Systematic Reviews: Knowing Where the Evidence Came From

Systematic Reviews are a key part of any research you do on a topic, because as the name implies, the evidence is reviewed systematically, with a formal plan, and the reader gets to know what the plan is, and how it was executed. Hopefully you will be getting more than someone's opinion about the medical literature, but instead an evaluation using specific criteria of quality. The biggest challenge with Systematic Reviews is that since they are so thorough, they can take a long time to be published, so the topic you are interested in might not have any, or be out of date.

A Narrative Review article is much more common. An author gives a summary or overview of the evidence, but doesn't have to tell you how they searched for the evidence, how many articles they looked at, or what their criteria was in deciding which articles to include.

TABLE 1. Contrasting systematic review and the methods of other types of reviews¹

Systematic review (minimum criteria) Other types of reviews A protocol (ie, working plan for the systematic review) is developed, along with a clearly formulated question. A protocol is not used, and the question may not be clear and concise. The literature is searched broadly by using many different methods (eg, searching multiple relevant databases, contacting experts, or scanning reference lists). The search strategy, including databases and years searched and search terms employed, is transparently reported in the systematic review manuscript. The literature may not be searched, or only the literature that the authors are aware of is searched. The search strategy is not reported or is not fully reported in the review manuscript. To determine study eligibility, the literature is screened by using criteria set a priori. Ideally, 2 independent reviewers screen all material and resolve conflicts through discussion. The eligibility criteria, including the number of articles that were excluded and the reasons for exclusion, are transparently reported in the systematic review manuscript. No eligibility criteria are set, and the authors are free to TAB and choose which studies should be included in the review. The inclusion criteria and the number of excluded articles are not reported in the manuscript. The risk of bias of the included studies is assessed by using validated and applicable study appraisal instruments to determine the validity of the study results. Ideally, 2 reviewers independently appraise the quality of all included studies and resolve conflicts through discussion. The quality of the included studies is not assessed, or unvalidated instruments are used to appraise the quality of included studies. Data are abstracted consistently from all included studies by using a previously defined data abstraction form. Ideally, 2 reviewers independently abstract data from all included studies and resolve conflicts through discussion. The data abstraction form is transparently described in the systematic review manuscript. The authors are free to TAB and choose which results from the included studies to report. Data may not be abstracted consistently from all included studies. The data abstraction form is not described. The results are synthesized by using the totality of evidence. A meta-analysis may be conducted if the included studies are deemed homogenous in terms of study population, study design, exposure or intervention examined, comparators studied, and outcomes assessed. Studies are summarized on the basis of the results that are most appealing to the authors. A meta-analysis may be performed with studies that are not homogenous. The discussion section provides an overall summary of the strengths and weaknesses of the included studies and a summary of the strengths and weaknesses of the systematic review itself. The discussion section may not provide an overall summary of the weaknesses of included studies or of the weaknesses of the review itself.

¹ One way to determine whether a study is a systematic review or another type of review, such as a narrative review, is to examine whether there is a methods section in the report. If a methods section is missing from the study report, chances are the study was not a systematic review, and, thus, it is susceptible to considerable bias in the results.

Related Resource:

Article on how to read a Review Paper

Introduction to Systematic Reviews

Crafts, Etc. Fair at Montgomery Hospital March 24th, 2010

I am excited to be part of this event! I will be in the Atrium with mosaics, including my new mosaic pendants. There's a lot of talent in the Montgomery Hospital Community, and I am profiling a few of the other vendors of handmade craft who have ties to MHMC.

Crafts, Etc. Fair
Sponsored by The Montgomery Hospital Auxiliary
Proceeds benefit the Auxiliary's pledge for cardiac telemetry equipment

When: Wednesday, March 24th, 9:00 am until 3:30 pm
Where: The Bridge Crosswalk and the Professional Building Atrium
***Cash, checks, major credit cards and payroll deduction accepted.***

Sandra Spitzer(married to Dr. Laurence Spitzer, Radiology)

Sandra Spitzer has been creating pottery for more than 8 years. Her works utilize earthy tones which add a beautiful compliment to your kitchen and home. She has worked at studios on the Main Line and locally. She has displayed her works at craft fairs, and local synagogue craft shows. She is also available on request to design made for order pieces.

