498 DOI: 10.1002/jrsm.1470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022]
Abstract
Meta-analysis results are usually presented in forest plots, which show the individual study results and the summary effect along with their confidence intervals. In this paper, we propose a system of linear springs as a mechanical analogue of meta-analysis that enables visualization and enhances intuition. The length of a spring corresponds to a study treatment effect and the stiffness of the spring corresponds to its inverse variance. To synthesize study springs we use two main operations: connection in parallel and connection in series. We show the equivalence between meta-analysis and linear springs for fixed effect and random effects pairwise meta-analysis and we also derive indirect treatment effects. We use examples to illustrate the different meta-analytical schemes using the corresponding system of springs. The proposed visualization can serve as an educational tool, especially useful for researchers with no statistical background. The analogy between meta-analysis and springs facilitates intuition for notions such as heterogeneity and the differences between fixed and random effects meta-analysis.
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Affiliation(s)
| | - Adriani Nikolakopoulou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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21
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Nakagawa S, Lagisz M, O'Dea RE, Rutkowska J, Yang Y, Noble DWA, Senior AM. The orchard plot: Cultivating a forest plot for use in ecology, evolution, and beyond. Res Synth Methods 2020; 12:4-12. [PMID: 32445243 DOI: 10.1002/jrsm.1424] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/22/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
"Classic" forest plots show the effect sizes from individual studies and the aggregate effect from a meta-analysis. However, in ecology and evolution, meta-analyses routinely contain over 100 effect sizes, making the classic forest plot of limited use. We surveyed 102 meta-analyses in ecology and evolution, finding that only 11% use the classic forest plot. Instead, most used a "forest-like plot," showing point estimates (with 95% confidence intervals [CIs]) from a series of subgroups or categories in a meta-regression. We propose a modification of the forest-like plot, which we name the "orchard plot." Orchard plots, in addition to showing overall mean effects and CIs from meta-analyses/regressions, also include 95% prediction intervals (PIs), and the individual effect sizes scaled by their precision. The PI allows the user and reader to see the range in which an effect size from a future study may be expected to fall. The PI, therefore, provides an intuitive interpretation of any heterogeneity in the data. Supplementing the PI, the inclusion of underlying effect sizes also allows the user to see any influential or outlying effect sizes. We showcase the orchard plot with example datasets from ecology and evolution, using the R package, orchard, including several functions for visualizing meta-analytic data using forest-plot derivatives. We consider the orchard plot as a variant on the classic forest plot, cultivated to the needs of meta-analysts in ecology and evolution. Hopefully, the orchard plot will prove fruitful for visualizing large collections of heterogeneous effect sizes regardless of the field of study.
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Affiliation(s)
- Shinichi Nakagawa
- Evolution & Ecology Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Malgorzata Lagisz
- Evolution & Ecology Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Rose E O'Dea
- Evolution & Ecology Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanna Rutkowska
- Institute of Environmental Sciences, Faculty of Biology, Jagiellonian University, Kraków, Poland
| | - Yefeng Yang
- Evolution & Ecology Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel W A Noble
- Division of Ecology and Evolution, Research School of Biology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alistair M Senior
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Camperdown, New South Wales, Australia
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22
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Rücker G, Schwarzer G. Beyond the forest plot: The drapery plot. Res Synth Methods 2020; 12:13-19. [PMID: 32336044 DOI: 10.1002/jrsm.1410] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 11/09/2022]
Abstract
In the era of the "reproducibility crisis" and the "P-value controversy" new ways of presentation and interpretation of the results of a meta-analysis are desirable. One suggestion that has been made for single studies almost six decades ago and taken up now and then is the P-value function. For a given outcome, this function assigns a P-value to each possible hypothetical value, given the data. Moreover, the P-value function simultaneously provides two-sided confidence intervals for all possible alpha levels. An application to meta-analysis, while suggested early, has not been widely established. We introduce the drapery plot that presents the P-value function for all individual studies and pooled estimates in a meta-analysis as curves and the prediction range for a single future study. We also present a scaled variant with the test statistic on the y-axis. Both plots visualize the full information of a pairwise meta-analysis. We see a drapery plot as a complementary figure to a forest plot. It may be even an alternative in meta-analyses with many studies where forest plots tend to become very large and complex.
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Affiliation(s)
- Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.,Present Address: Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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