Descriptive studies
OR=Odds ratio; RR=Relative risk; RCT= Randomized controlled trial; PPV: positive predictive value; NPV: negative predictive value; PLR: positive likelihood ratio; NLR: negative likelihood ratio; DOR: diagnostic odds ratio
A systematic review ends with the interpretation of results. At this stage, the results of the study are summarized and the conclusions are presented to improve clinical and therapeutic decision-making. A systematic review with or without meta-analysis provides the best evidence available in the hierarchy of evidence-based practice.[ 14 ] Using meta-analysis can provide explicit conclusions. Conceptually, meta-analysis is used to combine the results of two or more studies that are similar to the specific intervention and the similar outcomes. In meta-analysis, instead of the simple average of the results of various studies, the weighted average of studies is reported, meaning studies with larger sample sizes account for more weight. To combine the results of various studies, we can use two models of fixed and random effects. In the fixed-effect model, it is assumed that the parameters studied are constant in all studies, and in the random-effect model, the measured parameter is assumed to be distributed between the studies and each study has measured some of it. This model offers a more conservative estimate.[ 40 ]
Three types of homogeneity tests can be used: (1) forest plot, (2) Cochrane's Q test (Chi-squared), and (3) Higgins I 2 statistics. In the forest plot, more overlap between confidence intervals indicates more homogeneity. In the Q statistic, when the P value is less than 0.1, it indicates heterogeneity exists and a random-effect model should be used.[ 41 ] Various tests such as the I 2 index are used to determine heterogeneity, values between 0 and 100; the values below 25%, between 25% and 50%, and above 75% indicate low, moderate, and high levels of heterogeneity, respectively.[ 26 , 42 ] The results of the meta-analyzing study are presented graphically using the forest plot, which shows the statistical weight of each study with a 95% confidence interval and a standard error of the mean.[ 40 ]
The importance of meta-analyses and systematic reviews in providing evidence useful in making clinical and policy decisions is ever-increasing. Nevertheless, they are prone to publication bias that occurs when positive or significant results are preferred for publication.[ 43 ] Song maintains that studies reporting a certain direction of results or powerful correlations may be more likely to be published than the studies which do not.[ 44 ] In addition, when searching for meta-analyses, gray literature (e.g., dissertations, conference abstracts, or book chapters) and unpublished studies may be missed. Moreover, meta-analyses only based on published studies may exaggerate the estimates of effect sizes; as a result, patients may be exposed to harmful or ineffective treatment methods.[ 44 , 45 ] However, there are some tests that can help in detecting negative expected results that are not included in a review due to publication bias.[ 46 ] In addition, publication bias can be reduced through searching for data that are not published.
Systematic reviews and meta-analyses have certain advantages; some of the most important ones are as follows: examining differences in the findings of different studies, summarizing results from various studies, increased accuracy of estimating effects, increased statistical power, overcoming problems related to small sample sizes, resolving controversies from disagreeing studies, increased generalizability of results, determining the possible need for new studies, overcoming the limitations of narrative reviews, and making new hypotheses for further research.[ 47 , 48 ]
Despite the importance of systematic reviews, the author may face numerous problems in searching, screening, and synthesizing data during this process. A systematic review requires extensive access to databases and journals that can be costly for nonacademic researchers.[ 13 ] Also, in reviewing the inclusion and exclusion criteria, the inevitable mindsets of browsers may be involved and the criteria are interpreted differently from each other.[ 49 ] Lee refers to some disadvantages of these studies, the most significant ones are as follows: a research field cannot be summarized by one number, publication bias, heterogeneity, combining unrelated things, being vulnerable to subjectivity, failing to account for all confounders, comparing variables that are not comparable, just focusing on main effects, and possible inconsistency with results of randomized trials.[ 47 ] Different types of programs are available to perform meta-analysis. Some of the most commonly used statistical programs are general statistical packages, including SAS, SPSS, R, and Stata. Using flexible commands in these programs, meta-analyses can be easily run and the results can be readily plotted out. However, these statistical programs are often expensive. An alternative to using statistical packages is to use programs designed for meta-analysis, including Metawin, RevMan, and Comprehensive Meta-analysis. However, these programs may have limitations, including that they can accept few data formats and do not provide much opportunity to set the graphical display of findings. Another alternative is to use Microsoft Excel. Although it is not a free software, it is usually found in many computers.[ 20 , 50 ]
A systematic review study is a powerful and valuable tool for answering research questions, generating new hypotheses, and identifying areas where there is a lack of tangible knowledge. A systematic review study provides an excellent opportunity for researchers to improve critical assessment and evidence synthesis skills.
All authors contributed equally to this work.
Conflicts of interest.
