Systematic reviews

Systematic reviews are recent additions to the medical literature. In contrast to traditional narrative reviews, these reviews aim to answer a precisely defined clinical question and to do so in a way that is transparent and designed to minimize bias. Some of the defining features of systematic reviews are (1) a clear definition of the clinical question to be addressed, (2) an extensive and explicit strategy to find ail studies (published or unpublished) that may be eligible for inclusion in the review, (3) criteria by which studies are included and excluded, (4) a mechanism to assess the quahty of each study and, in some cases, (5) synthesis of results by use of statistical techniques of meta-analysis. By contrast, traditional reviews are subjective, are rarely well focused on a clinical question, lack explicit criteria for selection of studies to be reviewed, do not indicate criteria to assess the quality of included studies, and rarely can use meta-analysis. 

The explicit methodology of systematic reviews suggests that persons skilled in the art of systematic reviewing should be able to reproduce the data of a systematic review, just as researchers in chemistry or biochemistry expect to be able to reproduce published primary studies in their fields. This concept strengthens the credibility of systematic reviews, and workers in the field of EBM generally consider well-conducted systematic reviews of high-quality primary studies to constitute the highest level of evidence on a medical question. 

The explosion of research and the vastness of the medical literature are such that no one can read, much less digest, all relevant work. The massive amount of new technology, the poor quality of narrative reviews, and the necessity to provide an accurate digest for practicing clinicians constitute the background to the call for a more systematic review of literature. 

Systematic reviewing is time consuming and requires multiple sldlls. Usually a team is required, and the team should include at least one person experienced in the science and art. The team must agree on the chnical problem to be tadded and on the scope of the review. 

The review team must develop a protocol for the project. A protocol should include, in addition to a title, background information, composition of the review group, and a timetable  

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Preparative Methods. The thiophene ring system has been synthesized through numerous reaction types. A systematic review of these has been made (28) and is based on the number of components utilized in the constmction of the ring. Some 19 combinations are possible, utilizing five method types. Not all combinations have been reported and some would be of only minor benefit. 

Systematically review the process flow schematic looking at each process step and hazardous material to identify creative ways to improve the process by applying inherent safety principles to reduce or eliminate hazards. 

During the systematic review of the process flow schematic (Step 12) the team will examine some of the following questions ... 

Systematic review of plant design and operating experience to identify potential initiating events ... 

The review of the design requirements needs to be a systematic review, not a superficial glance. Design work will commence on the basis of what is written in the requirements or the brief, although you should ensure there is a mechanism in place to change the document should it become necessary later. In fact such a mechanism should be agreed at the same time as agreement to the requirement is reached. 

One simple way to start this task is first to identify those benefits as they relate to your company s operations. You might systematically review CCPS twelve elements of PSM, asking yourself at each stage, "Why is this a good idea " "What s the benefit of doing this " Then put yourself in the position of your selected sponsor and consider each element from that person s perspective. Ask yourself, "How can this activity or approach make my sponsor s job easier " "How would this activity improve my company "... 

Hemmann S, Graf J, Roderfeld M et al (2007) Expression of MMPs and TIMPs in liver fibrosis—a systematic review with special emphasis on anti-fibrotic strategies. J Hepatol 46 955-975... 

Bouza C, Magro A, Munoz A, et al Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence a systematic review. Addiction 99 811-828, 2004... 

Sticht J, Humbert M, Findlow S, Bodem J, Muller B, Dietrich U, Werner J, Krausslich HG (2005) A peptide inhibitor of HIV-1 assembly in vitro. Nat Struct Mol Biol 12 671-677 Stockman LJ, Bellamy R, Garner P (2006) SARS systematic review of treatment effects. PLoS... 

Hornberger J, Holodniy M, Robertus K, Winnike M, Gibson E, Verhulst E (2007) A systematic review of cost-utility analyses in HIV/AIDS imphcations for public pohcy, Med Decis Making 27(6) 789-821... 

Manusciatti W, Fitzpatrick RE, Goldman MP (2000) Treatment of facial skin using combinations of CO Q-switched alexandrite, flashlamp-pumped pulsed dye, and Er YAG lasers in the same treatment session. Dermatol Surg 26 114-120 Jordan R, Cummins C, Burls A (2000) Laser resurfacing of the skin for the improvement of facial acne scarring a systematic review of the evidence. Br J Dermatol 142 413-423... 

Kwak R A case of shock by pretesting of contrast media (in Japanese). Rinsho Hoshasen 1985 30 407M09. Morcos SK, Thomsen HS, Webb JA Prevention of generalized reactions to contrast media a consensus report and guidelines. Eur Radiol 2001 11 1720-1728. Tramer MR, von Elm E, Loubeyre P, Hauser C Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media systematic review. BMJ 2006 333 675. 

Jenkins C, Costello J, Hodge L Systematic review of prevalence of aspirin-induced asthma and its implications for clinical practice. BMJ 2004 328 434-437. Baldassarre S, Schandene L, Choufani G, Michils A Asthma attacks induced by low doses of celecoxib, aspirin and acetaminophen. J Allergy Clin Immunol 2006 117 215-217. 

Sheikh A, Shehata Y, Brown SGA, Simons PER 28 Adrenaline for the treatment of anaphylaxis Cochrane systematic review. Allergy 2009 64 204-212. 

Nurmatov U, Worth A, Sheikh A Anaphylaxis management plans for the acute and long-term management of anaphylaxis a systematic review. J Allergy Clin Immunol 2008 122 353-361. 

Simons PER, Lieberman PL, Read EJ Jr. Edwards ES Hazards of unintentional injection of epinephrine from auto-injectors a systematic review. Ann Allergy Clin Immunol 2009 102 267-272. Rawas-Qalaji MM, Simons PER, Simons KJ Sublingual epinephrine tablets versus intramuscular injection of epinephrine dose equivalence for potential treatment of anaphylaxis. J Allergy Clin Immunol 2006 117 398-403. 

Wahlbeck K, Cheine M, Essali A, Adams C (1999). Evidence of clozapine s effectiveness in schizophrenia a systematic review and metaanalysis of randomised trials. Am J Psychiatry 156, 990-9. 

Fan JY. Effect of backrest position on intracranial pressure and cerebral perfusion pressure in individuals with brain injury a systematic review. J Neurosci Nurs 2004 36(5) 278-288. 

Gupta R, Connolly ES, Mayer S, Elkind MS. Hemicraniectomy for massive middle cerebral artery territory infarction a systematic review. Stroke 2004 35(2) 539-543. 

Harris, J. P., Lopman, B. A., and O Brien, S. J. (2010). Infection control measures for nor-ovirus A systematic review of outbreaks in semi-enclosed settings. /. Hasp. Infect. 74,1-9. 

Tonelli M, Manns B, Feller-Kopman D. Acute renal failure in the intensive care unit a systematic review of the impact of dialytic modality on mortality and renal recovery. Am J Kidney Dis 2002 40 875-885. 

Guidelines agree that when antidepressants must be used, they should be combined with a mood-stabilizing drug to reduce the risk of mood switch to hypomania or mania.17,41 The question of which antidepressant drugs are less likely to cause a mood switch is not resolved. Anecdotal reports suggested bupropion may be less likely to cause this effect, but systematic reviews have not supported this conclusion. Prevailing evidence recommends that tricyclic antidepressants be avoided.41,43... 

Geddes JR, Burgess S, Hawton K, et al. Long-term lithium therapy for bipolar disorder systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004 161 217-222. 

Gijsman HJ, Geddes JR, Rendell JM, et al. Antidepressants for bipolar depression a systematic review of randomized, controlled trials. Am J Psychiatry 2004 161 1537-1547. 

Women often experience pelvic and back pain during pregnancy. Systematic review suggests that water aerobics, pillows that support the abdomen, physiotherapy, and acupuncture... 

Treat symptomatic trichomoniasis with oral metronidazole in order to alleviate maternal symptoms (Table 44—5). Do not treat asymptomatic disease. There is no evidence suggesting that treatment of asymptomatic disease will reduce the incidence of preterm labor or low birth weight, and systematic review suggests that this practice may even increase the incidence of preterm birth.40... 

Systematic review concludes that misoprostol shows greater efficacy versus dinoprostone, but this benefit is offset by a greater incidence of side effects.46 Compared with dinoprostone, misoprostol is associated with a higher incidence of uterine hyperstimulation, alterations in fetal heart rate, and fetal distress.46 Misoprostol also has been associated with uterine rupture in patients with previous delivery by cesarean section and should be avoided in this population.44... 

Mason L, Moore RA, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. Br Med J 2004 328 991. 

Heyland DK, Dhaliwal R, Suchner U. Immunonutrition. In Rolandelli RH, Bankhead R, Boullata JI, Compher CW, eds. Enteral and Tube Feeding. 4th ed. Philadelphia Elsevier 2005 224-242. Heyland DK, Novak F, Drover JW, et al. Should immunonutrition become routine in critically ill patients A systematic review of the evidence. JAMA 2001 286 944-953. 

Izzo, A. A. 8c Ernst, E. (2001). Interactions between herbal medicines and prescribed drugs a systematic review. Drugs, 61, 2163-75. 

Cochrane Library. The Cochrane Library [44] includes The Cochrane Database of Systematic Reviews, a collection of regularly updated, systematic reviews of the effects of health care. It is maintained by contributors to the Cochrane Collaboration. Cochrane reviews are reviews mainly of randomized controlled trials. To minimize bias, evidence is included or excluded on the basis of explicit quality criteria. Data are often combined statistically, with meta-analysis, to increase the power of the findings of numerous studies, each too small to produce reliable results individually. Database of Abstracts of Reviews of Effectiveness is also included. It consists of critical assessments and structured abstracts of good systematic reviews published elsewhere. The Cochrane Controlled Trials Register with bibliographic information on controlled trials and other sources of information on the science of reviewing research and evidence-based health care are part of the Cochrane Library. It is commercially available on CD-ROM or the Internet. 

P Glasziou, G Guyatt, DLM Sackett. Applying the results of trials and systematic reviews to individual patients. ACP J Club 129 A1516, 1998. 

Neurotransmitter depletion has been attempted in at least 90 studies and has been the subject of a number of systematic reviews, the most recent and comprehensive of which is a metaanalysis conducted by a research team at the University of Amsterdam.24 The hypotheses of these studies were based on the premise that lowered monoamine levels cause depression, in which case depletion of these neurotransmitters ought to trigger depression in people who are not depressed. Here is what actually happens. Experimentally lowering the level of available serotonin, or of norepinephrine and dopamine, in healthy volunteers who have never been depressed does not affect their mood in the slightest. 

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