PH6062 Research Synthesis and Meta-analysis
PHC 6062 Research Synthesis and Meta-analysis
GENERAL INFORMATION
DESCRIPTION
A. Course Overview:
This course is designed to train students in the conduct of a systematic literature review and
developing the skills critical for evidence-based clinical and public health practice. This course will
provide a detailed description of systematic review process and will combine didactic sessions with
in-class laboratory sessions where students will be taught how to perform each step in a review.
Students will be provided step-by-step guidance on how to perform a systematic review and will be
expected to apply all the tools taught in the class to a topic of their choosing. The final deliverable
for the course will be a systematic literature review with/without meta-analysis.
OBJECTIVES
B. Course Objectives:
By the completion of the course, the students will be able to:
1. Formulate key questions for a review.
2. Organize a literature search; identify which literature bases to search.
3. Abstract relevant information from appropriate studies in a systematic manner.
4. Rate the scientific quality of each study and the level of evidence for each question.
5. Create evidence tables and summary tables.
6. Summarize the studies’ findings.
7. Interpret the pattern of evidence in terms of strength and consistency.
8. Describe the elements of a meta-analysis and when such a step is appropriate.
MPH CONCENTRATION-SPECIFIC COMPETENCIES
The following competency will be reinforced in this course:
Competency
Critically evaluate reports of epidemiologic
Course Syllabus Version 5.0
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Course Objectives
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PH6062 Research Synthesis and Meta-analysis
studies
CLASS POLICIES AND PROCEDURES
C. Prerequisites:
Students must have completed both an introductory epidemiology and biostatistics course (PHC
6000 Introduction to Public Health Epidemiology, PHC 6065 Health Statistics)
D. Course Format:
This course will combine a modest amount of didactic material presented in lectures and readings
with a substantial amount of hands-on experience. Each student, or group of students, will be
expected to choose a topic for review. They will work individually or in small groups to carry out
each phase of a systematic literature review. Those whose work is more promising will be
encouraged to develop their reports into publishable papers.
E. Course Assignments:
- Course readings, in-class discussion.
- Homework on protocol of systematic literature review.
- Final paper with detailed outlines of the systematic review.
- Presentation of the review.
Course Readings: Students are expected to read all recommended materials before the class. All
recommended readings will be listed on moodle website.
Class Discussion: All students are required to participate in all discussions. Informal writings
followed by the discussion are encouraged and will be reviewed by the instructor.
Homework is essential to achieve the course outcome: Systematic reviews of the literature based
on concepts and research questions of the thesis, dissertations, or grant proposals will be
encouraged.
F. Course Evaluation:
Evaluation will be based on:
 Classroom Discussion Activities: 20%
 Homework & Exercises: 25%
 Final Presentation & Critique: 25%
 Final Literature Review Report: 30%
Students’ grades will be based on articulation in-class and in each stage of their project work. The
grade for the course will be based primarily on the quality of the final paper and/or presentation. A
paper is required for the final grade. Higher levels of performance will be expected from group
projects.
Power point Presentation: Each student must provide 1 copy of the power point handout for each
student colleague and the instructor at the time of the student final presentation. The student must
also submit the power point electronic file by email, 24 hours before his/her presentation is due.
Power point Critique: Using the rubric provided, each student must critically assess every student
power point presentation and provide the assessments at the end of each presentation session
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PH6062 Research Synthesis and Meta-analysis
(this is an assessment of how well you can critique your colleague’s work – so be critical in a
constructive manner and be fair. Your critique will not impact the grade of your colleague.
EVALUATION AND GRADING
The approximate guidelines for the transformation of percentages into grade points for this course
are:
A
AB+
B
BC+
92.6-100
89.6-92.5
86.6-89.5
82.6-86.5
79.6-82.5
76.6-79.6
C
CD+
D
DF
72.6-76.5
69.6-72.5
66.6-69.5
62.6-66.5
59.6-62.5
< 59.5
Late Submission Policy: A 5% penalty for every 24-hour period an item is submitted late. For
example, if an item worth 25% is submitted late, but within 24 hours of the stated deadline, the
item’s maximum value is reduced to 20%. If it is submitted after 24 hours but within 48 hours, its
value is reduced to 15%.
Incomplete Grade: An incomplete grade is permitted only in cases of exceptional circumstances
and following consultation with the instructor. In such cases an “I” grade will require a specific
written agreement between the instructor and the student specifying the time and manner in which
the student will complete the course requirements. Extension for completion of the work will not
exceed one year.
G. Attendance:
Attendance in the class is extremely important. Anytime a student is absent (or late) from a class, it
is the student’s responsibility to know the class materials/ announcements. Know at least one of
your classmate’s contact info.
READINGS
H. Textbooks:
Course materials will be selected from a variety of reference material and textbooks. All students
will be required to use the following course text book:

Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Cochrane
Collaboration, 2011. http://www.cochrane-handbook.org/
Supplementary Reading

Publications of the AHRQ Methods Reference Guide for Comparative Effectiveness
Reviews.
http://www.effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf
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PH6062 Research Synthesis and Meta-analysis
COURSE SCHEDULE AND ASSIGNMENTS
Session
1.
Title
Content

Course objectives & performance
expectations

What are systematic reviews, how
can they be useful, and how can I
conduct my own systematic
review?

The difference between systematic
reviews and other reviews.

Definitions of evidence.

Level of evidence.

Reporting the evidence.
Formulating a well-formed study question.

Population, intervention,
comparators, outcomes, setting
and timing (PICOTS).
Readings:

Framing questions that can be
answered.

Conceptual model and refined
hypotheses.
Introduction to evidence based analysis and
systematic reviews of literature.
Readings:
Taubes, G. Do we really know what makes us
healthy? NY Times Sept 16, 2007.
Helfand M, Balshem H. AHRQ Series Paper 2:
Principles for developing guidance: AHRQ and the
effective health-care program. J Clin Epidemiol.
2010 May; 63(5): 484-90.
Slutsky J, Atkins D, Chang S, Collins Sharp BA.
Comparing medical interventions: AHRQ and the
effective health-care program. J Clin Epidemiol.
2010; 63(5): 481-3.
No Class
2.
Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 5: Defining the review
question and developing criteria for including
studies.
Whitlock EP, Lopez SA, Chang S, Helfand M et al.
AHRQ Series Paper 3: Identifying, selecting, and
refining topics for comparative effectiveness
systematic reviews: AHRQ and the effective healthcare program. J Clin Epidemiol. 2010 May;
63(5):491-501.
In class exercise: Developing key questions on a common topic.
Homework: Students will choose a topic and identify three to four key questions and a logic
model. Assignment is due January 28 at 1200 hrs. Upload slides for in-class presentation with
a topic, research questions, and a logic model. Upload a Word or PDF document with
introduction, key questions, and a logic model.
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PH6062 Research Synthesis and Meta-analysis
3.
Developing a protocol for a systematic review.

Planning analysis and major
threats to consistency.
Readings:

Level of detail.

Clinical, methodological
heterogeneity.

Identifying salient variables.

Identifying eligibility criteria for the
studies.

Discussion of MeSH headings.

Search strategies and databases.
Readings:

Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 6: Searching for studies.
What literature to review and the
role of gray literature.

What types of studies to include in
a review

Developing search strategies
according to PICOTS

Steps in search strategy:
preliminary screen and actual
review.
Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 2: Preparing a Cochrane
review and Chapter 4: Guide to the contents of a
Cochrane protocol and review.
Norris S, Atkins D, Bruening W, et al. Selecting
observational studies for comparing medical
interventions. In: Agency for Healthcare Research
and Quality. Methods Guide for Comparative
Effectiveness Reviews [posted June 2010].
Rockville, MD.
4.
Searching the literature and identifying studies.
Chou R, Aronson N, Atkins D, Ismaila AS,
Santaguida P, Smith DH, Whitlock E, Wilt TJ, Moher
D. AHRQ Series Paper 4: Assessing harms when
comparing medical interventions: AHRQ and the
Effective Health-Care Program. J Clin Epidemiol.
2010 May;63(5):502-12.
Homework: Students will develop a study protocol, a search strategy and conduct a search
on their topic. Assignment is due on February 4 at 1200 hrs. Upload slides for in-class
presentation with definitions of PICOT, and the inclusion and exclusion criteria of the studies,
search strategies, strings, and the search results. Upload a Word or PDF document with a
study protocol and complete documented literature searches.
5.

