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 mostresearchers. Meta-analysis service plays an important role in clinical decisionmaking. Themeta-analysisinvolves inpairmeta-analysis(goesfroma2-Dtoamultidimensionalanalyticalframework)and network meta-analysis (several processes are being generated, like the adjusted indirect comparison, mixed- treatmentcomparison,multi-treatmentmeta-analysis,multi-armmeta-analysisandmultivariablemeta-analysis). The key features ofnetwork 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(theevaluationprotocolshouldbepublishedimmediatelyafterfinalizinganout-and-outrepositorysite) aspertheguidelinesathandforplan,carryout,andreportingofanetworkmeta-analysis. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing&Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

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 beadvantageous. The preliminary assessment results suggest that gold standard NMAs might bereplaced byamodifiedrapidNMAapproach.Evaluationofjudgementcouldbeusedtocompare summery methods ofproof. Networkmeta-analysiswithmodestimprovementsmightreplacegoldstandardnetwork 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-basedtools. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing&Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

IMPORTANT FACTORS FOR THE NETWORK META-ANALYSIS NETWORKMETA-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 appropriateevidence. Selection: The selection of the study being an importantstep towards thenetwork 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 caneasily adjustable for simpler evidencenetworks. Choosing the statistical package: There are several statistical packages available. The WinBUGS tool is oneofthemostcommonlyusedpackages.ItisquiteeasytocommandandcanbeusedwitheasebyR and other packages for the Bayesian modeling andanalysis. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing&Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

NETWORK META- ANALYSIS Choosing thesuitablestatistics: Binomial model generates relative risks, risk differences, odds ratios, probabilities of being best, numbers needed to treat, rankograms, andthe surface under the cumulative ranking curves. Numerous methods have been suggested for evaluating small-research results, including funnel plots inspectionafterrectifyingsummaryestimatesofthesubgroup,theCopasmethodandregressiontesting. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing&Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

Future perceptions of the networkmeta-analysis CONVERTINGSYNTHESISOFEVIDENCETOACTION: All the findings of a network meta-analysis should be applied to direct decision making, determine how to best interprettheassessmentresultsandapplytheminclinicalpractice,andtoincorporatetheinterventionthoroughly in depth with the most desirable risk-benefitbalance. 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 identifyingthe parallel effect of a specific intervention on differentendpoints. Therefore, when multiple interventions hold an analogous beneficial risk-benefit profile, it is important to choosethe one which is easier or cost effective toexecute. Publication Support | Research Services | Physician Writing | Scientific Communication Solution |Editing &Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

NETWORK META- ANALYSIS TOWARD ACCESSIBILITY AND INTEGRATION: The future of network meta-analysis lies in the thorny process of steering between the S cylla of state-of-the-artprocessesofperforminganacceptablesystematicreviewandtheCharybdisof effective dissemination and thriving accomplishment by stakeholders and decision-makers. Clear and easy tools catering innovative solutions to the complex issues have been dominating the clinical practice and Researchin the last few decades. A brilliant resource for clinical research processes is K aplan-Meier method backed survivalanalysiswithitsconcise,perfect,androbustfindingsindailyresearch,inspiteof its application in a massive amount of diversified and occasionally tricky contexts. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing&Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

LIMITATIONS OF NETWORK META-ANALYSIS Only specific situations require the network meta-analysis and inappropriate use of network meta-analysis can lead to misleading results such as Limitednetworkconnectivity(Mostoftheavailableresearcheshave un-compared all available treatments due to time or financial restraints; limited interpretation of indirect evidence L imited interpretation of ranking analysis Limitedexperienceofclinicianswiththestatisticsofnetworkmeta- analysis (due to study conduction by Un-trained clinicians and statistician). Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing&Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

SUMMARY Network meta-analysis and synthesis evidence will be a reality by the related application of straightforward but vigorous packages to implement network meta-analysis on numerous platforms like smartphones and tablets. Moreover, it is also a probability to create intelligent trial databases which will automatically upload the data received from individual data in a sort of collective network meta-analysis. Nosinglemeta-analysisshouldbeviewedasthefinal,butratherasatoolthat makes a refined form of evidence available to lead more accurate clinical practice. Publication Support | Research Services | Physician Writing | Scientific Communication Solution | Editing&Peer-Reviewing Copyright © 2019 pubrica. All rightsreserved

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Network meta analysis: A technique to synthesize evidence for Decision Making