Literature Review VS.

Systematic Analysis
Literature Reviews
Literature reviews have long been a means of summarizing and presenting overviews
of knowledge, current and historical, derived from a body of literature. They often make
use of the published literature; generally, published papers cited in a literature review
have been subjected to the blind peer-review process (a hallmark of most scientific
periodicals). The literature included in a literature review may encompass research
reports that present data, as well as conceptual or theoretical literature that focuses on a
concept
An author may conduct a literature review for a variety of reasons, including to1
• present general knowledge about a topic.
• show the history of the development of knowledge about a topic.
• identify where evidence may be lacking, contradictory, or inconclusive.
• establish whether there is consensus or debate on a topic.
• identify characteristics or relationships between key concepts from existing studies
relevant to the topic.
• justify why a problem is worthy of further study.

Traditional literature reviews, though useful, have major drawbacks in informing decision
making in nursing practice.
• Predominantly subjective, they rely heavily on the author's knowledge and
experience and provide a limited, rather than exhaustive, presentation of a topic.2
• Such reviews are often based on references chosen selectively from the evidence
available, resulting in a review inherently at risk for bias or systematic error.
• Traditional literature reviews are useful for describing an issue and its underlying
concepts and theories, but if conducted according to no stated methodology, they
are difficult to reproduce—leaving the findings and conclusions resting heavily on
the insight of the authors.1, 2
• In many cases, the author of the traditional review discusses only major ideas or
results from the studies cited rather than analyzing the findings of any single study.
Systematic Review
Since the traditional literature review lacks a formal or reproducible means of estimating the effect of a treatment,
including the size and precision of the estimate,2, 7 a considerably more structured approach is needed.

The “systematic review,” also known as the “research synthesis,” aims to provide a comprehensive, unbiased
synthesis of many relevant studies in a single document.2, 7, 8

While it has many of the characteristics of a literature review, adhering to the general principle of summarizing the
knowledge from a body of literature, a systematic review differs in that it attempts to uncover “all” of the evidence
relevant to a question and to focus on research that reports data rather than concepts or theory.3, 9

Explicit and exhaustive reporting of the methods used in the synthesis is also a hallmark of any well-conducted
systematic review. Reporting standards like those produced for primary research designs have been created for
systematic reviews.

The PRISMA statement, or Preferred Reporting Items for Systematic Reviews and Meta-Analyses, provides a
checklist for review authors on how to report a systematic review.10

Ultimately, the quality of a systematic review, and the recommendations drawn from it, depends on the extent to which
methods are followed to minimize the risk of error and bias.

For example, having multiple steps in the systematic review process, including study selection, critical appraisal,
and data extraction conducted in duplicate and by independent reviewers, reduces the risk of subjective
interpretation and also of inaccuracies due to chance error affecting the results of the review. Such rigorous methods
distinguish systematic reviews from traditional reviews of the literature.

The characteristics of a systematic review are well defined and internationally accepted. The following are the
defining features of a systematic review and its conduct:

• clearly articulated objectives and questions to be addressed

• inclusion and exclusion criteria, stipulated a priori (in the protocol), that determine the eligibility of studies
• a comprehensive search to identify all relevant studies, both published and unpublished
• appraisal of the quality of included studies, assessment of the validity of their results, and reporting of any
exclusions based on quality
• analysis of data extracted from the included research
• presentation and synthesis of the findings extracted
• transparent reporting of the methodology and methods used to conduct the review

Different groups worldwide conduct systematic reviews.

• Cochrane Collaboration (see http://handbook.cochrane.org).

primarily addresses questions on the effectiveness of interventions or therapies and has a strong focus on synthesizing
evidence from randomized controlled trials (RCTs)

• Centre for Reviews and Dissemination at the University of York (http://bit.ly/1g9WoCq)

• Joanna Briggs Institute (http://joannabriggs.org)

include other study designs and evidence derived from different sources in their systematic reviews.

• The Institute of Medicine issued a report in 2011, Finding What Works in Health Care: Standards for
Systematic Reviews, (see http://bit.ly/1cRIAg7).

which makes recommendations for ensuring “objective, transparent, and scientifically valid reviews”

How systematic reviews are conducted may vary; the methods used will ultimately depend on the question being
asked. The approach of the Cochrane Collaboration is almost universally adopted for a clear-cut review of treatment
effectiveness.

However, specific methods used to synthesize qualitative evidence in a review, for example, may depend on the
preference of the researchers, among other factors.7 The steps for conducting a systematic review will be addressed
below and in greater detail throughout this series.
 Review question and inclusion criteria.
Systematic reviews ideally aim to answer specific questions, rather than present general summaries of the
literature on a topic of interest.5, 8 A systematic review does not seek to create new knowledge but rather
to synthesize and summarize existing knowledge, and therefore relevant research must already exist on
the topic
Deliberation on the question occurs as a first step in developing the review protocol.5, 7 Nurses accustomed
to evidence-based practice and database searching will be familiar with the PICO mnemonic (Population,
Intervention, Comparison intervention, and Outcome measures), which helps in forming an
answerable question that encompasses these concepts to aid in the search.3, 8, 11 (The art of formulating
the review question will be covered in the second article of this series.)
(PICO IS NEEDED IN A SYSTEMATIC REVIEW? SO, I TRIED)
PICO
Population
Entry 1
Approximately 39.2% of men and women will be diagnosed with cancer at any site at some points of their
lifetime based on 2016-2018 data with about 67.7% of 5-year survival rate.
https://seer.cancer.gov/statfacts/html/all.html
Entry 2
Cancer is one of the leading cause of death worldwide accounting for about 10 million deaths in 2020 or 1
out of six deaths.
https://www.who.int/news-room/fact-sheets/detail/cancer
Entry 3
Good source of statistics
https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-
2021.html
Entry 4
By 2040, the number of new cancer cases per year is expected to rise to 29.5 million and the number of
cancer-related deaths to 16.4 million.
https://www.cancer.gov/about-cancer/understanding/statistics

Intervention
Moringa oleifera extracts

Comparing
Commercially available drugs

Outcome
Effective in inhibiting cancer cells from propagating (apoptosis etc.)
 Searching for studies
can be a complex task. The aim is to identify as many studies on the topic of interest
as is feasible, and a comprehensive search strategy must be developed and
presented to readers.3, 10
A strategy that increases in complexity is common, starting with an initial search of
major databases, such as MEDLINE (accessed through PubMed) and the Cumulative
Index to Nursing and Allied Health (CINAHL), using keywords derived from the review
question. This preliminary search helps to identify optimal search terms, including further
keywords and subject headings or indexing terms, which are then used when searching
all relevant databases.
Finally, a manual search is conducted of the reference lists of all retrieved papers to
identify any studies missed during the database searches.
The search should also target unpublished studies to help minimize the risk of
publication bias3, 5—a reality that review authors have to acknowledge. It arises
because researchers are more likely to submit for publication positive rather than negative
findings of their research, and scientific journals are inclined to publish studies that show
a treatment's benefits. Therefore, relying on findings only from published studies may
result in an overestimation of the benefits of an intervention. To date, locating unpublished
studies has been difficult, but resources for locating this “gray” literature are available and
increasing in sophistication. For example, Web search engines can search across many
governmental and organizational sites simultaneously. Similarly, there are databases that
index graduate theses and doctoral dissertations, abstracts of conference proceedings,
and reports that aren't commercially published. Contacting experts in the field may also
yield otherwise difficult-to-obtain information.
(di pa natin nagagawa)
Finally, studies published in languages other than English should be included, if
possible, despite the added cost and complexity of doing so. (The art of searching will be
addressed in the third paper in this series.)
(I think we tried pero wala naman na di nakaenglish right?)
Study selection and critical appraisal. The PICO elements can aid in defining the
inclusion criteria used to select studies for the systematic review. The inclusion criteria
place the review question in a practical context and act as a clear guide for the review
team as they determine which studies should be included.3 This step is referred to as
study selection.8 Once it's determined which studies should be included, their quality
must be assessed during the step of critical appraisal. (Both of these steps will be further
addressed in the fourth paper in this series.)

During study selection,

reviewers look to match the studies found in the search to the review's inclusion
criteria—that is, they identify those studies that were conducted in the correct
population, use interventions of interest, and record the predetermined and
relevant outcomes.3 The optimal research design for answering the review question is
also determined.
For example, for a systematic review evaluating the effectiveness of an intervention,
the most reliable evidence is thought to come from RCTs, which allow the inference of
causal associations between the intervention and outcome, rather than from other study
designs such as the cohort study, which lacks randomization and experimental “control.”
Any exclusion criteria should also be documented—for example, specific populations
or modes of delivery of an intervention.
(SI JASPER MAY ALAM NITONG PART NA ITO DAHIL SA PRISMA)
 During critical appraisal,
all studies to be included are first assessed for methodologic rigor.3 Although there are
some subtle differences, this appraisal is akin to assessing the risk of bias in reviews
that ask questions related to the effectiveness of an intervention. A systematic review
aims to synthesize the best evidence for clinical decision making. Assessing the validity
of a study requires careful consideration of the methods used during the research and
establishing whether the study can be trusted to provide a reliable and accurate
account of the intervention and its outcomes.5-8 Studies that are of low or
questionable quality are generally excluded from the remainder of the review process.
Exclusion of lesser-quality studies reduces the risk of error and bias in the findings of the
review.3
For the most part, critical appraisal focuses squarely on research design and the
validity and hence the believability of the study's findings rather than on the quality
of reporting, which depends on both writing style and presentation.10 For example,
when assessing the validity of an RCT, critical appraisal generally focuses on four types
of systematic error that can occur at different stages of a study:
selection bias (in considering how study participants were assigned to the treatment
groups), performance bias (in considering how the intervention was provided), attrition
bias (in considering participant follow-up and drop-out), and detection bias (in
considering how outcomes were measured).3
To aid the transparency and reproducibility of this process in the systematic review,
standardized instruments (checklists, scales) are commonly used when asking the
reviewers about the research they are reading.

