Traditional Systematic Review Research Articles

Making the Most of What We Already Know: A Three-Stage Approach to Systematic Reviewing.

Conducting a systematic review in social policy is a resource-intensive process in terms of time and funds. It is thus important to understand the scope of the evidence base of a topic area prior to conducting a synthesis of primary research in order to maximize these resources. One approach to conserving resources is to map out the available evidence prior to undertaking a traditional synthesis. A few examples of this approach exist in the form of gap maps, overviews of reviews, and systematic maps supported by social policy and systematic review agencies alike. Despite this growing call for alternative approaches to systematic reviews, it is still common for systematic review teams to embark on a traditional in-depth review only. This article describes a three-stage approach to systematic reviewing that was applied to a systematic review focusing in interventions for smallholder farmers in Africa. We argue that this approach proved useful in helping us to understand the evidence base. By applying preliminary steps as part of a three-stage approach, we were able to maximize the resources needed to conduct a traditional systematic review on a more focused research question. This enabled us to identify and fill real knowledge gaps, build on work that had already been done, and avoid wasting resources on areas of work that would have no useful outcome. It also facilitated meaningful engagement between the review team and our key policy stakeholders.

Understanding the theoretical underpinning of the exercise component in a fall prevention programme for older adults with mild dementia: a realist review protocol.

BackgroundOlder adults with mild dementia are at an increased risk of falls. Preventing those at risk from falling requires complex interventions involving patient-tailored strength- and balance-challenging exercises, home hazard assessment, visual impairment correction, medical assessment and multifactorial combinations. Evidence for these interventions in older adults with mild cognitive problems is sparse and not as conclusive as the evidence for the general community-dwelling older population. The objectives of this realist review are (i) to identify the underlying programme theory of strength and balance exercise interventions targeted at those individuals that have been identified as falling and who have a mild dementia and (ii) to explore how and why that intervention reduces falls in that population, particularly in the context of a community setting. This protocol will explain the rationale for using a realist review approach and outline the method.MethodsA realist review is a methodology that extends the scope of a traditional narrative or systematic evidence review. Increasingly used in the evaluation of complex interventions, a realist enquiry can look at the wider context of the intervention, seeking more to explain than judge if the intervention is effective by investigating why, what the underlying mechanism is and the necessary conditions for success. In this review, key rough programme theories were articulated and defined through discussion with a stakeholder group. The six rough programme theories outlined within this protocol will be tested against the literature found using the described comprehensive search strategy. The process of data extraction, appraisal and synthesis is outlined and will lead to the production of an explanatory programme theory.DiscussionAs far as the authors are aware, this is the first realist literature review within fall prevention research and adds to the growing use of this methodology within healthcare. This synthesis of evidence will provide a valuable addition to the evidence base surrounding the exercise component of a fall intervention programme for older adults with mild dementia and will ultimately provide clinically relevant recommendations for improving the care of people with dementia.Systematic review registrationPROSPERO CRD42015030169Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0212-x) contains supplementary material, which is available to authorized users.

Searching for research results to inform the design of an initial professional teacher education programme for the foundation phase: A systematic review

<p>This article reports on a systematic review conducted to inform the development of a professional teacher education programme for the foundation phase of schooling. The research question was: What do quality research studies identify as the components and/or characteristics of quality teacher education for the foundation phase programmes that allow new teachers to begin to teach for epistemological access. A search for systematic reviews on educational programmes related to foundation phase for initial teacher education was conducted for the period between 1980 and 2011. The researchers added Stage 0 as a fifth step to the traditional four-step systematic review process. Stage 0 or quasi-tertiary review allowed us to present substantive findings of the identified systematic reviews and to explore their methodological quality. From the initial 2876 hits (mostly health and medical studies), only 19 studies were related to the educational field. Only three of the 19 studies were finally accepted as eligible at Stage 0. None of the reviews directly addressed programme design but contained elements that were considered as useful when designing programmes. The present study makes it clear that there is a dearth of research on entire programmes related to initial teacher education for foundation phase teachers. </p>

Searching for the mechanisms of change: a protocol for a realist review of batterer treatment programmes

IntroductionConflicting results reported by evaluations of typical batterer intervention programmes leave many judicial officials and policymakers uncertain about the best way to respond to domestic violence, and whether to recommend...

