Claire Stansfield

The selection of search sources influences the findings of a systematic review of people’s views: a case study in public health

BackgroundFor systematic reviews providing evidence for policy decisions in specific geographical regions, there is a need to minimise regional bias when seeking out relevant research studies. Studies on people’s views tend to be dispersed across a range of bibliographic databases and other search sources. It is recognised that a comprehensive literature search can provide unique evidence not found from a focused search; however, the geographical focus of databases as a potential source of bias on the findings of a research review is less clear. This case study describes search source selection for research about people’s views and how supplementary searches designed to redress geographical bias influenced the findings of a systematic review. Our research questions are: a) what was the impact of search methods employed to redress potential database selection bias on the overall findings of the review? and b) how did each search source contribute to the identification of all the research studies included in the review?MethodsThe contribution of 25 search sources in locating 28 studies included within a systematic review on UK children’s views of body size, shape and weight was analysed retrospectively. The impact of utilising seven search sources chosen to identify UK-based literature on the review’s findings was assessed.ResultsOver a sixth (5 out of 28) of the studies were located only through supplementary searches of three sources. These five studies were of a disproportionally high quality compared with the other studies in the review. The retrieval of these studies added direction, detail and strength to the overall findings of the review. All studies in the review were located within 21 search sources. Precision for 21 sources ranged from 0.21% to 1.64%.ConclusionsFor reducing geographical bias and increasing the coverage and context-specificity of systematic reviews of people’s perspectives and experiences, searching that is sensitive and aimed at reducing geographical bias in database sources is recommended.

Psychosocial Predictors, Assessment, and Outcomes of Cosmetic Procedures: A Systematic Rapid Evidence Assessment

BackgroundRecent breast implant complications led to a UK government policy review of the evidence concerning cosmetic interventions. We synthesised cosmetic intervention research evidence covering psychosocial factors associated with requesting procedures and psychological outcomes, effects of procedures on psychological outcomes, preintervention assessments for identifying those at risk, alternative therapy effectiveness, and issues in achieving informed consent.MethodsUndertaking a systematic rapid evidence assessment, six databases and three journals were searched. Included studies were systematic reviews or primary studies of participants requesting cosmetic procedures; published 2002–2012; containing either psychological or psychosocial measures, a psychological outcome, or evaluation of informed consent. Reviewers independently assessed study eligibility, extracted data, and assessed quality, undertaking narrative synthesis.ResultsMethodological quality of the included 13 systematic reviews and 179 primary studies was low, with wide variation in psychosocial measures. Findings suggest several psychosocial factors (e.g., intimate partner violence) may be associated with requesting cosmetic surgery. Multiple factors (e.g., unrealistic expectations) may predict poor psychological outcomes. Current psychological screening tools focus predominantly on body dysmorphic disorder (BDD) symptoms. Psychological and pharmacological interventions are effective alternative BDD treatments. Patients and doctors bring different needs to informed consent discussions, inconsistently matched to those required by professional ethics, litigation risk, and facilitating profit.ConclusionsSystematically reviewing this literature for UK policy has highlighted that some groups may be at risk of poor post-cosmetic procedure outcomes. Practitioners and patients must explore reasons for seeking cosmetic procedures and discuss all potential results and alternative solutions. Future research should employ more robust methodologies to identify effects in those at risk, led by consensus on a core set of psychological outcomes.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Methods for documenting systematic review searches: a discussion of common issues

INTRODUCTIONnAs standardized reporting requirements for systematic reviews are being adopted more widely, review authors are under greater pressure to accurately record their search process. With careful planning, documentation to fulfill the Preferred Reporting Items for Systematic Reviews and Meta-Analyses requirements can become a valuable tool for organizing a systematic review literature search and planning updates.nnnMETHODSnA working group of information specialists convened to discuss current practice and were informed by a Web-based survey of over 260 systematic review authors, trials search coordinators, librarians, and other information specialists conducted in February/March 2011.nnnDISCUSSIONnSurvey responses provided insight into current practices and difficulties of reporting searches. These included a lack of time, tools, clear understanding of the requirements, and uncertainty about responsibility for documenting these elements. This paper will present some of the practical aspects of documenting the systematic literature search. Section 1 provides background information and rationale for this paper. Section 2 discusses issues and recommendations arising from survey results. Section 3 outlines specific elements to be recorded. Section 4 guides the reader through the information management process. Section 5 concludes with implications for future research and practice. These principles are applicable to any large literature search for systematic reviews, health technology assessments, and guideline development.

