literature reviews in medicine

Reproduced from Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies . Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x

• Last Updated: Sep 12, 2024 1:56 PM
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Literature Reviews: A How-To Guide

Faculty training: getting started with a literature review, temperature check, what is a literature review, purpose of a literature review, types of literature reviews, traditional (narrative) literature review, systematic review.

• Develop a Research Question
• Search for Previous Reviews
• Search the Literature
• Organize Key Findings
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Searching the literature is a professional skills that takes time and practice.

Learning Outcomes:

• Understand the purpose of a literature review, different types of reviews
• Understand the iterative nature of search and question development
• Develop and document search strategies using appropriate databases, terminology and search tools, revising and iterating the search to improve results
• Stay organized using various productivity tools and templates
• Poll Results

A literature review...

• generally describes what is known (or not) about a topic
• provides background for a larger piece of empirical work or can stand on their own
• guided by a clear and purposeful question
• essential first step in any research project
• helps to situate a study's research question(s), methodology and potential contributions to the field

Steinert, Y. & Thomas, A. (2016). When I say...literature reviews . Medical Education, 50 (4): 398-399.

The study example shown above goes on to review additional literature in the background section of the article.

Gill, A.C., Zhou, Y., Greely, J.T., Beasley, A.T., Purkiss, J., & Juneja, M. (2022). Longitudinal outcomes one year following implicit bias training in medical students. Medical Teacher, 44 (7): 744-751. https://doi.org/10.1080/0142159X.2021.2023120

The term literature reviews refers to both a process and an output product.

As a PROCESS, a literature review is a survey of scholarly publications related to a specific research question or topic.

As a PRODUCT, a literature review can be integrated into a research study

There are a multitude of review types, each differing in their purpose, degree of process and rigor.

For additional information on a variety of review methods, see the following article for an excellent overview:

Grant, M.J., & Booth, A. (2009). A typology of reviews: an analysis of 14 different review types and associated methodologies . Health Information and Libraries Journal, 26 : 91-108. DOI: 10.1111/j.1471-1842.2009.00848.x

Also see the following two guides from other libraries that include excellent descriptions and examples of a variety of review types (integrative, scoping, meta-analysis, etc.):

• Literature Reviews in Medicine and Health - Unv of Illinois Library
• How to Conduct a Literature Review (Health Sciences and Beyond) - Virginia Commonwealth Unv Library

A traditional (narrative) review summarizes a body of evidence on a topic using informal methods to find and interpret studies.

• summarizes and critiques the body of literature on a specific issue or topic
• research questions tend to be more general and broader
• provides context for research, identifies gaps in the literature, and situates research within an area of study
• often included with introduction to research study
• can be publication in its own right, and provides a deeper look at a specific issue or topic
• can be one or more authors
• can be completed in a few weeks to months

The rest of this guide focuses on the steps to complete a traditional (narrative) review.

Systematic reviews seek to collate evidence that fits pre-specified eligibility criteria in order to answer a specific research question. They aim to minimize bias by using explicit, systematic methods documented in advance with a protocol ( Cochrane Handbook ).

Features of a systematic review:

• Begins with a focused answerable clinical question (PICO framework)
• Establishes pre-specified, explicit, and reproducible eligibility criteria
• Uses comprehensive and exhaustive literature searches in multiple sources
• Employs comprehensive analysis of quality and validity of findings
• Reports collective interpretation of results
• Typically takes up to 1 year or more to complete
• Needs a team of experts - at least 3
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• Last Updated: May 16, 2024 2:55 PM
• URL: https://medlib.belmont.edu/LitReviews

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How to Conduct a Literature Review (Health Sciences and Beyond)

What is a literature review, traditional (narrative) literature review, integrative literature review, systematic reviews, meta-analysis, scoping review.

• Developing a Research Question
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A literature review provides an overview of what's been written about a specific topic. There are many different types of literature reviews. They vary in terms of comprehensiveness, types of study included, and purpose. 

The other pages in this guide will cover some basic steps to consider when conducting a traditional health sciences literature review. See below for a quick look at some of the more popular types of literature reviews.

For additional information on a variety of review methods, the following article provides an excellent overview.

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x. Review. PubMed PMID: 19490148.

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How to Write a Systematic Review of the Literature

Affiliations.

• 1 1 Texas Tech University, Lubbock, TX, USA.
• 2 2 University of Florida, Gainesville, FL, USA.
• PMID: 29283007
• DOI: 10.1177/1937586717747384

This article provides a step-by-step approach to conducting and reporting systematic literature reviews (SLRs) in the domain of healthcare design and discusses some of the key quality issues associated with SLRs. SLR, as the name implies, is a systematic way of collecting, critically evaluating, integrating, and presenting findings from across multiple research studies on a research question or topic of interest. SLR provides a way to assess the quality level and magnitude of existing evidence on a question or topic of interest. It offers a broader and more accurate level of understanding than a traditional literature review. A systematic review adheres to standardized methodologies/guidelines in systematic searching, filtering, reviewing, critiquing, interpreting, synthesizing, and reporting of findings from multiple publications on a topic/domain of interest. The Cochrane Collaboration is the most well-known and widely respected global organization producing SLRs within the healthcare field and a standard to follow for any researcher seeking to write a transparent and methodologically sound SLR. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), like the Cochrane Collaboration, was created by an international network of health-based collaborators and provides the framework for SLR to ensure methodological rigor and quality. The PRISMA statement is an evidence-based guide consisting of a checklist and flowchart intended to be used as tools for authors seeking to write SLR and meta-analyses.

