Module-3-SysReview-Process_2024-audio

Welcome to module three of the evidence analysis center orientation tutorial. In this module, you will learn about the evidence analysis center's systematic review process. The information in the evidence analysis library has been determined through a systematic process for reviewing nutrition research. This module covered the roles of the project team and the academy's rigor fives step systematic review process. Evidence based dietetics practice involves a process of asking questions, systematically finding research evidence and assessing its validity, applicability and importance to nutrition and dietetics practice decisions and applying relevant evidence in the context of the practice situation including professional expertise and the values and circumstances of patients, clients, customers, individuals, groups or populations to achieve the positive outcomes. The main objective of the evidence analysis library is to provide a resource that academy members can use to implement evidence-based recommendations in practice. So why incorporate evidence-based practices for dieticians to remain competitive in health care? They must incorporate evidence-based practice into their day to day practice decisions. Evidence-based practice enhances credibility with other healthcare team members and will help dieticians be more effective and efficient in their practice. Evidence-based practice can improve the quality of healthcare decrease wide variations in practice, reduce the gap between what is known from research and what happens in real life and takes advantage of biomedical knowledge. Let's get started with how the eal team prepares for the systematic review. In module two, we covered how the scoping review is the first phase in the evidence analysis process. The project team answers a question. Does the available literature justify a need for the systematic review? If the answer is yes, the team moves forward with the systematic review and the process begins, the scoping review results identified nutrition tactics which had not been covered by a recent review or guideline. Therefore, the project team decided to move forward with a systematic review. They will use the results to focus the systematic review scope including development of the po questions. The evidence analysis center systematic review process is a state of the art method for evaluating food and nutrition questions. It is conducted by a team consisting of topic experts and a project team trained in research analysis protocols, meticulous methods and web-based templates are used throughout the process to ensure objectivity, transparency and reproducibility of the process. The systematic review project team is comprised of the project manager, lead analyst, a panel of 6 to 8 topic experts, patient advocate methodologies, evidence analyst and a medical librarian experienced with systematic review searches. Expert panel members are appointed by the Council and research work group selection sub-committee. The sub-committee aims for a multidisciplinary team with a balance of clinicians and researchers requirements to become an expert panel member include a minimum of five years of practice or research experience. Three years of work related to the focus of the project and neither an advanced degree or at least eight years of experience in the topic area. This is the get involved section which can be accessed from the E A homepage for volunteer opportunities. Responsibilities of the expert panel include finalizing the evidence analysis, questions and search plan, reviewing work completed by the analysts and lead analysts finalizing and grading content, developing guideline recommendations and providing final approval and all material the group needs via teleconference calls usually twice a month. Patient advocate roles are designed to advise the expert panel on how particular therapies will impact the patient population under consideration and they should be closely involved in developing recommendations. The academy includes a patient advocate for guideline projects. When possible. The project manager and lead analyst facilitate and manage the expert panel in evidence analysis. Communication is key at every step of the evidence analysis process. The medical librarian experience with systematic reviews conducts an extensive literature, search and documents, the results. The methodologies oversees the entire process. The process that we are about to review is available on the E A from the policy and process tab here at a glance are the five steps in the systematic review process. Formulate the question gather the research appraise the articles synthesize the evidence and develop the conclusion statement and grade the strength of the supporting evidence step. One formulate the research question. As the expert panel develops the research questions, they categorize them by steps of the nutrition care process which includes nutrition, assessment, nutrition, diagnosis, nutrition, intervention and nutrition monitoring and evaluation. The research questions are developed in the PICO format. PICO stand for population intervention comparison and outcome. Utilizing the PUP format helps the expert panel develop questions that are neither too broad nor too specific. When developing questions in the PICO format, it is helpful to plug them into a PICO table to ensure each component of PICO is included. You can see by this example. The other question, how does daily caffeine intake affect the blood pressure of patients with chronic heart failure follows the PICO format. Patients with chronic heart failure is the population daily caffeine intake is the intervention. The comparison is no caffeine intake and the outcome is fat and blood pressure. When thinking of nutrition interventions that lead to specific outcomes, there are a variety of factors to keep in mind including the content context and delivery method of the intervention step two gather and classify the research. Before beginning the literature search, the expert panel must develop a detailed search plan. An information specialist conducts the actual search using appropriate search terms