Systematic Reviews:
Finding high-quality information for
evidence or support
Kristy Padron, MLIS
Reference & Instruction Librarian
kpadron@fau.edu

Scenario 1: Graduate Student
• He ompleted 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 she 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.

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.

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.

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.

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published and unpublished studies.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)

Example of a Systematic Review:
(Kazemzadeh, Manzari, & Pouresmail, 2017)
FAUNet ID required.

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)

• 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?

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.?

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

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.

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.
iv. Document your searches, including number of results.
v. 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 and strategy)
o Citation management tools: Mendeley, RefWorks
o File storage: Google Docs, cloud-based storage
3. Find studies in the literature.

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

• 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

Selecting
research:
• Number of
studies found
• Reasons for
excluding
studies

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)

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.

• 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).”
“

• 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.

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/

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

A Musical Take on the Systematic Review