Systematic Reviews in Evidence Based Medicine: Presenter 1: Dr. Subhasree Nag
Systematic Reviews in Evidence Based Medicine: Presenter 1: Dr. Subhasree Nag
Based Medicine
Dr. Subhasree Nag is a Senior Regional Solutions Consultant (APAC) for the life sciences
and scholarly research division at Clarivate. She completed her PhD from Texas Tech
University Health Sciences Center, USA and her post-doctoral training from Pacific
Northwest National Laboratory, USA.
A pharmacologist and toxicologist by training, she has more than 8 years of research
experience in anticancer drug discovery and pharmacokinetics areas with 26 peer
reviewed publications and more than 1500 citations.
At Clarivate, she is involved in promoting Clarivate's drug discovery and scholarly
research solutions, conducting author and research capacity workshops, bespoke
consulting projects, etc.
She was a co-author on the UGC-Good Academic Research Practices guidance
document released in 2020.
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Our panelist for today
Sanjay Rajan is a Senior Customer Education Trainer at Clarivate. He has over 14 years
experience in Information service Industry. He is an alumni of CSIR-NISCAIR and has
worked in various life sciences domains with several conference presentations. He is
engaged in supporting and helping academic organizations, research scholars, faculties
and students across South Asia in empowering their research & learning process. Sanjay
is a PQDT Global product champion and provides support across APAC, EMEA and USA
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Agenda
•What is a systematic review?
•Important Steps involved in SR for Medical research: Creating the
SR Protocol, PRISMA flow diagram, Assess risk of Bias, Synthesis,
and Interpretation
•Forming a question using the PICO(T) framework and Developing
the most effective search strategy
•Identify right platforms to search the most impactful documents
– the Web of Science and Health Research Premium Collection
Platform
•Exporting results to a Reference Management System
•Where to publish?
Narrative Reviews
• Usually written by experts in the field
• Use informal and subjective methods to
collect and interpret information
• Usually narrative summaries of the evidence
Systematic Reviews
review evidence on a clearly formulated question
that uses
methods to
• Identify
Each included study may be assigned an objective assessment • Select
of methodological quality preferably by using methods • critically appraise relevant primary research
conforming to the Preferred Reporting Items for Systematic • extract and analyse data from the studies that are
Reviews and Meta-Analyses (PRISMA) statement or the high- included in the review
quality standards of the Cochrane Collaboration
Read:
⚫ Klassen et al. Guides for Reading and Interpreting Systematic Reviews. Arch Pediatr Adolesc Med 1998;152:700-704.
⚫ Undertaking Systematic Reviews of Research on Effectiveness. CRD’s Guidance for those Carrying Out or Commissioning Reviews.
CRD Report Number 4 (2nd Edition). NHS Centre for Reviews and Dissemination, University of York. March 2001
⚫ Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The
Cochrane Collaboration, 2011. Available from [Link]., Section 1.2.2
Systematic vs. Narrative Review
Systematic Review Narrative Review
High-level overview of primary research on a focused question Qualitatively summarizes evidence on a topic using informal or
Definition that identifies, selects, synthesizes, and appraises all high quality subjective methods to collect and interpret studies
research evidence relevant to that question
Answers a focused clinical question Provide summary or overview of topic
Goals Eliminate bias Subject to author bias
Clearly defined and answerable clinical question Can be a general topic or a specific question
Question Recommend using PICO as a guide
Pre-specified eligibility criteria Introduction
Systematic search strategy Methods
Components Assessment of the validity of findings Discussion
Interpretation and presentation of results Conclusion
Reference list Reference list
Number of Authors Three or more One or more
Timeline Months to years, Average eighteen months Weeks to months
Thorough knowledge of topic Understanding of topic
Requirement Perform searches of all relevant databases Perform searches of one or more databases
Statistical analysis resources (for meta-analysis)
Connects practicing clinicians to high quality evidence Provides summary of literature on the topic
Value Supports evidence-based practice Cant replicate
Meta-analysis may be used to combine data
Source: [Link] 5
Key elements of a Systematic Review
Structured, systematic process involving several steps
Systematic Reviews use clearly-defined protocols and
• Formulate the question procedures that ensure accountability and transparency,
• Plan the review including:
• Comprehensive search
• Unbiased selection and abstraction process
• Critical appraisal of data A research question that addresses Population,
• Synthesis of data (may include meta-analysis)
• Interpretation of results
Intervention, Control, Outcome and Setting (PICOS)
• Reporting the review
• All steps described explicitly in the review methods (or similar)
([Link]
earn/[Link])
Limitations:
• Results may still be inconclusive Compliance with the PRISMA statement
• There may be no trials/evidence ([Link]
• The trials may be of poor quality
• The intervention may be too complex to be tested by a trial
• Practice does not change just because you have the evidence of
effect/effectiveness
Systematic Review Workflow
Scope of this Webinar Use Web of Science and In other
ProQuest for this part words….