Knowledge synthesis research: a bibliometric analysis

ObjectivesThe purpose of this article is to describe the volume and attributes of original research available in PubMed on emerging knowledge synthesis methods (excluding traditional systematic reviews) published by researchers. Study Design and SettingBibliometric analysis. ResultsSix-hundred eight studies related to the topic of knowledge synthesis methods were analyzed. Although there has been a steady increase in publications on knowledge synthesis methods since 2003, studies are dispersed among a large number of journals. Similarly, a large number of authors are publishing on these methods but in limited numbers for any individual. Relevant Medical Subject Headings that were applied most often to these studies included qualitative research, research design, meta-analysis as topic, and review literature as topic. ConclusionThere is no prevailing journal or author that is a leader in reporting on knowledge synthesis methods. Relevant Medical Subject Headings were either not applied to most records or not available for the synthesis method being examined. This may lend itself to inconsistencies and variations in methods making it challenging for researchers and research users to locate and appraise these articles.

Determinants of an urban origin student choosing rural practice: a scoping review

The shortage of physicians in rural and remote communities is an ongoing problem. Many studies have shown that the rural background of a student (ie rural origin) is a primary factor in recruiting physicians for practice in rural communities. Scoping reviews are primarily done to gauge the extent of literature on the research question at hand, typically with an intent that future research in that area is a constructive addition to pre-existing knowledge. This scoping review focuses on factors that predispose urban-origin students to choose a carrier in rural medicine. The study used Arksey and O'Malley's guidelines for a scoping review of the literature, which, in contrast to a traditional systematic review, is brief yet comprehensive. Medline (Ovid) and PubMed databases were used to review literature published between 1 January 1970 and 30 November 2014. After removing duplicates, articles were screened based on inclusion and exclusion criteria set up by the research team. The literature search resulted in 435 articles, 418 of which were excluded, leaving 17 articles for comprehensive review. Out of these 17 studies, the following four factors that suggest why urban-origin medical students may choose rural practice were generated: geographic diffusion of physicians in response to economic forces such as debt repayment and financial incentives (five studies), scope of practice and personal satisfaction (five studies), undergraduate and postgraduate rural training (nine studies) and premedical school mindset to practice rurally (five studies). Urban-origin students may choose rural practice because of market forces as well as financial incentives. The participation in undergraduate and postgraduate rural training is reported to positively alter the attitude of urban-origin students. A small subset of these students has a predetermined mindset to practice rurally at the time of matriculation. Obstacles for choosing a rural carrier include, but are not limited to lack of job and education opportunities for spouses/partners, lack of recreational and educational opportunities for children, and obscure opportunities for continuing medical education.

Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews.

BackgroundRapid review (RR) products are inherently appealing as they are intended to be less time-consuming and resource-intensive than traditional systematic reviews (SRs); however, there is concern about the rigor of methods and reliability of results. In 2013 to 2014, a workgroup comprising representatives from the Agency for Healthcare Research and Quality’s Evidence-based Practice Center Program conducted a formal evaluation of RRs. This paper summarizes results, conclusions, and recommendations from published review articles examining RRs.MethodsA systematic literature search was conducted and publications were screened independently by two reviewers. Twelve review articles about RRs were identified. One investigator extracted data about RR methods and how they compared with standard SRs. A narrative summary is presented.ResultsA cross-comparison of review articles revealed the following: 1) ambiguous definitions of RRs, 2) varying timeframes to complete RRs ranging from 1 to 12 months, 3) limited scope of RR questions, and 4) significant heterogeneity between RR methods.ConclusionsRR definitions, methods, and applications vary substantially. Published review articles suggest that RRs should not be viewed as a substitute for a standard SR, although they have unique value for decision-makers. Recommendations for RR producers include transparency of methods used and the development of reporting standards.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0040-4) contains supplementary material, which is available to authorized users.

Primary prevention of periodontitis: managing gingivitis.

Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major cause of tooth loss impacting negatively upon speech, nutrition, quality of life and self-esteem, and has systemic inflammatory consequences. Periodontitis is preventable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, lifelong. While mechanical plaque removal remains the bedrock of successful periodontal disease management, in high-risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis. The aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self-administered plaque control regimes; 2) the efficacy of self-administered inter-dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti-inflammatory (sole or adjunctive) approaches. Two meta-reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti-inflammatory agents) formed the basis of this consensus. Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with someevidence that reinforcement of oral hygiene provides further benefit. Re-chargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti-inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2min. is likely to be insufficient, especially when considering the need for additional use of inter-dental cleaning devices. In patients with gingivitis once daily inter-dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group.

