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How to Get Started with a Systematic Review in Epidemiology: an Introductory Guide for Early Career Researchers

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How to Get Started with a Systematic Review in Epidemiology: an Introductory Guide for Early Career Researchers Denison et al. Archives of Public Health 2013, 71:21 http://www.archpublichealth.com/content/71/1/21 ARCHIVES OF PUBLIC HEALTH METHODOLOGY Open Access How to get started with a systematic review in epidemiology: an introductory guide for early career researchers Hayley J Denison1*†, Richard M Dodds1,2†, Georgia Ntani1†, Rachel Cooper3†, Cyrus Cooper1†, Avan Aihie Sayer1,2† and Janis Baird1† Abstract Background: Systematic review is a powerful research tool which aims to identify and synthesize all evidence relevant to a research question. The approach taken is much like that used in a scientific experiment, with high priority given to the transparency and reproducibility of the methods used and to handling all evidence in a consistent manner. Early career researchers may find themselves in a position where they decide to undertake a systematic review, for example it may form part or all of a PhD thesis. Those with no prior experience of systematic review may need considerable support and direction getting started with such a project. Here we set out in simple terms how to get started with a systematic review. Discussion: Advice is given on matters such as developing a review protocol, searching using databases and other methods, data extraction, risk of bias assessment and data synthesis including meta-analysis. Signposts to further information and useful resources are also given. Conclusion: A well-conducted systematic review benefits the scientific field by providing a summary of existing evidence and highlighting unanswered questions. For the individual, undertaking a systematic review is also a great opportunity to improve skills in critical appraisal and in synthesising evidence. Keywords: Systematic review, Systematic review methods, Meta-analysis, Early career researchers, Evidence synthesis, Observational studies Background or significance of the result, thus reducing bias and im- Systematic review is a powerful research tool which aims proving our confidence in the conclusions [2]. A well- to identify and synthesize all evidence relevant to a re- conducted systematic review benefits the scientific com- search question. It is an improvement on a standard li- munity by providing a summary of existing evidence as terature review as it uses systematic methods to search well as identifying where knowledge is lacking [3]. In for, assess and combine the evidence [1]. The approach this way, systematic reviews are an important driver taken is much like that used in a scientific experiment, of research. Systematic reviews also provide decision- with high priority given to the transparency (and repro- makers with synthesized, reliable information which ducibility) of the methods used and to handling all evi- can then be used in policy-making. For example, the dence in a consistent manner. Cochrane Collaboration [4] produces and maintains sys- Systematic reviews aim to include all literature that is tematic reviews of the effectiveness of healthcare inter- relevant to the review question, no matter the direction ventions which have been primarily assessed using randomised trials. Systematic reviews can also be used * Correspondence: [email protected] † to combine the results of observational studies. This may Equal contributors help to highlight a future type of intervention to be in- 1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK cluded in a randomised trial [5], or to explore underlying Full list of author information is available at the end of the article © 2013 Denison et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Denison et al. Archives of Public Health 2013, 71:21 Page 2 of 8 http://www.archpublichealth.com/content/71/1/21 aetiological questions looking at the association between Developing a protocol risk factor(s) and the outcome of interest [6-8]. Before you begin your systematic review, it is imperative Systematic review is employed across a huge range of that you first develop a protocol that is agreed by all re- scientific disciplines, not only medicine, and may be viewers. This is important for several reasons. Firstly, it used by researchers of all levels. Early career researchers focuses the purpose of the review and ensures all re- (ECRs) may find themselves in a position where they de- viewers are agreed on this. It also establishes a priori cide to undertake a systematic review, for example a sys- how the review will be carried out, and ensures meth- tematic review may form part or all of a PhD thesis. odological consistency between reviewers. Finally, it Systematic reviews are often a major piece of work, and serves as a useful reference during the review process, may take considerable time to conduct. However, the for example when screening articles it will be helpful to returns from such a piece of work are potentially consid- have details of the inclusion criteria to hand. erable because they summarize all of the evidence in Your protocol needs to contain enough information to relation to a particular question. There are other advan- enable all reviewers to be able to carry out the review in tages, for example there is no collection of primary data a consistent manner. The first fundamental step in de- which can be costly and time-consuming, and review signing a review protocol is to accurately define the work gives a potentially broad exposure to a certain main aims of the review together with some background topic as well as epidemiological research in general. information. The review question should be clearly It is strongly advised that systematic reviews are car- stated, and may be one broad question or be broken ried out by at least two reviewers who work independ- down into smaller, more specific objectives. Take time to ently to screen abstracts, extract data and assess risk of consider the review question when designing your bias, thereby reducing the chance of reviewer bias and search strategy. When considering aetiological questions, increasing reliability. Those with no prior experience of the search strategy will focus on information relating to systematic review may need considerable support and the exposure and outcome which could be considered as direction getting started with such a project. Therefore, the overlap between two different subjects. For example, we have aimed to put together a guidance article, aimed searching for articles about the relationship between at ECRs, that sets out in simple terms how to get started having peripheral neuropathy and then having falls as a with a systematic review. This is not a comprehensive consequence will produce a much smaller number of re- guide, but rather a useful starting point encompassing sults than looking for either on their own (see Figure 1). signposts to other resources. The process of systematic This is referred to as an exposure/outcome model. review may be applied to many types of study, including The methods section of the protocol will cover the whole both observational and trial designs, and where data is process of the review. It should include details about the collected using quantitative or qualitative approaches. search strategy: which databases and years of publication For the purposes of this guide, we will be focusing on are to be searched; what types of search terms will be used the process of reviewing observational studies which (see Table 1); how the screening will be carried out; and have used quantitative methods. Reviewing qualitative what other methods of obtaining data will be used (such as research may involve quite different methodology to that screening reference lists and contacting authors). Inclusion presented here, so alternative resources for guidance criteria for the review will relate directly to the review on this topic are suggested. A good starting point is question, and should be outlined in sufficient detail that the Cochrane Qualitative and Implementation Methods other researchers could apply them. Group website [9]. Discussion Identifying the need for a systematic review Before embarking on a systematic review, it is important to check that you will not be duplicating existing re- search. You will therefore need to perform a literature search specifically looking for a systematic review on your topic, as well as checking databases which pro- spectively record systematic reviews such as PROSPERO [10]. If you do find an existing review, you will need to consider if a further one is now warranted (for example, because relevant research has been published in the in- Figure 1 Defining a search question: exposure/outcome model. terim period) [11]. Denison et al. Archives of Public Health 2013, 71:21 Page 3 of 8 http://www.archpublichealth.com/content/71/1/21 Table 1 Two main approaches to searching databases for Searching articles Searching databases MeSH (Medical Subject Headings) Terms Your search strategy should involve searching relevant da- ● Denoted by a trailing slash, e.g. Accidental Falls/ tabases of published peer-reviewed literature. MEDLINE ● The complete set of MeSH terms can be searched at http://www. and EMBASE are the preferred primary sources, and both nlm.nih.gov/mesh/ should be searched concurrently to ensure comprehensive ● Usual to put the explode operator beforehand, telling the database coverage of the literature [14,15]. There may also be sev- that you want articles with the given term as well as terms in eral other databases which are relevant to your review relevant sub-categories, e.g. exp Accidental Falls/ question; it is worth looking through a list such as that ● Those for the EMBASE database (“EMTREE”) include all of the MeSH provided by the Centre for Reviews and Dissemination terms (CRD) to identify these. Having selected which databases ● Look at terms assigned to relevant articles which you already have to use, you then need to choose a search system to run Free-text terms your searches.
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