Capturing how the variables are
reported as well as actual results.

Describe evidence table formats.
Readings:

Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 7: Selecting studies and
collecting data, and Chapter 8: Assessing risk of
bias in included studies.
Reorganize evidence table data
requirements as a coding sheet.

Develop coding sheet
dictionary/instructions.

Overview of the software used for
systematic reviews.
Developing data extraction forms - separate forms
for RCTs and observational studies.
In-class exercise: Developing an abstraction form for a research question.
In-class presentations: Students will present the results of their key questions, logic model &
study protocol.
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PH6062 Research Synthesis and Meta-analysis
Homework: Students will create an abstract form for their own key question. Pilot testing of
the form by abstracting one to two articles. Assignment is due on February 11 at 1200 hrs.
Upload slides for in-class presentation with abstraction forms and abstracted articles.
6.
Extracting data from a randomized controlled trial
and from an observational study. Analysis of
different types of the outcomes.

Creating evidence tables.

Identify different effect size
metrics.

Choose appropriate effect size
metric for review question.

Identify data requirements for
different effect size metrics.

Adapt evidence tables and coding
sheets to incorporate effect size
data.

Criteria of internal and external
validity of RCTs with different
exposures.
In-class presentations: Students will present their abstraction forms and the abstracted
articles.
Homework: Students will revise the abstraction forms and abstract ~ 5 articles. Students will
develop a study protocol. Assignment is due on February 18 at 1200 hrs. Upload a completed
Excel template with abstracted articles.
7.
Quantitative synthesis of evidence

Code studies using coding sheet
provided in class.
Readings:

Identify coding errors.

Examine coding reliability.

Pooling criteria.

Publication bias.

Fixed and random effects model.
Calculating effect sizes

Identify & explain formula for
calculating effect sizes:
Readings:

Identify & explain effect size metric
conversion formulas.
Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 7: Selecting studies and
collecting data, and Chapter 9: Analyzing data and
undertaking meta-analyses.
8.
Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 9: Analyzing data and
undertaking meta-analyses.
In-Class exercise: Effect size calculation practical exercise
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PH6062 Research Synthesis and Meta-analysis
9.

Introduction to Meta-analysis
Explain homogeneity/
heterogeneity with respect to
meta-analysis
Readings:
Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 9: Analyzing data and
undertaking meta-analyses.

o
Conceptual
o
Statistical
Identify and explain formula for
weighted average effect size:
o
Fixed effect model
o
Random effects model

Interpret a weighted average effect
size produced using REVMAN for
various effect size metrics

Compare and contrast fixed effect
and random effects meta-analytic
results produced using REVMAN
SPRING BREAK
10.
Assessing the quality of studies: Criteria for RCTs
and observational studies.

Definitions of quality.

Methodological and reporting
quality.
Readings:

RCTs and CONSORT.
Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 8: Assessing risk of bias in
included Studies; and Chapter 10: Addressing
reporting biases.

Quasi-experimental designs
including MOOSE.

Available tools for assessing
quality of individual studies and
what key issues standard
instruments may fail to recognize.
Biases in quality, including:
Moher D, Schulz KF, Altman DG. The CONSORT
statement: Revised recommendations for improving
the quality of reports of parallel-group randomised
trials. The Lancet. 2001;357:1191-1194.
Stroup DF, Berlin JA, Morton SC, Olkin I,
Williamson GD, Rennie D, Moher D, Becker BJ,
Sipe TA, Thacker SB. Meta-analysis of
observational studies in epidemiology: a proposal
for reporting. Meta-analysis Of Observational
Studies in Epidemiology (MOOSE) group. JAMA.
2000 Apr 19;283(15):2008-12.
o
Selection
o
Attrition
o
Performance
o
Detection
In-class exercise: Students will conduct meta-analysis calculations and will assess quality of
RCT with the Cochrane tool.
Homework: Students will evaluate quality of included studies in their abstraction forms.
Assignment is due on March 24 at 1200 hrs. Upload completed abstraction forms with quality
evaluation of the abstracted studies.
11.
Rating the body of evidence.
Readings:
Course Syllabus Version 5.0
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
The risk of bias.

