Systematic Reviews in the Health Sciences
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This document provides an overview of systematic reviews, including what they are, why they are important in health sciences research, and the steps involved in conducting one. It defines a systematic review as a comprehensive study that collects and analyzes data from multiple research studies to answer a specific question. It notes that systematic reviews use explicit and rigorous methods to minimize bias and provide reliable conclusions. The key steps outlined include developing a protocol and research question, conducting comprehensive searches, selecting and assessing studies, extracting and synthesizing data, and disseminating findings.
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Systematic Reviews in the Health Sciences
- 1. SYSTEMATIC REVIEWS IN THE HEALTH SCIENCES Becky Morin Hirsh Health Sciences Library June 10, 2015
- 2. WHAT IS A SYSTEMATIC REVIEW? "A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria to answer a specific research question. It uses explicit, systematic methods that are selected to minimize bias, thus providing reliable findings from which conclusions can be drawn and decisions made. Meta-analysis is the use of statistical methods to summarize and combine the results of independent studies." - Cochrane Collaboration 2
- 3. A SYSTEMATIC REVIEW IS: • Comprehensive • Composed of a clear question • Possessed of explicit and rigorous methods • A research study • Designed to limit bias
- 4. WHY YOU SHOULD CARE ABOUT THIS Zzzzzzz. Good thing I don’t work in Health Sciences. Zzzzzzzz.
- 5. SYSTEMATIC REVIEW = RESEARCH STUDY Systematic Reviews : Primary Studies :: Primary Studies : Individual Participants SRs are research studies and the subjects are primary studies, like RCTs
- 6. SYSTEMATIC REVIEW = RESEARCH STUDY • Literature searches provide the pool of studies • Quality Systematic Reviews require quality studies Give the same attention to the studies you include in a Systematic Review as you would to subjects in an experiment.
- 7. STEPS IN CONDUCTING A SYSTEMATIC REVIEW • Assess need • Assemble team • Create protocol • Conduct the review • Update the review as needed
- 8. ASSESS NEED Survey the landscape Is it worth the effort?
- 9. ASSESS NEED Ask these questions about a topic: • Is the question interesting to practitioners or researchers? • Are there existing Systematic Reviews? • Are those reviews of quality? • Are those reviews in need of an update?
- 10. ASSEMBLE THE TEAM A systematic review is NOT a solo project (& I don’t care what your professor said)
- 11. ASSEMBLE THE TEAM Required Skills and Expertise include: • Methods • Information Retrieval • Subject Knowledge – Several reviewers – A tie-breaker • Statistics – For Meta-Analysis
- 12. CREATE PROTOCOL There are Protocols you can adapt and follow • Cochrane Collaboration • Cambell Collaboration • PROSPERO • PRISMA-P guidelines
- 13. WHY ARE PROTOCOLS IMPORTANT?
- 14. SOUND PROTOCOL = LESS CHAOS
- 15. PARTS OF THE PROTOCOL (1) The Research Question PICO(TS) • Patient/population • Intervention (or exposure) • Comparison • Outcome • Timing • Study Design
- 16. PARTS OF THE PROTOCOL (2) The Inclusion/Exclusion Criteria • Study Types • Scope • Languages • Publication Types
- 17. PARTS OF THE PROTOCOL (3) Search Strategy • Databases • Search terms • Limits • Updates • Citation Management plan & tools Cochrane Reviews mandate Medline, EMBASE, & the Cochrane Library (but you’ll probably need other databases, grey lit., & handsearching, too)
- 18. SEARCH STRATEGY? (The Library can help with that)
- 19. SEARCH STRATEGY
- 20. PARTS OF THE PROTOCOL (4) The Study Selection • Review for: – Applicability – Bias • Based on Title & Abstract usually • Need at least two independent reviewers and a tie-breaker • Document everything – Include log of excluded studies and why
- 21. PARTS OF THE PROTOCOL (5) Data Extraction • For included studies – What data? – What software? – Procedures? – Author contacts – Language translation? – You read the whole article @ this point http://chmg.cochrane.org/sites/chmg.cochrane.org/ files/uploads/Template-Data%20Extraction- CHMG.pdf
- 22. PARTS OF THE PROTOCOL (6) Quality Assessment • Define criteria • Define the process • Will it effect the analysis?
- 23. PARTS OF THE PROTOCOL (7) Data Synthesis • Including Meta-analysis? – Qualitative or Quantitative? • What are the outcomes of interest? – Are outcomes comparable between studies? • Publication bias? If doing a Meta- Analysis, must include a statistician or similar expert on the team from Day One.
- 24. PARTS OF THE PROTOCOL (8) Dissemination • What is your publication plan? • Where would you like to publish? • Do you need approval from a funder or board?
- 25. CONDUCT THE REVIEW Just Follow The Protocol!
- 26. UPDATE THE REVIEW • New research findings can render a Systematic Review obsolete. • Cochrane recommends Reviews be updated every 2 years or include commentary explaining why not. • Updates can be simply re-running searches or may involve restructuring research questions
- 27. WHY DOES IT MATTER?
