1. Systematic Reviews E.B.N Prepared By Dr. Nahed Said Al Nagger

2. Lecture VI

3. Learning Objectives • Define systematic review. • Identify what is the systematic review. • State the purpose of systematic review. • Describe how to conduct systematic review. • Explain the characteristics of systematic review. • Discuss Cochrane collaborations & library.

4. Glossary Define systematic review? A summary of the medical literature that uses clear methods to perform a comprehensive literature search and critical appraisal of individual studies and that uses appropriate statistical techniques to combine these valid studies.

5. Review vs. systematic review • Review Isan article that summarizes a number of different primary studies and may draw conclusions about the effectiveness of a particular intervention. A review may or may not be systematic. continue

6. Review vs. systematic review • Systematic review (systematic overview) A review of the evidence on a clearly formulated question that uses systematic and clear methods to identify, select and critically appraise relevant primary research, and to remove and analyze data from the studies that are included in the review by using statistical methods (meta-analysis).

7. What are the Meta-analysis? A systematic review that uses quantitative methods to make and summarize the results.

8. What are TheForms of Systematic Review? • Systematic Reviews takes many shapes and forms, depending on the type and expertise of the audience. - Chapters in textbooks. - Report to expert committees. - State of the art reviews for clinical journals. They include

9. What is the purpose of systematic review? The main purpose of systematic reviews is to bring their audience rapidly up to speed with the current information of specific clinical areas.

10. How to conduct a systematic review? • State objectives and hypotheses. • Outline eligibility criteria, stating types of study, types of participants, types of interventions and outcomes to be examined. continue

11. How to conduct a systematic review ( cont.,)? • Perform a comprehensive search of all relevant sources for potentially eligible studies. • Examine the studies to decide eligibility.

12. How to conduct a systematic review (cont.,): • Construct a table describing the characteristics of the included studies. • Assess methodological quality of included studies.

13. How to conduct a systematic review (cont.,): • Extract data (with a second investigator if possible) with involvement of investigators if necessary. • Analyse results of included studies, using statistical synthesis of data (meta-analysis ), if appropriate. • Prepare a report of review, stating aims, materials and methods, and describing results and conclusions.

14. Summary of steps in conducting systematic literature reviews Summary of steps in conducting systemic literature reviews

15. Why do we need reviews ? • Need much information to make the right decision. • Not enough time – busy physician & nurses.

16. Which is Cochrane Systematic Reviews? • It is an international organization. • It prepares, maintains and promotes the accessibility of systematic reviews of the effects of health care interventions.  CochraneCollaboration

17. What is the Cochrane Collaboration Logo? • Illustrates a systematic review • of data from 7 randomized controlled trials • (RCT) comparing one health care treatment with a placebo. • Each horizontal line represents results of one trial.  

18. Characteristics of Cochrane Reviews • High quality, • Up-to-date systematic reviews • Intended to help decision makers to cope with the large volume of literature by summarizing the reliable evidence of the benefits and risks of healthcare. continue

19. Characteristics of Cochrane Reviews • limit bias and reduce chance effects, thus providing more reliable results for drawing decisions about health care.  

20. Cochrane Collaboration (cont.) • The target audience for Cochrane reviews are people making decisions about healthcare. • It has 15 centers worldwide, with 7000 members. • Each subject area in health care is covered by a specialized Cochrane review group.

21. What are the role of review group of Cochrane collaborations? • Determining the objectives and eligibility criteria for including trials. • Identifying studies that are likely to meet the eligibility criteria. • Tabulating the characteristics and assessing the methodological quality of each study identified.

22. Role of review group of Cochrane collaborations ( CONT.) • Excluding studies that do not meet the eligibility criteria. • Compiling the most complete set of data feasible, involving the investigators if possible. • Analyzing the results of eligible studies, using a meta-analysis or statistical synthesis of data if appropriate and possible.

23. Role of review group of Cochrane collaborations ( CONT.) - Performing sensitivity analyses if appropriate and possible. • preparing a structured report of the review that states the aims of the review, describes the materials and methods used and reports the results.

24. What are the aims of Cochrane collaboration? • Evidence –based. • Easily accessible. • Internationally developed. • Quality controlled. • Clinically useful. • Periodically updated.

25. Which is Cochrane Library? • The Cochrane Library is the product of the Collaboration's work and includes reports and protocols of over 1000 systematic reviews produced within the Collaboration, abstracts of over 1800 reviews summarized and critically appraised by the Centre for Reviews. • The Cochrane Library is the most comprehensive source of updated systematic review.

26. √ Use the Cochrane Library to answer questions such as: • Is treatment effective? • Is accepted practice "best” practice? • What is the best treatment?

27. Do not use Cochrane Library for answering the following questions: -To obtain general health care information -To answer queries on causation, prognosis & epidemiology.   -To search for clinical practice guidelines.

28. What is the Cochrane Collaboration Logo? • Illustrates a systematic review • of data from 7 randomized controlled trials • (RCT) comparing one health care treatment with a placebo.

29. Clinical Scenario

30. Step OneIdentify the Burning Question • An example of a unit based clinical question might be: • How do I assess pain in a ventilated • non-communicative patient ? ?

31. Step TwoCollect Most Relevant and Best Evidence • How do I find current research on pain in this patient population? • Find what is in the literature! • Literature Search • How do I do that at Shands?

32. Now let’s show you how to begin a search of the literature at Shands from your computer desktop

33. Getting Started on your Literature SearchClick on Internet Explorer on desktop

34. In the address bar, type in www.borland.ufl.edu Press Enter or click <Go>

35. You will arrive at the Borland Health Sciences Library Main Page

36. Once you arrive at the Borland Library main page you will be able to begin your search by using various Databases

37. Databases • PubMed- a comprehensive database that searches multiple medical sources • CINAHL – a nursing focused database: Cumulative Index of Nursing and Allied Health Literature • There are several databases available but, we will use these three in this module

38. At the Borland Health Sciences Library Site you can double - click on:PubMed

39. At the PubMed site, type in your search word/s • Search Word/sare areas of interest on a specific clinical topic or problem. • Example:“Pain assessment in the ventilated patient”

40. PUBMED is a database that searches multiple medical sourcesAt the PubMed site, type in your search word/s

41. We found 9 articles on this initial search Use the scroll bar to view more

42. <Double Click> on the blue author names and you will go to the article !

43. You can change your search word combination to get additional articles

44. Sometimes you will have access to the entire article by clicking on Full Text or Online

45. Other times you may have to go to the library and find the journal “in print”

46. Cochrane Library Access: On Databases page, enter cochrane. • Effectiveness of using acupuncture for low back pain • efficacy of asthma self-management education on health outcomes in children

47. Cochrane: Search Results • Tips: click on Cochrane Reviews to see systematic reviews: Click on Other Reviews for an abstract of review of an individual RCT; Click on Clinical Trials to see individual RCT.

48. CINAHL • The use of probiotics to treat urinary tract infections Tips: Perform a subject search using CINAHL Headings; Limit search results to special interest: evidence-based practice

49. Let’s Try a Different Method of Searching the LiteratureStart at the Borland Health Sciences Library Main Page and Click on <Databases>

50. This Page Will Appear after clicking on <Databases>A Commonly Used Database for Nursing is CINAHL (Click Here)