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MDM 1b HemeOnc Module Learning Guide: Systematic Review and Meta-Analysis

Faculty Name:
Learning Activity Title:
Learning Activity Type:

Small Group Leaders


Eric Terman, Katie Hufmeyer (moderators)
Systematic Review and Meta-Analysis
Small group discussion (90 minutes)
Phone:

Contact Info:
Preferred Method of Contact:
Learning Objectives:

Preparatory Work:

Email:
e-terman@northwestern.edu
khufmeyer@northwestern.edu

Campus Address:

e-mail
1. Apply available scientific evidence from systematic reviews and/or metaanalyses to a patient decision scenario. (MKS-1f)
2. Critically appraise 2 systematic reviews +/- meta-analysis. (CLQI-3a)
3. Communicate analysis and application of scientific material in a clear,
concise and organized manner. (ECIS-3)
For all group members:
Read the patient scenario.
Read the assigned articles.
Please also review the recommendation statement of the USPSTF
regarding lung cancer screening found at:
http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htm
Note that some groups will not have assigned student leaders this
time. Everyone should prepare both articles as though you were
going to lead the discussion and come to class prepared to discuss
in detail.
If you are assigned to be a small group leader this session:
Read the patient scenario and assigned articles.
Read the appropriate CAT template and complete it for your article
along with a PICO question that is relevant to the patient scenario.
Meet with your small group faculty as outlined in the MDM 1b
course guide.
The CAT is the main method of direct evaluation and is the
equivalent of a take home exam therefore when it is your turn to
create a CAT, do not work with anyone else aside from your faculty
mentor.
Article 1: Humphrey LL et al. Screening for Lung Cancer With Low-Dose
Computed Tomography: A Systematic Review to Update the U.S. Preventive
Services Task Force Recommendation. Ann Intern Med. 2013;159:411-420.
Article 2: Detterbeck et al. Screening for Lung Cancer: Diagnosis and
Management of Lung Cancer,3rd ed: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines. Chest 2013; 143(5)(Suppl):e78S
e92S.

Patient scenario: Mr. C is a 69 year old man who smoked a pack a day from age 20
to age 60. His birthday present to himself at age 60 was to quit smoking, which he
did successfully without relapse. He presents for primary care and by his report has
a history of a mild heart attack and has had coronary artery stents placed. He is
currently on an ACE inhibitor with normal BP at this visit, and he does not have
diabetes or other known chronic diseases. He has an army buddy who was
recently diagnosed with advanced stage lung cancer, and he is wondering whether
screening could have prevented this dismal prognosis for his friend as well as
whether he should be screened for lung cancer himself.

Outline:

Students will be responsible for reading two original articles that involve systematic review and/or metaanalysis to assess use of screening modalities (primarily but not exclusively low-dose CT scan) for lung
cancer. Discussion will also include review of the recently published USPSTF guidelines on this topic as
well as review of what the guideline recommendations actually mean (e.g. the USPSTF levels of evidence).

Summary Learning Points:

Relevance:

Guiding Questions:

Further Study:

1. Systematic reviews differ from general reviews in that the inclusion of


articles should be based on objective and transparent criteria that ideally
the reader would be able to replicate, similar to any other type of research
study.
2. Meta-analysis is generally defined to be the mathematical combination of
evidence from multiple studies to create a summary risk estimate, and a
systematic review should be performed to assess the appropriate evidence
to include.
Meta-analysis is an increasingly used study type that helps to condense a
body of evidence on a clinical topic to a summary risk estimate that can
help in clinical decision making. However, adoption of clinical practice
based on a poorly performed meta-analysis would be potentially harmful
just as with any other study type, so clinicians need to have some skill at
assessing the quality of the systematic reviews and meta-analyses that
they read.
1. What is the level of evidence assigned to the USPSTF guidelines for lung
cancer screening? What does this level of evidence mean?
2. What criteria make a good systematic review? What type of bias is most
common?
3. What type of mathematical model(s) are you looking for when reading a
meta-analysis? How do you judge that the authors used an appropriate
method of combining evidence?
JAMA Users Guide on Summarizing the Evidence (available through
Galter library JAMA Evidence online)