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What is Systematic Literature Review?
“collates all empirical evidence that fits pre-specified eligibility criteria in order to
answer a specific research question ”
clearly stated objectives with pre-defined eligibility criteria for
studies
a systematic search that attempts to identify all studies
systematic presentation, and synthesis, of the characteristics
and findings of the included studies
What is Systematic Literature Review?
“A systematic review is a review in which
there is a comprehensive search for
relevant studies on a specific topic, and
those identified are then appraised and
synthesized according to a predetermined
and explicit method
A systematic review attempts to collate all empirical evidence that fits pre-
specified eligibility criteria in order to answer a specific research question. It uses
explicit, systematic methods that are selected with a view to minimizing bias, thus
providing more reliable findings from which conclusions can be drawn and
decisions made
Characteristics of Systematic Literature Review
• Clearly stated title and objectives
• Comprehensive strategy to search for relevant studies (unpublished and published)
• Explicit and justified criteria for the inclusion or exclusion of any study
• Clear presentation of characteristics of each study included and an analysis of
methodological quality
• Comprehensive list of all studies excluded and justification for exclusion
Why we need Systematic Review?
The large amount of literature requires researchers alike to rely on systematic reviews in order to
make an informed decision.
Systematic Reviews minimize bias. “A systematic review is a more scientific method of summarizing
literature because specific protocols are used to determine which studies will be included in the
review.”
Massive numbers of publications
Why we need Systematic Review?
“The volume of published material makes it impractical for an individual clinician to remain up to
date on a variety of common conditions.
Reliable summary of otherwise unmanageable mounts of evidence
Decision makers require review of evidences available
What are Traditional Reviews?
Traditional reviews provide a broad overview of a research topic with no clear
methodological approach. Information is collected and interpreted
unsystematically with subjective summaries of findings.
Authors aim to describe and discuss the literature from a contextual or
theoretical point of view. Although the reviews may be conducted by topic
experts, due to preconceived ideas or conclusions, they could be subject to
bias.
“Systematic reviews are overviews of the literature undertaken by identifying, critically appraising
and synthesising results of primary research studies using an explicit, methodological approach.
They aim to summarise the best available evidence on a particular research topic.”
Advantages of Systematic Review Over Traditional Review
Who undertakes Systematic Reviews?
Multidisciplinary teams of people which include:
1.Clinicians
2. Health services researchers
3. Information scientists
4. Statisticians
5. Health Economists
6. Patient and public involvement – particularly for guidelines
Cochrane Library Campbell collaboration
A collection of databases that An open access journal committed to
contain different types of high- publishing systematic reviews as well
quality, independent evidence to as methods research papers, and
inform healthcare decision-making. evidence and gap maps.
EMBASE
Embase (oftenstyled EMBASE for Excerpta
Medical data BASE) is a biomedical and
pharmacological bibliographic database of
published literature designed to support
information managers
MEDLINE
MEDLINE (Medical Literature Analysis and Retrieval System Online, or
MEDLARS Online) is a bibliographic database of life sciences and
biomedical information. It includes bibliographic information for articles from
academic journals covering medicine, nursing, pharmacy, dentistry,
veterinary medicine, and health care.
Stages of Systematic Reviews
Stages in Systematic Reviews
• What are the study objectives?
Formulate a research • What are the operational definitions?
question • What types of study designs?
• Introduction- rationale, objective, definitions
• Methods- Inclusion and Exclusion criteria,
Develop the research
search strategy study selection process
protocol
description of data mgt & data collection process
Conduct literature Use synonyms,
search plurals, word
variants, AND, OR
• From the selected literature be clear of what you need
• Identify whether the literature has the study details needed and
the data expected for analysis
Select studies as per
• Collect the information regarding the following from collected
prototcol
literature:
1. Methodology
2. Population
3. Interventions being compared
4. Outcomes evaluated
• A team of at least 2 reviewers should evaluate the
Appraise studies as per
methodological quality of a selection of full text articles.
prototcol
• Use a checklist to determine whether studies meet the criteria
of the protocol.
• The amount of data to needs to be extracted depends upon the
judgement of the researcher
Extract data • The level of judgement depends upon the following:
• The extent of data that is sufficient to describe studies
• The extent of data that is sufficient to allow you to undertake the
planned analysis
• The extent of data that is sufficient so you do not need to return
to the full text papers
• Analyze data for issues such as variation across studies
Analyze results and (heterogeneity) and sensitivity of findings. Consider running
interpret the results a meta-analysis of results.
• Consider limitations (including biases), strength of evidence,
applicability, economic effects, and implications for future
practice or research.
PRISMA flow diagrams
The flowTo diagram depicts
tell readers why totheread
flowthe
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information through
and what they the different
phasescan of expect
a systematic
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the article.
identified, included and excluded, and the reasons for exclusions.
It is an evidence-based minimum set of items for reporting in
systematic
reviews and meta-analyses.
The PRISMA flow diagram visually summarises the screening
process. It initially records the number of articles found and then
To present the context of the problem.
makes the selection process transparent by reporting on decisions
made at various stages of the systematic review.
PRISMA flow diagrams
PRISMA flow diagrams
PRISMA flow diagrams
META Analysis
The statistical analysis of a large collection of analysis results from
individual studies for the purpose of integrating the findings.
A quantitative, formal, epidemiological study design used to
systematically assess the results of previous research to derive
conclusions about that body of research.
Analysts use well recognised, systematic methods to account for
differences in sample size, variability in study approach and
findings and test how sensitive their results are to their own
systematic review protocol (study selection and statistical analysis)
Significance of META Analysis
By combining results into one large study, it
reduces the time and energy that decision-makers
spend looking at research.
Meta-analysis can make sense of inconclusive and
conflicting data from each original study.
Through meta-analysis, researchers can combine
smaller studies, essentially making them into one
big study, which may help show an effect.
A meta-analysis can help increase the accuracy of
the results. This is also because it is, in effect,
increasing the size of the study.
Steps of META Analysis A well-defined research question describes
the
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most crucial impacted
step in by the intervention
a meta-analysis is
and the treatment’s possible
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How to report META Analysis
Meta analysis reporting consists of following steps:
1. Title
2. Abstract
3. Introduction
4. Methods
5. Results
6. Discussion Results section should Include a flow
Most of it similar to systematic review however the chart of studies included
results and the discussion section are profoundly The various plots used in meta analysis
different. include:
1. Forest plots
2. Funnel plots
3. Bubble plots
4. Galbraith/radial plots
5. L’abbe plots
Forest Plots
Forest plots are useful tools for showing the main
features of meta-analysis results and Funnel Plots
comprehensively visualizing the direction and A funnel plot is a scatter plot that compares the
magnitude of the overall effect. An essential tool to precision (how close the estimated intervention
summarize information on individual studies, give a effect size is to the true effect size) and results
visual suggestion of the amount of study of individual studies. It is commonly used in
heterogeneity, and show the estimated common meta-analyses to visually detect publication
effect, all in one figure. bias.
L’Abbe Plots
Bubble Plots
A bubble chart is commonly used to visualize One of several graphs commonly used to
relationships between three or more numeric display data visually in a meta-analysis of
variables. Each bubble in a chart represents a clinical trials that compare a treatment and a
single data point. control intervention.
Systematic Review vs META Analysis
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