Jeff Margraf(married to Peggy Weimar, Clinical Manager, Maternity)
Jeff Margraf received his B.F.A. with High Honors from Mason Gross School of the Arts at Rutgers University. He has worked as a professional artist for the past 17 years, exhibiting in
New York, Philadelphia and other locations. His work is in corporate and private collections throughout the United States. He will be selling original dichroic glass jewelry.


Trish Wingert(worked in IS)
Elsie P. Jewelry Designs is a family owned and operated company located in the Philadelphia suburbs. Beginning as a hobby in 2007, jewelry design quickly became a major part of our lives. Dedicated to my great grandmother, Elsie P. was born! All pieces are handcrafted, so no two are quite the same. Our jewelry is created using semi precious stones, sterling silver, brass, Swarovski crystals, Czech glass and freshwater and glass pearls.

Be sure to come check it out! Other MHMC folk include Beverlee Ciccone, Lisa Phillips, Susan Cloud, and Melissa Phillips and Wendy Harris(hopefully I didn't forget anyone!) Over 15 vendors of handcrafted arts, candles, handbags, chocolates, baked goods, and Avon. March 24th, 2010, 9:00 am-3:30 pm on the bridge crosswalk and in the Pro Building 3rd floor Atrium. For more info call 610-270-2076

Diagnosaurus for Differential Diagnosis on your mobile device

McGraw-Hill's Diagnosaurus 2.0, the FREE medical PDA software, is used by tens of thousands of students, physicians, and health professionals. Download the FREE Diagnosaurus 2.0 PDA tool which has 1000+ differential diagnosis to help you make informed decisions. Diagnosaurus 2.0 is derived from McGraw-Hill's CURRENT Consult Medicine 2007.

Cochrane Collaboration: Evidence Based Medicine

The Cochrane Collaboration is an independent, international, not-for-profit organization, and is one of the most respected leaders in evidence based medicine. Their contributors work together to produce systematic assessments of healthcare interventions, known as Cochrane Reviews, which are published online in The Cochrane Library. Cochrane Reviews are intended to help providers, practitioners and patients make informed decisions about health care, with comprehensive, reliable and relevant source of evidence on which to base these decisions.

Summaries of Cochrane Reviews are available free online. If you want to read a full Cochrane Review, this is only available via the publisher.

One entity affiliated with the Cochrane Collaboration, the Cochrane Primary Health Care Field, includes a list of Pearls(Practical Evidence About Real Life Situations), highlighting Cochrane Reviews of interest to Primary Care. This site hasn't been moved to CC's new site yet, so the reviews stop in 2009, unfortunately.

ePSS: Electronic Preventive Services Selector

Search and Browse U.S. Preventive Services Task Force (USPSTF) recommendations on your PDA or mobile device with ePSS, now including iPhone and iPod Touch.

The Electronic Preventive Services Selector (ePSS) is an application designed to help primary care clinicians identify the screening, counseling, and preventive medication services that are appropriate for their patients.

The ePSS is available both as a web application and a mobile application. The ePSS information is based on the current recommendations of the U.S. Preventive Services Task Force and can be searched by specific patient characteristics, such as age, sex, and selected behavioral risk factors.

Hand Hygiene: Is your heart in it?

Check out this article forwarded by our Infection Control Nurse, Kelly Romano, about Abington Hospital's efforts to increase hand hygiene, after the death of a patient from a hospital acquired infection.



Hand Hygiene Resources:
A collection of Hand Hygiene Signs for printing
World Health Organization Hand Hygiene Resources
CDC Hand Hygiene in Healthcare Setting