Network Meta-Analysis: A technique to synthesize evidence for Decision Making

INTRODUCTION Clinical decision requires balanced decision among resources, tasks, skills and values. It relies on external aspects that are not easily modulated (such as religious beliefs or economic resources) and largely beyond the reach of most researchers. Meta-analysis service plays an important role in clinical decision making. The meta-analysis involves in pair meta-analysis (goes from a 2-D to a multidimensional analytical framework) and network meta-analysis (several processes are being generated, like the adjusted indirect comparison, mixed- treatment comparison, multi-treatment meta-analysis, multi-arm meta-analysis and multivariable meta-analysis). The key features of network meta-analysis must be as evidence-based (From pairwise meta-analysis to network meta-analysis) and reviewing process also should be designed (before the data are effectively retrieved) and registered (the evaluation protocol should be published immediately after finalizing an out-and-out repository site) as per the guidelines at hand for plan, carry out, and reporting of a network meta-analysis. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing &Peer-Reviewing Copyright © 2019 pubrica. All rights reserved

NETWORK META- ANALYSIS Network meta-analysis is a unique and powerful tool for enhancing clinical decision making. When converting to action, knowledge that rapid systematic reviewingprocesses yield could be advantageous. The preliminary assessment results suggest that gold standard NMAs might be replaced by a modified rapid NMA approach. Evaluation of judgement could be used to compare summery methods of proof. Network meta-analysis with modest improvements might replace gold standard network meta-analysis. The researchers with execution tools might use a more advanced networkmeta-analysis technique to lower the time and resources required for knowledge transfer to practice while creating more patient-based tools. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing &Peer-Reviewing Copyright © 2019 pubrica. All rights reserved

IMP ORTANT FACT ORS FOR THE NETWO RK ME TA- ANA LYSIS ANALYSIS Search: There are several available databases such as MEDLINE/PubMed, Cochrane Library, Europe PubMed Central, SciELO, LILACS, Embase, etc. must be used for the searching process to lead the appropriate evidence. NETWORK META- Selection: The selection of the study being an importantstep towards the network meta-analysis. Choosing the framework: Among all frameworks, Bayesian framework is considered to be the most popular and accepted framework for NMA. It allows more robust modeling that can easily adjustable for simpler evidence networks. Choosing the statistical package: There are several statistical packages available. The WinBUGS tool is one of the most commonly used packages. It is quite easy to command and can be used with ease by R and other packages for the Bayesian modeling and analysis. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing &Peer-Reviewing Copyright © 2019 pubrica. All rights reserved

Choosing the suitable statistics: Binomial model generates relative risks, risk differences, odds ratios, probabilities of being best, numbers needed to treat, rankograms, and the surface under the cumulative ranking curves. Numerous methods have been suggested for evaluating small-research results, including funnel plots inspection after rectifying summary estimates of the subgroup, the Copas method and regression testing. ANALYSIS NETWORK META- Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing &Peer-Reviewing Copyright © 2019 pubrica. All rights reserved

Future perceptions of the network meta-analysis CONVERTING SYNTHESIS OF EVIDENCE TO ACTION: All the findings of a network meta-analysis should be applied to direct decision making, determine how to best interpret the assessment results and apply them in clinical practice, and to incorporate the intervention thoroughly in depth with the most desirable risk-benefit balance. The best possible way to do this is by absolute risk measurements, numbers required to be treated, and rankograms, making decision on credible or confidence intervals, instead of point estimates, while identifying the parallel effect of a specific intervention on different endpoints. Therefore, when multiple interventions hold an analogous beneficial risk-benefit profile, it is important to choose the one which is easier or cost effective to execute. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing &Peer-Reviewing Copyright © 2019 pubrica. All rights reserved

TOWA RD ACCE SSIBILIT Y AND INT EGRATIO N: ANALYSIS The future of network m e t a - anal ys is lies in the thorny proces s of steeri ng between the S cylla of sta te- of- the- a rt p roc esses of p erform ing a n a c c ep ta b le system a tic review a nd the Cha ryb d is of effecti ve di ssemi nati on and thri ving ac c om pl ishment by stak ehol ders and deci sio n - mak ers . NETWORK META- Cl ear and eas y tool s cateri ng innovati ve sol uti ons to the compl ex issues have been domi nati ng the cl ini cal practi ce and Res earch in the las t few decades . A bri lliant res ource for cl ini cal res earch proces ses is K a p l a n - Meier m et hod back ed surviva l a na lysis with its c onc ise, p erfec t, a nd rob ust find ing s in d a ily resea rc h, in sp ite of its appl icati on in a mas sive amount of di vers ified and occas ional ly trick y contex ts . Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing &Peer-Reviewing Copyright © 2019 pubrica. All rights reserved

LIMITATIONS OF NETWORK META- ANALYSIS Onl y speci fic situati ons requi re the network m e t a - anal ys is and inappropri ate us e of network m e t a - anal ys is can lead to mi sleadi ng res ul ts such as Lim ited net w ork c onnec t ivit y ( Most of the a va ila b le resea rc hes ha ve u n - c om pared al l avai labl e t reatments dueto res trai nts ; limi ted interpretati on of indi rect evi dence time or financi al L imi ted interpretati on of rank ing analysis Lim ited exp erienc e of c linic ia ns with the sta tistic s of network m eta - anal ys is ( due to study conducti on by Un - trai ned cl ini ci ans and stati stici an). Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing &Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

SUMMARY Network m e t a - anal ys is and synthes is evi dence wi ll be a real ity by the rel ated appl icati on of strai ghtforward but vigorous pack ages to impl ement network m e t a - anal ys is on numerous pl atforms like smartphones and tabl ets . Moreover, it is al so a probabi lity to create intelligent tr ial databases whi ch wi ll automati cal ly upl oad the data recei ved from indi vidual data in a sort of col lecti ve network m e t a - anal ys is. No sing le m eta - a na lysis should b e view ed a s the fina l, b ut ra ther a s a to ol tha t mak es a refi ned form of evi dence avai labl e to lead more accurate cl ini cal practi ce. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing &Peer-Reviewing Copyright © 2019 pubrica. All rights reserved

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Network Meta-Analysis: A technique to synthesize evidence for Decision Making