Performing Systematic Literature Reviews With Novices: An Iterative Approach

Reviewers performing systematic literature reviews require understanding of the review process and of the knowledge domain. This paper presents an iterative approach for conducting systematic literature reviews that addresses the problems faced by reviewers who are novices in one or both levels of understanding. This approach is derived from traditional systematic literature reviews and based on observations from four systematic reviews performed in an academic setting. These reviews demonstrated the importance of defining iterations for the eight tasks of the review process. The iterative approach enables experiential learning from the two levels of understanding: the process level and the domain level.

Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes.

ObjectiveTo identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts.DesignThis is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts.ResultsThis review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme.ConclusionThrough a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts.

RAPID REVIEW: AN EMERGING APPROACH TO EVIDENCE SYNTHESIS IN HEALTH TECHNOLOGY ASSESSMENT

Increasingly, healthcare decision makers demand quality evidence in a short timeframe to support urgent and emergent decisions related to procurement, clinical practice, and policy. Health technology assessment (HTA) producers are responding by developing innovative approaches to evidence synthesis that can be executed more quickly than traditional systematic review. These approaches, and the broader implications they bring to bear on health decision making and policy development, however, are generally neither well-understood nor well-described. This study intends to contribute to an emerging literature around methodological approaches to rapid review in HTA by outlining those developed and implemented by the Canadian Agency for Drugs and Technologies in Health (CADTH). Since 2005, CADTH has developed and implemented a rapid review approach that synthesizes evidence to support informed healthcare decisions and policy. Rapid Response reports are tailored to the identified needs of Canadian health decision makers, representing a range of options with regard to depth, breadth, and time-to-delivery. Preliminary observations indicate that CADTH's approach to rapid evidence review is generally well-received by Canadian health decision makers; real-world case studies provide pragmatic examples of how health decision makers have used Rapid Response reports to support evidence-informed health decisions across Canada. Rapid review is becoming an increasingly important approach to evidence synthesis, both within and external to the field of HTA. Transparent reporting of the methods used to develop rapid review products will be critical to the assessment of their relevance, utility and effects in a range of contexts.

The End of X‐rays for Suspected Small Bowel Obstruction? Using Evidence‐based Diagnostics to Inform Best Practices in Emergency Medicine

The End of X‐rays for Suspected Small Bowel Obstruction? Using Evidence‐based Diagnostics to Inform Best Practices in Emergency Medicine

Knowledge Integration in Cancer: Current Landscape and Future Prospects

Knowledge integration includes knowledge management, synthesis, and translation processes. It aims to maximize the use of collected scientific information and accelerate translation of discoveries into individual and population health benefits. Accumulated evidence in cancer epidemiology constitutes a large share of the 2.7 million articles on cancer in PubMed. We examine the landscape of knowledge integration in cancer epidemiology. Past approaches have mostly used retrospective efforts of knowledge management and traditional systematic reviews and meta-analyses. Systematic searches identify 2,332 meta-analyses, about half of which are on genetics and epigenetics. Meta-analyses represent 1:89-1:1162 of published articles in various cancer subfields. Recently, there are more collaborative meta-analyses with individual-level data, including those with prospective collection of measurements [e.g., genotypes in genome-wide association studies (GWAS)]; this may help increase the reliability of inferences in the field. However, most meta-analyses are still done retrospectively with published information. There is also a flurry of candidate gene meta-analyses with spuriously prevalent "positive" results. Prospective design of large research agendas, registration of datasets, and public availability of data and analyses may improve our ability to identify knowledge gaps, maximize and accelerate translational progress or-at a minimum-recognize dead ends in a more timely fashion.

