Study Design
Part II
Ass. Prof. Hadeel Farouk
Types of Questions
Problem Example Study Design
What are the causes of Cohort Study/
Etiology malocclusion? Case Control
What is the prevalence of
Prevalence malocclusion in Egypt? Cross sectional
How is malocclusion Diagnostic test
Diagnosis diagnosed? accuracy
What is the best way to treat Randomized
Treatment malocclusion? Controlled Trial
How will malocclusion develop
Prognosis over time? Cohort Study
Is one intervention more Cost
Cost-
cost-effective than another? effectiveness
effectivness
Study
Type of question Best study design
Cross-sectional or prospective, blinded
Diagnosis
comparison to the gold standard
Randomized controlled trial > Cohort study >
Therapy
Case–control > Case series
Prognosis Cohort study > Case–control > Case series
Harm/etiology Cohort study > Case–control > Case series
WHAT IS A REVIEW ARTICLE
A review article is an article that collects and
summarizes published knowledge about a certain
topic
TYPES OF REVIEW ARTICLES
Narrative review
Systematic review
NARRATIVE REVIEW
CHARACTERISTICS
Has no formal scheme for article selection
Published by invited experts
Covers a single point or topic
Bias !!!!
Examples:
1. Dental clinic in Urban areas
2. Seminars in orthodontics
3. Oral and maxillofacial surgery clinics in Egypt
4. Atlas of Oral and Maxillofacial Surgery Clinics of North
America
HOW TO WRITE A NARRATIVE REVIEW
(REVIEWING THE LITERATURE)
1. Decide on your topic
2. Read lots of reviews about the topic
3. Write down a scheme of ideas
4. For each idea, find the most important articles
5. Write in chronological order
6. In case of the thesis (could be divided into
sections or ideas). Within each section follow the
same sequence
SYSTEMATIC REVIEW
WHAT IS A SYSTEMATIC REVIEW
A systematic review attempts to collate all empirical evidence that
fits pre-specified eligibility criteria to answer a specific research
question
CHARACTERISTICS
A clearly stated set of objectives with pre-defined eligibility criteria
An explicit, reproducible methodology;
A systematic search that attempts to identify all studies that would
meet the eligibility criteria;
An assessment of the validity of the findings of the included studies,
A systematic presentation, and synthesis, of the characteristics and
findings of the included studies
Systematic Reviews
Focus on a clinical topic and answer a specific question. An
extensive literature search is conducted to identify studies
with sound methodology. The studies are reviewed, assessed
for quality and the results are summarized according to the
predetermined criteria of the review question.
A Meta-analysis will thoroughly examine several valid
studies on a topic and mathematically combine the results
using accepted statistical methodology to report them as if
they were one large study.
Traditional review Systematic review
not to be well-focused on focus on specific clinical
a specific problem questions
not including all of the including all of the relevant
relevant studies studies
Not combining the combining the
information from the information from the studies
studies
Subjective Objective
The results of a systematic review will represent the best, most
current evidence available that addresses a specific clinical
question
Follow
strict
Evaluate the protocols
Require prior
strength of determination
the available of search
evidence methods
Advantages
of a
Have systematic
review Reduce
evaluation
bias
criteria
Include only
Focus on
specific clinically
clinical relevant
questions information
STEPS TO CONDUCT A SYSTEMATIC REVIEW
1. Research question
2. Searching for studies
3. Inclusion/exclusion
4. Data abstraction
5. Quality assessment
6. Result synthesis
7. Conclusion
8. Meta-analysis conduction
1-RESEARCH QUESTION
Reviews and meta-analyses are not a fishing expedition
Focused research question that targets a specific clinical
problem or hypothesis
PICO + study types
(population, intervention, comparison, outcome)
2-SEARCH
Documented
Multiple databases (PubMed, Embase…etc.)
Grey literature (conference proceedings, eminent researchers,
reference lists). Clinical trial registries
Time limit (justified or not)
3-INCLUSION/ EXCLUSION
Removal of duplicates (reference manager)
Title/abstract screening ( 2 authors)
Full-text screening (1 or 2 authors). Link together multiple
reports of the same study (different publications containing
the same experiment should be managed as one entry)
Contact authors for missing data.
Criteria:
1. Language
2. Study type
3. Sample size
4. Follow up
5. Assessment method
6. Date
4-DATA EXTRACTION
Summarize and extract all necessary information from
the included studies into tables
Unify units and numbers (do the necessary conversion
when necessary)… usually, a biostatistician is needed for
this step
5- ASSESSMENT OF RISK OF BIAS/ QUALITY ASSESSMENT
Quality assessment vs risk of bias
Different available tools
6&7- SYNTHESIZING RESULTS AND CONCLUSIONS
Collect similar interventions or assessment methods (if
applicable)
Compare between different studies
Show points of strengths and weaknesses
If a similar review presented, compare your findings to it
Conclude your understanding or new hypothesis
8- META-ANALYSIS
Check for homogeneity
Check for publication bias (file drawer problem)
Conduct meta-analysis
PRISMA
Preferred reporting method
for systematic reviews and
Meta-analysis
Color Stability of Single-Shade Resin
Composites in Direct Restorations: A
Systematic Review and Meta-Analysis of
Randomized Controlled Trials
