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Systematic Reviews: Finding High-Quality Information for Evidence or Support

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A brief overview of the purposes, steps, and considerations in systematic reviews.

Tiny URL: http://tinyurl.com/fau-sysrev

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Systematic Reviews: Finding High-Quality Information for Evidence or Support

  1. 1. Systematic Reviews: Finding high-quality information for evidence or support Kristy Padron, MLIS Reference & Instruction Librarian kpadron@fau.edu
  2. 2. Scenario 1: Graduate Student • He completed a state of the science report after completing a literature review. • His advisor suggests expanding this by adding inclusion criteria for studies because it may be helpful for developing his thesis. Scenario 2: Nursing Professor • She plans to eventually do research on a topic, but first wants to do a literature review and then summarize the studies that use the same methodology. • Results from this will help her design her own future study on her topic. Scenario 3: Director of a Clinic • A nurse-director and her staff want to launch some new services at a busy clinic. • To fund them, her team is applying for a prestigious grant, and the application requires supporting information.
  3. 3. What do these scenarios have in common? • They take steps of a standard literature review or state of the science report to an advanced level. • The search for information needs to be selective, and located through an objective and rigorous process. • Each will use information to provide evidence or support for something: o Interventions or treatments o Policies, best practices or protocols o Writing grants or seeking funding o Various decision-making matters • A systematic review can be utilized for all of these scenarios.
  4. 4. Objectives: • Define “systematic review” and its purposes in the nursing profession. • Outline the overall steps involved in a systematic review. • Identify some considerations (logistical/technical, planning) when undertaking a systematic review.
  5. 5. What is a systematic review? • A document that provides an unbiased and comprehensive synthesis of relevant studies and research. • Also known as a “research synthesis.” What are the purposes of a systematic review? • Summarizes and synthesizes existing knowledge. • Enables researchers to make an objective assessment of primary research evidence in order to inform or support various aspects of nursing practice.
  6. 6. Characteristics of a systematic review: • Utilizes explicit objectives and questions to be addressed. • Determines relevant studies with stated inclusion and exclusion criteria. • Studies are found through a comprehensive search for published and unpublished studies. • Included studies are appraised for many factors (methodology, validity, etc.). • Data from included studies may be extracted and analyzed. • Searches and methodology are documented and transparent. (Aromataris & Pearson, 2014)
  7. 7. Example of a Systematic Review: (Kazemzadeh, Manzari, & Pouresmail, 2017) FAUNet ID required.
  8. 8. Overall Steps: 1. Identify a question or a clinical problem. 2. Create a review protocol (inclusion criteria). 3. Find studies in the literature. 4. Study selection: pick relevant studies based on review protocol. 5. Critically appraise the quality of studies. 6. Collect data from each selected study. 7. Synthesize and summarize findings from included studies. 8. Document the method by writing a review, report or article. (The Joanna Briggs Institute for Evidence Based Nursing and Midwifery, 2001)
  9. 9. • First, establish a need for the review. • Utilize PICO to create a specific question. • Make sure enough primary or original research has been done on the question. • The question gives a direction for the review and forms the basis of protocol to be used. 1. Identify a question or a clinical problem. Example: Based on the results of clinical trials, what interventions can nurses design and implement for smoking cessation in hospitalized patients?
  10. 10. 2. Create a review protocol • Based on the PICO question, select the optimal research design for answering the question. • Protocol and pre-established criteria reduce the chances of bias, making a search more objective. • Establish eligibility (inclusion and exclusion criteria) based on the question. o Research design and methodology  Population (People)  Qualitative or Quantitative?  RCT, Quasi-experimental, Nonexperimental, etc.?
  11. 11. 2. Create a review protocol Based on the results of clinical trials, what interventions can nurses design and implement for smoking cessation in hospitalized patients? Population Hospitalized patients who smoke Intervention (Explores which ones) Comparison Outcome Measures Smoking cessation Inclusion Criteria Intervention studies, preferably randomized controlled trials, involving smoking cessation intervention designed by a nurse Exclusion Criteria review papers, expert opinion, non-intervention studies, papers examining the effect of pharmacological interventions on quitting