Family Physician Participation in Maintenance of Certification

The American Board of Family Medicine has completed the 7-year transition of all of its diplomates into Maintenance of Certification (MOC). Participation in this voluntary process must be broad-based and balanced for MOC to have any practical national impact on health care. This study explores family physicians' geographic, demographic, and practice characteristics associated with the variations in MOC participation to examine whether MOC has potential as a viable mechanism for dissemination of information or for altering practice. To investigate characteristics associated with differential participation in MOC by family physicians, we performed a cross-sectional comparison of all active family physicians using descriptive and multinomial logistic regression analyses. Eighty-five percent of active family physicians in this study (n = 70,323) have current board certification. Ninety-one percent of all active board-certified family physicians eligible for MOC are participating in MOC. Physicians who work in poorer neighborhoods (odds ratio [OR] = 1.105; 95% confidence interval [CI], 1.038-1.176), who are US-born or foreign-born international medical graduates (OR = 1.221; 95% CI, 1.124-1.326; OR = 1.444; 95% CI, 1.238-1.684, respectively), or who are solo practitioners (OR = 1.460; 95% CI, 1.345-1.585) are more likely to have missed initial MOC requirements than those from a large, undifferentiated reference group of certified family physicians. When age is held constant, female physicians are less likely to miss initial MOC requirements (OR = 0.849; 95% CI, 0.794-0.908). Physicians practicing in rural areas were found to be performing similarly in meeting initial MOC requirements to those in urban areas (OR = 0.966; 95% CI, 0.919-1.015, not significant). Large numbers of family physicians are participating in MOC. The significant association between practicing in underserved areas and lapsed board certification, however, warrants more research examining causes of differential participation. The penetrance of MOC engagement shows that MOC has the potential to convey substantial practice-relevant medical information to physicians. Thus, it offers a potential channel through which to improve health care knowledge and medical practice.

How has research into cytokine interactions and their role in driving immune responses impacted our understanding of periodontitis?

To review current knowledge on cytokine interactions and the cytokine-mediated links between innate and adaptive immunity that are relevant to the pathophysiology of periodontitis. A structured review of the literature was undertaken to identify relevant research publications using a Medline search from 1950 to September 2010. The focus of the search was on the functional role of cytokines, i.e. their actions and responses relevant to the pathogenesis of periodontal disease rather than more descriptive studies of their expression in tissues and body fluids. It was not possible to conduct a traditional systematic review with a focussed question due to the heterogeneity of published research. There is enormous heterogeneity in the periodontal literature in terms of experimental approaches. We have the deepest understanding of the role of the pro-inflammatory cytokines [e.g. interleukin (IL)-1β, tumour necrosis factor-α, IL-6] with accumulating data on T-cell regulatory cytokines (e.g. IL-12, IL-18), chemokines and cytokines which mediate bone cell development and function (e.g. receptor activator of NF-κB ligand, osteoprotegerin). It is clear that there are multiple, overlapping and complex functional links between cytokines with regulatory control exerted at a number of levels and involving numerous cell types (both immune cells and resident cells in the periodontium). Cytokines appear to interact functionally in networks in the periodontium and integrate aspects of innate and adaptive immunity. However, our understanding is far from complete, particularly how molecular and cellular pathways relate to disease pathogenesis. We should adopt consistent experimental approaches to gain better insight into the totality of cytokine networks and how they drive immune responses in the periodontium.

Metoda analizy i krytyki piśiennictwa w nauce o informacji i bibliotekoznawstwie w XXI wieku

Artykuł zawiera charakterystykę wybranych aspektów metody analizy i krytyki piśmiennictwa. Stwierdzono znaczący wzrost zainteresowania tym sposobem postępowania badawczego w informatologii i bibliotekoznawstwie w XXI w. Rozważono dwie podstawowe role analizy i krytyki piśmiennictwa w dociekaniach naukowych - pomocniczą, heurystyczną oraz niezależną, wiedzotwórczą. Wskazano jej fazy i warianty, w tym - wersję tradycyjną, przegląd systematyczny i metaanalizę. Przedstawiono wyniki badań pilotażowych, dotyczących niektórych własności metody analizy i krytyki piśmiennictwa we współczesnej nauce o informacji i bibliotekoznawstwie.

Expediting systematic reviews: methods and implications of rapid reviews.

