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_Eastern Health Library Service_: Systematic Reviews

What are systematic reviews and meta-analyses?

Systematic reviews (SRs) are the type of research in which a process of reviewing all existing evidence from the past primary research is undertaken. A systematic review provides a summary of the overall quality of the past individual studies relevant to answering a research question. Therefore, systematic reviews are considered the best evidence amongst the different types of research.

Cochrane. (2016, Jan 28). What are systematic reviews? [video]. YouTube. https://youtu.be/egJlW4vkb1Y

The process of reviewing includes collecting, appraising and analysing the findings of empirical / primary research studies (such as randomised controlled trials, observational studies etc.), summarising and then synthesising the evidence. A meta-analysis in a systematic review is the use of statistical methods to summarise the results of all included studies in a review so as to understand the clinical and statistical significance of the research findings.

Systematic reviews and meta-analyses are traditionally used for evaluating cost-benefits and effectiveness of treatments, interventions and diagnostic tests, drug adverse effects and prognostics and risk factors of medical conditions. However, they can also be used for summarising the quality of other types of reviews. For example, there are systematic reviews of rapid reviews, systematic reviews of scoping reviews and systematic reviews of research methods.

You may also be interested in featured reading: What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences written by Zachary Munn, Cindy Stern, Edoardo Aromataris, Craig Lockwood and Zoe Jordan (2018) and Errors to avoid when searching for studies for systematic reviews: A guide for nurse researchers written by Simon Briscoe (2023).


Free course available: 

The Campbell Collaboration's online course on systematic reviews and meta-analysis is now available. This is a self-paced, asynchronous course covering the entire process of systematic reviews from problem formulation to meta-analysis, was designed with Campbell Collaboration researchers in mind, but appropriate for anyone interested in learning rigorous review methods for the social sciences.  The course is currently being offered for free and learners may be solicited for feedback, as the developers are trying to continually update and improve the course.  

Free registration here.

Main Types of Review

Click   or   below to learn more about different reviews. Click    to open examples of review papers.

Rapid Review
 What is it?
(JBI, 2020a)
 Cochrane Rapid Review (RR) Methods (Cochrane Training, 2020a)
 PRISMA-RR: a reporting guideline for rapid reviews of primary studies is currently under development.
(Stevens, et. al. , 2022)
 
Example:
(Lal & Adair, 2014)

Scoping Review
Whether to do scoping review or systematic review?
(JBI, 2020b)
Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach  (Munn, et. al., 2018)
 Steps of Scoping Reviews (Evidence Synthesis Ireland, 2020)
 Conduct and report  guidance (JBI, 2020c)
 PRISMA for Scoping Reviews (PRISMA, 2021)
                                              Example:
(Fusar-Poli, et. al., 2020)

Umbrella Review
 What is it? 
(JBI, 2020d)
 Reporting Guideline: Preferred Reporting Items for Overviews of Reviews (PRIOR) (Pollock, 2019)
 
Example:
(Radua, et. al., 2018)

Narrative Review / Synthesis without a Meta-Analysis (SWiM)
 Different types of SRs
(JBI, 2020e) 
 SWiM reporting guideline
(Cochrane Training, 2020b)    
SWiM reporting guideline 
(Campbell et. al., 2020)
 
Jump to the detail step-by-step process of conducting a systematic review.

Example:

(Johnson & Sandford, 2005)

Systematic Review with a Meta-Analysis
 What is it? 
(Cochrane, 2016)
 How to interpret a forest plot in a meta-analysis? (Clinical Information Sciences, 2016)
What does CI 95% mean? (O'Brien & Yi, 2016, p. 1680)
 
Jump to the detail step-by-step process of conducting a systematic review
 
Examples:
 SR of treatment / intervention effectiveness
(Stacey et. al., 2017)
SR of prognostic / risk factors (Bates et. al., 2007)
SR of adverse effects        (Shuster, Jones & Salmon,        2007)
SR of diagnostic test accuracy (Sun et.al., 2012)

Living Systematic Review
 Introduction to Living Systematic Reviews   
(Cochrane Training, 2017)
Living Systematic Reviews: towards real-time evidence for health-care decision-making (Mavergames & Elliott, 2022)
 Living systematic reviews guidance (Cochrane, 2021)
 What, why, planning and guidance document (The Cochrane Collaboration, 2022)
  The PRISMA - LSR: an extension of the PRISMA 2020 statement for Living Systematic Reviews is currently under development.
(Kahale, et. al., 2022)
 

Example:
(Thombs, et. al.,2020)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References:

Bates, M.N., Khalakdina, A., Pai, M., Chang, L., Lessa, F., & Smith, K.R. (2007). Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis. Archives of internal medicine167(4), 335-342.