There are no conflicts of interest.
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In Step 8, you will write an article or a paper about your systematic review. It will likely have five sections: introduction, methods, results, discussion, and conclusion. You will:
The PRISMA Checklist will help you report the details of your systematic review. Your paper will also include a PRISMA chart that is an image of your research process.
Click an item below to see how it applies to Step 8: Write the Review.
To write your review, you will need the data from your PRISMA flow diagram . Review the PRISMA checklist to see which items you should report in your methods section.
When you screen in Covidence, it will record the numbers you need for your PRISMA flow diagram from duplicate removal through inclusion of studies. You may need to add additional information, such as the number of references from each database, citations you find through grey literature or other searching methods, or the number of studies found in your previous work if you are updating a systematic review.
A librarian can advise you on the process of organizing and writing up your systematic review, including:
Be sure to reference reporting standards when writing your review. This helps ensure that you communicate essential components of your methods, results, and conclusions. There are a number of tools that can be used to ensure compliance with reporting guidelines. A few review-writing resources are listed below.
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) is a 27-item checklist used to improve transparency in systematic reviews. These items cover all aspects of the manuscript, including title, abstract, introduction, methods, results, discussion, and funding. The PRISMA checklist can be downloaded in PDF or Word files.
The PRISMA Flow Diagram visually depicts the flow of studies through each phase of the review process. The PRISMA Flow Diagram can be downloaded in Word files.
If you have also searched additional sources, such as professional organization websites, cited or citing references, etc., document your grey literature search using the flow diagram template version 1 PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources or the version 2 PRISMA 2020 flow diagram for updated systematic reviews which included searches of databases, registers and other sources .
Complete the boxes documenting your database searches, Identification of studies via databases and registers, according to the PRISMA flow diagram instructions. Complete the boxes documenting your grey literature and/or hand searches on the right side of the template, Identification of studies via other methods, using the steps below.
There are different PRISMA flow diagram templates for new and updated reviews, as well as different templates for reviews with and without grey literature searches. Be sure you download the correct template to match your review methods, then follow the steps below for each portion of the diagram you have available.
Step 1: Preparation Download the flow diagram template version 1 PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only or the version 2 PRISMA 2020 flow diagram for updated systematic reviews which included searches of databases and registers only .
Run the search for each NOTE:Some citation managers automatically remove duplicates | |
To avoid reviewing duplicate articles, If you are using Covidence to screen your articles, you can | |
The next step is to add the number of articles that you will screen. This should be the number of records identified minus the number from the duplicates removed box. | |
You will need to screen the titles and abstracts for articles which are relevant to your research question. Any articles that appear to help you provide an answer to your research question should be included. Record the number of articles excluded through title/abstract screening in the box to the right titled "Records excluded." You can optionally add exclusion reasons at this level, but they are not required until full text screening. | |
This is the number of articles you obtain in preparation for full text screening. Subtract the number of excluded records (Step 5) from the total number screened (Step 4) and this will be your number sought for retrieval. | |
List the number of articles for which you are unable to find the full text. Remember to use Find@UNC and to request articles to see if we can order them from other libraries before automatically excluding them. | |
This should be the number of reports sought for retrieval (Step 6) minus the number of reports not retrieved (Step 7). Review the full text for these articles to assess their eligibility for inclusion in your systematic review. | |
After reviewing all articles in the full-text screening stage for eligibility, enter the total number of articles you exclude in the box titled "Reports excluded," and then list your reasons for excluding the articles as well as the number of records excluded for each reason. Examples include wrong setting, wrong patient population, wrong intervention, wrong dosage, etc. You should only count an excluded article once in your list even if if meets multiple exclusion criteria. | |
The final step is to subtract the number |
Step 1: Preparation Download the flow diagram template version 1 PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources or the version 2 PRISMA 2020 flow diagram for updated systematic reviews which included searches of databases, registers and other sources .
If you have identified articles through other sources than databases (such as manual searches through reference lists of articles you have found or search engines like Google Scholar), enter the total number of records from each source type in the box on the top right of the flow diagram. | |
This should be the total number of reports you obtain from each grey literature source. | |
List the number of documents for which you are unable to find the full text. Remember to use Find@UNC and to request items to see if we can order them from other libraries before automatically excluding them. | |
This should be the number of grey literature reports sought for retrieval (Step 2) minus the number of reports not retrieved (Step 3). Review the full text for these items to assess their eligibility for inclusion in your systematic review. | |
After reviewing all items in the full-text screening stage for eligibility, enter the total number of articles you exclude in the box titled "Reports Excluded," and then list your reasons for excluding the item as well as the number of items excluded for each reason. Examples include wrong setting, wrong patient population, wrong intervention, wrong dosage, etc. You should only count an excluded item once in your list even if if meets multiple exclusion criteria. | |
The final step is to subtract the number of excluded articles or records during the eligibility review of full-texts from the total number of articles reviewed for eligibility. Enter this number in the box labeled "Studies included in review," combining numbers with your database search results in this box if needed. You have now completed your PRISMA flow diagram, which you can now include in the results section of your article or assignment. |
Step 1: Preparation Download the flow diagram template version 2 PRISMA 2020 flow diagram for updated systematic reviews which included searches of databases and registers only or the version 2 PRISMA 2020 flow diagram for updated systematic reviews which included searches of databases, registers and other sources .
