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Picot J, Hartwell D, Harris P, et al. The Effectiveness of Interventions to Treat Severe Acute Malnutrition in Young Children: A Systematic Review. Southampton (UK): NIHR Journals Library; 2012 Apr. (Health Technology Assessment, No. 16.19.)

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The Effectiveness of Interventions to Treat Severe Acute Malnutrition in Young Children: A Systematic Review.

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Appendix 1Protocol methods

Systematic review

The systematic review will be undertaken in accordance with guidance from the Centre for Reviews and Dissemination (University of York).90

Delphi study to specify the research question

A Delphi method will be used to help identify and prioritise the key research questions that should be addressed by the systematic review. Through an iterative process a panel of experts will have the opportunity to identify questions and then reach a consensus about which they consider most important. There will be three-rounds in the Delphi process. In the first round a set of questions identified in the development of the research protocol will be sent to the panel members. They will be asked to score these on the basis of their importance, adding any additional questions. Responses from the panel members will be analysed and the questions prioritised on the basis of the median score [plus upper quartile (UQ) and lower quartile (LQ)]. A subset of the questions that receive the highest median scores will go forward to the subsequent rounds. Any additional questions suggested by the panel members will be assessed to see if they are already encompassed within the original list. Up to five new questions may be included in the second round, with selection based on the relevance to the scope of the review and the frequency with which they are identified by the panel members. For the second and third rounds, panel members will see the median score for each question from the previous round and decide whether or not they wish to revise their original score (i.e. whether they wish to move closer to the group consensus or maintain their original score for the question). In addition, they will be asked to score any new questions introduced as part of the first round. At the conclusion of the third round the panel members will be sent a list of the research questions in priority order for information. The prioritised list will form the basis from which the research questions to be addressed by the systematic review will be identified, with the final decision on how many questions will be addressed based on the extent of the evidence and the resources available for the research. Conduct of the Delphi process will be overseen by an independent Chair appointed by NIHR HTA programme.

Literature search

Literature will be identified from several sources including electronic databases, bibliographies of articles and consultation with experts in the area. A comprehensive database of relevant published and unpublished articles will be constructed using the Reference Manager software package.

The searches carried out will include:

  • General health and biomedical databases: MEDLINE; EMBASE; PubMed (previous 6 months); The Cochrane Library.
  • Specialist electronic databases: DARE; The Cochrane Library; Health Technology Assessment Database (HTA); NHS EED; EconLit; Specialist databases as appropriate.
  • Contact with individual experts and those with an interest in the field.
  • Checking of reference lists.
  • Research in Progress: UKCRN.

All databases will be searched from inception to the current date. In the first instance searches will be conducted in all languages with non-English-language articles set to one side in a separate foreign-language reference database. The primary focus will be English-language articles but the need to include non-English articles will be considered in the light of what is found and within the constraints of available time for translation.

Study inclusion

Studies will be selected for inclusion through a two-stage process using the predefined and explicit criteria. The full literature search results will be screened independently by two reviewers to identify all citations that may meet the inclusion criteria. Full manuscripts of all selected citations will be retrieved and assessed by two reviewers against the inclusion criteria. Studies published as abstracts or conference presentations will only be included if sufficient details are presented to allow an appraisal of the methodology and the assessment of results to be undertaken. Any disagreements over study inclusion will be resolved by consensus or if necessary by arbitration by a third reviewer.

The planned inclusion/exclusion criteria for the systematic review are shown in Table 65.

TABLE 65. Inclusion criteria for the systematic review.


Inclusion criteria for the systematic review.

Data extraction

The extraction of studies' findings will be conducted by two reviewers using a pre-designed and piloted data extraction form to avoid any errors. Any disagreements between reviewers will be resolved by consensus or if necessary by arbitration by a third reviewer.

Quality assessment

The methodological quality of included studies will be assessed using formal tools specific to the design of the study and focusing on possible sources of bias. Quality assessment of RCTs will be conducted using criteria developed by the CRD (University of York)90 and observational studies will be assessed using criteria such as those developed by CRD (University of York),90 Spitzer.91 Decisions about the quality assessment tool used will be made following selection of the evidence. Study quality will be assessed by two reviewers. Any disagreements between reviewers will be resolved by consensus or if necessary by arbitration involving a third reviewer.

Data synthesis

The methods of data synthesis will be determined by the nature of the studies identified through searches and included in the review. Studies will be synthesized through a narrative review with tabulation of results of included studies. Where possible the results from individual studies will be synthesized through meta-analysis, with sources of heterogeneity of results investigated by subgroup analyses if applicable. The specific methods for meta-analysis and for the detection and investigation of heterogeneity will depend upon the summary measure selected.

© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK98560


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