This document discusses systematic reviews and summarizes their key aspects in 3 sentences: Systematic reviews aim to identify, select, appraise and synthesize all relevant studies on a clearly formulated question using explicit and reproducible methods. They involve developing a comprehensive search strategy, selecting sources, managing references, critically appraising studies, and synthesizing findings through meta-analysis or meta-synthesis. Record keeping, peer review, and use of software can help ensure systematic reviews are objective, reproducible, and follow best practices.

1. Systematic Reviews Lorie Kloda McGill University Library Carol Stephenson WLU Library May 18-19, 2010

2. Knowledge Syntheses 2 Systematic review Meta analysis Scoping review Evidence mapping Mixed methods synthesis Mata-synthesis approaches Realist synthesis approaches

3. Systematic Reviews 3 “…reviews of a clearly formulated question that use explicit methods to identify, select, and critically appraise relevant research and to collect and analyse data from the studies that are included in the review.” Cochrane Collaboration

4. From: Wong R. (2003). Systematic reviews and the Cochrane Collaboration. Oncology Rounds, 5(10). [Available from www.oncologyrounds.ca].

5. Types of Review Articles Individual patient data (IPD) meta-analyses All reviews (also called overviews) Meta-analyses Reviews that are not systematic (traditional, narrative reviews) Systematic reviews Pai M., et al. (2004). Systematic reviews and meta-analyses: An illustrated, step-by-step guide. National Medical Journal of India, 17(2), 86-95.

6. In practice, not all meta-analyses are conducted as part of SRs Individual patient data (IPD) meta-analyses All reviews (also called overviews) Meta-analyses Reviews that are not systematic (traditional, narrative reviews) Systematic reviews

7. Benefits of Knowledge Syntheses 7 ___________ ___________ ___________ ___________ ___________

8. Cochrane Reviews 8 Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment (co-registered with Campbell Collaboration) Motivational interviewing for smoking cessation

9. Asking Questions 9 What is the most effective way to educate youth about HIV/AIDS?

10. Generating a Research Question 10 COPES (Client-oriented, practical, evidence search) Question: Client type and problem What you might do Alternate course of action What you want to accomplish Question Types: Effectiveness question Prevention question Assessment question Description question Risk question

11. COPES Question 11 Among teenage school children, which HIV/AIDS prevention program will result in the highest percentage of condom use during sexual encounters?

12. 12 Which is the most effective way to prevent Hmong youth from joining gangs? Among Hmong and Asians less than 16 years old, which gang prevention program will most effectively prevent them from joining a gang?

13. Sample Effectiveness Questions 13 If children of mothers in a shelter home for abused women receive play therapy or nothing, then will the former have higher self-esteem? If aged persons without dementia just being admitted to a nursing home participate in a new admissions support group, then will they experience lower depression than those who do not? If high school students who have been identified as alcohol problem drinkers are matched with a peer mentor or not so matched, then will the matched group have higher academic performance? Gibbs, L. E. (2003). Evidence-Based Practice for the Helping Professions. Toronto: Thomson.

14. Activity 1: Posing a Specific Question 14

16. Database of Abstracts of Reviews of Effects (DARE)

17. Health Technology Assessments

19. MEDLINE

20. PsycINFO

21. ….15

22. Steps in a Systematic Review Define the clinical question Identify all relevant research (published and unpublished) Select studies for inclusion Assess the quality of each study Synthesize the findings (meta-analysis or meta-synthesis, if possible) Interpret the findings and present an unbiased summary 16 McGowan, J. & Sampson, M. (2005). Systematic reviews need systematic searchers. Journal of the Medical Library Association, 93(1), 74-80.

23. Systematic Reviews Lorie Kloda McGill University Library Carol Stephenson WLU Library May 18-19, 2010

24. 18 “Conducting a comprehensive, objective and reproducible search for studies can be the most time consuming and challenging task in preparing a systematic review.” Higgins, J.P.T.& Green, S. (eds.) (2009). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2. The Cochrane Collaboration. Available from www.cochrane-handbook.org.

25. Steps in a Comprehensive Literature Search 19 Database /trial registry searches Grey literature search Hand searches Conference proceedings Major journals Bibliographies Citation searches Snowball searches Review papers All included studies Contact researchers Initial searches Supplemental searches

26. Selection of Sources 20 Databases Several required (+ clinicial trial registries) Unpublished trials contribute ~20% of the weight in meta-analysis Fries JF, Krishnan E. (2004). Equipoise, design bias, and randomized controlled trials: The elusive ethics of drug development. Arthritis Res Ther, 6, R250-R255. Grey literature “unpublished,” fugitive,” “in-house,” “non-commercial” Definition/distinction not important; as long as it’s relevant, it should be included Reduces publication bias Hopewell S, McDonald S, Clarke MJ, Egger M. Grey literature in meta-analyses of randomized trials of health care interventions. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: MR000010. DOI:10.1002/14651858.MR000010.pub3.

27. Citation Searching 21 Supplements subject search Across disciplines Can be used for books or book chapters “Safety net” – can confirm a comprehensive strategy 3 citation databases offer overlapping content: Web of Science (“Science Citation Index”) – most multisciplinary Scopus Google Scholar – can lead to grey lit Search all 3 if possible, using a few key references Kloda, L.A. (2007). Evidence Summary: Use Google Scholar, Scopus and Web of Science for comprehensive citation tracking. Evidence Based Library and Information Practice 2 (3),87-90.

28. Activity 2: Selecting Sources 22

29. 23 “Terms within social sciences are often ambiguous, poorly defined and constantly changing. Unfortunately, the use of controlled vocabularies and indexing is not applied across the social sciences databases with the same rigour as in medical databases.” Papaioannou, D., Sutton, A., Carroll, C., Booth, A. & Wong, R. (2010). Literature searching for social science systematic reviews: Consideration of a range of search techniques. Health Information and Libraries Journal, 27(2),114-122.

30. Search Strategy Development 24 Keywords (natural language) Truncation, synonyms, alternative spelling Subject Headings Explode Limitations Languages, date, publication type Boolean (logical operators), Field searching Title, abstract Hedges (optimal search strategies; filters)

31. Activity 3: Search Strategy 25

32. Peer Review 26 Entire protocol can be peer reviewed, including the search Checklist developed (PRESS) for assessing quality of search McGowan, J., Sampson, M. & Lefebvre, C. (2010). An evidence based checklist for the peer review of electronic search strategies (PRESS EBC). Evidence Based Library and Information Practice 5 (1),149-154.

33. Activity 4: Peer Review 27

35. Who developed and conducted the search

36. Supplementary methods: hand searches, citation searches, snowball searches, contacting known researchers

37. Full electronic search strategy for at least one database, such that it can be repeated

38. Use of hedges or any peer reviewed search strategies

40. Removes duplicates

41. Search for full-text articles online

42. Groups (folders)

43. Annotations

44. Citation in manuscriptSystematic Review Software e.g., EPPI-Reviewer

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48. Critical Appraisal 33 Primary studies: EQUATOR network Systematic Reviews: AMSTAR