Exploring issues in the conduct of website searching and other online sources for systematic reviews: how can we be systematic?

Websites and online resources outside academic bibliographic databases can be significant sources for identifying literature, though there are challenges in searching and managing the results. These are pertinent to systematic reviews that are underpinned by principles of transparency, accountability and reproducibility. We consider how the conduct of searching these resources can be compatible with the principles of a systematic search. We present an approach to address some of the challenges. This is particularly relevant when websites are relied upon to identify important literature for a review. We recommend considering the process as three stages and having a considered rationale and sufficient recordkeeping at each stage that balances transparency with practicality of purpose. Advances in technology and recommendations for website providers are briefly discussed.

Capacity for conducting systematic reviews in low- and middle-income countries: a rapid appraisal

BackgroundSystematic reviews of research are increasingly recognised as important for informing decisions across policy sectors and for setting priorities for research. Although reviews draw on international research, the host institutions and countries can focus attention on their own priorities. The uneven capacity for conducting research around the world raises questions about the capacity for conducting systematic reviews.MethodsA rapid appraisal was conducted of current capacity and capacity strengthening activities for conducting systematic reviews in low- and middle-income countries (LMICs). A systems approach to analysis considered the capacity of individuals nested within the larger units of research teams, institutions that fund, support, and/or conduct systematic reviews, and systems that support systematic reviewing internationally.ResultsInternational systematic review networks, and their support organisations, are dominated by members from high-income countries. The largest network comprising a skilled workforce and established centres is the Cochrane Collaboration. Other networks, although smaller, provide support for systematic reviews addressing questions beyond effective clinical practice which require a broader range of methods. Capacity constraints were apparent at the levels of individuals, review teams, organisations, and system wide. Constraints at each level limited the capacity at levels nested within them. Skills training for individuals had limited utility if not allied to opportunities for review teams to practice the skills. Skills development was further constrained by language barriers, lack of support from academic organisations, and the limitations of wider systems for communication and knowledge management.All networks hosted some activities for strengthening the capacities of individuals and teams, although these were usually independent of core academic programmes and traditional career progression. Even rarer were efforts to increase demand for systematic reviews and to strengthen links between producers and potential users of systematic reviews.ConclusionsLimited capacity for conducting systematic reviews within LMICs presents a major technical and social challenge to advancing their health systems. Effective capacity in LMICs can be spread through investing effort at multiple levels simultaneously, supported by countries (predominantly high-income countries) with established skills and experience.

Search wide, dig deep: literature searching for qualitative research. An analysis of the publication formats and information sources used for four systematic reviews in public health

BACKGROUNDnWhen literature searching for systematic reviews, it is good practice to search widely across different information sources. Little is known about the contributions of different publication formats (e.g. journal article and book chapter) and sources, especially for studies of peoples views.nnnMETHODnStudies from four reviews spanning three public health areas (active transport, motherhood and obesity) were analysed in terms of publication formats and the information sources they were identified from. They comprised of 229 studies exploring peoples perceptions, beliefs and experiences (views studies) and were largely qualitative.nnnRESULTSnAlthough most (61%) research studies were published within journals, nearly a third (29%) were published as research reports and 5% were published in books. The remainder consisted of theses, conference papers and raw datasets. Two-thirds of studies (66%) were located in a total of 19 bibliographic databases, and 15 databases provided studies that were not identified elsewhere. PubMed was a good source for all reviews. Supplementary information sources were important for identifying studies in all publication formats.nnnCONCLUSIONSnUndertaking sensitive searches across a range of information sources is essential for locating views studies in all publication formats. We discuss some benefits and challenges of utilising different information sources.

