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182  Locke Aug 19 2024 Srma Project Advice

182.1 Summary

  • Lessons LearnedMDCRC 6200: SR/MA
  • Objectives
  • Aim to publish your stuff!
  • Topic Choices
  • Our PICO(T): RCTs involving…
  • Strengths of our Topic:
  • Weaknesses of our topic
  • Strengths / Weaknesses of our team
  • Timeline
  • Our Progress:
  • brian.locke@imail.org

182.2 Slide outline

182.2.1 Slide 1

  • Lessons LearnedMDCRC 6200: SR/MA
  • Brian Locke MD MSc
  • Assistant Professor, Academic Track
  • Shock Trauma ICU, Schmidt Chest Clinic
  • Intermountain Medical Center
  • Aug 20, 2024 ### Slide 2
  • Objectives
  • Walk through the timeline of our project (MDCRC 6200 ’22)
  • Discuss considerations for topic choice
  • Discuss some things that went well (& not) with our team
  • Highlight pitfalls
  • Open discussion/brainstorm ### Slide 3
  • Aim to publish your stuff!
  • It’s bad [science] to abandon partly completed SRMAs
  • Get [career] credit for the time you spend
  • You’ll learn the most by making the project ‘publication quality’
  • There are venues for all types of project – just scope it correctly
  • Group of 3 (Tee, Ainhoa, Myself) – rest of TA’s contributed, especially CJ after course completed. ### Slide 4
  • Topic Choices
  • Hypercapnia & Weight 1 study
  • Limited by the literature
  • Prevalence of OSA in ICU boring
  • Need group enthusiasm
  • OSA & Weight Loss?
  • GLP-1RAs → Meds → Meds & Surg
  • Initially, only found 3 studies
  • Ultimately found 10 (trial registers!)
  • → Gap: little direct evidence on new weight management options (GLP-1s) & OSA ### Slide 5
  • Our PICO(T): RCTs involving…
  • Patients: adults with overweight or obesity and who have OSA
  • Intervention: either an anti-obesity medication (FDA approved or not) or bariatric surgery.
  • Comparison: placebo, no treatment, or usual care (including CPAP or lifestyle modification).
  • Outcome: change in Apnea Hypopnea Index (AHI)
  • (Time): at least 4 weeks duration
  • Question: How much heterogeneity in AHI change is explained percentage weight change between randomization and last follow-up
  • The real (50 million $3,000/yr ) $150 billion question: Will tirzepatide treat OSA? ### Slide 6
  • Strengths of our Topic:
  • Emerging field (GLP-1 RA’s!) with a knowledge gap
  • Able to quantitatively analyze
  • meta-analysis and meta-regression
  • 3→10 RCTs (started borderline low, ended borderline high)
  • Similar analyses existed, but never our question & we had new studies ### Slide 7
  • Weaknesses of our topic
  • Many ongoing trials
  • Short window before needing to redo
  • Pressure with other SRMA groups
  • (also, indicates of a good topic)
  • Meta-regression: more nuanced
  • Be careful with complex analyses
  • Expertise, reviewers, etc.
  • (but, enabled addressing a gap) ### Slide 8
  • Strengths / Weaknesses of our team
  • Mix of interests and strengths
  • Defined roles: methods & subject matter, metabolic research, systematic review expert, etc.
  • Organization:
  • we used a shared box (discuss conventions)
  • ultimately github for the code: https://github.com/reblocke/AOM-and-Bari-Surg-for-OSA-SRMA ### Slide 9
  • Timeline
  • The class deadlines come fast
  • Sessions are more useful the more you’ve done.
  • Polished > Rough >> Nothing
  • Objectives build on each other
  • Don’t fall behind early!
  • Date
  • Topics
  • Week 3
  • 09/03
  • Ignite #1 – Research proposal presentation
  • Week 6
  • 09/24
  • Ignite #2 – Search/screening presentations
  • Week 10
  • 10/29
  • Ignite #3 – Data extraction, study characteristics, and prelim results
  • Week 13
  • 11/19
  • Ignite #4 – Prelim Findings & Abstract
  • Progress will be MUCH slower once the class finishes. ### Slide 10
  • TODO: No text extracted from this slide. ### Slide 11
  • TODO: No text extracted from this slide. ### Slide 12
  • TODO: No text extracted from this slide. ### Slide 13
  • TODO: No text extracted from this slide. ### Slide 14
  • TODO: No text extracted from this slide. ### Slide 15
  • Our Progress:
  • Completed draft Dec 2022
  • Fine-tuned methods/figures & back-and-forth data requests from borderline includable studies until June 2023
  • Submitted ➞ Reject from JAMA Network Open June 2023
  • Submitted to Obesity Review – July 2023
  • Revisions – Sept to Oct 2023
  • Accepted Dec 2023
  • Published Feb 2024 ### Slide 16
  • Our Progress:
  • Completed draft Dec 2022
  • Fine-tuned methods/figures & back-and-forth data requests from borderline includable studies until June 2023
  • Submitted ➞ Reject from JAMA Network Open June 2023
  • Submitted to Obesity Review – July 2023
  • Revisions – Sept to Oct 2023
  • Accepted Dec 2023
  • Published Feb 2024 ### Slide 17
  • brian.locke@imail.org
  • Feel free to use my STATA code
  • (will make more sense after the STATA session)
  • Other SRMA recommendations:
  • Read related SRMAs to understand structure/framing
  • Keep the STATA template ready to combine studies you read about
  • (MA is fast but takes practice, SR is slow/methodological)
  • Takeaways:
  • Choose a topic where:
  • All group members are excited about the question
  • There is a literature to support the SRMA
  • It’s a hot topic
  • Project Execution
  • Use box or another shared drive to organize
  • Choose simple, quantitative methods if possible
  • Meet early deadlines

182.3 Learning objectives

  • Lessons LearnedMDCRC 6200: SR/MA
  • Objectives
  • Aim to publish your stuff!
  • Topic Choices
  • Our PICO(T): RCTs involving…

182.4 Bottom line / summary

  • Lessons LearnedMDCRC 6200: SR/MA
  • Objectives
  • Aim to publish your stuff!
  • Topic Choices
  • Our PICO(T): RCTs involving…

182.5 Approach

  1. TODO: Outline the initial assessment or decision point.
  2. TODO: Outline the next diagnostic or management step.
  3. TODO: Outline follow-up or escalation criteria.

182.6 Red flags / when to escalate

  • TODO: List red flags that require urgent escalation.

182.7 Common pitfalls

  • TODO: Capture common errors or missed steps.

182.8 References

TODO: Add landmark references or guideline citations.

182.9 Slides and assets

182.10 Source materials