This document provides an overview of systematic reviews and the Support Unit for Research Evidence (SURE). It discusses why systematic reviews are useful for evidence-based decision making in public health and primary care. Key benefits of systematic reviews include being reliable, transparent, cost-effective, able to separate strong evidence from weak evidence, generalizable, having a global reputation, following internationally agreed standards, and being used by professionals, policymakers, and others. The document then provides background on SURE, describing its skills, projects, and approaches. It discusses databases and information sources used for reviews. The document highlights top sources of systematic reviews for public health and describes some of SURE's current and completed projects. It discusses the value of systematic reviews

1. Systematic reviews,
Cochrane+ and
SURE
Alison Weightman
Support Unit for Research Evidence
October 2011

2. Today’s Presentation
• Why systematic reviews?
• SURE: Background
• Cochrane+: sources of SRs for
public health & primary care
• The nub! How helpful for
policy and practice?
• SURE: Current approaches

3. Evidence based decision making in
primary care and public health
Why look for systematic review(s) first
“A review of a clearly formulated question that
uses systematic and explicit methods to identify,
select, and critically appraise relevant research,
and to collect and analyse data from the studies
that are included in the review”
http://www2.cochrane.org/resources/glossary.htm

4. 1. Reliable
• Avoids selection bias
(where an author may
choose studies
supporting his or her
view) since all relevant
studies are included
• Inclusion/exclusion
criteria decided at the
outset
• Example is for
intervention studies

5. 2. Transparent
• The methodology is
given in full and can be
reproduced exactly by
others

6. 3. Makes financial sense
• A systematic review can
be a quicker and
cheaper way of finding
out what works than
embarking on a new
primary research study.
• Current surge of interest
within and far beyond the
health sphere [partly as a
result of the financial
recession?]

7. 4. Separates the wheat from the
chaff
• Separating well
conducted and salient
studies that are worthy of
further consideration and
reflection from poorly
conducted studies –
critical appraisal

8. 5. Generalisable
• If studies are similar
enough, results from
different areas of the globe
can be combined to
increase generalisability.
• Synthesis methods may be
employed – eg meta-
analysis for efficacy
studies, meta-ethnography
for „views & opinions‟
studies.

9. 6. Global reputation
• Started within health care &
in developed economies –
eg Cochrane collaboration
- but now far beyond health
care and global.
• Campbell: education, crime
& justice, social welfare
3ie & DFID: Aid policy and
international development

10. 7. Internationally agreed standards
• For journal and other
publications, editors are
increasingly adopting
international and
stringent criteria eg
• PRISMA for systematic
reviews of evaluation
studies; MOOSE for
systematic reviews of
observational studies

11. 8. Systematic reviews are used by..
• Professionals to guide
their practice
• Economic analysts to
estimate likely costs of
interventions based on
effectiveness
• Researchers to guide
future research
• Policy makers to decide
policy

12. SURE: Support Unit for Research Evidence
Part of the Information Services Directorate
Based at the Cardiff University Heath Campus
Established in 2000
Almost entirely grant funded

13. SURE: Background
• Specialists in, but not limited to, public health/social science
• Trials Search Coordinators and the Specialized Register of
Studies for the Cochrane Public Health Group
• Home of Co-convenor of the Cochrane Information Retrieval
Methods Group
• Particular skills in:
 Critical appraisal
 Advanced literature searching
 Summarising research evidence
 Teaching systematic review methods
• 50 publications including 44 systematic reviews since 2000
• >£2 million in grant income

15. Advanced literature Searching
•Complex search strategies in electronic databases
•Grey literature:
 Conference proceedings
 Trial registers
 Internet searching
• Google scholar
• Web sites of relevant organisations
•Contacting experts
•Reference lists of relevant papers

16. Identification of the Indicators of the Social
Determinants of Cancer, Child Health and
Older People‟s Health

17. Databases and information sources
• Age Line • NICE [includes ReFer, Regard,
• ASSIA SIGLE, Intute]
• ChildData • PsycINFO
• CINAHL • Science Citation Index
• Cochrane Library • Social Care Online
• Community Wise • Social Science Citation Index
• Embase • Social Services Abstracts
• EPPI Centre • Sociological Abstracts
• ERIC • Local Government Data Unit
• HMIC Wales
• IBSS • NHS Plans & National Service
Frameworks for Wales and
• IDOX Information Services England within subject areas
• Medline [Includes CancerLit]