Keywords: evidence based design; healthcare design; systematic literature review.

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How to conduct a literature review

The purpose of literature reviews and how to execute them.

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In recent decades, the ‘evidence-based medicine’ movement has become widely accepted and, consequently, decisions regarding what is best practice are informed by the best available evidence [1] . However, an ever-increasing quantity of evidence published in literature has meant that healthcare providers, researchers, and policy makers are inundated with unmanageable amounts of information, which can hinder, rather than inform, rational decision making [2] . It is therefore vital that healthcare professionals, including pharmacists, appreciate the importance of evaluating the available evidence when attempting to answer a clinical question [3] . A literature review can therefore be considered “the comprehensive study and interpretation of literature that relates to a particular topic” [4] .

When conducted correctly, a literature review can be viewed as more than simply a cursory overview of the literature on a given topic. Indeed, they are often viewed as a piece of research in their own right. A historical example of the value of literature reviews in informing evidence-based practice is that of streptokinase in the treatment of myocardial infarction (MI). In the 1970s, 33 separate clinical trials comparing streptokinase with a placebo for the treatment of MI had been conducted and their results published. Individually, these trials provided inconclusive evidence regarding the role of streptokinase. However, a re-analysis of their combined results clearly demonstrated the beneficial effect of streptokinase. As a result the medicine became part of the standard treatment following MI, thereby transforming care and saving lives [2] .

Narrative versus systematic literature reviews

Literature reviews can be broadly divided into narrative (descriptive) reviews and systematic reviews [5] . The most important difference between the two categories of reviews is the difference in their level of associated scientific rigour. Narrative literature reviews provide an overview of the literature, typically from the perspective of an ‘expert in the field’ [1] . Such reviews often report findings in a format that includes a brief summary of each included study. While such reviews can be informative, particularly when there has been no previous attempt to assimilate the literature in a given area, narrative reviews are often criticised as having a high risk of various types of bias associated with them [6] . Narrative reviews typically rely on subjective and non-systematic methods of selecting and reviewing data. Consequently, authors may intentionally or unintentionally cite only those literature sources that reinforce the author’s preconceived hypotheses or promote their own views on a topic [7] .

In contrast to a narrative review, a systematic literature review aims to identify all the available evidence on a topic and appraise the quality of that evidence [4] . Therefore, such reviews have the ability to either answer the research question or, failing that, identify gaps in the existing literature which highlight the need for further high quality research into a specific area [8] . Established in 1993, the Cochrane collaboration is an international organisation that produces systematic reviews, often regarded as the gold standard of evidence, concerning the effectiveness of healthcare interventions.

The purpose of a literature review

Literature reviews may be conducted for a variety of reasons, for example, to form part of a research proposal or introductory section in an academic paper, or to inform evidence-based practice [8] . The original focus of evidence-based medicine concerned mainly clinical research questions, such as the streptokinase example. However, increasingly, more research is being conducted in the area of health services research, which incorporates social science perspectives with the contribution of individuals and institutions that deliver care. Pharmacy practice research (a sub-type of health services research) is concerned with investigating how and why people access pharmacy services, new roles for pharmacists, and outcomes for patients as a result of pharmacy services [9] . Whether conducting either a clinical pharmacy or a pharmacy practice literature review, the following basic principles outlined in this article should be followed.

Searching with a strategy

While time and resource constraints may not allow for a definitive systematic review to be conducted, those attempting to undertake a literature review should nevertheless adopt a ‘systematic approach’ [10] . The first step in any literature review is to define the research question (i.e. the scope of the review). This will inform which studies or other forms of evidence are to be included and excluded from the literature review.

Questions that should be asked at this stage include:

• Which study designs are relevant to the review? For example, double-blind randomised controlled trials, observational studies or qualitative research.
• Is there a particular population of interest? For example, paediatrics, pregnant women or people living in care homes.
• Are there particular outcomes of interest? For example, mortality, costs or quality of life.

The literature search strategy is a fundamental component of any literature review, because errors in the search process could produce an incomplete and therefore biased evidence base for the review. Where possible, reviewers should consult with a pharmacy or healthcare librarian who can assist in developing and refining an appropriate search strategy [11] . The search should be conducted in more than one electronic database to help ensure all relevant papers are identified. The main medical literature databases are Medline and Embase. International Pharmaceutical Abstracts (IPA) is also an important database to consider because it indexes many pharmacy-specific journals not found in the larger databases. It should also be remembered that pharmacy literature often overlaps with other disciplines therefore consideration should be given to databases such as the Cumulative Index of Nursing and Allied Health (CINAHL), as well as condition-specific databases, for example PsycInfo.