Briscoe, S. (2023). Errors to avoid when searching for studies for systematic reviews: A guide for nurse researchers. International Journal of Older People Nursing, 00, e12533. https://doi.org/10.1111/opn.12533

Campbell, M., McKenzie, J.E., Sowden, A., Katikireddi, S.V., Brennan, S.E., Ellis, S., ... & Thomson, H. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ, 368:l6890. https://www.bmj.com/content/368/bmj.l6890

Clinical Information Sciences. (2016, Jun 22). Interpreting a forest plot of a meta-analysis [video]. YouTube. https://www.youtube.com/watch?v=WgJWrHFgh8s

Cochrane Training. (2020a, April 24). Part 2: Cochrane Rapid Review (RR) Methods: A Look at Interim Recommendations [video]. YouTube. https://www.youtube.com/watch?v=b99SCLIeV44 

Cochrane Training. (2020b, March 3). SWiM reporting guideline: introduction [video]. YouTube. https://www.youtube.com/watch?v=8YoHQe-53hY

Cochrane. (2016, Jan 28). What are systematic reviews? [video]. YouTube. https://youtu.be/egJlW4vkb1Y

Cochrane. (2021, May 4). Living systematic review guidance [video]. YouTube. https://youtu.be/SXUkCh8UG1Q 

Cochrane Training. (2017, April 21). Introducing living systematic reviews [videos]. YouTube. https://www.youtube.com/playlist?list=PLxFw8aTtvq-cyp0IW6xdPu5jc5BlOCYZ6

Evidence Synthesis Ireland. (2020, November 13). Scoping review steps - Heather Colquhoun [video]. YouTube. https://youtu.be/5NtTSiCD580

Fusar-Poli, P., De Pablo, G.S., De Micheli, A., Nieman, D.H., Correll, C.U., Kessing, L.V., ... & van Amelsvoort, T. (2020). What is good mental health? a scoping review. European Neuropsychopharmacology31, 33-46.

JBI. (2020a, October 20). 5 What are rapid reviews? [video]. YouTube. https://youtu.be/wg0Hjb-_mqU

JBI. (2020b, October 20). 3 Should I undertake a scoping review or a systematic review? [video]. YouTube. https://youtu.be/BlFExKNmvCM

JBI. (2020c, July 31). How to conduct and report your scoping review: latest guidance [video]. YouTube. https://www.youtube.com/watch?v=5Db5JILJDRQ

JBI. (2020d, December 9). The JBI systematic review toolkit: diverse approaches to evidence synthesis [video]. YouTube. https://www.youtube.com/embed/tXWUaoN3J30?start=1960&end=2050

JBI. (2020e, October 20). 2 What are the different types of systematic reviews? [video]. YouTube. https://youtu.be/Y_rMBiHFyHI

Johnson, A. & Sandford, J. (2005). Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home: systematic review. Health education research20(4), 423-429. https://academic.oup.com/her/article/20/4/423/632669

Kahale, L.A., Piechotta, V., McKenzie, J.E., Dorando, E., Iannizzi, C., Barker, J.M., ... & Akl, E.A. (2022). Extension of the PRISMA 2020 statement for living systematic reviews (LSRs): protocol. F1000Research11(109), 109.

Lal, S. & Adair, C.E. (2014). E-mental health: a rapid review of the literature. Psychiatric services65(1), 24-32.

Mavergames, C. & Elliott, J. (2022). Living systematic reviews: towards real-time evidence for health-care decision-making. BMJ Best Practice. https://bestpractice.bmj.com/info/toolkit/discuss-ebm/living-systematic-reviews-towards-real-time-evidence-for-health-care-decision-making/

Munn, Z., Peters, M. D., Stern, C., Tufanaru, C., McArthur, A. & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology18(1), 1-7. 

Munn, Z., Stern, C., Aromataris, E., Lockwood, C. & Jordan, Z. (2018). What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC medical research methodology18(1), 1-9.

