This is a part of our course for PhD students of medical informatics in Tehran University of Medical Sciences

1. Systematic Review Dr. F. Jahedi 2011

3. emphasised in 1992: Inadequacy of traditional reviews If original studies of the effects of clot busters after heart attacks had been systematically reviewed the benefits of therapy would have been apparent as early as the mid-1970s. Need for a rigorous systematic approach Text books and narrative reviews were woefully inadequate in summarising the current state of knowledge.

4. When systematic reviews are needed Whenever there is: Explosion in biomedical publishing A substantive question Several primary studies (perhaps with disparate findings) Substantial uncertainty

5. The process of systematic review Defining an appropriate therapeutic question Searching the literature (For an unbiased assessment, this search must cover all the literature) Assessing the studies Eligibility for inclusion Study quality Reported findings Combining the results Qualitative Quantitative => Meta-analysis Placing the findings in context

6. A good Systematic Review Formulates a Question Conducts a Literature Search Refines the search by applying predetermined inclusion and exclusion criteria Extracts the appropriate data and assess their quality and validity Synthesizes, interprets, and reports data

7. Key Characteristics of Systematic Reviews Clearly stated title and objectives Comprehensive strategy to search for relevant studies (unpublished and published) Explicit and justified criteria for the inclusion or exclusion of any study Clear presentation of characteristics of each study included and an analysis of methodological quality Comprehensive list of all studies excluded and justification for exclusion

8. Literature Search Challenges Database Bias Publication Bias English-language bias Citation bias

9. Hierarchies of evidence I–1 Systematic review of several double-blind randomised control trials. I–2 One or more large double- blind randomised control trials. II–1 One or more well-conducted cohort studies. II–2 One or more well-conducted case-control studies. II–3 A dramatic uncontrolled experiment. III Expert committee sitting in review; peer leader opinion. IV Personal experience.

10. Challenges

11. Challenges: On the user side: Physical accessibility / conditions of access (costs, convenience, filters) Computer literacy Health literacy On the information provider side: Findability Readability Design and usability

12. Challenge: eHealth Literacy

13. Challenge: Language

14. Challenges:Accessibility

15. Challenges:Accessibility

16. Challenges:Accessibility

17. Challenges:Accessibility

18. Challenges:Accessibility

19. Visualization from the various routes through a portion of the Internet