Systematic Review (Advanced Course: Module 6 Appendix) This module explains why HINARI users might want to start by searching evidence-based resources and highlights HINARI, as well as, freely available resources that support evidence-based practice. 13 December 2018

The material for this appendix is part of: Performing systematic reviews in resource-limited settings Sarah Young and Erin Eldemere May 19, 2018 MLA Annual Conference, Atlanta GA Performing systematic reviews in resource-limited settings May 19, 2018 MLA Annual Conference, Atlanta GA 13 December 2018

Archie Cochrane, 1979 A Scottish doctor who promoted the use of randomized controlled trials to improve medical care. "It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials." 13 December 2018

What is a systematic review? “…a scientific investigation that focuses on a specific question and uses explicit, pre-specified scientific methods to identify, select, assess, and summarize the findings of similar but separate studies.” Source: “Finding What Works in Health Care”, Institute of Medicine, Available from https://www.ncbi.nlm.nih.gov/books/NBK209518/ 13 December 2018

Systematic review vs. traditional lit review Review stage Narrative review Systematic review Review question Question is broad and terms are not well-defined Question is specific; terms and protocol are defined in advance Study selection Convenience sampling and biased selection Exhaustive searches with pre-defined criteria applied for selection by more than one reviewer Quality assessment None Selected studies assessed for risk of bias and study quality Synthesis Qualitative and narrative; vote-counting may be used Sometimes quantitative, including meta-analysis with risk of bias considered 13 December 2018

In general, a systematic review aims to decrease bias and increase reproducibility and transparency. They provide guidance for practice and policy-making, and identify gaps in knowledge and a need for research. 13 December 2018

Bias in research synthesis Reviews Publications Research reports Studies (all data collected) Adapted from Campbell Collaboration training slides 13 December 2018

Bias in research synthesis Reviews Publications Research reports Studies (all data collected) Review methods bias Publication bias Outcome reporting bias Negative results Positive results 13 December 2018

Bias in research synthesis Reviews Publications Research reports Studies (all data collected) Negative results Positive results 13 December 2018

Bias in research synthesis Meta-analysis Publications Research reports Studies (all data collected) Negative results Positive results 13 December 2018

Bias in research synthesis Systematic reviews Publications Research reports Studies (all data collected) Negative results Positive results 13 December 2018

Types of systematic review questions The effectiveness of a treatment or intervention The rate, prevalence or trends of occurrence of a condition The correlation or association of factors The accuracy of a diagnostic test The reliability or validity of a method or measure Systematic review questions are specific and answerable. They consider measurable constructs and are practical from a policy or practice perspective. 13 December 2018

An example of a systematic review that we’ll be using today. 13 December 2018

Search and screen for studies Define the question Search and screen for studies Assess study quality Extract and combine data These are the steps of a full systematic review. Discuss and conclude findings Disseminate results 13 December 2018

Search and screen for studies Define the question Search and screen for studies Assess study quality Extract and combine data You’ll often see things, particularly outside of medicine, that are called ‘systematic reviews’ but they omit the study quality assessment phase. These could also be called systematic maps or scoping reviews. We’ll discuss these shortly and how they differ or why they may be useful or not. Discuss and conclude findings Disseminate results 13 December 2018

Search and screen for studies Complex contexts Define the question Lack of expertise and access Lack of multiple reviewers Search and screen for studies Assess study quality Lack of expertise Extract and combine data Challenges in resource limited settings. Discuss and conclude findings Lack of funding Disseminate results 13 December 2018

SR steps and librarian’s role Develop SR Protocol Refine research question Identify sources for searching Develop search strategy Define inclusion/exclusion criteria Develop grading rubric Identify Research Question Perform Search Run database searches Search grey literature Hand search journals and websites Calls to listservs or known researchers if any Initial Screening Screen titles/abstracts Independent reviewers determine Yes/No/Maybe Yes/Maybe carry through Write up of SR Librarian assists in write-up of methods section Analysis and Synthesis Grading Assess quality of evidence in included articles Librarian can provide support for rubric documentation Eligibility Screening Screen abstracts/full text for inclusion/exclusion criteria Record reasons for exclusion 13 December 2018

Resources to learn more Margaret Foster’s Webinar Series: https://nnlm.gov/scr/professional-development/systematic- review-series John’s Hopkins Coursera Course: Intro to Systematic Review and Meta-Analysis: https://www.coursera.org/learn/systematic-review Campbell Collaboration Training Resources: https://www.campbellcollaboration.org/research- resources/training-courses.html Cochrane Interactive Learning(free access to income-eligible countries):  https://training.cochrane.org/interactivelearning 13 December 2018

Resources to learn more Updated 2018 12 13 December 2018