By clinical education librarians at UI Libraries’ Hardin Library for the Health Sciences Jennifer DeBerg and Heather Healy
Since 2011, Hardin Library for the Health Sciences has provided a systematic review service to support research across the health sciences. Systematic reviews, a critical component of evidence-based clinical practice, follow a specific research methodology that attempts to identify, select, assess, and synthesize all the studies related to a specific question to guide decision making. Related review types include meta-analyses and meta-syntheses. All these review types need to follow a process that minimizes bias to ensure the results are valid.
ROLES FOR LIBRARIANS
Unfortunately, not all systematic reviews are conducted using a bias-minimizing methodology, which can have significant implications for decision making in healthcare. Several efforts have focused on improving the quality of systematic reviews that are developed and published.
Published in 2009, PRISMA—Preferred Reporting Items in Systematic Reviews and Meta-Analysis—is a framework of reporting standards that addresses problems observed in methodology quality. Parts of the standards relate to conducting rigorous and systematic searches of the literature to locate the relevant studies and to reporting specific details of the searching process. Two important elements of the framework are the PRISMA flow diagram and the PRISMA checklist.
In 2011, the Health and Medicine Division (formerly the Institute of Medicine) of the National Academies of Science, Engineering, and Medicine in the report Finding What Works in Health Care: Standards for Systematic Reviews states that a librarian or other information professional should be included in developing the systematic review search plan. Additionally, a 2014 article by Rethlefsen, Murad, and Livingston from the Journal of the American Medical Association indicates that gaining assistance from librarians helps ensure thoroughness and reproducibility.
The primary role for health sciences librarians is to help develop and conduct highly sensitive bibliographic database search strategies that capture all the published evidence related to the research question. Hardin librarians have each attended formal systematic review training to learn the specialized literature searching process.
The training also covers the methodology for the whole review, as well as the reporting standards for reviews. Other roles librarians play can include
project manager, reference manager, reference screener, consultant for the team, and others.
The roles Hardin librarians play varies based on what the researchers need and may range from something simple, such as training the researchers how to manage records in EndNote, a citation management tool, or a thorough review of already-completed search strategies. More often, however, researchers request the most complete service, which may include all or a combination of the following: assistance with the development of the review protocol (the research plan); deciding which bibliographic databases to search; design of bibliographic database search strategies (including identifying and testing potential search terms); removing duplicates from the search results; finding missing abstracts; accessing full text of articles from the search results; and writing the search methods for reporting in the article or other end product. Sometimes, researchers request help with searching for grey or non-traditionally published literature, another part of review methodology that helps minimize bias.
Systematic reviews that demand the most extensive level of service require between 20 and 100 hours of librarian time. The total amount of time depends on many variables, such as the organization and communication of the research team, the nature of the topic, the number of databases to be searched, particularities of the databases, including subject heading availability and the quality of the indexed records. When this level of service is provided librarians request co-authorship on the resulting article because this level of contribution meets the standards for authorship recommended by the International Committee of Medical Journal Editors. When lesser but still substantial assistance has been provided, librarians may request a formal acknowledgment rather than co-authorship.
Not all requests for assistance result in a published systematic review. In consultation with librarians, some researchers discover their project idea is not a good fit for the systematic review methodology, and so their project takes another direction. Systematic reviews require significant time and work, frequently taking a year or more to complete. In some cases, projects may be started but not completed due to the researchers’ time constraints, inability to secure a project team, lack of methodological expertise, or other reasons. Some projects are completed but are reported at conferences with no intent to publish the results as an article.
GROWTH OF THIS SERVICE
Between 2011 and 2016, the small team of Hardin librarians initiating and developing the service created a two-part workshop to help train faculty, staff, and students about developing search strategies for systematic reviews. They also developed a hard copy intake form and created an online guide that allow researchers to request assistance and to provide resources to help with their process. In this timeframe, the service received about 25 requests for assistance.
