systematic reviews in the health sciences
TRANSCRIPT
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SYSTEMATIC REVIEWS
IN THE HEALTH SCIENCES
Becky MorinHirsh Health Sciences Library
June 10, 2015
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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 Collaboration2
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A SYSTEMATIC REVIEW IS:
• Comprehensive
• Composed of a clear question
• Possessed of explicit and rigorous methods
• A research study
• Designed to limit bias
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WHY YOU SHOULD CARE ABOUT THIS
Zzzzzzz. Good thing I don’t work in
Health Sciences.Zzzzzzzz.
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SYSTEMATIC REVIEW = RESEARCH STUDY
Systematic Reviews : Primary Studies
::
Primary Studies : Individual Participants
SRs are research
studies and the subjects are
primary studies, like RCTs
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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.
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STEPS IN CONDUCTING A SYSTEMATIC
REVIEW
• Assess need
• Assemble team
• Create protocol
• Conduct the review
• Update the review as needed
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ASSESS NEED
Survey the landscape
Is it worth the effort?
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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?
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ASSEMBLE THE TEAMA systematic
review is NOT a solo project
(& I don’t care what your
professor said)
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ASSEMBLE THE TEAM
Required Skills and Expertise include:
• Methods
• Information Retrieval
• Subject Knowledge
– Several reviewers
– A tie-breaker
• Statistics
– For Meta-Analysis
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CREATE PROTOCOL
There are Protocols you can adapt and follow
• Cochrane Collaboration
• Cambell Collaboration
• PROSPERO
• PRISMA-P guidelines
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WHY ARE PROTOCOLS IMPORTANT?
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SOUND PROTOCOL = LESS CHAOS
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PARTS OF THE PROTOCOL
(1) The Research Question
PICO(TS)
• Patient/population
• Intervention (or exposure)
• Comparison
• Outcome
• Timing
• Study Design
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PARTS OF THE PROTOCOL
(2) The Inclusion/Exclusion Criteria
• Study Types
• Scope
• Languages
• Publication Types
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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)
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SEARCH STRATEGY?
(The Library can help with that)
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SEARCH STRATEGY
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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
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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
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PARTS OF THE PROTOCOL
(6) Quality Assessment
• Define criteria
• Define the process
• Will it effect the analysis?
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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.
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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?
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CONDUCT THE REVIEW
Just Follow The Protocol!
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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
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WHY DOES IT MATTER?
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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
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SO…
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WHAT CAN I, THE LIBRARIAN, DO?
I’m helping.
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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
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IS ALL HOPE LOST?
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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
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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
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RESOURCES
Start with our LibGuide:
http://researchguides.library.tufts.edu/SystematicReviews?hs=a
Seek expert advice here:
• Cochrane Handbook of Systematic Reviews of Interventions: http://handbook.cochrane.org/
• PRISMA: http://www.prisma-statement.org/
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REMEMBER…