Question 1

Before starting out to do a systematic review, the most important requirement is:

Accepted Answer

A) A lot of time 
B) A clear research question 
C) To have read a narrative review on the same topic, preferably by a Professor 
D) To have read the appropriate guidelines on how to conduct a systematic review 
E) Ready access to relevant online databases and search engines 
A) A lot of time 
B) A clear research question 
C) To have read a narrative review on the same topic, preferably by a Professor 
D) To have read the appropriate guidelines on how to conduct a systematic review 
E) Ready access to relevant online databases and search engines B

Question 2

You are of course concerned about the quality of studies included in a systematic review.In general RCTs are the 'gold standard' design, especially for interventions,
But there are many circumstances when they are infeasible, unethical or otherwise
Inappropriate.Identify for which of the following research questions an RCT would
Not be the optimal design.

Accepted Answer

A) Does beta‐carotene prevent skin cancers in Scandinavians? 
B) Does smoking cigarettes cause heart attacks in women? 
C) How effective are large‐scale population‐based screening programmes in lowering mortality from breast cancer? 
D) Does long‐term aspirin use lower mortality after a heart attack among male doctors? 
E) None of the above 
A) Does beta‐carotene prevent skin cancers in Scandinavians? 
B) Does smoking cigarettes cause heart attacks in women? 
C) How effective are large‐scale population‐based screening programmes in lowering mortality from breast cancer? 
D) Does long‐term aspirin use lower mortality after a heart attack among male doctors? 
E) None of the above B

Question 3

After applying your inclusion/exclusion criteria you have results for over 100 studies. Which of the following strategies (select all that apply) will help you organise the
Information about the studies and present the results most clearly?

Accepted Answer

A) Include a simple table giving brief descriptions of each study in one table row (probably as an online appendix given the very large number of studies) 
B) Include key elements for each study including the study design, sample size, exposure measure, effect size and confounder control 
C) Order the studies by study type (cohort or RCT) and sample size, largest first 
D) Provide a forest plot in which you use the highest RR you can find in each paper to maximise the visual impact 
E) Conduct a meta‐analysis to give a simple summary effect estimate no matter what the pattern of the data is 
A) Include a simple table giving brief descriptions of each study in one table row (probably as an online appendix given the very large number of studies) 
B) Include key elements for each study including the study design, sample size, exposure measure, effect size and confounder control 
C) Order the studies by study type (cohort or RCT) and sample size, largest first 
D) Provide a forest plot in which you use the highest RR you can find in each paper to maximise the visual impact 
E) Conduct a meta‐analysis to give a simple summary effect estimate no matter what the pattern of the data is A, B ,C

Question 4

You are commissioned to write a quantitative systematic review.Which of the following research questions is framed in the most epidemiologically appropriate
Way?

Accepted Answer

A) What is the relation between body size and genito‐urinary cancers? 
B) What is the relation between obesity and genito‐urinary cancers? 
C) By how much does obesity (measured as body mass index, BMI) increase a woman's risk of developing genito‐urinary cancer? 
D) By how much does obesity (measured as BMI) increase a woman's risk of developing renal (kidney) cancer? 
E) By how much does body size increase risk of renal cancer? 
A) What is the relation between body size and genito‐urinary cancers? 
B) What is the relation between obesity and genito‐urinary cancers? 
C) By how much does obesity (measured as body mass index, BMI) increase a woman's risk of developing genito‐urinary cancer? 
D) By how much does obesity (measured as BMI) increase a woman's risk of developing renal (kidney) cancer? 
E) By how much does body size increase risk of renal cancer?