  12. 12. 3. Find studies in the literature. A. Develop a comprehensive search strategy. i. Search terms: Keywords or natural language (“diabetes”) and controlled vocabulary such as MeSH or CINAHL Headings (“diabetes mellitus type 2”) ii. Information sources a. Databases (CINAHL, PubMed and others for health sciences) b. Journals (especially for manual searching) c. Gray literature (unpublished reports, or published through non- academic channels) may be found through an internet search or Google Scholar.
  13. 13. iii. Chain / reference searching (backwards searching): searching the references used in studies to find what may had been missed in initial search. iv. Manual searching: look through journals or publications. v. Document your searches, including number of results. vi. Interlibrary Loan: Use interlibrary loan service to request documents not available through the FAU Libraries. B. Make a plan for saving, storing, and sharing information. o Word processing (keep track of search terms, number of results and strategy) o Citation management tools: Mendeley, RefWorks o File storage: Google Docs, cloud-based storage 3. Find studies in the literature.
  14. 14. Search strategy: Listing keywords and databases used to search. Databases: • Web of Knowledge, • ProQuest • Medscape • MedlinePlus • Ovid SID • Magiran • PubMed • Science Direct Publications: • English language • 1990-2015 Keywords: • Smoking Cessation Cessation • Smoking • Nursing Processes Processes
  15. 15. • Review the studies found through searches. • Select studies that match the PICO elements and review protocol. • Selection is potentially the most time- consuming part of a systematic review. 4. Study selection: choosing relevant studies based on review protocol
  16. 16. Selecting research: • Number of studies found • Reasons for excluding studies
  17. 17. 5. Critically appraise the quality of studies • Critical appraisal: assessing study qualities using (established) tools and criteria, especially for validity and reliability. o Appraisal tools or instruments: helps with transparency and replication of the review. o JBI Critical Appraisal Tools (for research designs and systematic review)
  18. 18. 6. Collect data from each selected study • Use a data extracting tool based on the data needs. o AHRQ Systematic Review Data Repository (SRDR) o SR Toolbox (includes tools for other parts of a review) • Extract relevant data as it relates to the review question. • Synthesize the data. o Allows exploring similarities or inconsistencies. o Present in a narrative summary. o A meta-analysis takes a systematic review further by pooling and analyzing the data.
  19. 19. • Provides an overall conclusion of findings as well as potential limitations. • Allows comparisons of studied effects in different studies, settings and participants. • Recommendations for clinical practice and implications for future research should be based on the synthesized finding. • Written as a narrative summary. 7. Synthesize and summarize findings from included studies Furthermore, studies suggest that hospitalization can be a golden opportunity to quit smoking as there are regulations banning smoking and the role of nurses becomes highlighted (Kazemzadeh. Manzari, & Pouresmail, 2017, p. 273).” “
  20. 20. • Reporting standards are available for systematic reviews. • Use a reporting standard as advised: o PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses o National Academies of Science, Health and Medicine Division Standards of Systematic Reviews 8. Document the method by writing a review, report or article.
  21. 21. FAU Library Resources • FAU Libraries: http://www.fau.edu/library o Cochrane Collection (examples of systematic reviews) o CINAHL o PubMed o Other Medical Databases o RefWorks (Citation management tool) • Nursing LibGuide: http://libguides.fau.edu/nursing-boca • Interlibrary Loan: http://www.library.fau.edu/depts/ill/illdept.htm • Request a Research Consultation: http://libweb.fau.edu/eforms/request-a- research-consultation-or-faculty-orientation/
  22. 22. Aromataris, E. & Pearson, A. (2014). The systematic review: An overview. AJN: American journal of nursing, 114(3): 53-58. DOI: 10.1097/01.NAJ.0000444496.24228.2c (FAUNet ID required) The Joanna Briggs Institute for Evidence Based Nursing and Midwifery (2001). An introduction to systematic reviews. Changing Practice, Supplement 1: 1-6. Kazemzadeh, Z., Manzari, Z. S., & Pouresmail, Z. (2017). Nursing interventions for smoking cessation in hospitalized patients: A systematic review. International Nursing Review, 64(2), 263-275. DOI: 10.1111/inr.12320 (FAUNet ID required) References Systematic Review Tools JBI Critical Appraisal Tools (for research designs and systematic review) AHRQ Systematic Review Data Repository (SRDR) SR Toolbox (includes tools for other parts of a review) PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses National Academies of Science, Health and Medicine Division Standards of Systematic Reviews
  23. 23. A Musical Take on the Systematic Review

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