18. Search Strategy
Social determinant terms
1 prosperity.mp. (350) 18 house own$.mp. (13)
2 wealth.mp. (3929) 19 renter.mp. (5)
3 unemploy$.mp. (7367) 20 car own$.mp. (77)
4 poverty.mp. (20570) 21 overcrowd$.mp. (1195)
5 earning$.mp. (1908) 22 income.mp. (35798)
6 low pay.mp. (49) 23 standard of living.mp. (417)
7 salary.mp. (1800) 24 central heating.mp. (114)
8 debt$.mp. (1905) 25 family conflict.mp. (387)
9 arrear$.mp. (16) 26 poor housing.mp. (163)
10 social class.mp. (23104) 27 educational attainment.mp. (1616)
11 socio-economic.mp. (8590) 28 educational achievement.mp. (403)
12 socioeconomic.mp. (80451) 29 deprivation.mp. (41158)
13 social security.mp. (6863) 30 inequalit$.mp. (7500)
14 social welfare.mp. (6070) 31 financial hardship.mp. (104)
15 social mobility.mp. (595) 32 social position.mp. (359)
16 housing tenure.mp. (127) 33 damp housing.mp. (38)
17 home own$.mp. (152) 34 social isolation.mp. (9350)

19. Search Strategy
33 damp housing.mp. (38) 56 perceived inadequacy.mp. (22)
34 social isolation.mp. (9350) 57 civic communit$.mp. (5)
35 social exclusion.mp. (199) 58 domestic violence.mp. (3744)
36 social network$.mp. (2730) 59 engagement in community.mp. (3)
37 decision latitude.mp. (236) 60 social stigma.mp. (296)
38 social relationship$.mp. (1480) 61 social capital.mp. (418)
39 effort-reward.mp. (113) 62 social status.mp. (2220)
40 job opportunit$.mp. (174) 63 family status.mp. (271)
41 promotion prospects.mp. (27) 64 single parent.mp. (1513)
42 social gradient.mp. (135) 65 sole parent.mp. (9)
43 family breakdown.mp. (46) 66 lone parent.mp. (35)
50 social cohesion.mp. (138 67 divorce.mp. (4268)
51 poor environment.mp. (93) 68 marital separation.mp. (61)
52 social contacts.mp. (673) 69 ethnic$.mp. (59718)
53 social attachment$.mp. (97) 70 refugee$.mp. (5355)
54 social integration.mp. (965) 71 good nutrition.mp. (296)
55 emotional ties.mp. (37)

20. Search Strategy
72 household composition.mp. (163) 89 *"Public Housing"/ (370)
73 family composition.mp. (184) 90 property own$.mp. (46)
74 crowding.mp. (4126) 91 racial$.mp. (12725)
75 school performance.mp. (1198) 92 sociodemographic.mp. (9350)
76 school attendance.mp. (463) 93 inequit$.mp. (1698)
77 housing condition$.mp. (1117) 94 disadvantaged.mp. (3422)
78 benefit recipient$.mp. (11) 95 Immigrant$.mp. (7999)
79 household type.mp. (37) 96 Rental.mp. (243)
80 housing design.mp. (27) 97 affluen$.mp. (1820)
81 employment status.mp. (1983) 98 Rented.mp. (166)
82 economic inactivity.mp. (8) 99 Salaries.mp. (11250)
83 social housing.mp. (91) 100 shift work.mp. (1052)
84 access to health care.mp. (1878) 101 social disparit$.mp. (89)
85 access to services.mp. (525) 102 social effect$.mp. (360)
86 community participation.mp. (984) 103 uninsured.mp. (5085)
87 social environment.mp. (26711) 104 social inclusion.mp. (76)
88 Social disadvantage.mp. (237) 105 or/1-104 (351713)