This webinar will offer detailed
suggestions for only some stages of the
entire Systematic Review on Biomedical
topics:
• Evaluation of Online Literature
Sources
• Which databases and main
research types
• Translating the Review Question
into a search query
• Building the Search strategy –
Best practices
• Running the most efficient search
• Post Processing tools: Document
the strategy
• Save the results
Why these databases? They are structured and help answer the question in the PICO format
Steps in a Systematic Review
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How do we define the search?
EX.: Can antibiotics help alleviate the symptoms of a sore throat better
than anti-inflammatories?
• Costs/Economic Evaluation reviews Gomersall JS, Jadotte YT, Xue Y, Lockwood S, Riddle D, Preda A. Conducting systematic
reviews of economic evaluations. Int J Evid Based Healthc. 2015;13(3):170–
178. [PubMed]
• Prevalence and/or Incidence reviews Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for
systematic reviews of observational epidemiological studies reporting prevalence and
• Diagnostic Test Accuracy reviews cumulative incidence data. Int J Evid Based Healthc. 2015;13(3):147–153. [PubMed]
Campbell JM, Klugar M, Ding S, et al. Diagnostic test accuracy: methods for systematic
• Etiology and/or Risk reviews review and meta-analysis. Int J Evid Based Healthc. 2015;13(3):154–162. [PubMed]
• Psychometric reviews McArthur A, Klugarova J, Yan H, Florescu S. Innovations in the systematic review of
text and opinion. Int J Evid Based Healthc. 2015;13(3):188–195. [PubMed]
• Prognostic reviews Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the
methodological quality of studies on measurement properties of health status
measurement instruments: an international Delphi study. Qual Life
• Methodological systematic reviews Res. 2010;19(4):539–549. [PubMed]
• The Background section of the protocol should put your review in the context of what you already know, and the
questions you want to answer.
• The Objective section should be derived from the research question and should relate to the PICO elements
• The Methodology should be planned using the Cochrane Handbook, and its guidance based on the latest
methodological research-Keep broad inclusion criteria, and be cognizant of rationale for exclusion
• Decide which studies will be selected for the review (inclusion criteria)and how will they be assessed (including
software use)
Qualities of a good search
✓ Clear research question
✓ Comprehensive search
✓All domains, no language restriction, unpublished and published literature, up-to-date
✓ Document the search (replicability)
Quality of evidence generated by a review depends entirely on the primary studies which
make up the review.
Read:
[Link]
Components of Electronic Searching
• Describe each PICO component
• Start with primary concept
• Find synonyms
• Identify MeSH / descriptors / subject headings
• Add text words
• Add other components of PICO question to narrow citations (may use study
filter)
• Examine abstracts
• Harness the power of citations
• Use search strategy in other databases (may need adapting)
Read:
[Link]
[Link]
Sample Review Methodology
Sample Review Methodology
Evidence Based Research Types - Definitions
• Case report – a description of a particular service or event, often focusing on unusual
aspects of the reported situation or adverse occurrences.
• Case series – a description of more than one case.
• Case-control study – An observational study in which the cases have the issue of interest but
the controls do not.
• Cohort study – An observational study of a particular group over a period of time.
• Randomized Controlled Trial – An experimental study in which users are randomly allocated
to one of two or more options, where some get the option of interest and others get
another option (e.g. a standard service).