When conducting searches on electronic databases, thought must be given to the search terms used. Several keywords can exist for each search term and all should be included in the search (e.g. older adult/elderly/aged, are all terms that could be used synonymously). Most databases also have the facility to identify all possible endings of the key terms; this is usually denoted with an asterisk. For example, by searching for ‘pharm*’, articles containing any of the following would be retrieved: pharmacist, pharmacists, pharmacy, pharmaceutical. Boolean operators (e.g. ‘and’, ‘or’, ‘not’) can also be used to combine search terms to refine the search results [12] .

Avoiding publication bias

It has been well documented that studies that report significant results are more likely than those reporting non-significant results to be published, cited by others and produce multiple publications, introducing what is known as ‘publication bias’. Consequently, such studies are also more likely to be identified and included in systematic reviews [13] .

For this reason, efforts should be made to identify all relevant literature on the review topic so the search should not be limited solely to electronic databases [14] . Additional search strategies include hand-checking relevant article reference lists and personal communication with experts in the field. Searching the ‘grey literature’ is of particular importance for pharmacy practice literature reviews because relevant articles written by non-academic pharmacists are often not published in traditional academic journals [15] .

The importance of such additional search strategies cannot be underestimated. Greenhalgh and Peacock reported that, in a literature review concerning innovations in healthcare organisations, 51% of the sources included in the eventual review were identified by hand-searching reference lists, while an additional 24% were identified through personal communications [7] . The search strategy, including databases searched, all search terms used, the limits of the search (for example, written in the English language, published in the last decade), the number of results retrieved from each resource and the date the search was conducted should be carefully documented. Although it can never be guaranteed that the entirety of relevant literature will be identified, conducting the search in a systematic manner will help avoid omissions, and where they do exist they can be said to be unintentional [9] .

Once the search has been performed, the next step is to screen the titles or abstracts (or both) of the identified articles against the predefined inclusion and exclusion criteria. If the article cannot be excluded on the basis of the information contained in the abstract, efforts must be made to access the full paper in order to reach a decision. Conducting a literature review can be a time-consuming process and the time taken to complete is directly related to number of citations identified by the initial search. Allen et al . [16] calculated that it would take a reviewer more than 1,000 hours to complete a literature review involving the screening of 2,500 articles. For this reason, it is worth considering the use of free citation management software, such as Refworks, Mendeley and Endnote, which can be used to manage references retrieved from the literature search.

Drawing conclusions

Studies identified as part of a literature review may report contradictory findings and the quality of the individual studies will have a direct impact on the overall findings of the literature review. When assimilating the evidence identified, the reviewer should attempt to assess the quality of the evidence provided by the individual studies to arrive at valid conclusions [6] . It is recommended that when conducting a literature review, the author should make a judgement of the quality of the evidence provided within the included studies or articles using appropriate assessment guidelines [17] . For example, the Cochrane Collaboration’s risk-of-bias tool attempts to aid quality assessment in terms of assessing potential sources of bias in studies.

In an effort to draw quantitative conclusions within a systematic review, data from individual studies may be pooled quantitatively and reanalysed. A meta-analysis is a statistical method used to combine the outcomes of individual studies to produce data with more power than the individual studies. By pooling the results of individual studies, the sample size is effectively increased, thereby increasing the statistical power of the analysis, which in turns narrows the confidence interval around the effect size, with the result that the overall estimate of effect is more robust [9] . Individual studies included in the analysis are assigned weights, with greater weight assigned to studies with larger sample sizes. The results of a meta-analysis are often displayed graphically in what is known as a “forest plot” [18] .

Publishing your literature review

Targeting an appropriate journal.

• Ensure the scope of your review aligns with the scope of the journal. Familiarise yourself with the journal’s mission statement and the typical content of the journal.
• Be aware of the journal’s target audience in relation to the scope of the review (e.g. does the journal have a pharmacy-specific or multidisciplinary audience? Does the journal have a national or international readership?)
• Consider whether the journal offers open-access publishing. Increasingly, funding bodies stipulate that articles are published only in open-access journals.
• Look at the journal’s impact factor. While articles published in journals with higher impact factors tend to get cited more, high-impact journals have lower article acceptance rates, making it potentially more challenging to get your review published.

Submitting the manuscript

• Familiarise yourself with the journal’s ‘guidelines for authors’. These will dictate the accepted word limit of a review in addition to other formatting and submission stipulations surrounding tables, figures and references, etc.
• Write a cover letter, addressed to the editor of the journal, to accompany your manuscript submission. The cover letter should highlight why the review is important and why you think it is a good fit for the chosen journal. 

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[1] Akobeng AK. Understanding systematic reviews and meta-analysis. Arch Dis Child 2005;90:845–848. doi: 10.1136/adc.2004.058230

[2] Mulrow CD. Systematic Reviews: Rationale for systematic reviews. The BMJ 1994;309:597. doi: 10.1136/bmj.309.6954.597

[3] Guyatt G, Cairns J, Churchill D et al . Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA 1992;268:2420–2425. doi: 10.1001/jama.268.17.2420

[4] Aveyard H. Doing a literature review in health and social care: a practical guide. 3rd Edn. Open University Press 2014. doi: 10.7748/ns.29.27.30.s33

[5] Grant MJ & Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J 2009;26:91–108. doi: 10.1111/j.1471-1842.2009.00848.x

[6] Green BN. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med 2006;5:101–117. doi: 10.1016/S0899-3467(07)60142-6

[7] Greenhalgh T & Peacock R. Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. The BMJ . 2005;331:1064–1065. doi: 10.1136/bmj.38636.593461.68

[8] Jesson J & Lacey F. How to do (or not to do) a critical literature review. Pharmacy Education 2006;6:139–148. doi: 10.1080/15602210600616218

[9] Babar Z. Pharmacy Practice Research Methods: Adis/Springer International Publishing, Switzerland, 2015.

[10] McKee M & Britton A. Conducting a literature review on the effectiveness of health care interventions. Health Policy Plan 1997;12:262–267. doi: 10.1093/heapol/12.3.262

[11] McGowan J & Sampson M. Systematic reviews need systematic searchers. J Med Libr Assoc 2005;93:74–80.

[12] Cronin P, Ryan F & Coughlan M. Undertaking a literature review: a step-by-step approach. BJN 2008;17:38–43.  doi: 10.12968/bjon.2008.17.1.28 059

[13] Sterne J, Egger M & Smith GD. Investigating and dealing with publication and other biases in meta-analysis. The BMJ 2001;323:101. doi: 10.1136/bmj.323.7304.101

[14] Crumley ET, Wiebe N, Cramer K et al . Which resources should be used to identify RCT/CCTs for systematic reviews: a systematic review. BMC Med Res Methodol 2005;5:24. doi: 10.1186/1471-2288-5-24

[15] Charrois T, Durec T & Tsuyuki R. Systematic reviews of pharmacy practice research: methodologic issues in searching, evaluating, interpreting, and disseminating results. Ann Pharmacother  2009;43:118–122. doi: 10.1345/aph.1l302

[16] Allen E & Olkin I. Estimating time to conduct a meta-analysis from number of citations retrieved. JAMA 1999;282:634–635. PMID: 10517715

[17] Jüni P, Altman DG & Egger M. Assessing the quality of controlled clinical trials. The BMJ 2001;323:42–46. doi: 10.1136/bmj.323.7303.42

[18] Lewis S & Clarke M. Forest plots: trying to see the wood and the trees. The BMJ 2001;322:1479–1480. doi: 10.1136/bmj.322.7300.1479

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Writing in the Health Sciences: Research and Lit Reviews

• Research and Lit Reviews
• Tables and Figures
• Citation Management
• Further Reference

What Is a Literature Review?

In simple terms, a literature review investigates the available information on a certain topic. It may be only a knowledge survey with an intentional focus. However, it is often a well-organized examination of the existing research which evaluates each resource in a systematic way. Often a lit review will involve a series of inclusion/exclusion criteria or an assessment rubric which examines the research in-depth. Below are some interesting sources to consider.

The Writing Center's Literature Reviews - UNC-Chapel Hill's writing center explains some of the key criteria involved in doing a literature review.

Literature Review vs. Systematic Review - This recent article details the difference between a literature review and a systematic review. Though the two share similar attributes, key differences are identified here.

Literature Review Steps

1. Identify a research question. For example: "Does the use of warfarin in elderly patients recovering from myocardial infarction help prevent stroke?"

2. Consider which databases might provide information for your topic. Often PubMed or CINAHL will cover a wide spectrum of biomedical issues. However, other databases and grey literature sources may specialize in certain disciplines. Embase is generally comprehensive but also specializes in pharmacological interventions.

3. Select the major subjects or ideas from your question.  Focus in on the particular concepts involved in your research. Then brainstorm synonyms and related terminology for these topics.

4. Look for the  preferred indexing terms for each concept in your question. This is especially important with databases such as PubMed, CINAHL, or Scopus where headings within the MeSH database or under the Emtree umbrella are present.  For example, the above question's keywords such as " warfarin " or "myocardial infarction" can involve related terminology or subject headings such as "anti-coagulants" or "cardiovascular disease."

5. Build your search using boolean operators. Combine the synonyms in your database using boolean operators such as AND or OR. Sometimes it is necessary to research parts of a question rather than the whole. So you might link searches for things like the preventive effects of anti-coagulants with stroke or embolism, then AND these results with the therapy for patients with cardiovascular disease.

6. Filter and save your search results from the first database (do this for all databases). This may be a short list because of your topic's limitations, but it should be no longer than 15 articles for an initial search. Make sure your list is saved or archived and presents you with what's needed to access the full text.

7. Use the same process with the next databases on your list. But pay attention to how certain major headings may alter the terminology. "Stroke" may have a suggested term of "embolism" or even "cerebrovascular incident" depending on the database.

8. Read through the material for inclusion/exclusion . Based on your project's criteria and objective, consider which studies or reviews deserve to be included and which should be discarded. Make sure the information you have permits you to go forward. 

9. Write the literature review. Begin by summarizing why your research is important and explain why your approach will help fill gaps in current knowledge. Then incorporate how the information you've selected will help you to do this. You do not need to write about all of the included research you've chosen, only the most pe rtinent.

10. Select the most relevant literature for inclusion in the body of your report. Choose the articles and data sets that are most particularly relevant to your experimental approach. Consider how you might arrange these sources in the body of your draft. 

Library Books

Call #: WZ 345 G192h 2011

ISBN #: 9780763771867

This book details a practical, step-by-step method for conducting a literature review in the health sciences. Aiming to  synthesize the information while also analyzing it, the Matrix Indexing System enables users to establish a  structured process for tracking, organizing and integrating the knowledge within a collection.

Key Research Databases

PubMed -  The premier medical database for review articles in medicine, nursing, healthcare, other related biomedical disciplines. PubMed contains over 20 million citations and can be navigated through multiple database capabilities and searching strategies.

CINAHL Ultimate - Offers comprehensive coverage of health science literature. CINAHL is particularly useful for those researching the allied disciplines of nursing, medicine, and pharmaceutical sciences.

Scopus - Database with over 12 million abstracts and citations which include peer-reviewed titles from international and Open Access journals. Also includes interactive bibliometrics and researcher profiling.

Embase - Elsevier's fully interoperable database of both Medline and Emtree-indexed articles. Embase also specializes in pharmacologic interventions.

Cochrane - Selected evidence-based medicine resources from the Cochrane Collaboration that includes peer-reviewed systematic reviews and randomized controlled trials. Access this database through OVID with TTUHSC Libraries.

DARE - Literally the Datatase of Abstracts of Reviews of Effectiveness, this collection of systematic reviews and other evidence-based research contains critical assessments from a wide variety of medical journals.

TRIP - This TRIP database is structured according to the level of evidence for its EBM content. It allows users to quickly and easily locate high-quality, accredited medical literature for clinical and research purposes.

Web of Science - Contains bibliographic articles and data from a wide variety of publications in the life sciences and other fields. Also, see this link for conducting a lit review exclusively within Web of Science.

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Literature Reviews in Medicine and Health

• Types of Literature Reviews

Narrative Review

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Rapid Review

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Sage Research Methods Online

• Systematic Review Methods Map Explore the research methods terrain, read definitions of key terminology, and discover content relevant to your research methods journey

Froms, Handouts, Guides

• Differences between types of reviews from University of Toronto Libraries
• Systematic Reviews & Other Review Types Very helpful explanations form Temple University
• Types of Reviews Comparison chart from Duke University Medical Center Library
• A typology of reviews A typology of reviews: an analysis of 14 review types and associated methodologies. Grant MJ, Booth A. Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x. Review.

• summarizes, synthesizes and critiques the body of literature on a specific issue or topic
• provides context for research, identifies gaps in the literature, and situates research within an area of study
• often included with introduction to research study
• can be publication in its own right, and provides a deeper look at a specific issue or topic
• Publication does not include methods

Systematic Review

• comprehensive review and analysis of literature related to a focused question
• uses specific criteria for inclusion
• reports search strategy and methods for inclusion/exclusion
• inclusive studies address the same issue, in similar populations, in similar circumstances

Seeks to systematically search for, appraise and synthesize research evidence, often adhering to guidelines on the conduct of a review.

SEARCH aims for exhaustive, comprehensive searching.

APPRAISAL includes quality assessment that may determine inclusion/exclusion.

SYNTHESIS is narrative with tabular accompaniment.

ANALYSIS includes what is known; recommendations fo practice. What remains unknown; uncertainly around findings, recommendations for future research.

Source: A typology of reviews: an analysis of 14 review types and associated methodologies. Grant MJ & Booth A. Health information and Libraries Journal year : 2009 26(2):91 -108. doi: 10.1111/j.1471-1842.2009.00848.x.

Meta-analysis

A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine.

Source: MeSH: https://www.ncbi.nlm.nih.gov/mesh/68015201

Technique that statistically combines the results of quantitative study to provide a more precise effect of the results.

SEARCH aims for exhaustive, comprehensive searching. May use funnel plot to assess completeness. requires either very sensitive search to retrieve all studies or separately conceived quantitative and qualitative strategies.

APPRAISAL includes quality assessment that may determine inclusion/exclusion and/or sensitivity analyses.

SYNTHESIS is graphical and tabular with narrative commentary.

ANALYSIS includes numerical analysis of measures of effect assuming absence of heterogeneity.

Assessment of what is already known about a policy or practice issue, by using systematic review methods to search and critically appraise existing research.

SEARCH is determined by time constraints.

APPRAISAL is a time-limited formal quality assessment.

SYNTHESIS is narrative and tabular.

ANALYSIS includes quantities of literature and overall quality/direction of effect of literature.

Scoping Review

Preliminary assessment of potential size and scope of available research literature. Aims to identify nature and extent of research evidence (usually including ongoing research).  

SEARCH is determined by time/scope constraints. May include research in progress.

APPRAISAL does not include formal quality assessment.

SYNTHESIS is tabular with some narrative commentary.

ANALYSIS characterizes quantity and quality of literature, perhaps by study design and other key features.

Mapping Review

Map out and categorize existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature.

SEARCH is determined by time/scope constraints.

APPRAISAL does not include formal quality assessment

SYNTHESIS may be graphical and tabular.

ANALYSIS characterizes quantity and quality of literature, perhaps by study design and other key features. May identify need fo primary aor secondary research. Numerical analysis of measures of effect assuming absence of heterogeneity.

From: A typology of reviews: an analysis of 14 review types and associated methodologies. Grant MJ & Booth A. Health information and Libraries Journal year : 2009 26(2):91 -108. doi: 10.1111/j.1471-1842.2009.00848.x.

Critical Review

Aims to demonstrate writer has extensively research literature and critically evaluated its quality. Goes beyond mere description to include degree of analysis and conceptual innovation. Typically results in hypothesis or model.

SEARCH seeks to identify most significant items in the field

APPRAISAL attempts to evaluate according to contribution; no formal quality assessment.

SYNTHESIS is narrative, perhaps conceptual or chronological.

ANALYSIS seeks to identify conceptual contribution to embody existing or derive new theory.

Integrative Review

An integrative review provides a synthesis of literature on a topic and may include critique or commentary. They may discuss theory or frameworks behind a topic. The require a comprehensive literature search.

Umbrella Review

Specifically refers to review compiling evidence from multiple reviews into one accessible and usable document. Focuses on broad condition or problem for which there are competing interventions and highlights reviews that address these intervention and their results.

SEARCH incudes identification of component reviews, but no search for primary studies.

APPRAISAL includes quality assessment of studies within component reviews and/or of reviews themselves.

ANALYSIS includes what is known; recommendations for practice. What remains unknown; recommendations for future research.

ource: A typology of reviews: an analysis of 14 review types and associated methodologies. Grant MJ & Booth A. Health information and Libraries Journal year : 2009 26(2):91 -108. doi: 10.1111/j.1471-1842.2009.00848.x.

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What is a literature review?

Systematic reviews vs literature reviews, literature reviews - articles, writing literature reviews, frequently used journal article databases.

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The literature review is the qualitative summary of evidence on a topic using informal or subjective methods to collect and interpret studies.The literature review can inform a particular research project or can result in a review article publication.

• Aaron L. Writing a literature review article. Radiol Technol. 2008 Nov-Dec; 80(12): 185-6.
• Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD. Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int. 2011 Nov; 31(11): 1409-17.
• Matharu GS, Buckley CD. Performing a literature review: a necessary skill for any doctor. Student BMJ. 2012; 20:e404. Requires FREE site registration
• Literature Reviews The Writing Center at University of North Carolina at Chapel Hill has created a succinct handout that explains what a literature review is and offer insights into the form and construction of a literature review in the humanities, social sciences, and sciences.
• Review Articles (Health Sciences) Guide Identifies the difference between a systematic review and a literature review. Connects to tools for research, writing, and publishing.

• Systematic Approaches to a Successful Literature Review by Andrew Booth; Diana Papaioannou; Anthea Sutton Call Number: Norris Medical Library, Upper Level, LB 1047.3 B725s 2012
• Documenting your search This resource provides guidance on how to document and save database search strategies.
• Cochrane Database of Systematic Reviews
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Writing a Literature Review: Examples & Tutorials

• Phase 1: Scope of Review
• Phase 2: Finding Information
• Phase 3: Recording Information
• Phase 4: Evaluating Information
• Phase 5: Organizing the Review
• Phase 6: Writing the Review & Bibliography
• Tools & Resources
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Examples of Lit. Reviews

Sample Literature Review -Here is a sample literature review written by a librarian at American University Library.

Deshmukh, Marion F. " The Visual Arts and Cultural Migration in the 1930s and 1940s: A Literature Review. " Central European History (Cambridge University Press / UK) 41.4 (2008): 569-604. Dunjó, Jordi, et al. " Hazard and Operability (HAZOP) Analysis. A Literature Review ." Journal of Hazardous Materials 173.1-3 (2010): 19-32. Gibbons, Susan. " Understanding Empathy as a Complex Construct: A Review of the Literature ." Clinical Social Work Journal 39.3 (2011): 243-52.

Liddle, H. A. (2004). Family-based therapies for adolescent alcohol and drug use: Research contributions and future research needs.   Addiction , 99 (Suppl.2), 76-92.

Mayer, David J. " Acupuncture: An Evidence-Based Review of the Clinical Literature ." Annual Review of Medicine 51:1 (2000): 49-63.

Meyer, Sebastian, Bruno Glaser, and Peter Quicker. " Technical, Economical, and Climate-Related Aspects of Biochar Production Technologies: A Literature Review. " Environmental science & technology 45.22 (2011): 9473-83.

• Writing the Literature Review Part I Defines what a literature review is - and is not.
• Writing the Literature Review Part II Organizing sources, basic steps in the writing process.
• Literature Review Overview for Graduate Students Understand how studies relate to one another, how your own ideas fit within the existing literature.
• Interactive tutorial for literature reviews in Education & Behavioral Sciences • Understanding the Literature Review • Identifying Sources for the Literature Review • Finding Review and Research Articles • Putting it All Together

Literature Review Overview

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Systematically Reviewing the Literature: Building the Evidence for Health Care Quality

There are important research and non-research reasons to systematically review the literature. This article describes a step-by-step process to systematically review the literature along with links to key resources. An example of a graduate program using systematic literature reviews to link research and quality improvement practices is also provided.

Introduction

Systematic reviews that summarize the available information on a topic are an important part of evidence-based health care. There are both research and non-research reasons for undertaking a literature review. It is important to systematically review the literature when one would like to justify the need for a study, to update personal knowledge and practice, to evaluate current practices, to develop and update guidelines for practice, and to develop work related policies. 1 A systematic review draws upon the best health services research principles and methods to address: What is the state of the evidence on the selected topic? The systematic process enables others to reproduce the methods and to make a rational determination of whether to accept the results of the review. An abundance of articles on systematic reviews exist focusing on different aspects of systematic reviews. 2 – 9 The purpose of this article is to describe a step by step process of systematically reviewing the health care literature and provide links to key resources.

Systematic Review Process: Six Key Steps

Six key steps to systematically review the literature are outlined in Table 1 and discussed here.

Systematic Review Steps

1. Formulate the Question and Refine the Topic

When preparing a topic to conduct a systematic review, it is important to ask at the outset, “What exactly am I looking for?” Hopefully it seems like an obvious step, but explicitly writing a one or two sentence statement of the topic before you begin to search is often overlooked. It is important for several reasons; in particular because, although we usually think we know what we are searching for, in truth our mental image of a topic is often quite fuzzy. The act of writing something concise and intelligible to a reader, even if you are the only one who will read it, clarifies your thoughts and can inspire you to ask key questions. In addition, in subsequent steps of the review process, when you begin to develop a strategy for searching the literature, your topic statement is the ready raw material from which you can extract the key concepts and terminology for your strategies. The medical and related health literature is massive, so the more precise and specific your understanding of your information need, the better your results will be when you search.

2. Search, Retrieve, and Select Relevant Articles

The retrieval tools chosen to search the literature should be determined by the purpose of the search. Questions to ask include: For what and by whom will the information be used? A topical expert or a novice? Am I looking for a simple fact? A comprehensive overview on the topic? Exploration of a new topic? A systematic review? For the purpose of a systematic review of journal research in the area of health care, PubMed or Medline is the most appropriate retrieval tool to start with, however other databases may be useful ( Table 2 ). In particular, Google Scholar allows one to search the same set of articles as PubMed/MEDLINE, in addition to some from other disciplines, but it lacks a number of key advanced search features that a skilled searcher can exploit in PubMed/MEDLINE.

Examples of Electronic Bibliographic Databases Specific to Health Care

Note: These databases may be available through university or hospital library systems.

An effective way to search the literature is to break the topic into different “building blocks.” The building blocks approach is the most systematic and works the best in periodical databases such as PubMed/MEDLINE. The “blocks” in a “building blocks” strategy consist of the key concepts in the search topic. For example, let’s say we are interested in researching about mobile phone-based interventions for monitoring of patient status or disease management. We could break the topic into the following concepts or blocks: 1. Mobile phones, 2. patient monitoring, and 3. Disease management. Gather synonyms and related terms to represent each concept and match to available subject headings in databases that offer them. Organize the resulting concepts into individual queries. Run the queries and examine your results to find relevant items and suggest query modifications to improve your results. Revise and re-run your strategy based on your observations. Repeat this process until you are satisfied or further modifications produce no improvements. For example in Medline, these terms would be used in this search and combined as follows: cellular phone AND (ambulatory monitoring OR disease management), where each of the key word phrases is an official subject heading in the MEDLINE vocabulary. Keep detailed notes on the literature search, as it will need to be reported in the methods section of the systematic review paper. Careful noting of search strategies also allows you to revisit a topic in the future and confidently replicate the same results, with the addition of those subsequently published on your topic.

3. Assess Quality

There is no consensus on the best way to assess study quality. Many quality assessment tools include issues such as: appropriateness of study design to the research objective, risk of bias, generalizability, statistical issues, quality of the intervention, and quality of reporting. Reporting guidelines for most literature types are available at the EQUATOR Network website ( http://www.equator-network.org/ ). These guidelines are a useful starting point; however they should not be used for assessing study quality.

4. Extract Data and Information

Extract information from each eligible article into a standardized format to permit the findings to be summarized. This will involve building one or more tables. When making tables each row should represent an article and each column a variable. Not all of the information that is extracted into the tables will end up in the paper. All of the information that is extracted from the eligible articles will help you obtain an overview of the topic, however you will want to reserve the use of tables in the literature review paper for the more complex information. All tables should be introduced and discussed in the narrative of the literature review. An example of an evidence summary table is presented in Table 3 .

Example of an evidence summary table

Notes: BP = blood pressure, HbA1c = Hemoglobin A1c, Hypo = hypoglycemic, I = Internet, NS = not significant, PDA = personal digital assistant, QOL = quality of life, SMBG = self-monitored blood glucose, SMS = short message service, V = voice

5. Analyze and Synthesize Data and information

The findings from individual studies are analyzed and synthesized so that the overall effectiveness of the intervention can be determined. It should also be observed at this time if the effect of an intervention is comparable in different studies, participants, and settings.

