2. Systematic Review
• A document that provides an unbiased and comprehensive synthesis
of relevant studies and research.
oPooling multiple studies with the same or very similar PICO/
question and research designs.
oSelected studies are based on pre-established criteria.
oAlso known as a “research synthesis.
• It is considered to be one of the highest levels of evidence in
evidence-based practice (EBP)** because of its rigor.
oHierarchy of Evidence for Intervention/Treatment Questions in
3. Purposes of a systematic review
• Summarizes and synthesizes existing knowledge.
• Enables researchers to make an objective assessment of primary
research evidence in order to inform or support various aspects of
medical technology practice.
oInterventions or treatments.
oPolicies, best practices, or protocols o Support for grants or
when seeking funding.
oVarious decision-making matters.
4. Characteristics of a Systematic Review
• Utilizes explicit objectives and questions to be addressed.
• Determines relevant studies with stated inclusion and exclusion
• Studies are found through a comprehensive search for published
and unpublished studies.
• Included studies are appraised for many factors (methodology,
• Data from included studies may be extracted and analyzed.
• Searches and methodology are documented and transparent
(protocols may or may not be published).
5. Overall Steps:
1. Identify a question or a clinical problem.
2. Create a review protocol (inclusion criteria).
3. Find studies in the literature.
4. Study selection: pick relevant studies based on review protocol.
5. Critically appraise the quality of studies.
6. Collect data from each selected study.
7. Synthesize and summarize findings from included studies.
8. Document the method by writing a review, report or article.
6. 1. Identify A Question Or A Clinical Problem.
• First, establish a need for the review.
• Utilize PICO to create a specific question.
• Make sure enough primary or original research has been done on
• The question gives a direction for the review and forms the basis of
protocol to be used.
7. 2. Create A Review Protocol
• Based on the PICO question, select the optimal research design for
answering the question.
• Protocol and pre-established criteria reduce the chances of bias,
making a search more objective.
• Establish eligibility (inclusion and exclusion criteria) based on the
oResearch design and methodology
Qualitative or Quantitative?
RCT, Quasi-experimental, Nonexperimental, etc.?
8. Based on the results of clinical trials, what interventions can
medical technologists design and implement for smoking
cessation in hospitalized patients?
Population Hospitalized patients who smoke
Intervention (Explores which ones)
Outcome Measures Smoking cessation
Inclusion Criteria Intervention studies, preferably randomized controlled trials, involving
smoking cessation intervention designed by a nurse
Exclusion Criteria review papers, expert opinion, non-intervention studies, papers
examining the effect of pharmacological interventions on quitting
9. 3. Find studies in the literature.
A. Develop a comprehensive search strategy.
I. Search terms: Keywords or natural language (“diabetes”) and
controlled vocabulary such as MeSH or CINAHL Headings
(“diabetes mellitus type 2”)
II. Information sources
a) Databases (CINAHL, PubMed and others for health sciences)
b) Journals (especially for manual searching)
c) Gray literature (unpublished reports, or published through
non- academic channels) may be found through an internet
search or Google Scholar.
10. III. Chain / reference searching (backwards searching): searching the
references used in studies to find what may had been missed in initial
IV. Manual searching: look through journals or publications.
V. Document your searches, including number of results.
VI. Interlibrary Loan: Use interlibrary loan service to request
documents not available through the FAU Libraries.
B. Make a plan for saving, storing, and sharing information.
o Word processing (keep track of search terms, number of results and
o Citation management tools: Mendeley, RefWorks
o File storage: Google Docs, cloud-based storage
11. 4. Study selection: choosing relevant studies based on
• Review the studies found through searches.
• Select studies that match the PICO elements and review protocol.
• Selection is potentially the most time- consuming part of a
12. 5. Critically appraise the quality of studies
• Critical appraisal: assessing study qualities using (established) tools
and criteria, especially for validity and reliability.
o Appraisal tools or instruments: helps with transparency and
replication of the review.
oJBI Critical Appraisal Tools (for research designs and systematic
13. 6. Collect data from each selected study
• Use a data extracting tool based on the data needs.
o AHRQ Systematic Review Data Repository (SRDR)
o SR Toolbox (includes tools for other parts of a review)
• Extract relevant data as it relates to the review question.
• Synthesize the data.
o Allows exploring similarities or inconsistencies.
o Present in a narrative summary.
o A meta-analysis takes a systematic review further by pooling
and analyzing the data.
14. 7. Synthesize and summarize findings from included studies
• Provides an overall conclusion of findings as well as potential
• Allows comparisons of studied effects in different studies, settings and
• Recommendations for clinical practice and implications for future
research should be based on the synthesized finding.
• Written as a narrative summary
15. 8. Document the method by writing a review, report or article.
• Reporting standards are available for systematic reviews.
• Use a reporting standard as advised:
oPRISMA - Preferred Reporting Items for Systematic Reviews and
oNational Academies of Science, Health and Medicine Division
Standards of Systematic Reviews