184 Locke Aug 2024 Srma Project Advice
184.1 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
184.2 Slide outline
184.2.1 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 (or 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 $100 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
- Invest time to
184.3 Learning objectives
- Lessons LearnedMDCRC 6200: SR/MA
- Objectives
- Aim to publish your stuff!
- Topic Choices
- Our PICO(T): RCTs involving…
184.4 Bottom line / summary
- Lessons LearnedMDCRC 6200: SR/MA
- Objectives
- Aim to publish your stuff!
- Topic Choices
- Our PICO(T): RCTs involving…
184.5 Approach
- TODO: Outline the initial assessment or decision point.
- TODO: Outline the next diagnostic or management step.
- TODO: Outline follow-up or escalation criteria.
184.6 Red flags / when to escalate
- TODO: List red flags that require urgent escalation.
184.7 Common pitfalls
- TODO: Capture common errors or missed steps.
184.8 References
TODO: Add landmark references or guideline citations.