In the Previous
| |
At the bottom of the column, There will also be a box for the total number of studies included in your |
For more information about updating your systematic review, see the box Updating Your Review? on the Step 3: Conduct Literature Searches page of the guide.
Scientific articles often follow the IMRaD format: Introduction, Methods, Results, and Discussion. You will also need a title and an abstract to summarize your research.
You can read more about scientific writing through the library guides below.
Systematic reviews follow the same structure as original research articles, but you will need to report on your search instead of on details like the participants or sampling. Sections of your manuscript are shown as bold headings in the PRISMA checklist.
Title | Describe your manuscript and state whether it is a systematic review, meta-analysis, or both. |
---|---|
Abstract | Structure the abstract and include (as applicable): background, objectives, data sources, study eligibility criteria, participants, interventions, quality assessment and synthesis methods, results, limitations, conclusions, implications of key findings, and systematic review registration number. |
Introduction | Describe the rationale for the review and provide a statement of questions being addressed. |
Methods | Include details regarding the protocol, eligibility criteria, databases searched, full search strategy of at least one database (often reported in appendix), and the study selection process. Describe how data were extracted and analyzed. If a librarian is part of your research team, that person may be best suited to write this section. |
Results | Report the numbers of articles screened at each stage using a PRISMA diagram. Include information about included study characteristics, risk of bias (quality assessment) within studies, and results across studies. |
Discussion | Summarize main findings, including the strength of evidence and limitations of the review. Provide a general interpretation of the results and implications for future research. |
Funding | Describe any sources of funding for the systematic review. |
Appendix | Include entire search strategy for at least one database in the appendix (include search strategies for all databases searched for more transparency). |
Refer to the PRISMA checklist for more information.
Consider including a Plain Language Summary (PLS) when you publish your systematic review. Like an abstract, a PLS gives an overview of your study, but is specifically written and formatted to be easy for non-experts to understand.
Tips for writing a PLS:
Learn more about Plain Language Summaries:
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Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.
Keywords: evidence; guide; meta-analysis; meta-synthesis; narrative; systematic review; theory.
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IMAGES
VIDEO
COMMENTS
A systematic review collects secondary data, and is a synthesis of all available, relevant evidence which brings together all existing primary studies for review (Cochrane 2016). A systematic review differs from other types of literature review in several major ways.
Systematic literature reviews (SRs) are a way of synthesising scientific evidence to answer a particular research question in a way that is transparent and reproducible, while seeking to include all published evidence on the topic and appraising the quality of this evidence.
1. Decide on your team. 2. Formulate your question. 3. Plan your research protocol. 4. Search for the literature. 5. Screen the literature. 6. Assess the quality of the studies. 7. Extract the data. 8. Analyze the results. 9. Interpret and present the results. Registering your systematic literature review.
A systematic review collects secondary data, and is a synthesis of all available, relevant evidence which brings together all existing primary studies for review (Cochrane 2016). A systematic review differs from other types of literature review in several major ways.
The PRISMA checklist includes 27 items related to the content of a systematic review and meta-analysis and includes abstracts, methods, results, discussions, and financial resources. PRISMA helps writers improve their systematic review and meta-analysis report.
A Systematic Review (SR) is a synthesis of evidence that is identified and critically appraised to understand a specific topic. SRs are more comprehensive than a Literature Review, which most academics will be familiar with, as they follow a methodical process to identify and analyse existing literature (Cochrane, 2022).
In this article, through a systematic search on the methodology of literature review, we categorize a typology of literature reviews, discuss steps in conducting a systematic literature review, and provide suggestions on how to enhance rigor in literature reviews in planning education and research.
It will likely have five sections: introduction, methods, results, discussion, and conclusion. You will: Review the reporting standards you will use, such as PRISMA. Gather your completed data tables and PRISMA chart.
A systematic literature review is a method which sets out a series of steps to methodically organize the review. In this paper, we present a guide designed for researchers and in particular early-stage researchers in the computer-science field.
This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems.