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Systematic Reviews

An introduction to systematic reviews, with examples from health sciences and medicine

Synthesis

It's best to set up a template for extracting the data from the research papers you're critiquing. One way of doing this is to adapt  EndNote fields for the raw data - so each summary is associated with both the citation record and the .pdf. You can  export or copy the data to a spreadsheet.

It will be important to be able to present all of your data accurately and effectively, although it will have come from  a (usually large) number of quantitative studies.

One way of doing this is with a Forest plot. A Forest plot is a graphical representation of the mean, range and variance of results in each study, all visually aligned so that the key range of values common to all studies is readily seen.

 

Figure 1. Forest plot embedded in Excel worksheet. Note the Confidence Intervals around the determined Standard Errors overlap, with a central tendency indicated by the diamond.

Source: Neyeloff et al (2012) UNDER  Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)

Image of Forest Plot and Excel datadata

A review matrix and summary tables are convenient ways to summarise and quickly rearrange qualitative information  and observations to achieve a draft outline.

You can easily set up a table in a word processor or spreadsheet. Aim to itemise the most important content column by column, with one article per row. The rows can be rearranged and regrouped at need or at whim, so it doesn't matter which articles you start with. 

Example of a summary table
Author/s Publication year Patients Intervention & Control Outcomes Appraisal Further questions
             
             
             
             

See

Garrard, J. (2014). Health sciences literature review made easy: The matrix method, 4th ed.  Burlington, MA: Jones & Bartlett Learning.

Realist and meta-narrative syntheses, appropriately conducted,  are qualitative equivalents to (quantitative) meta-analyses. They are more likely to used in reviewing health policies and guidelines rather than answering clinical questions.

Realist reviews systematically examine complex social interventions to discover and understand any factors influencing the links between an intervention and its outcomes (summed up in the question "what works, how, for whom, in what circumstances and to what extent?").

Meta-narrative reviews are similar but adapted for use when a policy-related topic has been researched in different ways by different teams, especially when differing terms and vocabularies have emerged in the literature. 

The UK National Institute of Health Research has developed guidelines and standards through its RAMESES initiatives.

Realist syntheses

RAMESES publication standards: realist syntheses
BMC Medicine 2013, 11:21
http://www.biomedcentral.com/1741-7015/11/21

For a summary see http://www.ramesesproject.org/media/RS_qual_standards_researchers.pdf

Meta-narrative reviews

RAMESES publication standards: meta-narrative reviews
BMC Medicine 2013, 11:20
http://www.biomedcentral.com/1741-7015/11/20

For a summary see http://www.ramesesproject.org/media/MNR_qual_standards_researchers.pdf

See also Greenhalgh, T., Wong, G., Westhorp, G., & Pawson, R. (2011). Protocol-realist and meta-narrative evidence synthesis: evolving standards (RAMESES). BMC medical research methodology11(1), 115.

Best-fit framework synthesis is a literature review technique in two distinct stages. It's an approach suited to urgent and important  policy questions, where an iterative approach to selecting search terms and refining the search strategies can give a more timely and scalable result.

In the first stage, an initial conceptual model is selected, realizing this can only be an approximation to  the content and contexts of the research domain. This is used as basis for an initial search.

This framework is then modified in response to the evidence reported in the studies found. The final framework may include elements of the first model, modified factors, and new factors that were not originally anticipated.

 

Dixon-Woods, M. (2011). Using framework-based synthesis for conducting reviews of qualitative studies. BMC Medicine  9: 39.

Carroll C., Booth A., Leaviss J., & Rick J. (2013). "Best fit" framework synthesis: refining the method. BMC Medical Research Methodology 13:37.

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