[Solution]Instructions for Term Paper: “Mini Meta-Analysis”

Select an epidemiological association of interest to you, regarding a specific health condition and a factor that either protects or increases the risk for that…

Select an epidemiological association of
interest to you, regarding a specific health condition and a factor
that either protects or increases the risk for that condition (excluding
any examples used in the meta analysis lecture). Using an example from that
lecture, a valid research question might be: “Does fruit and vegetable
consumption decrease the risk for breast cancer?” You are required to search for
relevant articles on the PubMed
website: remember to access it via the Dahlgren Library or other Georgetown
library web site, so that you can get the full text articles, which you will
need in order to do this assignment. The rules for article selection are:

Full text, original research
articles only – no reviews, and no meta-analysesEnglish languageCase-control, cohort, or
randomized controlled studies onlySelect a minimum of 8 articles
and a maximum of 12 See instructions in Results C.3
below, i.e. be sure that your selected set of articles will allow you to
conduct one subset analysis by study design, year, or other characteristic such
as gender.

Preliminary search and approval process

Conduct a preliminary search to make sure
enough articles that meet the above criteria have been published for your
research question. If there are more than 12 articles published, come up with
at least two different ways of how you will choose the final 12 (most recent,
largest sample sizes, study design type, etc. – see Methods section on Page 2
of this document). Prepare a document
with the following information and bring a print copy to class on April 4:

Study questionPubMed search terms usedNumber of relevant articles
found based on preliminary searchA plan for choosing the final
set of articles (if >12 relevant articles have been published)

You can continue with your term
paper once you receive final approval from Dr. Dash or Dr. Loffredo, both of
whom will be in the classroom to discuss your term papers. DO NOT START WRITING
YOUR FINAL TERM PAPER OR MAKING TABLES BEFORE RECEIVING WRITTEN APPROVAL FROM A
FACULTY MEMBER IN THIS COURSE. If changes are recommended in your topic, please
follow up with them by email.

Once you have received approval, read each article carefully and thoroughly to ensure that it meets
the above criteria. Sometimes a paper appears to be relevant according to the
abstract, but when you read the full text you find problems. If that happens,
you may need to exclude the paper and go on to the others. Save the PubMed
abstract to a file, which you will include in your paper (see below). Be sure that you understand the methods and results,
and that you can extract the OR or RR and the 95% CI from the article.
Sometimes you will find an article that does not explicitly report those
statistics but does report the data such that you can calculate it yourself:
this would be a valid study to include if all other criteria are fulfilled. You
will be extracting key information from each article and entering into a table,
as described below; you will also create forest plots and write a qualitative
assessment of the strengths and weaknesses of the articles you included.
Therefore this assignment combines elements of the narrative (qualitative)
review and the meta-analysis (quantitative).

Required Elements of the Paper

In general, the paper must be
double-spaced, 11- or 12-point font, with all pages numbered, and with your
name included in the header on each page. It should be a single document with
embedded tables and graphs. There are no specifications for margins. Please
observe the page limits described below.

Title page: one page

Write the title
of your paper (e.g. “Association of marigolds with increased risk for chicken
allergy”). Include the following statement and sign it.

I pledge on my honor that I have not
given nor received any unauthorized assistance on this term paper, nor have I
read or included any previously published meta-analysis on my research topic.

___________________                  _______________________________        __________

Name                                                  Signature
                                            Date

Introduction: one page

Give a general
overview of the health condition and the risk/protective factor that you are
investigating. State the specific research question you are investigating. If
the results of your analysis show that the factor appears to be strongly
associated with the disease, how might the public health be impacted?

Methods: one page

Describe the specific
search terms that you used to find your articles on PubMed. How many
articles did that search yield, and how did you narrow your selection to 8 to
12 articles? It is very important to avoid bias in how you selected the
articles to review. If you are not sure how to limit your article set, ask any
of the faculty for guidance. (For example, you found 20 articles using the
search terms “marigolds AND chicken allergy” and selected the 10 most recent
papers. Or you found 30 and selected only the 12 most recent studies that were
conducted in the U.S.) Be aware that the faculty should be able to repeat your
search and find the same initial number of articles, and the subset that
corresponds to your selection criteria.

Describe the specific
methods that you used to compare and contrast results between studies,
e.g. what graphics and sub-group analyses did you conduct? Mention the specific
software you used to create the forest plots.

Results: no page limits, suggested maximum of 8 (4 for tables and graphs, 4
for text)

Create a
table listing the articles you analyzed. Each row
will be one specific article. Make columns for the first author’s last name,
year of publication, location (country, state, etc…), type of study design
(case-control, etc…), sample size, method of assessment of the health
condition, method of assessment of the risk or protective factor, the
unadjusted OR or RR and its 95% CI, and the adjusted statistic and what was
included in the adjustment (for example, RR=2.0, 95% CI 1.5-3.5, adjusted for
age and gender). You can include additional columns for any other factors or
subgroups you think are important (optional). It is not necessary to order the
studies by year unless that makes sense for your specific topic; you can place
them into any order that helps you to show important findings, e.g. by study
design. You must write descriptive text
(one or more paragraphs) to summarize the major results shown in your
table: not describing every row and column, but giving your overall
impressions. Embed the table following the descriptive text.

Create a
forest plot for the full group of studies
you analyzed in the table (a list of available software will be provided
separately, or you can make the plot by hand or in Excel). Clearly label all
elements of the plot, as in the example from the lecture. Write a paragraph to summarize your impressions of the pattern
revealed in the plot. You do not have to calculate the summary statistic and
95% CI, nor the Q statistic. It is not necessary to make each data point
proportionate to its sample size. Embed the plot following this descriptive
text.

Create a
minimum of two additional forest plots for a subset analysis. For example, compare and contrast findings by case-control vs.
cohort studies, by year of publication, by method of disease or risk factor
assessment, or by any other characteristic that you believe to be important
(e.g. gender, race, age group). Write
one or more paragraphs describing your impressions/interpretations of the
data plots. Embed the plots following this descriptive text.

Summary and
Conclusions: one or two pages

Briefly
summarize what was revealed in your analysis. Then comment on the relative
strengths and weaknesses of the studies, not article by article, but making
more general observations across studies (e.g. “Six of the ten studies used a
very flawed questionnaire to estimate marigold consumption”). Be sure to use the “epidemiological”
terminology and concepts we have learned in the course (show your knowledge!),
e.g. the types of bias and confounding that might exist given the study
design, and whether these appeared to be actually present in the
specific studies you analyzed. Speculate on the future direction(s) that
research should ideally take to more conclusively answer the general research
question you posed in the Introduction. Conversely, are you satisfied with the
results of your analysis, and why? Finally, provide a one-sentence Conclusion
that answers your research question.

Appendix: no page limits

Attach the
downloaded PubMed abstracts of your articles. Hint: you can save abstracts to
the clipboard in PubMed and then you can save to file or e-mail to yourself.
(Note: if you need help with PubMed techniques in general, campus library staff
members are very skilled and can give you some pointers.)

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