• Systematic review – An approach that involves capturing and assessing the evidence by
some systematic method, where all the components of the approach and the assessment
are made explicit and documented. Some systematic reviews include a meta-analysis (see
below).
• Meta-analysis - A method of synthesizing the data from more than one study, in order to
produce a statistic summary.
Type of Question and Study Design
Can be searched as
Document Types in
various databases
Figure taken from (Level of Evidence (2011), Oxford Centre for Evidence-based Medicine, CEBM).
Read: [Link]
Analysis and Interpretation
Critical Appraisal
Critical appraisal is the process of systematically looking at research papers to assess three
important things: trustworthiness, value and relevance.
When critically appraising a research paper the first step is to examine the study for any bias.
.
A study which is sufficiently free from bias is said to have internal validity. A study will be said to
have external validity when it can be generalized to the clinical (or wider population) context.
Critical appraisal checklists (see here, here, here, and here) provide a framework for interpreting
and determining the reliability of the evidence. Checklists are designed to help you answer the
questions - is the study unbiased, are the findings reliable, and are the findings valid?
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Analysis and Interpretation
Synthesis and Interpretation
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Building the search from a PICO question
Can antibiotics help alleviate the symptoms of a sore throat better than anti-inflammatories?
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Web of Science Platform
Multidisciplinary research experience and content types all linked together - across the sciences,
social sciences, and arts and humanities
34,000+ 87 Million
Journals across the Patents for over 43
platform million inventions
2 Billion +
Statistics as of November 2022 28
citations
Research with confidence
Web of Science Core Collection
*Read ISI's Value of Bibliometric Databases Report Statistics as of October 2021 © Clarivate 2021 29
Protect your research reputation
Editorial integrity and publisher neutrality
*[Link]
keep-fooling-one-of-the-worlds-leading-databases/ More information Statistics as of October 2021 © Clarivate 2021 30
Preprint Citation Index
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Connect preprints to the scholarly ecosystem
Assess preprint quality with more data and stay up to date
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Assess and monitor research with powerful analytics
Meticulous metadata construction
Cited references for all All author names and Funding data from
papers back to 1900 addresses captured for 2008-present enables
help you discover the all papers ensures that you to understand the
origins of today’s your high stakes funding landscape and
scholarly research. decisions are the right connect outputs to
ones. grants.
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For Effective Systematic Literature Review
Effective
Systematic
Literature Review
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Leveraging the Unique and Unpublished Findings
Industry relies on academia for Academia relies on industry for
basic research and evaluating clinical trials funding, equipment, and infrastructure
Successful collaborations
• Statins and reduction in deaths from cardiovascular disease in 1980s
• Anti-HIV medicine and reduction in deaths from AIDS in 1990s
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Health Research Premium Collection
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Health Research Premium | Single point of Access Across all Health and Medical
Specialties
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What Do You Get in ProQuest HRPC
631
209
Magazines Trade
Journals
7,051 5,653
Publications Scholarly
Journals
132,817 254
Dissertation Ebook
& Thesis Chapters &
Reports &
Others
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World-class Biomedical and Health Journals
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Highest Quality Publishing Partners
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Using Web of Science for SR
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Find published Systematic Reviews
Depending on the database, the terms can be indexed as Document Types or Subjects.
Medline
Useful Document Types:
• Comparative Study
• Meta-analysis
• Multicenter Study
• Randomized Control Trial
• Systematic Review
• Validation Studies
[Link]
Find Published Systematic Reviews- Web of Science Platform
Medline
Synonyms of pharyngitis
might help with the Free text
search
Retrieving Systematic Reviews available in literature
• Run the topic search, then limit to the Systematic Review or Meta-analysis documents.
• Not all the databases have these definitions in the Doc Type, however most often they
are included in the title of the document.
Database Selection: WoS Platform
384 records
Harnessing the power of citations
Retrieving Systematic Reviews available in literature
• Run the topic search, then limit to the Systematic Review or Meta-analysis documents.
• Not all the databases have these definitions in the Doc Type, however most often they
are included in the title of the document.