The need for consistency,
directness, and precision.
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PH6062 Research Synthesis and Meta-analysis
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter
Y, Alonso-Coello P,
Schünemann HJ; GRADE Working Group. GRADE:
an emerging consensus on rating quality of evidence
and strength of recommendations. BMJ. 2008 Apr
26;336(7650):924-6.
Atkins D, Briss PA, Eccles M, Flottorp S, Guyatt GH,
Harbour RT, Hill S, Jaeschke R, Liberati A, Magrini
N, Mason J, O'Connell D, Oxman AD, Phillips B,
Schünemann H, Edejer TT, Vist GE, Williams JW Jr;
GRADE Working Group. Systems for grading the
quality of evidence and the strength of
recommendations II: pilot study of a new system.
BMC Health Serv Res. 2005 Mar 23;5(1):25.

Dose-response association.

Plausible confounding that would
decrease the observed effect.

Strength of association and the
magnitude of effect.

Bias in publication.

Strength of evidence grades and
definitions of same.
Class exercise: Students will present the results from quantitative and qualitative synthesis of
evidence
Homework: Students will rate a body of evidence for their key questions. Assignment is due
on March 31 at 1200 hrs. Upload analytical plans, including quantitative data, qualitative
synthesis of evidence, pooling criteria and pooling data.
12.
Summarizing the findings.

Creating summary tables
corresponding to research
hypotheses.
Readings:

Plotting results from the studies.
Cochrane Handbook for Systematic Reviews of
Interventions, Chapter 12: Interpreting results and
drawing conclusions.

Strength of evidence.

Heterogeneity and consistency of
evidence: Forest plots

Reconciling differences:
Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter
Y, Schünemann HJ; GRADE Working Group. What is
"quality of evidence" and why is it important to
clinicians? BMJ. 2008 May 3;336(7651): 995-8.
Review.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA
Group. Preferred reporting items for systematic
reviews and meta-analyses: the PRISMA statement.
Ann Intern Med. 2009 Aug 18;151(4):264-9, W64.
o
Measures
o
Samples
o
Methods and design

Publication bias.

Summarizing evidence when
meta-analysis is not feasible.

Generalizability.
Class exercise: Students will rectify contrasting findings from two articles on the same topic.
Homework: Students will develop summary tables, key messages. Assignment is due on
April 7 at 1200 hrs. Upload slides for in-class presentation with summary tables and key
messages. Upload a Word or PDF document with evidence tables and summary tables.
13.
Writing the report or paper, including templates,
outlines, and storyline.
Readings:

Discussion of Transparency.

Presenting major findings.

Strength and consistency of the
evidence and explanation of
Cochrane Handbook for Systematic Reviews of
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PH6062 Research Synthesis and Meta-analysis
Interventions, Chapter 12: Interpreting results
and drawing conclusions.
Shojania KG, Sampson M, Ansari MT, Ji J,
Doucette S, Moher D. How quickly do systematic
reviews go out of date? A survival analysis. Ann
Intern Med. 2007; 147:224-233.
inconsistencies.

Implications for practice and policy.

Affecting limitations.