in multiple databases. The team then reviews the search plan results. They review the articles and determine which articles to include and which to exclude any full text article that is reviewed and excluded must have a valid reason. All of which is documented and published on the E A. The entire search process is thoroughly documented. Conducting a thorough search of multiple databases is critical. This diagram shows that the initial search is wide duplicate articles and articles that don't match the inclusion criteria are excluded in the title screening. The prison checklist is an evidence based set of items for reporting and systematic reviews. A flow chart is generated that depicts the flow of information through the different phases of a systematic review. It maps out the number of records identified included and excluded. The final Prisma chart is included in the published manuscript. The prisma totals are published in the E A sort list. As you can see from this image study designed in ascending level of the pyramid generally exhibit increased quality of evidence and reduce risk of bias confidence in causal relations increases at the upper levels. However, it is important to keep in mind that within each type of study design, there is a spectrum as previously indicated. The search is thoroughly documented and published on the E A under the section titled search plan and results listed as the date of the search as well as inclusion and exclusion criteria. Information on the study participants setting size sample and dropout rate. The expert panel may decide to specify additional criteria by which articles are appraised also included are the total number of hits databases, search number of included articles and number of excluded articles. This is an example of an inclusion criteria from the Oncology project. The layup for the exclusion criteria is similar. The E A list of citations that are included in the review and excluded full text articles that are excluded will have a reason for exclusion, clearly documented. Step three critically appraise each article evidence analysts critically appraise each article using the data extraction template designed to capture specific outcomes. They also complete a risk of bias assessment for each study in research bias occurs when systemic error is introduced into sampling or testing by selecting or encouraging one outcome or answer over others. The tool guides the analyst to recognize various threads that may undermine sound research and that could lead to invalid conclusions. Each article included in the systematic review is critically appraised by a double blind assessment. Two evidence analysts complete the risk of biased tool blinded to each other's answers. Disagreements are reviewed by a third party and the consensus is then reached. This is an example of a completed worksheet. It includes the study characteristics, study design, research purpose, inclusion and exclusion criteria funding information plus other relevant information for each included article step four, synthesize the evidence, delete analyst reviews, the completed worksheets and risk a bias assessment completed by the evidence. Analysts evidence summaries are a synthesis of the evidence into a narrative format and a meta analysis when possible. Additionally, a summary table is created to provide information and the studies and outcomes at a glance meta analysis is conducted when multiple studies report data and an outcome that can be pulled together, findings are reported in forest plots. Here is an example from the nutritional genomics systematic review. The narrative summary should provide an overall summary of the findings of the included studies and their biases, Strengths and limitations. Here is an example of a narrative summary. The evidence is synthesized summary of finding tables are provided at the end of the narrative section. A summary of findings table provides the ability to evaluate the quality of evidence being analyzed in the clear and transparent format considering the number of studies included and the study designs risk of bias across studies precision of findings and other information links to the summer tables are available within the evidence narrative. This is an example of a summary of findings table from the preterm infant project. Expand the worksheet section to see a bibliography for each research question. Click on each citation to see detailed information on each study including the risk of bias assessment step five develop conclusion statement and grade the strength of the supporting evidence. The conclusion statement is the answer to the evidence analysis question. This is why following the po format during the question development process is so important to be able to provide a concise answer for each question. Conclusion statements are drafted by the leading analyst and reviewed approved and graded by the expert panel. The expert panel uses this conclusion grading table. During the grading process, they consider the quality, consistency and quantity of studies as well as clinical impact and generalisability. When discussing and deciding upon a grade for the conclusion statement, conclusion statements are created by the expert panel to help the user interpret the strength of the evidence, the lower the value of the grade, the stronger the evidence. You can download a copy of the grading table from the home page or the quick view link section of the EAL. This is an example of a published conclusion statement from the Pediatric White Management project and the E A, the expert panel assigned a grade one good or strong to the strength of the evidence. The final step is to publish all of the content on the evidence analysis library website. All E content is free to academy members. Non academy members may subscribe to the EAL. Once the systematic review is finalized, it may be used to develop evidence-based nutrition practice guidelines, position papers, consensus reports presented at meetings and submitted for publication. You have completed module three. Please proceed to module four to learn about the development of evidence-based nutrition practice guidelines. Thank you.