Question 5

Which of the following statements about the conduct and reporting of systematic reviews and meta?analyses are true? (Select all that apply)

Accepted Answer

A) The review should be considered as a research paper in its own right, and structured accordingly 
B) Literature search strategies must be detailed enough to permit their repetition by the reader 
C) All funding sources must be specified 
D) Weaknesses of the primary data sources (included studies) and of the review itself should be discussed 
E) A formal causal argument should be presented in the Discussion 
A) The review should be considered as a research paper in its own right, and structured accordingly 
B) Literature search strategies must be detailed enough to permit their repetition by the reader 
C) All funding sources must be specified 
D) Weaknesses of the primary data sources (included studies) and of the review itself should be discussed 
E) A formal causal argument should be presented in the Discussion

Question 6

You may have noted that the x‐axis of the plot uses a logarithmic scale (the distance from 1-2 is the same as that from 2-4 and from 4-8).This is:

Accepted Answer

A) To ensure the correct visual balance between RRs that are positive (>1.0) and those that reflect an inverse association (<1.0) B) A mistake - linear (arithmetic) scales are easier to work with and interpret C) Irrelevant, since the range of RRs is quite small D) To allow a very wide range of effect sizes to be included on the one plot A) To ensure the correct visual balance between RRs that are positive (>1.0) and those that reflect an inverse association (<1.0) B) A mistake - linear (arithmetic) scales are easier to work with and interpret C) Irrelevant, since the range of RRs is quite small D) To allow a very wide range of effect sizes to be included on the one plot

Question 7

Looking at the same figure (remember that Studies 1, 2 and 5 are cohort studies, 3 and 4 are case‐control studies, and they are arranged in order of year of publication,
Earliest first), Which of the following statements is/are reasonable? The order in
Which the studies are presented:

Accepted Answer

A) Is fine as it is 
B) Is the best possible because it takes the time dimension into account 
C) Allows us to see clearly the substantial heterogeneity of the results 
D) Would be improved if the studies were grouped by type 
A) Is fine as it is 
B) Is the best possible because it takes the time dimension into account 
C) Allows us to see clearly the substantial heterogeneity of the results 
D) Would be improved if the studies were grouped by type

Question 8

In a systematic review of aspirin as a possible preventive of lung cancer (Feskanich et al., British Journal of Cancer, 2007
Http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2360462/pdf/6603996a.pdf), the
Authors identified all papers with original data that assessed the relation between
Aspirin use and lung cancer incidence or mortality (N=18) and then excluded:
- Retrospective analyses (N=4)
- Prospective studies that did not account for smoking (N=3)
- Studies with no quantitative measure of aspirin use (N=2).
Which of the following statements are true? (select all that apply)

Accepted Answer

A) The results of the review will be biased because 9 of the 18 studies were excluded 
B) It is appropriate to exclude retrospective studies because of potential biases in aspirin recall and selection of controls 
C) It is appropriate to exclude retrospective studies because their results are likely to be confounded 
D) It is inappropriate to exclude the retrospective studies because there is only a small number of studies overall 
E) It is appropriate to exclude studies with no control for confounding by smoking because this is likely to influence the association between aspirin and lung cancer 
A) The results of the review will be biased because 9 of the 18 studies were excluded 
B) It is appropriate to exclude retrospective studies because of potential biases in aspirin recall and selection of controls 
C) It is appropriate to exclude retrospective studies because their results are likely to be confounded 
D) It is inappropriate to exclude the retrospective studies because there is only a small number of studies overall 
E) It is appropriate to exclude studies with no control for confounding by smoking because this is likely to influence the association between aspirin and lung cancer

Question 9

Having decided on your research question, you establish your criteria for which studies to include.Which (if any) of the criteria listed below should not be a basis for
Including a study in your review? (Select all that apply)

Accepted Answer

A) It must be an analytical epidemiological study in humans 
B) It must include individual data on body size and on the presence or absence of kidney cancer 
C) It must either include an estimate of the effect of body size on kidney cancer risk (e.g. OR, RR), or include data allowing such an effect to be estimated 
D) It must report results for at least 50 cases of renal cancer 
E) It must be a prospective study (cohort or RCT)
F)Noneoftheabove 
A) It must be an analytical epidemiological study in humans 
B) It must include individual data on body size and on the presence or absence of kidney cancer 
C) It must either include an estimate of the effect of body size on kidney cancer risk (e.g. OR, RR), or include data allowing such an effect to be estimated 
D) It must report results for at least 50 cases of renal cancer 
E) It must be a prospective study (cohort or RCT)
F)Noneoftheabove

