Synthesis

• Select [Synthesis] from the top menu bar

• Select [Meta-Analysis]

• You will first need to enter a comparison. Select [Create] to do this. Once you have entered the comparison title, you need to create an outcome. Select [Open] and then [Create]. Type in the title of your outcome, select the tick to confirm and then select whether your outcome is dichotomous or continuous

• Select [Plot]

• Once in the plotting stage, you will need to put in the parameters for your meta-analysis. You can try some different options here. For starters (and using the drop down menus), select ‘inverse variance’ as the statistical method, use a ‘fixed’ model with the ‘odds ratio’ as the effect measure, with ‘95%’ confidence interval. In the data table, select your study (using the drop down menu) and enter the events and the total sample from both the experimental and control arms. Select [Add] and then complete this information for other studies that contain outcome data This will produce your forest plot.

• Click [Save] and then [Back] to return to the synthesis home page

Comparative meta-analysis

Proportional meta-analysis

After the forest-plot has been generated, click the blue [Export] button and select the format and resolution required for your export

Computational problems can occur when there are cells with zero events for the meta-analysis of dichotomous values.

When using the Inverse Variance or the Mantel-Haenszel  statistical methods, systematic reviewers will need to add a continuity correction of 0.5 to each cell, for which a zero event occurs. E.g. If I have zero events out of 100 in the control group and 1 event out of 100 in the experimental group, this will need to change to 0.5 events out of 100.5 in the control group and 1.5 events out of 100.5 in the experimental group. The appropriateness of doing such a correction is debatable but yields consistent results in most scenarios.

When using the Peto Odds Ratio as the statistical method, this continuity correction does not need to be manually input by the reviewer. The Peto Odds Ratio is capable of dealing with zero event cells through the underlying statistical formula. However, using such a method is usually reserved for outcome data that is extremely rare, or uncommon.

No matter the approach you take to dealing with zero event data within SUMARI, it needs to be clearly and transparently documented in the review protocol and the systematic review itself.

• Select [Synthesis] from the top menu bar

• Select [Qualitative] 

• Select [Start]

• The first step is your findings page. Here, enter your study by selecting [Create Study] and enter the author/s name. Select the tick and click on [Open]. Start entering each finding by selecting [Create Finding] You will need to type in the finding and accompanying illustration. Make sure to assign a level of credibility. 

• Once complete, proceed to the categories page [Categories]. Select [Create Category] to add in the name of the category as well as a summary. All categories will appear on the right hand side of the page. To assign a finding/s (on the left hand side of the page) click on the finding to highlight it. You can select multiple findings at once. Select [Assign Selected] and select the category from the drop down menu. The finding will be moved to the right hand side of the page underneath the designated category.

• Once you have completed allocating your findings, proceed to the synthesized findings page [Synthesized Findings] Select [Create] to create a new synthesized finding. You will also need to add a description. To assign a category/categories (on the left hand side of the page) click on the category to highlight it. You can select multiple categories at once. Select [Assign Selected] and select the Synthesized Finding from the drop down menu. The category/categories will be moved to the right hand side of the page underneath the designated synthesized finding.

• Once completed select [Meta-Aggregative Flowchart].

Performing Qualitative Synthesis

To export the meta-aggregative flowchart hover your cursor over the flowchart. A pop-up should appear providing you with different image formats in which the flowchart can be exported.