In 2016, several new staff joined the team and helped make important improvements to the service, including a redesign of the online guide (see link at the bottom of page 23) development of an online intake form and other documents needed to support workflow, implementation of an improved file structure for organizing projects, revisions to workshop materials, and regular meetings to discuss service changes and ongoing learning opportunities in this specialty area. Since these changes were enacted in early 2017, the service has received 109 requests for support from researchers. The total for the full duration of the service is approximately 170 requests for assistance.
Recently published systematic reviews have been completed with support from Hardin librarians, including Chris Childs, Jen DeBerg, Janna Lawrence, and Heather Healy. Reviews cover a wide range of research topics and appear journals such as World Journal of Gastroenterology, The Journal of Arthroplasty, Clinical Infectious Diseases, and Journal of General Internal Medicine.
ASSESSING THE SERVICE
For the past few years, a team at Hardin has worked to assess the impact of the systematic review service on reviews authored by health sciences faculty at the UI. Hardin librarians have co-authored or been formally acknowledged in 50 published systematic reviews.
The team has also examined whether the systematic reviews authored by UI health sciences faculty (whether they included a librarian or not) met standards detailed by the PRISMA checklist. The team found that approximately 75% of reviews include the PRISMA flow diagram, an important signifier of the quality of the review process. The inclusion of this diagram, however, does not reflect the quality of the literature search. The team’s findings indicate that measures of the inclusion of a replicable search strategy, which provides transparency for the search process, are around 40% and inclusion of both subject heading and keywords in the search strategies, a signifier of search comprehensiveness, are around 30%.
Hardin librarians are continuing to discuss how to improve the reach of the systematic review service in sustainable ways that might include further development of general training workshops or redesign of the online guide to help increase awareness of systematic review standards among faculty. The librarian team is small and expanding the service to increase the amount of direct involvement of librarians in systematic reviews is not feasible currently. Furthermore, increased awareness and use of the standards relies not only efforts by librarians and researchers but also on the awareness of the standards by journal editors and journal peer reviewers.
The assessment team is analyzing which departments publish systematic reviews most often and which are most likely to benefit from assistance. Hardin librarians are hopeful that as they extend education to those who need it most, they can continue to positively influence the quality of the methodology for systematic reviews in the health sciences.
FOR FURTHER READING
Visit guides.lib.uiowa.edu/systematicreviews for an online guide to the service.
The following list provides a sampling of recently published systematic reviews that were completed with support from HLHS librarians, including Chris Childs, Jen DeBerg, Janna Lawrence, and Heather Healy:
Ashat, M., Arora, S., Klair, J. S., Childs, C. A., Murali, A. R., & Johlin, F. C. (2019). Bilateral vs unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: A systemic review and meta-analysis. World Journal of Gastroenterology, 25(34), 5210–5219. https://doi.org/10.3748/wjg.v25.i34.5210
Bedard, N. A., DeMik, D. E., Owens, J. M., Glass, N. A., DeBerg, J., & Callaghan, J. J. (2019). Tobacco use and risk of wound complications and periprosthetic joint infection: A systematic review and meta-analysis of primary total joint arthroplasty procedures. The Journal of Arthroplasty, 34(2), 385–396.e4. https://doi.org/10.1016/j.arth.2018.09.089
Puig-Asensio, M., Braun, B. I., Seaman, A. T., Chitavi, S., Rasinski, K. A., Nair, R., Perencevich, E. N., Lawrence, J. C., Hartley, M., & Schweizer, M. L. (2019). Perceived benefits and challenges of Ebola preparation among hospitals in developed countries: A systematic literature review. Clinical Infectious Diseases. Advance online publication. https://doi.org/10.1093/cid/ciz757
Seaman, A. T., Steffen, M., Doo, T., Healy, H. S., & Solimeo, S. L. (2018). Metasynthesis of patient attitudes toward bone densitometry. Journal of General Internal Medicine, 33(10), 1796–1804. https://doi.org/10.1007/s11606-018-4587-3