Ch 9: Systematic Reviews

4) Extract, Analyze, & Synthesize

* extract basic information about design, sample, study variables, & results. *enter study information into evidence tables & create lists in order to identify differences & commonalities & patterns. * these similarities & differences are further explored to determine the reason for the differences. *assumptions, inclusion & exclusion, & faulty reasoning can affect conclusions.

1) Formulate the Topic or Question.

*A review panel with expertise in the issue of interest identifies a topic/issue/problem that needs summarization. *A review panel (vs an individual) has > potential to conduct an IRR that is free of error & bias due to "checks & balances." *broad topic requires retrieval/appraisal of > # of studies vs narrow topic; this = Scope.

Non-randomized studies

*ie.: cohort, case controlled, controlled before & after. *provide evidence of benefit or harm of interventions, particularly long-term & rare

Use of IRRs

*increasingly published in clinical journals -> guide clinical teams to design nursing protocols. *well-conducted, recent IRR saves a clinical project from having to identify, retrieve, appraise, analyze, & summarize research findings. *conclusions are interpretations of findings.

3) Appraise

*relevant studies are carefully appraised fro quality. *eliminate studies that are biased or not credible d/t methods used. *sort final articles into subtopics.

5) Produce Report

*reports open with stating the problem & why important. *note if focused on population or setting, and one or several outcomes. *explain the process that was used to search for study reports including databases searched, key terms used, & any inclusion or exclusion criteria. *utilizes tables to display quick overview of methods & results of the studies. *reports findings that are consistent, conflicting, & equivocal as well as gaps in research base -> bottom line conclusions are set forth. *indicate how their conclusions square with prior work on the topic, summarize the limitations of the body of research & offer opinions regarding the clinical implications of the conclusions.

Types of studies included

*review panel decides which studies to include based on clinical issue. *previously, an SR only included randomized (experimental) studies. *SRs about treatment effectiveness now recognize the contributions of qualitative/observational/non-experimental studies.

2) Systematically search for studies & Screen for Relevance

*review panel includes a health science librarian d/t expertise in locating research reports. *search starting point = computerized databases (only includes published studies). *initial goal = identify ALL potential studies. *read abstracts -> reduces the # of articles by eliminating non-research reports or off topic studies. *two or more persons use inclusion criteria to determine which studies are relevant.

Goal of Analysis

*to reach a conclusion -> Synthesis: combining of conclusions/findings from many studies.

List the steps reviewers perform when conducting SRs.

1) Formulate the Topic or Question. 2) Systematically search for studies & Screen for Relevance 3) Appraise 4) Extract, Analyze, & Synthesize 5) Produce Report *these steps have been set to control error & bias.

Name and describe the three types of (SRs).

1) Integrative research review (chapter focus) 2) Meta-analysis 3) Metasynthesis

Who sets the methods for conducting SRs?

1) Joanna Briggs Institute. 2) Cochrane Collaboration. 3) Institute of Medicine

List 5 things that make SRs different from literature reviews.

1) Prescribed Criteria 2) Production Process Reporting 3) Research Reports 4) What is reported 5) Quality Filter

Qualitative studies unique contribution

1) pt's perceptions about treatment 2) problems pts have following a regimen 3) consistent integration of tx recommendations into pt's daily lives 4) quality of life outcomes associated with tx

Metasynthesis

A SR review in which findings from several (or many) QUALitative studies examining an issue are merged to produce generalizations and theories.

Meta-analysis

A SR review involving a statistical pooling of the results from several (or many) QUANtitative studies examining an issue to produce a statistical result with the larger sample size.

Integrative research review (IRRs) (AKA: State-of-the-Science Summary, Narrative Review or Qualitative SRs)

A narrative summary SR of past research in which the findings from various studies are integrated using logical/analytical reasoning + findings tables & lists -> conclusions. *MORE commonly found in clinical nursing journals.

Database

A structured, updated collection of informational records about articles, books, and other resources; access to the records is managed with computer software. *ex: CINAHL, MEDLINE, and PsycINFO.

Appraisal

Making objective, systematic judgments regarding the credi¬bility, clinical significance, and applicability of research evidence to deter¬mine if changes in practice should be made based on the evidence

What is the goal of an SR?

Reach conclusions regarding specific issues by compiling & analyzing findings from several studies.

What is reported

SRs are based on a wide & diligent search for studies vs LRs are selective in what they report.

Production Process Reporting

SRs are expected/require a detailed report about how they were done/production process vs with LRs there is no production process. *increases the likelihood of LRs bias.

Research Reports

SRs only utilize research reports from large databases vs LRs can include essays, anecdotal accounts & opinion.

What are systematic reviews and what purpose do they serve?

SRs pull together the findings of various studies into one document -> bigger picture. Should be done carefully so as not to introduce bias into conclusions.

Quality Filter

SRs use a quality filter either to exclude poor quality studies or to categorize the quality of studies included.

Delivery System

The context in which direct clinical care is given; it is made up of a network of logistics including patient flow, scheduling, communications, supplies and equipment availability, role responsibilities, work patterns, accountability structures, and other work dynamics that support direct patient care.

Scope

The range or breadth of a question, project, review, or guideline including a description of what is included. *The broader the issue/topic, the > resources required to conduct the review -> more difficult the summary is to produce -> longer the report.

Prescribed Criteria

There is prescribed criteria regarding how an SR should be done vs LRs have NO prescribed process. *increases the likelihood of LRs bias.