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- | ====== Efficacy of Drugs for Heart Failure ====== | ||
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- | **Project Intro:** | ||
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- | Your client, the Boston Institution for Reviewing Drugs (BIRD), has posed the research question, " **How do the existing pharmacological therapies for heart failure with reduced ejection fraction compare with respect to safety outcomes: mortality, serious adverse events, cardiac events?" | ||
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- | BIRD has asked //you// to create a living systematic review to answer this question. <font 11.0pt/ | ||
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- | ===== Step 0A: Background research ===== | ||
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- | ==== Tasks: ==== | ||
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- | - Don't know what heart failure is or what reduced ejection fraction means? **YouTube it!** | ||
- | - Never heard of ACEi, ARB, ARNi and/or valsartan/ | ||
- | - Want to understand the mechanism behind the drug? Google is your best friend. đ <font 11.0pt/ | ||
- | ===== Step 0B: Nest Initialization ===== | ||
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- | ==== Getting Started ==== | ||
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- | === Tasks: === | ||
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- | - Log into Nested Knowledge. If this is your first time, [[: | ||
- | - Read [[https:// | ||
- | - Focus on the PICO of the review. This stands for Population, Interventions, | ||
- | - Create a [[: | ||
- | - Click skip when this pops up: (More on this later!) | ||
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- | {{ : | ||
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- | **Add a nest description** | ||
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- | **Tasks:** | ||
- | - Navigate to Admin-\> | ||
- | - Add a description that lays out the research question that will be addressed in this review. Why might a researcher care about heart failure with reduced ejection fraction? Why is valsartan/ | ||
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- | **Copy the Protocol** | ||
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- | **Tasks:** | ||
- | - Copy the [[: | ||
- | - Add anything you'd like to make this protocol more complete. | ||
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- | **Invite Users and Admins** | ||
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- | **Tasks:** | ||
- | - [[: | ||
- | - Invite Nicole Hardy, Ranita Tarchand and Kevin Kallmes. Make us admins. | ||
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- | Admin and Owners have permission to add other Users. Admins may also edit the protocol and nest description. Users can conduct literature searches, screen, modify exclusion reasons, tag, and extract data. | ||
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- | ===== Step 1: Understanding the Protocol ===== | ||
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- | * Hopefully, you've read the protocol by now. When reading the protocol, you should be focusing on the PICOs. | ||
- | * Here is the PICO for this nest based on the protocol: | ||
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- | {{ : | ||
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- | * <font 11pt/ | ||
- | * <font inherit/ | ||
- | ===== Step 2: Literature Search ===== | ||
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- | ==== Tasks: ==== | ||
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- | - Review [[: | ||
- | - Add a search using Literature Search that returns \<300 results. (Hint: Use the PICO I gave you. đ) | ||
- | - Typically you should include key words indicating the type of study youâre looking for, the patient population and specific interventions if you know them. Whereas including specific outcomes of interest or âplaceboâ may make your search too broad. | ||
- | - When structuring your search, utilize quotation marks ââ to search for specific word pairings, parentheses () to group similar words separated by the OR function, and separate grouped words by the AND function. | ||
- | - Hint: Look up if there are alternative names for any words of interest and include them in the search using the OR function. For example, (ARNi OR sacubitril/ | ||
- | - Why <300? A good research question should be focused and narrow. If your search is returning >500 studies, it might be that your search and research question are too broad. | ||
- | - Set the search to run every month. | ||
- | - Play around with [[: | ||
- | - Add a search you create from [[: | ||
- | - Add these papers manually: | ||
- | * 32865377 | ||
- | * 32978755 | ||
- | * 31475296 | ||
- | - **Bonus task: | ||
- | ===== Step 3: Screening ===== | ||
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- | **Configure Exclusion Reasons** | ||
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- | For this project, you should only include randomized controlled trials. Exclude in vitro studies, editorials, case series, and secondary analyses. Exclude studies that do not show patient outcomes, such as protocols. | ||
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- | === Tasks: === | ||
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- | - View our page on [[: | ||
- | - Once you are in your nest, go to the Configure Exclusion Reasons. | ||
- | - By clicking "Add Manual Exclusion," | ||
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- | **Note: **Some exclusion reasons can be automated such as publication date. This is done through using âBulk Actionsâ and here is a [[https:// | ||
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- | **Screen Sequentially** | ||
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- | === Tasks: === | ||
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- | - Click Screening in the panel on the left-hand side. | ||
- | - Read the title and abstract of the study and include or exclude according to the criteria defined in the protocol. | ||
- | - If the abstract contains insufficient information to decide, (sometimes the outcomes of interest are not obvious or included in the title/ | ||
- | - If you don't have access to the full text, message us via email (include the PMID you're searching for) or try Sci-Hub. If you still cannot find it, after reaching out to us, add the exclusion reason âFull Text Unavailableâ. | ||
- | - After reviewing the article, if you determine it should be excluded, select an appropriate exclusion reason, then hit âexclude.â | ||
- | - If you want to include the study, upload a full text PDF of the study to the nest, accessible either through PubMed or an online library subscription, | ||
- | - Screen at least 30 studies. Donât stop until you have at least 6 included studies. If you have screened 30 studies and havenât yet included at least 6 studies, stop and check in with us. This may be because your literature search may have produced results that are too broad or too specific. | ||
- | - Once you have 6 included studies, click here: | ||
- | - Then, click here: {{ : | ||
- | - Once it's done loading, click done and refresh the page. | ||
- | - You should now see a probability instead of "train inclusion model." | ||
