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Systematic Reviews: Consolidating Research Evidence for EBP 51 © style_TTT/Shutterstock © Jones & Bartlett Learning, LLC CHAPTER© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Systematic Reviews: Consolidating © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEResearch OR DISTRIBUTION EvidenceNOT for FOR EBPSALE OR DISTRIBUTION THEODORA D. KWANSA © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT problem/phenomenonFOR SALE OR DISTRIBUTION and the related review question(s) might relate to the effects of clinical intervention, healthcare CHAPTER OBJECTIVES policy, or the effectiveness of specifi c aspects of professional The main objectives of this chapter are to: practice. Identifying, compiling, critiquing, summarizing, and condensing the best available evidence and synthesiz- • Explore the significance, rationale, and benefits © Jones & Bartlett Learning, LLCing these compose the stages© ofJones systematic & Bartlett review. As Learning, the LLC of systematic reviews NOT FOR SALE OR DISTRIBUTIONname suggests, systematic reviewsNOT areFOR rigorous SALE in ORterms DISTRIBUTION of • Examine the process of reviewing, condensing, following exact processes, transparent in terms of being and summarizing research evidence applicable to different contexts in actual situations, and • Describe the processes of data extraction and repeatable. They provide cumulative evidence from the abstraction fi ndings of pertinent studies that policy makers and clinical ©• Jones Identify the& Bartlettprocesses ofLearning, quantitative LLCresearch practitioners© canJones draw &on. Bartlett Thus, systematic Learning, reviews LLC can be NOTsynthesis, FOR SALEmeta-analysis, OR DISTRIBUTION and the PRISMA used to employNOT evidence-based FOR SALE bestOR practice,DISTRIBUTION designed to statement achieve positive outcomes and patient satisfaction. Other • Explore the approaches to synthesizing qualitative benefi ts include helping to inform and direct policy, and research evidence and the related terminologies clinical decision making, and the development of standards • State the need for systematic reviews, meta- to ensure correct implementation of recommended guidelines. © Jones & Bartlettanalysis, Learning, and qualitative LLC research synthesis © Jones Hemingway & Bartlett and Learning, Brereton (2009)LLC identifi ed specifi c NOT FOR SALE OR DISTRIBUTION NOT professionalsFOR SALE and OR stakeholders DISTRIBUTION who may require sound and trustworthy information at varied times, on a considerable range of interventions and aspects of healthcare delivery. Introduction Healthcare practitioners—clinicians, nurses, therapists, and healthcare managers—as well as policy makers, patients, and This chapter focuses on systematic reviews of multiple © Jones & Bartlett Learning, LLCconsumer representatives may,© at Jones some time & Bartlettor another, Learning,seek LLC studies with similar design(s) and method(s) and combining specifi c evidence-based information on clinical interventions and condensing the fiNOT ndings FOR for evidence-based SALE OR DISTRIBUTION support NOT FOR SALE OR DISTRIBUTION or aspects of the healthcare policy, such as the effects, prac- of professional practice. Meta-analysis, which allows for ticality, signifi cance, and the relevance of certain aspects of pooling and interpreting emerging concepts to create new professional practice or a specifi c treatment. These authors theories, is also explored. note that systematic reviews help to ease the additional demand © Jones & Bartlett Learning, LLC on practitioners© Jones who may & Bartlettbe inundated Learning, with several LLC reports TheNOT Rationale FOR SALEand Advantages OR DISTRIBUTION and emergingNOT new FOR fi ndings SALE from ORnumerous DISTRIBUTION research studies. of Systematic Reviews for EBP Practitioners constantly face the challenge and professional expectation to keep up to date with ongoing advances in sci- Generally, systematic reviews are informative overviews of entifi c techniques and new procedural interventions. Emerging carefully selected primary research studies that have rigor- new ideas often involve implementing changes in policy, clini- © Jones &ously Bartlett applied Learning,specifi c research LLC design(s), methodology, and© Jonescal decisions, & Bartlett and guidelines Learning, (Brown LLC et al., 2006; Crombie & NOT FORmethods SALE to OR investigate DISTRIBUTION a clinical problem/phenomenon. ThisNOT Davies,FOR SALE2009; Petticrew, OR DISTRIBUTION 2003; Petticrew & Roberts, 2006). 