Systematic Review
By
Dr. Dina Al-Amir
What is a systematic review?
A systematic review is a literature review that gathers all available
research within a delimited research area and according to a specific
methodology.
Systematic reviews usually rate at the top of evidence hierarchy since
they analyze and evaluate results from all available, original research
articles that answers a specific research question.
The entire process of conducting a systematic review, from formulating
a research question to establishing a protocol, searching the literature
and finally collating, examining and analyzing the results, needs to
proceed according to a carefully planned methodology.
All stages of the process should be documented.
Systematic reviews sometimes contain so-called meta-analyses,
wherein the collected data is combined using statistical methods.
There are also international guidelines that detail how systematic
reviews should be reported, the Prisma Guidelines.
It can take between 6 months and 2 years to conduct a systematic review.
Apart from field-specific knowledge and awareness of research methodology,
you may need people in your team who are experts in statistical analysis and
literature searches.
To reduce risk for bias, it is also recommended that at least two people,
independent of one another, review all found articles and choose which studies
to include in the review.
Apart from suitable databases in which to conduct your search, you will also
want access to a program that can help you manage your references, such as
EndNote.
Conduct a search in PROSPERO, for example, to ensure that there are no
ongoing projects that resemble yours.
PROSPERO is an international systematic review registry that aims to promote
transparency and open science, reduce reporting bias and help prevent
unintended duplication and research waste.
Plan on writing a protocol. The protocol can be registered, in PROSPERO for
example.
Research Question
A key starting point for a systematic review is a clear, carefully delimited
research question.
A well formulated question will help:
❑ Frame your entire research process
❑ Determine the scope of your review
❑ Provide a focus for your searches
❑ Help you identify key concepts
❑ Guide the selection of your papers
In clinical research, it is common to use the PICO
structure: Population, Intervention, Control and Outcome.
To ensure that your research question is “searchable,” identify its key
elements.
You will use these to create search blocks that will then form the basis for
the search strings used in the different databases.
You would only rarely use all parts of the PICO-question in a search; most
of the time, you will focus on population and intervention.
A general principle is that a systematic search should consist of only a few
blocks.
The more search blocks you have, the narrower your search will be; the
narrower your search, the greater your risk of excluding relevant articles.
Develop a search strategy
An important aspect of a systematic review is an exhaustive literature
search.
The search should have high sensitivity, that is, it should be created in such
a way that the search will retrieve all relevant articles within a research
area, or at least discover as many as possible.
This is also called conducting a wide search. A wide search means that not
all search results will be relevant.
In systematic literature searching, a precision of two-three percent is
common.
In contrast to a wide search, a narrow (or precise) search will result in a
larger share of relevant hits, but you also run the risk of missing relevant
studies.
Get started with your literature search
It’s often a good idea to start with a slightly less structured search in the
various databases, a so-called test search.
When you test search, you simultaneously discover what terminology is
common in the field, and thus find more search terms.
At this point, it’s a good idea to see if there are any systematic
reviews within your research area that have already been published.
Sometimes published reviews will include their search strategy in the
appendix.
You should also identify a few key articles, that is, the most significant
studies within your research field.
These should ideally be articles that correspond to your research question as
closely as possible.
You can use these key articles to both construct your own search strategy and
to test it.
if your search does not retrieve your key articles, then your strategy needs to
be modified.
You may also want to see if there are any validated search
filters you can use.
Search filters are sets of search terms chosen to restrict a
search to a selection of references, such as articles based on
method or study type.
Finding search terms
Determining what the relevant search terms are an important part of the
systematic search.
It’s often a good idea to start with a test search where you use the subject
headings and synonyms you’re already familiar with.
By scanning titles, abstracts and subject headings, you may find
additional, useful search terms.
A subject heading is equivalent to a term and all its synonyms.
This subject heading is used to tag all articles about a specific topic.
Using subject headings enables you to find all articles about a subject
regardless of what word the author has used to describe the topic.
Many subject heading lists also use subheadings which you can use for
more advanced searches.
Examples of subheadings are diagnosis, therapy and genetics. This
means that you could conduct a search for the subject heading diabetes
mellitus type 2 with the subheading diagnosis.
if you want to find articles about respiratory failure you should start by
checking if there is a subject heading for that in the database in which
you are searching. In the database PubMed the list of subject headings
is called MeSH (Medical Subject Headings).
In MeSH, the subject heading for respiratory failure is respiratory
insufficiency.
Respiratory insufficiency synonymous to respiratory failure, respiratory
distress, respiratory depression and ventilatory depression.
Free-text searching
It is not always possible to find relevant terms in the subject headings list
and some databases do not have subject headings, such as Web of
Science and Google Scholar.
In such cases, you have to construct a free-text search instead.
When you do a free-text search, you will only find articles where the
author has used the exact same terms that you are using in your search.
To find information on heart attack you might have to use words such
as: heart attack, myocardial infarction, heart infarction, cardiac arrest
To find information on overweight you might have to use words such
as: obese, obesity, overweight
Documentation
PRISMA
As with any type of research, the review process in a systematic review
should be transparently documented in all parts, clearly reported in the
final publication, and reproducible.
To help you do this, follow established guidelines, such as those found in
the PRISMA Guidelines (Preferred Reporting Items for Systematic Reviews
and Meta-Analyses).
The guidelines describe how systematic reviews should be reported.
PRISMA 2020 consists of a checklist with 27 points and several flowcharts
According to PRISMA’s checklist, all databases, registries and other sources
used to find articles should be reported, in addition to the date when each
source was last searched.
The search strategy should be documented in full for each database, and
can be published in an appendix to the published review article.
The Preferred Reporting Items for
Systematic reviews and Meta-Analyses
(PRISMA)
It was designed to help systematic reviewers transparently report why the
review was done, what the authors did, and what they found.
Systematic reviews serve many critical roles.
1) They can provide information about state of knowledge in a field, from which
future research priorities can be identified;
2) they can address questions that otherwise could not be answered by individual
studies;
3) They can identify problems in primary research that should be rectified in
future studies;
4) and they can generate or evaluate theories about how or why phenomena
occur.
Systematic reviews therefore generate various types of knowledge for
different users of reviews (such as patients, healthcare providers,
researchers, and policy makers).
To ensure a systematic review is valuable to users, authors
should prepare a transparent, complete, and accurate account
of why the review was done, what they did (such as how studies
were identified and selected) and what they found (such as
characteristics of contributing studies and results of meta-
analyses).