6. Write the Systematic Review

The PRISMA 12 and ENTREQ 13 checklists can be useful resources when writing a systematic review. These uniform reporting tools focus on how to write coherent and comprehensive reviews that facilitate readers and reviewers in evaluating the relative strengths and weaknesses. A systematic literature review has the same structure as an original research article:

TITLE : The systematic review title should indicate the content. The title should reflect the research question, however it should be a statement and not a question. The research question and the title should have similar key words.

STRUCTURED ABSTRACT: The structured abstract recaps the background, methods, results and conclusion in usually 250 words or less.

INTRODUCTION: The introduction summarizes the topic or problem and specifies the practical significance for the systematic review. The first paragraph or two of the paper should capture the attention of the reader. It might be dramatic, statistical, or descriptive, but above all, it should be interesting and very relevant to the research question. The topic or problem is linked with earlier research through previous attempts to solve the problem. Gaps in the literature regarding research and practice should also be noted. The final sentence of the introduction should clearly state the purpose of the systematic review.

METHODS: The methods provide a specification of the study protocol with enough information so that others can reproduce the results. It is important to include information on the:

• Eligibility criteria for studies: Who are the patients or subjects? What are the study characteristics, interventions, and outcomes? Were there language restrictions?
• Literature search: What databases were searched? Which key search terms were used? Which years were searched?
• Study selection: What was the study selection method? Was the title screened first, followed by the abstract, and finally the full text of the article?
• Data extraction: What data and information will be extracted from the articles?
• Data analysis: What are the statistical methods for handling any quantitative data?

RESULTS: The results should also be well-organized. One way to approach the results is to include information on the:

• Search results: What are the numbers of articles identified, excluded, and ultimately eligible?
• Study characteristics: What are the type and number of subjects? What are the methodological features of the studies?
• Study quality score: What is the overall quality of included studies? Does the quality of the included studies affect the outcome of the results?
• Results of the study: What are the overall results and outcomes? Could the literature be divided into themes or categories?

DISCUSSION: The discussion begins with a nonnumeric summary of the results. Next, gaps in the literature as well as limitations of the included articles are discussed with respect to the impact that they have on the reliability of the results. The final paragraph provides conclusions as well as implications for future research and current practice. For example, questions for future research on this topic are revealed, as well as whether or not practice should change as a result of the review.

REFERENCES: A complete bibliographical list of all journal articles, reports, books, and other media referred to in the systematic review should be included at the end of the paper. Referencing software can facilitate the compilation of citations and is useful in terms of ensuring the reference list is accurate and complete.

The following resources may be helpful when writing a systematic review:

CEBM: Centre for Evidence-based Medicine. Dedicated to the practice, teaching and dissemination of high quality evidence based medicine to improve health care Available at: http://www.cebm.net/ .

CITING MEDICINE: The National Library of Medicine Style Guide for Authors, Editors, and Publishers. This resource provides guidance in compiling, revising, formatting, and setting reference standards. Available at http://www.ncbi.nlm.nih.gov/books/NBK7265/ .

EQUATOR NETWORK: Enhancing the QUAlity and Transparency Of health Research. The EQUATOR Network promotes the transparent and accurate reporting of research studies. Available at: http://www.equator-network.org/ .

ICMJE RECOMMENDATIONS: International Committee of Medical Journal Editors Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals. The ICJME recommendations are followed by a large number of journals. Available at: http://www.icmje.org/about-icmje/faqs/icmje-recommendations/ .

PRISMA STATEMENT: Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Authors can utilize the PRISMA Statement checklist to improve the reporting of systematic reviews and meta-analyses. Available at: http://prisma-statement.org .

THE COCHRANE COLLABORATION: A reliable source for making evidence generated through research useful for informing decisions about health. Available at: http://www.cochrane.org/ .

Examples of Systematic Reviews To Link Research and Quality Improvement

Over the past 17 years more than 300 learners, including physicians, nurses, and health administrators have completed a course as part of a Master of Health Administration or a Master of Science in Health Informatics degree at the University of Missouri. An objective of the course is to educate health informatics and health administration professionals about how to utilize a systematic, scientific, and evidence-based approach to literature searching, appraisal, and synthesis. Learners in the course conduct a systematic review of the literature on a health care topic of their choosing that could suggest quality improvement in their organization. Students select topics that make sense in terms of their core educational competencies and are related to their work. The categories of topics include public health, leadership, information management, health information technology, electronic medical records, telehealth, patient/clinician safety, treatment/screening evaluation cost/finance, human resources, planning and marketing, supply chain, education/training, policies and regulations, access, and satisfaction. Some learners have published their systematic literature reviews 14 – 15 . Qualitative comments from the students indicate that the course is well received and the skills learned in the course are applicable to a variety of health care settings.

Undertaking a literature review includes identification of a topic of interest, searching and retrieving the appropriate literature, assessing quality, extracting data and information, analyzing and synthesizing the findings, and writing a report. A structured step-by-step approach facilitates the development of a complete and informed literature review.

Suzanne Austin Boren, PhD, MHA, (above) is Associate Professor and Director of Academic Programs, and David Moxley, MLIS, is Clinical Instructor and Associate Director of Executive Programs. Both are in the Department of Health Management and Informatics at the University of Missouri School of Medicine.

Contact: ude.iruossim.htlaeh@snerob

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