Pollock, M., Fernandes, R.M., Pieper, D., Tricco, A.C., Gates, M., Gates, A., & Hartling, L. (2019). Preferred Reporting Items for Overviews of Reviews (PRIOR): a protocol for development of a reporting guideline for overviews of reviews of healthcare interventions. Systematic reviews8(1), 1-9.

PRISMA. (2021). PRISMA for Scoping Reviews. http://www.prisma-statement.org/Extensions/ScopingReviews

Radua, J., RamellaCravaro, V., Ioannidis, J.P., Reichenberg, A., Phiphopthatsanee, N., Amir, T., ... & FusarPoli, P. (2018). What causes psychosis? An umbrella review of risk and protective factors. World psychiatry17(1), 49-66.

Shuster, J.J., Jones, L.S., & Salmon, D.A. (2007). Fixed vs random effects metaanalysis in rare event studies: the rosiglitazone link with myocardial infarction and cardiac death. Statistics in medicine26(24), 4375-4385.

Stevens, A., Garritty, C., Hersi, M., & Moher, D. (2018). Developing PRISMA-RR, a reporting guideline for rapid reviews of primary studies (Protocol). EQUATOR Network. https://www.equator-network.org/wp-content/uploads/2018/02/PRISMA-RR-protocol. pdf.

Severn M, Mierzwinski-Urban M, Farrah K, Walter M, Spry C,  Argáez C. Grey literature.  Last updated 15 March 2023. In: SuRe Info: Summarized Research in Information Retrieval for HTA.  Available from: https://www.sure-info.org//grey-literature.

Sun, W., Wang, K., Gao, W., Su, X., Qian, Q., Lu, X., ... & Shi, Y. (2011). Evaluation of PCR on bronchoalveolar lavage fluid for diagnosis of invasive aspergillosis: a bivariate metaanalysis and systematic review. PLoS One6(12), e28467.

The Cochrane Collaboration. (2022). Living systematic reviews. Conhrane Community. https://community.cochrane.org/review-production/production-resources/living-systematic-reviews

Thombs, B.D., Bonardi, O., Rice, D.B., Boruff, J.T., Azar, M., He, C., ... & Benedetti, A. (2020). Curating evidence on mental health during COVID-19: A living systematic review. Journal of psychosomatic research133, 110113.

PICOT stands for

Population / Patient / Problem

- What is the specific population of the subject / the patients' problem or situation?

 

Intervention 

- What is the therapy / intervention to be evaluated?

 

Comparison (optional)

- What is the main alternative?

 

Outcome

- What could the intervention affect? or the likelihood of leading to an outcome under circumstances?

 

Timeframe (optional)

- What is the specific period of time the research focus on?

Type of Clinical Research Question Relevant Elements Example

Therapy / Intervention

- How effective is a therapy / intervention, such as drug treatments, clinical therapies, or lifestyle changes?


Benefit & Risk Analysis

- Would an intervention bring benefits outweigh its risks?


Diagnosis

- How accurate is a testing tool for diagnosis?


Prognosis

- What are the likelihood of the outcome under circumstances?

P, I, CO, T

 

 

P, I, O

 

 

P, I, C, O

 

 

P, O

Does a risk assessment checklist or score help to prevent falls compared to patient education alone on elderly patients during short-stay hospitalisation?

 


Does HPV vaccines bring protection to indigenous people in Japan outweigh its potential side-effects?

 


How accurate is a blood test comparing to a urine test for hCG results in earliest detection of pregnancy?

 


For adolescents with early detected Multiple sclerosiswhat is the likelihood of progressive supranuclear palsy?

 Check out how to formulate a PICO question via Ovid database

PICo stands for

Population / Problem

- What is the specific population of the subject / the patients' problem or situation/condition or diseases in the specific population?

 

Interest

- What is the phenomena / the defined event /experience /activity to be examined

 

Context

- What is the specific context to have the experience / activity

 
Type of Clinical Research Question Relevant Elements Example

Experience evaluation

- What is the experience of an event /activity?

P, I, Co What are the caregivers' experiences on seeking quality respite care provide from nursing home in the State of Victoria, Australia?

ECLIPSE stands for

Expectation

- the improvement / expected information channels / innovation related to the service / policy? 

 

Client group

- the client group that the service is for / the policy affect

 

Location

- the location of the service cover? 

 

Impact

the service or policy can be evaluated whether or not it has had a desire outcome

 

 

Professionals

- the professionals involved in providing the service / related to the policies

 

SEvice

- What is the service / relevant policies to be reviewed?