Tabulation of research needs.
Class exercise: Students will present summary tables and conclusions.
Homework: Upload your slides and drafts of the systematic review on April 12 by 1200 hrs to
receive comments and recommendations from instructors.
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Presentations:
Each student or student group will give a Power Point presentation. Student reviewers of the
presentations will write critiques. Presentations should include key questions, conceptual
model, search strategy, data analysis, and interpretation.
Final Assignment due on April 20, 2012 by 1200 hrs – Upload a systematic review that
includes an introduction, key questions, a conceptual model, search strategy, data analysis
and interpretation.
15.
Final Paper Due.
NOTE:
“All written work must be submitted through www.turnitin.com where it will be checked for
plagiarism. Work that is found to be plagiarized will receive a failing grade and the student may be
subject to charges of academic misconduct.”
All students are required to complete this online tutorial and turn in the certificate in the next class.
http://www.cte.usf.edu/plagiarism/plagindex.html
FIU HONOR CODE
Students are urged to be careful that they properly attribute and cite others' work in their own
writing. In addition, original work is expected in this course. It is unacceptable to hand in
assignments for this course for which you receive credit in another course unless by prior
agreement with the instructor. Building on a line of work begun in another course or leading to a
thesis, dissertation, or final project is acceptable.
If you have any questions, consult the instructor.
Students are responsible for knowing and complying with all FIU Policies and Regulations
listed in the Student Handbook and also at the following link:
http://policies.fiu.edu/files/740.pdf. The following are excerpts:
Reason for Policy:
“Graduate students at Florida International University are expected to adhere to the highest
standards of integrity in every aspect of their lives. Honesty in academic matters is part of this
obligation. Academic integrity is adherence to those special values regarding life and work in an
Course Syllabus Version 5.0
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PH6062 Research Synthesis and Meta-analysis
academic community. Any act or omission by a graduate student which violates this concept of
academic integrity and undermines the academic mission of the University shall be defined as
academic misconduct and shall be subject to the procedures and penalties that follow.”
Definition of Academic Misconduct:
Academic misconduct is defined as the following intentional acts or omissions committed by any
FIU graduate student:
“Cheating: The unauthorized use of books, notes, aids, electronic sources; or unauthorized use of
on-line exams, library materials or assistance from another person with respect to examinations,
course assignments, field service reports, class recitations; or the unauthorized possession of
examination papers (or on-line examinations) or course materials, whether originally authorized or
not. Any student helping another cheat may be found guilty of academic misconduct”
Plagiarism: The deliberate use and appropriation of another's work without any indication of the
source and the representation of such work as the student's own. Any student, who fails to give
credit for ideas, expressions or materials taken from another source, including internet sources, is
guilty of plagiarism. Any student helping another to plagiarize may be found guilty of academic
misconduct.
Misrepresentation: Intentionally lying to a member of the faculty, staff, administration, or an
outside agency to gain academic advantage for oneself or another, or to misrepresent or in other
ways interfere with the investigation of a charge of academic misconduct.
Misuse of Computer Services: The unauthorized use of any computer, computer resource or
computer project number, or the alteration or destruction of computerized information or files or
unauthorized appropriation of another's program(s).
Bribery: The offering of money or any item or service to a member of the faculty, staff,
administration or any other person in order to commit academic misconduct.
Conspiracy and Collusion: The planning or acting with one or more fellow students, any member of
the faculty, staff or administration, or any other person to commit any form of academic misconduct
together.
Falsification of Records: The tampering with or altering in any way of any academic record used
or maintained by the University.”
Disability Statement
It is University policy to provide, on a flexible and individualized basis, reasonable accommodations
to students who have a documented disability (e.g., physical, learning, psychiatric, vision, hearing,
or systemic) that may affect their ability to participate in course activities or to meet course
requirements. Students with disabilities are encouraged to contact Disability Services to have a
confidential discussion of their individual needs for accommodations.
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PH6062 Research Synthesis and Meta-analysis
Statement of Understanding
Late Submission Policy: A 5% penalty for every 24-hour period an item is submitted late. For
example, if an item worth 25% is submitted late, but within 24 hours of the stated deadline, the
item’s maximum value is reduced to 20%. If it is submitted after 24 hours but within 48 hours, its
value is reduced to 15%.
If any of the above occurs due to an emergency, you must submit verifiable, written documentation
of the emergency. This does not, however, guarantee avoidance of penalty.
I understand the penalty for not meeting specified class deadlines.
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Remove this page from your syllabus and turn in before leaving class today.
Course Syllabus Version 5.0
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