BackgroundPolicy makers and others often require synthesis of knowledge in an area within six months or less. Traditional systematic reviews typically take at least 12 months to conduct. Rapid reviews streamline traditional systematic review methods in order to synthesize evidence within a shortened timeframe. There is great variation in the process of conducting rapid reviews. This review sought to examine methods used for rapid reviews, as well as implications of methodological streamlining in terms of rigour, bias, and results.MethodsA comprehensive search strategy--including five electronic databases, grey literature, hand searching of relevant journals, and contacting key informants--was undertaken. All titles and abstracts (n = 1,989) were reviewed independently by two reviewers. Relevance criteria included articles published between 1995 and 2009 about conducting rapid reviews or addressing comparisons of rapid reviews versus traditional reviews. Full articles were retrieved for any titles deemed relevant by either reviewer (n = 70). Data were extracted from all relevant methodological articles (n = 45) and from exemplars of rapid review methods (n = 25).ResultsRapid reviews varied from three weeks to six months; various methods for speeding up the process were employed. Some limited searching by years, databases, language, and sources beyond electronic searches. Several employed one reviewer for title and abstract reviewing, full text review, methodological quality assessment, and/or data extraction phases. Within rapid review studies, accelerating the data extraction process may lead to missing some relevant information. Biases may be introduced due to shortened timeframes for literature searching, article retrieval, and appraisal.ConclusionsThis review examined the continuum between diverse rapid review methods and traditional systematic reviews. It also examines potential implications of streamlined review methods. More of these rapid reviews need to be published in the peer-reviewed literature with an emphasis on articulating methods employed. While one consistent methodological approach may not be optimal or appropriate, it is important that researchers undertaking reviews within the rapid to systematic continuum provide detailed descriptions of methods used and discuss the implications of their chosen methods in terms of potential bias introduced. Further research comparing full systematic reviews with rapid reviews will enhance understanding of the limitations of these methods.

Missing the forest (plot) for the trees? A critique of the systematic review in tobacco control.

BackgroundThe systematic review (SR) lies at the core of evidence-based medicine. While it may appear that the SR provides a reliable summary of existing evidence, standards of SR conduct differ. The objective of this research was to examine systematic review (SR) methods used by the Cochrane Collaboration ("Cochrane") and the Task Force on Community Preventive Services ("the Guide") for evaluation of effectiveness of tobacco control interventions.MethodsWe searched for all reviews of tobacco control interventions published by Cochrane (4th quarter 2008) and the Guide. We recorded design rigor of included studies, data synthesis method, and setting.ResultsAbout a third of the Cochrane reviews and two thirds of the Guide reviews of interventions in the community setting included uncontrolled trials. Most (74%) Cochrane reviews in the clinical setting, but few (15%) in the community setting, provided pooled estimates from RCTs. Cochrane often presented the community results narratively. The Guide did not use inferential statistical approaches to assessment of effectiveness.ConclusionsPolicy makers should be aware that SR methods differ, even among leading producers of SRs and among settings studied. The traditional SR approach of using pooled estimates from RCTs is employed frequently for clinical but infrequently for community-based interventions. The common lack of effect size estimates and formal tests of significance limit the contribution of some reviews to evidence-based decision making. Careful exploration of data by subgroup, and appropriate use of random effects models, may assist researchers in overcoming obstacles to pooling data.

Evidence-based gender findings for children affected by HIV and AIDS – a systematic overview

This review (under the International Joint Learning Initiative on Children and AIDS) provides a detailed evidence analysis of gender, children and AIDS. Six systematic reviews provide the most up to date evidence base on research surrounding children and HIV on key topics of treatment resistance and adherence, schooling, nutrition, cognitive development and orphaning and bereavement. Traditional systematic review techniques were used to identify all published studies on four key topics, then studies were selected according to adequacy criteria (sufficient size, control group and adequate measures). A gender analysis was performed on included studies, detailing whether gender was measured, results were analysed by gender or any gender-based findings. For family studies, both the gender of the parents and gender of the child are needed. Secondary analysis by gender was performed on existing systematic reviews for treatment resistance and adherence. Of the 12 studies on treatment resistance, 11 did not look at gender. One found boys at a seven-fold risk compared to girls. For medication adherence, gender was not significant. Of the 15 studies on schooling, 12 analysed findings by gender with an overall female disadvantage. Of the 14 studies on nutrition, nine analysed by gender with mixed findings. Of the 54 studies on cognitive development, 17 provided gender data, but only four analysed by gender with few differences established. Of the 15 studies on bereavement, seven analysed data by gender again with mixed findings. Major policies fail to provide gender data for young children. WHO, UNAIDS and the international data sets are not gathered or coded by gender for young children (generally under 15 years of age) despite well-established gender challenges in later life. This review shows that the current evidence base is inadequate. Data on gender variation and outcome are urgently needed to inform policy and research on children and HIV.

Conducting systematic reviews to inform occupational therapy practice.

Systematic reviews (SRs) are increasingly used in the health professions to evaluate research evidence to guide practice and justify reimbursement for services. Despite the importance of SRs in the health professions, there is no definitive guide for how to conduct a useful, high-quality review. In this article we will (1) provide an overview of the process of writing a traditional SR with particular emphasis on design and conduct, (2) discuss limitations of the traditional SR in occupational therapy, and (3) describe how information is synthesized and used for clinical practice.