49 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284114942_CH03.indd 49 06/11/17 2:24 pm 50 PART I Exploration of the Concept of Evidence-Based Practice and Related Practical Challenges © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Without a doubt, information from a large amount of Despite the above observations, as Petticrew (2003) NOT FORresearch SALE is easierOR DISTRIBUTION to grasp when condensed in a systematicNOT remarked, FOR SALE systematic OR DISTRIBUTIONreviews are often criticized for not review (Hemingway & Brereton, 2009). Earlier proponents, incorporating precise guidance on what indicates evidence including Oxman (1993), maintained that the pooling of of effective or ineffective interventions. However, reviews several studies yields better assurance, in terms of more of healthcare interventions may not yield enough evidence comprehensive evidence,© about Jones the &effectiveness Bartlett ofLearning, specific LLCto answer precise questions ©on Jones the effectiveness & Bartlett or inef Learning,- LLC interventions. Systematic reviews allow for determining and fectiveness of specific interventions. Perhaps practitioners confirming consistencyNOT in studies FOR that SALE are conducted OR DISTRIBUTION across might find it less daunting toNOT conduct FOR systematic SALE ORreviews DISTRIBUTION different clinical contexts and targeting comparable patient if they could find review guidelines that state parameters populations. A single independent study, by contrast, may and instructions for applying them to ensure standard- fall short of being generalizable to other population groups. ization. Arguably, non-systematic review is a quick way Systematic© Jones reviews & Bartlett have the Learning, additional benefit LLC of thor- to put forth© introductory Jones & Bartlettpapers on Learning,specific opinions LLC on oughness as long as the reviewer(s) use well-designed and policy and practice. Nonetheless, that process falls short approvedNOT frameworks. FOR SALE Conducted OR DISTRIBUTION correctly, systematic of providingNOT an all-inclusive FOR SALE combination OR DISTRIBUTION of best avail- reviews can provide a clearer picture of the overall effects, able evidence. The general view is that a non-systematic both positive and adverse, of particular clinical interven- review carried out carelessly and incorrectly can yield tions. In addition to confirming what is already known, serious misrepresentation of detail and cause confusion. © Jonessystematic & Bartlett reviews Learning, also help LLCto identify the deficits or gaps© JonesPetticrew & Bartlett (2003) examined Learning, the reasonsLLC for the lack of in professional knowledge and practice and thus provide specific guidance for systematic reviews of social and NOT FORa guideSALE for OR future DISTRIBUTION research Brown et al., 2006; Petticrew,NOT healthcare FOR SALE interventions. OR DISTRIBUTION He highlighted Millward, Kelly, 2003; Petticrew & Roberts, 2006). Crombie and Davies and Nutbeam’s 2001 work, which showed a limitation in (2009) note that a key feature of systematic reviews is the the number of trials in social and health care and reviews unbiased critical appraisal of all the available relevant studies. involving outcome assessments. A concise summation of© the Jones rationales, & Bartlett main benefits, Learning, and LLC © Jones & Bartlett Learning, LLC the significance of systematic reviews is outlined in Box 3-1. NOT FOR SALE OR DISTRIBUTIONNon-Systematic ReviewsNOT Examined FOR SALE OR DISTRIBUTION BOX 3-1 Summary of the Emphasis on Non-systematic reviews do not necessarily aim to identify Systematic Reviews for EBP all the relevant published studies that applied a specific research design or methodology to investigate a specific © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Provide cumulative evidence from relevant avail- clinical problem. Rather than critically appraising and NOTable FOR studies SALE to inform OR clinical DISTRIBUTION practitioners and synthesizingNOT the research FOR SALEfindings, OR non-systematic DISTRIBUTION reviews policy and decision makers characteristically present a broad discussion of the find- Provide sound evidence basis for guiding organi- ings from some studies and substantiate with relevant zational policy decisions on standards of health references. Additionally, non-systematic reviews do not care and practice require adherence to an exact and precise review protocol. © Jones & BartlettReveal theLearning, impact of specific LLC policy regulations © JonesConsequently, & Bartlett without Learning, compliance LLCor application of specific NOT FOR SALEon OR particular DISTRIBUTION aspects of professional practice NOTpre-set FOR criteriaSALE toOR the DISTRIBUTION study selection, a non-systematic Yield better assurance,
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