(I need the full check list with reference kung san galling yung checklist for
INCOMPLETE OUTCOME DATA AND SELECTIVE REPORTING)
 Data extraction and synthesis.
Once the quality of the research has been established, relevant data aligned to the
predetermined outcomes of the review must be extracted for the all-important
synthesis of the findings. (These steps will be addressed in the fifth paper in this series.)
Data synthesized by systematic reviews are the results extracted from the individual
research studies; as with critical appraisal, data extraction is often facilitated by the use
of a tool or instrument that ensures that the most relevant and accurate data are collected
and recorded.3 A tool may prompt the reviewer to extract relevant citation details, details
of the study participants including their number and eligibility, descriptive details of the
intervention and comparator used in the study, and the all-important outcome data.
Generic extraction tools for both quantitative and qualitative data are readily available.12
The data collected from individual studies vary with each review, but they should always
answer the question posed by the review. While undertaking a review, reviewers will find
that data extraction can be quite difficult—often complicated by factors of the included
studies such as incomplete reporting of study findings and differing ways of reporting and
presenting data. When these issues arise, reviewers should attempt to contact the
authors to obtain missing data, particularly for recently published research.5
Data synthesis is a principal feature of the systematic review.3, 6, 7, 9 There are various
methods available, depending on the type of data extracted that's most appropriate to the
review question.7 An example of a systematic review addressing a question of the
effectiveness of a nursing intervention is one examining nurse-led cardiac rehabilitation
programs following coronary artery bypass graft surgery; the review aims to give an
overall estimate of the intervention's effectiveness on patients’ health-related quality of
life and hospital readmission rates.13 Depending on the question asked, such a synthesis
of the results of relevant studies also allows for exploration of similarities or
inconsistencies of the treatment effect in different studies and among various settings and
populations.5 Where inconsistencies are apparent they can be analyzed further. The
synthesis either provides a narrative summary of the included studies or, where
possible, statistically combines data extracted from the studies. This pooling of
data is termed “meta-analysis.”14
A meta-analysis may be included in a systematic review as a practical way of evaluating
many studies.
Meta-analysis should ideally be undertaken only when studies are similar enough;
studies should
• sample from similar populations,
• have similar objectives and aims,
• administer the intervention of interest in a similar fashion, and (most important)
• measure the same outcomes.
3 Meta-analysis is rarely appropriate when such similarities do not appear across studies.
Meta-analysis requires transforming the findings of treatment effect from individual
studies into a common metric and then using statistical procedures across all of the
findings to determine whether there is an overall effect of the treatment or association.8,
9, 14
The typical output from a statistical synthesis of studies is the
• measure or estimate of effect;
• the confidence interval, which indicates the precision of the estimate; and the
• quantification of the differences (heterogeneity) between the included studies and
the statistical impact of these differences, if any, on the analysis.
There are many different statistical methods by which results from individual studies can
be combined during the meta-analysis. The results of the meta-analysis are commonly
displayed as a forest plot, which gives the reader a visual comparison of the findings.

“Owing to the limited availability of relevant trials, reviews that aim to examine the
effectiveness of an intervention may resort to evidence from experimental studies
other than RCTs and even from observational studies; such reviews have the potential
to play a greater role in evidence-based nursing, where trials, historically, have been
rare.15 But when conducting a systematic review of studies using designs other
than the RCT, a reviewer must take into account the biases inherent in those
designs and make definitive recommendations about the effectiveness of a
practice with caution”

(SO YUNG PAPER NATIN IS NOT ABOUT RCT’S OR YUNG MGA MISMONG
PATIENTS BUT RATHER CAME FROM EXPERIMENTAL STUDIES)
A systematic review that addresses both quantitative and qualitative studies, as well as
theoretical literature, is referred to as an “integrative” or “comprehensive” systematic
review.6, 15 The motivation for conducting a comprehensive review is often to provide
further insight into why an intervention appears to have a benefit (or not). “Realist”
reviews, another emerging form of evidence synthesis, often look to answer questions
surrounding complex interventions, including how and for whom an intervention works.7,
16 Formalized methods for these types of reviews are still being validated.
https://journals.lww.com/ajnonline/fulltext/2014/03000/the_systematic_review__an
_overview.28.aspx#:~:text=The%20%E2%80%9Csystematic%20review%2C%E2%
80%9D%20also,studies%20in%20a%20single%20document.