- 28. HEALTH CARE LITERATURE WEDGE* Letters, editorials, thought pieces, narrative reviews Lab-based studies Small-scale human research studies Large RCTs, economic evaluations, systematic reviews, meta-analyses, practice guidelines *McKibbon KA. 1998
- 29. SO…
- 30. WHAT CAN I, THE LIBRARIAN, DO? I’m helping.
- 31. THE LIBRARIAN’S ROLE • Gather background information on the project (an intake form may be helpful) • Provide guidelines (such as PRISMA) and resources to craft a protocol • Get yourself added to the team as a co-author But most of the time, your job is to burst the bubble and help the patron move on
- 32. IS ALL HOPE LOST?
- 33. OTHER TYPES OF REVIEWS Reviews of increasing complexity, from narrative reviews to systematic reviews... with complexity comes an increase in time & resources needed HLWIKI International http://hlwiki.slais.ubc.ca/index.php/Scoping_reviews
- 34. OTHER TYPES OF REVIEWS • Narrative Review – Focused on an overview of a topic, may contain opinion • Scoping Review – Like a Narrative Review, but also searches for gaps in the research literature • Rapid Review – Similar to an accelerated Systematic Review, targeted toward filling urgent needs in health care • Horizon Scan – Scopes out areas for further research and study
- 35. RESOURCES Start with our LibGuide: http://researchguides.library.tufts.edu/Systemati cReviews?hs=a Seek expert advice here: • Cochrane Handbook of Systematic Reviews of Interventions: http://handbook.cochrane.org/ • PRISMA: http://www.prisma-statement.org/
- 36. REMEMBER…
- 37. THANK YOU FOR YOUR ATTENTION ! Do you have any questions? Becky Morin rebecca.morin@tufts.edu (617) 636-3969
Editor's Notes
- OK, how many of you have encountered systematic reviews in your library lives to date? (hands) Do you mind sharing? Have you been asked to participate in one? Review searches from one? Asked for advice in starting one?
- We can trace the systematic review’s origins to Dr. Archibald Cochrane, a Scottish physician who was a vocal advocate for the adoption of evidence based practice in medicine and a staunch believer in the value of gathering evidence from Randomized Controlled Trials. Dr. Cochrane called for the creation of “critical summaries” of RCTs, which is, I suppose, the simplest definition of what a typical systematic review is. Benefits of systematic reviews are many, in particular their aggregate nature helps to ferret out random error and bias present in individual studies, and also helps evaluate consistency of results across multiple studies. So, systematic reviews are intended as critical summaries of information collected under predetermined criteria that pull together and summarize information on a particular topic. And part of their rigor involves not only specification of those criteria, but thorough documentation of search methodologies. Before I go further, I’d like to specify that many organizations and groups produce systematic reviews, and many individuals and journals publish systematic reviews that don’t conform to the standards I’m going to talk about today. But I counsel patrons that following the PRISMA checklist (PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the Cochrane template results in transparent and well-documented systematic reviews, and if you’re going to do this thing, you might as well do it right.
- Systematic Reviews are creeping out to other disciplines, whether you like it or not. When we talk about systematic reviews in healthcare, we’re talking about studies that are published in journals, sometimes done as a capstone or PhD dissertation-level project, and when we talk about a gold standard of a rigorous review, we are usually talking about Cochrane Reviews. The Cochrane Collaboration is an independent, non-profit, non-governmental organization consisting of a group of more than 31,000 volunteers in more than 120 countries.[3] The collaboration was formed to organize medical research information in a systematic way to facilitate the choices that health professionals, patients, policy makers and others face in health interventions according to the principles of evidence-based medicine. But they aren’t the only game in town. There’s also the Campbell Collaboration, which deals with systematic reviews regarding interventions in education, crime and justice, social welfare, and international development. Over the last decade, systematic reviews has emerged as a research focus in Software Engineering, and in engineering education. As the model continues to gain popularity, there is a greater likelihood that you will be called to advise, assist, or participate in a systematic review.
- When I talk to researchers about Systematic Reviews, one of the points I stress is that you are performing a research study, not “just” a literature review. Your methods must be documented, and your actions reproducible! I tell potential authors that a good systematic review needs to be carried out like any research study, including documentation of parameters and conditions, and painstaking notes regarding procedures and results
- I’m really going to focus on the first three points here, because failing to plan is planning to fail, and it’s the early part of the process that I find people need the most information about.
- IF you’re going to propose a Cochrane Review, you need to search their database of systematic reviews to make sure someone hasn’t already proposed or conducted a similar project.
- The protocol is the plan for steps you will follow in conducting the review Cochrane Library search, limit to protocols Ongoing reviews have protocols
- The literature wedge is another triangular representation that helps to illustrate the importance of systematic reviews. This is another way of thinking about ideas, concepts, or experiments in biomedicine. The largest part of the wedge represents the bantering phase, the throw against the wall and see what sticks phase. Ideas from that phase deemed worthy move into the lab, at which point many are deemed unworthy of further testing. An even smaller number move to human research, and an even smaller number get to the phase of synthesized, filtered research.
- You might be wondering if systematic reviews are so crucial in evidence based practice, and the procedure is so involved, how long does it take to complete one? Here’s Cochrane’s timeline… I counsel no less that one year, and I always say that one year is usually not enough time, given the demands on members of the team.
- Systematic Reviews are a team effort, and there are rules to follow on your path to success. No need to reinvent the wheel.