Database Selection: WoS Platform
((Throat or pharyn*) <near/2> (ache or pain or sore or inflammation)) or Pharyngitis or pharyngalgia
(Topic) AND (Anti-Bacterial or Anti-Mycobacterial or Antibacterial or Antimycobacterial or Bactericid* or
Bacteriocidal or Bacteriocide* or Anti-infective or Anti-microbial or Antiinfective or Antimicrobial)
<near/2>(Compound* or agent* or drug*) or Antibiotic* (Topic)
Literature Search
Navigating the Citation Network to follow a research thread and find possible relevant outliers
• Cites References – the research that a paper cites
• Times Cited – more recently published papers that cite the paper
• Related Records – papers which share at least one cited reference in common with the paper.
If they share citations, they’re likely discussing similar topics.
Highly Cited and Hot Paper indicators put citation counts into Citation take time to accrue, so they are not a good indicator
context. They take into account the field of research, year of of influence for recent publications. For this reason we provide
publication and document type, comparing ‘like with like’. This Usage Counts. Every time a Web of Science user clicks a full
information comes from our Essential Science Indicators. text link or exports a record, the record’s Usage Count is
incremented. So it provides an indication of interest.
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Data Evaluation
Viewing the Full Text to understand content Open Access Status
To fully understand any publication you need to read it. Web of Some reviews include an evaluation of Open Access, others
Science has several in built routes to access Full Text. In have a requirement to either include or exclude Open Access
addition you could add EndNote Click to your browser to publications. Web of Science has Open Access version as a
leverage subscription services as well as Open Access sources. filter, so these types of evaluation can be carried out.
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Managing your Results
The Marked List page stores records selected from
your search results. After marking records, you can
save your Marked List and return to it later.
Save up to 50 Marked Lists with up to 50,000 records per
list. In order to save, you must be logged into your Web of
Science personal profile.
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Managing your Results
Saving (and revisiting) your Searches
Saving a search is a way to return to that search
as many times as needed to complete your
work.
Web of Science stores the search statement you
use in your personal profile, so that you can
always return to it and edit, or rerun it against
different time periods or parameters.
You can create complex queries by combining
many searches together in your Search History,
then save the combinations (Export search
session) so they don't have to be recreated
each time you come into Web of Science.
They mean your results are repeatable.
You can also send your search methods to
other Web of Science users.
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Managing your Results
Creating Alerts (to keep up to date)
Your Web of Science account also allows you to use your Saved Searches as
Alerts that notify you of updates in the data.
Search Alerts - save a search and establish a daily, weekly or monthly email
notification when new publications are added that match.
In addition, there are two other types of Alert:-
Citation Alerts - have a favourite or important article you want to
track? We'll notify you when it receives new citations.
Table of Contents Alerts (Journal Alerts) - subscribers to our Current
Contents Connect database can set up TOC alerts for their favorite journals
all in one place.
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Managing your Results
Outputting your Results
The relevant results can be exported to other
applications, for further analysis or to cite in
your review.
Common options are to export to Excel for
analysis and to EndNote (or another Reference
Management application) for citing.
You can stipulate how much metadata is
exported by selecting an option from the list.
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Writing the literature review
FIND AND SELECT CITATIONS and EDIT CITATIONS to add information such as a page REFORMAT YOUR ENTIRE PAPER
insert them into your manuscript. number, or remove a reference from a group of citations. and bibliography with one click.
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Publishing your Literature Review
Compare your options and start the
submission process
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Publishing your Literature Review
Use Journal Citation Reports to
compare journals you might publish in
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Publishing your Literature Review
The Master Journal List provides
plenty of useful information too
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ProQuest Platform: The power of HRPC
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Recommended Search techniques on Proquest
Need to rerun the search periodically? In the Results page you can save the search in My Research, either to rerun it
manually (Save Search) or to get automatic notifications of new documents with a given frequency (Create Alert)
Saving the Results
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Build your own Systematic Review search Recommended Best Practices
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic
Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from
[Link]/handbook.
Booth A. Searching for qualitative research for inclusion in systematic reviews: a structured methodological review.
Systematic Reviews 2016; 5: 74.
Egger M, Smith GD. Bias in location and selection of studies. BMJ 1998; 316: 61-66.
[Link]
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review
and meta-analysis protocols (PRISMA-P) 2015 statement
Additional Reading Resources
84
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Q&A
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