1. 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.
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2. 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
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3. 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."
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4. 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
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5. 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
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6. 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.
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7. Bias in research synthesis
Reviews
Publications
Research reports
Studies (all data collected)
Adapted from Campbell Collaboration training slides
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8. Bias in research synthesis
Reviews
Publications
Research reports
Studies (all data collected)
Review methods bias
Publication bias
Outcome reporting bias
Negative results Positive results
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9. Bias in research synthesis
Reviews
Publications
Research reports
Studies (all data collected)
Negative results Positive results
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10. Bias in research synthesis
Meta-analysis
Publications
Research reports
Studies (all data collected)
Negative results Positive results
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11. Bias in research synthesis
Systematic
reviews
Publications
Research reports
Studies (all data collected)
Negative results Positive results
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12. 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.
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13. An example of a systematic review that we’ll be using today.
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14. 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
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15. 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
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16. 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
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17. 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
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18. Resources to learn more
Margaret Foster’s Webinar Series:
review-series
John’s Hopkins Coursera Course: Intro to Systematic Review and Meta-Analysis:
Campbell Collaboration Training Resources:
resources/training-courses.html
Cochrane Interactive Learning(free access to income-eligible countries):  
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19. Resources to learn more
Updated
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