- | - This tells you the probability of inclusion (in this case) is 3%. | ||
- | - Bonus task: Click on where it says P(inclusion) and look at the graph. See if you can understand what it means! | ||
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- | **Note: | ||
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- | ===== Step 4: Tag Studies ===== | ||
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- | ==== Building a Tagging Hierarchy ==== | ||
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- | **Tasks:** | ||
- | - Under the tagging menu, go to " | ||
- | - Guidelines for creating tags can be found [[: | ||
- | - The tagging hierarchy is essentially the break down of our PICO. From the broadest categories at the top that branch out to more specific categories as you go down. | ||
- | - Add Root Tags: A root tag is a tag that has no " | ||
- | - Add the following " | ||
- | - Study Type | ||
- | - Patient Characteristics | ||
- | - Interventions | ||
- | - Outcomes | ||
- | - Add Child Tags(non-root): | ||
- | - Add these child tags to study type: | ||
- | - RCT | ||
- | - Add these child tags to Patient Characteristics: | ||
- | - Age | ||
- | - Sex | ||
- | - New York Heart Association (NYHA) functional classes | ||
- | - Left ventricular ejection fraction (LVEF) | ||
- | - Add these child tags to Interventions | ||
- | - Placebo | ||
- | - Sacubitril/ | ||
- | - Empalgliflozin | ||
- | - Add this child tag to Outcomes | ||
- | - Serious Adverse events (SAE) | ||
- | - Add this child tag to SAE | ||
- | - Symptomatic hypotension | ||
- | - Clinical Outcomes | ||
- | - Add these child tags to Clinical Outcomes: | ||
- | - All-cause mortality | ||
- | - i. Cardiovascular death | ||
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- | **Note: | ||
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- | ==== Applying Tags ==== | ||
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- | === Tasks: === | ||
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- | - Click on [[: | ||
- | - Apply the tags to all 6 studies. | ||
- | - Keep in mind when you apply a tag you want to add relevant text that is the source of the tag. For example, if you tag NYHA class in the study, you will want to write the table you found it in or copy and paste the sentence where they talk about it. | ||
- | - Note: Aren't you glad you uploaded all the full texts in the screening stage? That's why we have you upload full texts while screening. | ||
- | - Be sure to check the supplements for reported data if they arenât given in the main article. It is useful to do a CTRL + F to search for specific key words in large pdfs. | ||
- | - After tagging all 6 studies, go back and make sure you tagged the study titled âEffect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trialâ by Desai et al., 2019. This is an important study and is required to be extracted after tagging. | ||
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- | For a complete list of suggested tags, see [[: | ||
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- | * Explore the search exploration page to find frequently appearing words and phrases. | ||
- | * Explore other, related nests and examine their Tagging Hierarchies | ||
- | * Consider the general categories of interest (patient characteristics, | ||
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- | **Note: | ||
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- | ===== Step 5: Extract Data ===== | ||
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- | ==== Configure Data Elements ==== | ||
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- | **Tasks:** | ||
- | - Using [[: | ||
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- | - Age | ||
- | - LVEF | ||
- | - Configure the following data elements as categorical: | ||
- | - Sex | ||
- | - NYHA class | ||
- | - Configure the following data elements as dichotomous: | ||
- | - All-cause mortality | ||
- | - Cardiovascular death | ||
- | - Symptomatic hypotension | ||
- | - Configure interventions hierarchy as shown in Part A in the [[: | ||
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- | **Note: | ||
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- | **Extract Studies** | ||
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- | **Tasks:** | ||
- | - Click on Extraction and follow [[: | ||
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- | - Note: Median and mean are not interchangeable. IQR and range are not interchangeable. Standard deviation (SD) and standard error (SE) are not interchangeable! | ||
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- | **Note**** :** Here is a [[https:// | ||
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- | ===== Step 6: Wrapping Up ===== | ||
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- | **Qualitative Synthesis: | ||
- | * This link talks about [[: | ||
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- | **Tasks:** | ||
- | - Play around with this. Click on the slices and see what happens. What relationship does this diagram have with the tagging hierarchy? **Compare them and see!** | ||
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- | **Quantitative Synthesis: | ||
- | * This link talks about [[: | ||
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- | **Tasks:** | ||
- | - Play around with this. Look at different data elements. Do the data make sense? Are there any numbers that seem out of place (too high or too low?) **Go back and check these numbers for errors.** | ||
- | - Play around with the NMA and see if you can figure out what the numbers mean. | ||
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- | **Study Inspector: | ||
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- | **Tasks:** | ||
- | - Click on [[: | ||
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- | - Why are there 3 different places to click study inspector? Does it matter which one you click? What happens if you click the study inspector in screening vs. tagging vs. extraction? | ||
- | - Play around with the different filters! | ||
- | - Learn how to save a filter and see what this does. | ||
- | - **DO NOT DO ANY BULK ACTIONS. Your manager will provide guidance on bulk actions.** | ||
- | **Other Things to Play Around with:** | ||
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- | **Dashboard** | ||
- | * Under Nest Home, click [[: | ||
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- | **Manuscript Editor** | ||
- | * Under Synthesis, click on [[: | ||
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- | **Export** | ||
- | * Under Synthesis, click Export. Learn how to export all the [[: | ||
- | * Learn how to export [[: | ||
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- | **Comments** | ||
- | * You can leave study level and nest level [[: | ||
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- | **Dual vs. standard screening** | ||
- | * In our software, you can dual screen. Learn about this [[: | ||
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- | **Risk of Bias (ROB)** | ||
- | * In our software you can also conduct ROBs. This one is a big one and we'll conduct separate trainings on this. For now, review this page in the [[: | ||
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- | Download this file! {{: | ||
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