Searching for systematic reviews of the effects of social and environmental interventions: a case study of children and obesity

SETTINGnAlthough an important part of the evidence base in health, systematic reviews are not always easy to find. Difficulties are compounded when interventions under review are social and environmental (that is, targeting wider determinants of health). The authors explored searches from a descriptive map containing thirty-two systematic reviews evaluating the effectiveness of social and environmental interventions for childhood obesity.nnnQUESTIONSnWhich sources give the highest yield of relevant reviews per 100 records? What is the value of searching databases that index literature beyond the health arena when looking for data on the effectiveness of social and environmental interventions?nnnMETHODSnThe authors analyzed search results from nineteen databases and calculated the precision and the relative and unique contribution of each source.nnnRESULTSnSearches of specialist systematic review databases-Database of Abstracts of Reviews of Effects (DARE), Database of Promoting Health Effectiveness Reviews (DoPHER), and Health Technology Assessment (HTA)-had the highest precision, although MEDLINE, CINAHL, and PsycINFO located many additional reviews. The Cochrane Database of Systematic Reviews should be searched for health-related reviews. Searches of education, transportation, social policy, and social sciences databases did not identify additional reviews. Searching websites and bibliographies was important.nnnCONCLUSIONSnSearches for review-level evidence could profitably start with the specialist review databases. Searches of the major health-related databases are essential, but database searching beyond them may not identify much additional evidence. Internet and hand-search remain important sources of reviews not found elsewhere. Comparison of the results with previous research suggests that appropriate sources for locating primary and secondary evidence may be different.

‘Clustering’ documents automatically to support scoping reviews of research: a case study

BACKGROUNDnScoping reviews of research help determine the feasibility and the resource requirements of conducting a systematic review, and the potential to generate a description of the literature quickly is attractive.nnnAIMSnTo test the utility and applicability of an automated clustering tool to describe and group research studies to improve the efficiency of scoping reviews.nnnMETHODSnA retrospective study of two completed scoping reviews was conducted. This compared the groups and descriptive categories obtained by automatically clustering titles and abstracts with those that had originally been derived using traditional researcher-driven techniques.nnnRESULTSnThe clustering tool rapidly categorised research into themes, which were useful in some instances, but not in others. This provided a dynamic means to view each dataset. Interpretation was challenging where there were potentially multiple meanings of terms. Where relevant clusters were unambiguous, there was a high precision of relevant studies, although recall varied widely.nnnCONCLUSIONSnPolicy-relevant scoping reviews are often undertaken rapidly, and this could potentially be enhanced by automation depending on the nature of the dataset and information sought. However, it is not a replacement for researcher-developed classification. The possibilities of further applications and potential for use in other types of review are discussed.

Does Being Overweight Impede Academic Attainment? A Systematic Review.

Objectives: To examine evidence from studies exploring the relationship between childhood obesity and educational attainment. Design: A systematic review of secondary analyses and observational studies published in English after 1997 examining attainment as measured by grade point average or other validated measure, in children aged 6 to16 years, in high-income countries. Methods: Eleven databases from the fields of public health, education and social science were searched, along with 19 specialist registers and catalogues. Hand searching of relevant journals, contacting of experts and citation searching were undertaken. Two reviewers used standardized tools to independently carry out data extraction and assess the quality of included studies. Evidence was synthesized in a narrative summary. Results: Twenty-nine studies were identified for inclusion. Overall, the evidence suggested that higher weight is weakly associated with lower educational attainment among children and young people. Differences between average attainment of overweight and non-overweight children were marginal, with potentially negligible real-world implications for test scores. Limited evidence suggested that little variation in achievement was explained by weight status alone. Almost half the studies found that other factors, such as socioeconomic status, may better explain much of the negative association between obesity and attainment. Conclusion: Theoretical and methodological inconsistencies were evident both within and between many of the studies. As such, the results of the included studies must be interpreted with caution. If the negative association between obesity and attainment is accepted, it still remains doubtful whether obesity is exerting a socially important effect upon educational attainment.

Cochrane update: identifying health-related research resources relevant to low- and middle-income countries

Claire Stansfield1, Alison LWeightman2, Josephine Kavanagh1, Marit Johansen3 Evidence for Policy and Practice Information and Coordinating Centre, (EPPI-Centre), Institute of Education, University of London, UK Support Unit for Research Evidence (SURE), Cardiff University, UK Norwegian Knowledge Centre for the Health Services, Global Health Unit, Cochrane Effective Practice and Organisation of Care Group (Norwegian Satellite), Oslo, Norway Address correspondence to Claire Stansfield, E-mail: c.stansfield@ioe.ac.uk