Type of Clinical Research Question Relevant Elements Example

Policy review

- What had been learnt from the experience?


Service evaluation

- Can the service reach its goals / meet the expectation?

- How can a service be improved?

- Find out evidence of good service / intervention

EC, L, IP, Se

 

 

EC, L, IPSe

 

 

From nurse managers' perspective,How effective is the hospital visitor policy during COVID-19 pandemic being put in place assisting in preventing the spread of COVID-19 to the community?

 


What is the caregivers' experience on seeking referral channels among community mental health services in metropolitan Melbourne?

 

Check out the following article to understand how ECLIPSE use for assisting in health service / health policy research in details:

Wildridge, V., & Bell, L. (2002). How CLIP became ECLIPSE: a mnemonic to assist in searching for health policy/management information. Health Information & Libraries Journal19(2), 113-115.

Check out more about  qualitative research methodology

SPIDER stands for

Sample

- What is the subject / population / group of people of the research? 

 

Phenomenon of Interest

- What is the experience / projects / services / program to be evaluated?

 

Design

- What is the methodology of research (usually qualitative ones) you are looking for?     

 

Evaluation

- How or what is positive / negative of an experience? / How good / efficient is a service?

 

Research type        

- Qualitative / mixed-method?

Type of Clinical Research Question Relevant Elements Example

Understanding experience

- What had been learnt from the experience?


Service evaluation

- How can a service be improved?

- Find out evidence of good service / intervention

S, PI, D, E, R

 

 

 

S, PI, D, E, R

What are the retired people's experience of volunteering in an acute hospital setting

(by questionnaires and focus groupsMixed-method research


What are the barriers of accessing emergency service for people with a physical disability

(by focus groups and telephone interviewsQualitative research

Check out the following article to understand how SPIDER use for sytheisisng qualitative evidence in details:

Cooke, A., Smith, D.M. & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res. 22(10):1435-43. doi: 10.1177/1049732312452938.

Check out more about qualitative research methodology

Cooke, A., Smith, D.M. & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res. 22(10):1435-43. doi: 10.1177/1049732312452938.

SPICE stands for

Setting

- where or in what kind of setting?

 

Perspective

- from whom point of view or for whom?

 

Intervention

- what is the intervention / activity to be evaluated?

 

Comparison (Optional)

- another intervention to compare with

 

Evaluation

- what is the results? outcome?

Type of Clinical Research Question Relevant Elements Example

Evaluation of practice /seeking best practice/ Evaluation an project

- How effective is the current intervention in a setting for the specific group?

S, P, I, CE

How supportive did student nurses find online consultation comparing to small group discussion sessions during clinical placement in a rural community health setting?

SR_identify key concepts and related terms

Your answerable clinical question and PICO contains the key concepts of your research. Use those key concepts to start for identifying related terms, synonyms (including variant spellings of medical terms) and related highly relevant concepts you would like to include in your search.

 

The following example shows you how to turn PlCO and clinical questions into a key concepts and related terms table:

Scenario

Your research team is going to find out what find out what is the evidence so far showing form the literature that whether a low-carbohydrate diet are more effective than a low-fat diet for managing weight and glycemic control on Type 2 diabetes individuals. As there are quit a lots of research on this topic and some systematic reviews. You team decided to do an umbrella review (a systematic review of systematic reviews) on this to see if any change and/or any new evidence.

PICO

P - Type 2 diabetic patients with obesity

I - low-carbohydrate diet

C - low fat diet

O - managing weight and glycemic control

Research Question

Comparing with a low fate diet, did a low-carbohydrate diet more effective for weight control and glycemic control among Type 2 diabetes patients?

 

Key concepts Type 2 diabetes weight (control)

glycemic (control)

 low-fat diet low-carbohydrate diet

 Related terms

(related to the context of this review)

 

obesity / obesed

overweight

(weight) loss

(weight) management

(weight) maintenance

glycemic /glycaemic index (GI) 

blood glucose level (BSL)

hyperglycemia / hyperglycaemia

hypoglycemia / hypoglycaemia

 
 

Mediterranean diet

However, the key-concept and related-term table is not finalised at this stage. When you make use of the next tip to look up Subject Headings, you may find more related terms and concepts for your evidence-based research. Let's check out the next tip: Use Subject Headings to learn more.

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