A systematic review is a literature review focused on a single question which tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews are generally regarded as the highest level of medical evidence by evidence-based medicine professionals. An understanding of systematic reviews and how to implement them in practice is becoming mandatory for all professionals involved in the delivery of health care.
[edit] Characteristics
A systematic review is a summary of research (often in the biomedical or healthcare context) that uses explicit methods to perform a thorough literature search and critical appraisal of individual studies to identify the valid and applicable evidence. It often, but not always, uses appropriate techniques (meta-analysis) to combine these valid studies, or at least uses grading of the levels of evidence depending on the methodology used. A systematic review uses an objective and transparent approach for research synthesis, with the aim of minimising bias. While many systematic reviews are based on an explicit quantitative meta-analysis of available data, there are also qualitative reviews which nonetheless adhere to the standards for gathering, analyzing and reporting evidence. The EPPI-Centre have been influential in developing methods for combining both qualitative and quantitative research in systematic reviews[1]. Other recent developments include realist reviews and the meta-narrative approach.[2]
[edit] Cochrane collaboration
Many healthcare journals now publish systematic reviews, but the best-known source is the Cochrane Collaboration, a group of over 6,000 specialists in health care who systematically review randomised trials of the effects of treatments and, when appropriate, the results of other research. Cochrane reviews are published in the Cochrane Database of Systematic Reviews section of the Cochrane Library, which to date (February 2007) contains 2,893 complete reviews and 1,646 protocols.
The Cochrane Group provides a handbook for systematic reviewers of interventions, where they suggest that each systematic review should contain the following main sections:
Background
Objectives
Methods of the review
Results
Conclusion and discussion
There are seven steps for preparing and maintaining a systematic review, as outlined in the Cochrane Handbook:
Formulating a problem
Locating and selecting studies
Critical appraisal of studies
Collecting data
Analyzing and presenting results
Interpreting results
Improving and updating reviews
[edit] Strengths and weaknesses
While systematic reviews are regarded as the strongest form of medical evidence, a review of 300 studies found that not all systematic reviews were equally reliable, and that their reporting could be improved by a universally agreed upon set of standards and guidelines.[3]
A further study by the same group found that of 100 guidelines reviewed, 4% required updating within a year, and 11% after 2 years; this figure was higher in rapidly-changing fields of medicine, especially cardiovascular medicine.[4] 7% of systematic reviews needed updating at the time of publication. [4] A 2003 study suggested that extending searches beyond major databases, perhaps into gray literature, would increase the effectiveness of reviews.[5]
[edit] References
^ (Thomas J, Harden A, Oakley A, Oliver S, Sutcliffe K, Rees R. Brunton G. Kavanagh J (2004) Integrating qualitative research with trials in systematic reviews: an example from public health. British Medical Journal 328:1010-1012)
^ Fraser MacFarlane; Olivia Kyriakidou; Bate, Paul; Richard Peacock; Greenhalgh, Trisha (2005). Diffusion of Innovations in Health Service Organisations: A Systematic Literature (Studies in Urban and Social Change). Blackwell Publishing Professional. ISBN 0-7279-1869-9.
^ Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG (2007). "Epidemiology and reporting characteristics of systematic reviews". PLoS Med. 4 (3): e78. doi:10.1371/journal.pmed.0040078. PMID 17388659.
^ a b Shojania KG, Sampson M, Ansari MT, Ji J, Doucette S, Moher D (2007). "How quickly do systematic reviews go out of date? A survival analysis". Ann. Intern. Med. 147 (4): 224–33. PMID 17638714.
^ Savoie I, Helmer D, Green CJ, Kazanjian A (2003). "Beyond Medline: reducing bias through extended systematic review search". Int J Technol Assess Health Care 19 (1): 168–78. doi:10.1017/S0266462303000163. PMID 12701949. |
发表于 2008-11-4 14:12
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