Question 10

The following figure displays results from a systematic review and meta‐analysis of the effects of sun exposure on mental health.The RRs represent the association between
Higher sun exposure and good mental health.Studies 1, 2 and 5 are cohort studies, 3 and 4
Are case‐control studies.They are arranged in order of year of publication, earliest first.   Which of the following statements are true? (Select all that apply) The summary
Result of the meta‐analysis:

Accepted Answer

A) Tells us for certain that sunlight is good for mental health 
B) Is meaningless because of the extreme heterogeneity of the RRs 
C) Is of practical public health importance 
D) Is helpful in assessing whether the relation might be causal 
E) Is statistically significant 
A) Tells us for certain that sunlight is good for mental health 
B) Is meaningless because of the extreme heterogeneity of the RRs 
C) Is of practical public health importance 
D) Is helpful in assessing whether the relation might be causal 
E) Is statistically significant

Before starting out to do a systematic review, the most important requirement is:

After applying your inclusion/exclusion criteria you have results for over 100 studies. Which of the following strategies (select all that apply) will help you organise the Information about the studies and present the results most clearly?

You are commissioned to write a quantitative systematic review.Which of the following research questions is framed in the most epidemiologically appropriate Way?

Which of the following statements about the conduct and reporting of systematic reviews and meta?analyses are true? (Select all that apply)

You may have noted that the x‐axis of the plot uses a logarithmic scale (the distance from 1-2 is the same as that from 2-4 and from 4-8).This is:

Looking at the same figure (remember that Studies 1, 2 and 5 are cohort studies, 3 and 4 are case‐control studies, and they are arranged in order of year of publication, Earliest first), Which of the following statements is/are reasonable? The order in Which the studies are presented:

Having decided on your research question, you establish your criteria for which studies to include.Which (if any) of the criteria listed below should not be a basis for Including a study in your review? (Select all that apply)

How Long Is a Piece of String Measuring Disease Frequency

Who, What, Where and When Descriptive Epidemiology

Healthy Research: Study Designs for Public Health

Why Linking Exposure and Disease

Heads or Tails: the Role of Chance

All That Glitters Is Not Gold: The Problem of Error

Muddied Waters: The Challenge of Confounding

Who Sank the Boat Association and Causation

Surveillance: Collecting Health-Related Data for Epidemiological

Outbreaks, Epidemics and Clusters

Prevention: Better Than Cure

Early Detection: What Benefits at What Cost

Filters

Exam 11: Assembling the Building Blocks: Reviews and Their Uses

Before starting out to do a systematic review, the most important requirement is:

After applying your inclusion/exclusion criteria you have results for over 100 studies. Which of the following strategies (select all that apply) will help you organise the Information about the studies and present the results most clearly?

You are commissioned to write a quantitative systematic review.Which of the following research questions is framed in the most epidemiologically appropriate Way?

Which of the following statements about the conduct and reporting of systematic reviews and meta?analyses are true? (Select all that apply)

You may have noted that the x‐axis of the plot uses a logarithmic scale (the distance from 1-2 is the same as that from 2-4 and from 4-8).This is:

Looking at the same figure (remember that Studies 1, 2 and 5 are cohort studies, 3 and 4 are case‐control studies, and they are arranged in order of year of publication, Earliest first), Which of the following statements is/are reasonable? The order in Which the studies are presented:

Having decided on your research question, you establish your criteria for which studies to include.Which (if any) of the criteria listed below should not be a basis for Including a study in your review? (Select all that apply)

How Long Is a Piece of String Measuring Disease Frequency

Who, What, Where and When Descriptive Epidemiology

Healthy Research: Study Designs for Public Health

Why Linking Exposure and Disease

Heads or Tails: the Role of Chance

All That Glitters Is Not Gold: The Problem of Error

Muddied Waters: The Challenge of Confounding

Who Sank the Boat Association and Causation

Surveillance: Collecting Health-Related Data for Epidemiological

Outbreaks, Epidemics and Clusters

Prevention: Better Than Cure

Early Detection: What Benefits at What Cost

Filters