21. Search Strategy
Study terms
106 exp Controlled Clinical Trials/ 115 exp Meta-Analysis/ (7588)
(53225) 116 meta-analys$.ti,ab. or
107 exp Random Allocation/ (59871) metaanalys$.ab,ti. or meta
108 exp Double-Blind Method/ (93163) analys$.ab,ti. (17210)
109 exp Single-Blind Method/ (11128) 117 Cochrane.ab,sh,ti. (8158)
110 ((singl$ or doubl$ or trebl$ or tripl$) 118 (review$ or overview$).ti. or
adj5 (blind$ or mask)).ti,ab. (88154) review$.pt. or (synthes$ adj3
111 (control$ adj (trial$ or stud$ or (literature$ or research or studies or
evaluation$ or experiment$)).mp. data)).ab,ti. (1361158)
(419822) 119 pooled analys$.ab,ti. or ((data adj2
112 randomi?ed.hw,ti,ab,pt. (336615) pool$) and studies).mp. (3068)
113 (cohort: or survey: or qualitativ: or 120 ((hand or manual or database$ or
cross section: or case stud: or evaluat: computer$) adj2 search$).ab,ti.
or audit: or longitudinal: or (10520)
questionnaire:).ti,ab. (1757661) 121 ((electronic or bibliographic$) adj2
114 (case stud: or evaluat: or audit: or (database$ or data base$)).ab,ti.
longitudinal: or questionnaire:).ti,ab. (2627)
(1453166)

22. Search Strategy
122 ((review$ or overview$) adj10 Cancer terms
(systematic$ or methodologic$ or 128 neoplasm$.mp. (1486462)
quantitativ$ or research$ or 129 malignan$.mp. (273106)
literature$ or studies or trial$ or 130 Polycythemia Vera.mp. (3927)
effective$)).ab. (148334) 131 Myeloproliferative Disorder$.mp.
123 census$.mp. (10083) (4717)
124 registry.mp. (22497) 132 cancer$.mp. (611077)
125 registries.mp. (30974) 133 exp neoplasms/ (1830218)
126 follow up stud$.mp. (356983) 134 tumo?r$.mp. (951252)
127 or/106-126 (3598245) 135 Myelodysplastic Syndrome$.mp.
(9373)
136 Immunoproliferative Disorder$.mp.
(133)
137 or/128-136 (2145924)
138 105 and 127 and 137 (13438)
Social Cancer
determinant Study design terms
terms terms

23. Additional Search
Methods
• Hand searching reference lists
• Contacting experts
• Electronic Tables of Content (ETOCs)
• Website search

24. Critical Appraisal
The in-depth examination of the
research evidence to assess its validity,
results and relevance before using it to
inform a decision
“The science of „trashing‟ papers”
(Greenhalgh T. 1997 BMJ publications)

25. Critical
Appraisal

26. Summarising the Evidence
To make an accurate summary of all the
appraised evidence, including methodology
and quality

27. Completed
Projects: Examples

30. Top five sources of systematic
reviews of relevance to public health
in the UK
1. Cochrane Library www.thecochranelibrary.com/
2. Database of promoting health effectiveness reviews
(DoPHER), EPPI-Centre
http://eppi.ioe.ac.uk/webdatabases/Intro.aspx?ID=2
3. Health Evidence Canada http://health-
evidence.ca/articles/search
4. PubMed clinical queries
http://www.ncbi.nlm.nih.gov/pubmed/clinical
5. NICE www.nice.org.uk/

31. 1. Cochrane Library

32. 2. DoPHER

33. 3. Health Evidence ca

34. 4. PubMed Clinical Queries

35. 5. NICE guidelines

36. Value of SRs for policy?
• Participants • Timely
- frequent updates/current
• Intervention
• Orientated to policy
•
•
Comparison
Outcomes
≠ • Problem driven
– meaningful outcomes
• Setting • Implementation
- costed
• Context
– what works for whom?

37. Current Projects:
Examples

38. Collaboration review update

40. NICE THR guidance:
Linking efficacy and barriers/facilitators evidence
Figure: From Harden A, Brunton G, Fletcher A, Oakley A. Teenage pregnancy and social disadvantage:
systematic review integrating controlled trials and qualitative studies. BMJ 2009; 339: b4254

41. SURE
• Informal advice on finding evidence to
support primary care and public health
• Training
• Information support for grant applications
• Research partnerships/shared bids
• Commissions

42. Training workshops

43. To encourage and assist
collaborative working between researchers
involved in systematic reviews
http://www.cf.ac.uk/insrv/libraries/sure/sysnet/index.html

44. Finally…
Information is a source of learning. But
unless it is organised, processed, and
available to the right people in a format
for decision making, it is a burden, not a
benefit.”
William Pollard
The Soul of the Firm. Grand Rapids: Zondervan Publishing House 2000

45. SURE@cf.ac.uk
WeightmanAL@cf.ac.uk
www.cardiff.ac.uk/insrv/sure