
About Systematic Reviews

The Difference Between Narrative Review and Systematic Review
Reviews in scientific research are tools that help synthesize literature on a topic of interest and describe its current state. Different types of reviews are conducted depending on the research question and the scope of the review. A systematic review is one such review that is robust, reproducible, and transparent. It involves collating evidence by using all of the eligible and critically appraised literature available on a certain topic. To know more about how to do a systematic review , you can check out our article at the link. The primary aim of a systematic review is to recommend best practices and inform policy development. Hence, there is a need for high-quality, focused, and precise methods and reporting. For more exploratory research questions, methods such as a scoping review are employed. Be sure you understand the difference between a systematic review and a scoping review , if you don’t, check out the link to learn more.
When the word “review” alone is used to describe a research paper, the first thing that should come to mind is that it is a literature review. Almost every researcher starts off their career with literature reviews. To know the difference between a systematic review and a literature review , read on here. Traditional literature reviews are also sometimes referred to as narrative reviews since they use narrative analysis to synthesize data. In this article, we will explore the differences between a systematic review and a narrative review, in further detail.
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Narrative Review vs Systematic Review
Both systematic and narrative reviews are classified as secondary research studies since they both use existing primary research studies e.g. case studies. Despite this similarity, there are key differences in their methodology and scope. The major differences between them lie in their objectives, methodology, and application areas.
Differences In Objective
The main objective of a systematic review is to formulate a well-defined research question and use qualitative and quantitative methods to analyze all the available evidence attempting to answer the question. In contrast, narrative reviews can address one or more questions with a much broader scope. The efficacy of narrative reviews is irreplaceable in tracking the development of a scientific principle, or a clinical concept. This ability to conduct a wider exploration could be lost in the restrictive framework of a systematic review.
Differences in Methodology
For systematic reviews, there are guidelines provided by the Cochrane Handbook, ROSES, and the PRISMA statement that can help determine the protocol, and methodology to be used. However, for narrative reviews, such standard guidelines do not exist. Although, there are recommendations available.
Systematic reviews comprise an explicit, transparent, and pre-specified methodology. The methodology followed in a systematic review is as follows,
- Formulating the clinical research question to answer (PICO approach)
- Developing a protocol (with strict inclusion and exclusion criteria for the selection of primary studies)
- Performing a detailed and broad literature search
- Critical appraisal of the selected studies
- Data extraction from the primary studies included in the review
- Data synthesis and analysis using qualitative or quantitative methods [3].
- Reporting and discussing results of data synthesis.
- Developing conclusions based on the findings.
A narrative review on the other hand does not have a strict protocol to be followed. The design of the review depends on its author and the objectives of the review. As yet, there is no consensus on the standard structure of a narrative review. The preferred approach is the IMRAD (Introduction, Methods, Results, and Discussion) [2]. Apart from the author’s preferences, a narrative review structure must respect the journal style and conventions followed in the respective field.
Differences in Application areas
Narrative reviews are aimed at identifying and summarizing what has previously been published. Their general applications include exploring existing debates, the appraisal of previous studies conducted on a certain topic, identifying knowledge gaps, and speculating on the latest interventions available. They are also used to track and report on changes that have occurred in an existing field of research. The main purpose is to deepen the understanding in a certain research area. The results of a systematic review provide the most valid evidence to guide clinical decision-making and inform policy development [1]. They have now become the gold standard in evidence-based medicine [1].
Although both types of reviews come with their own benefits and limitations, researchers should carefully consider the differences between them before making a decision on which review type to use.
- Aromataris E, Pearson A. The systematic review: an overview. AJN. Am J Nurs. 2014;114(3):53–8.
- Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropratic Medicine 2006;5:101–117.
- Linares-Espinós E, Hernández V, Domínguez-Escrig JL, Fernández-Pello S, Hevia V, Mayor J, et al. Metodología de una revisión sistemática. Actas Urol Esp. 2018;42:499–506.
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Systematic reviews versus narrative reviews in clinical anatomy: Methodological approaches in the era of evidence-based anatomy
Affiliations.
- 1 International Evidence-Based Anatomy Working Group, Krakow, Poland.
- 2 Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
- 3 Division of Medicine, Stavanger University Hospital, Stavanger, Norway.
- 4 Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.
- 5 Seattle Science Foundation, Seattle, Washington, USA.
- PMID: 29322553
- DOI: 10.1002/ca.23042
Two main types of review articles with distinct characteristics and goals are commonly found in the scientific literature: systematic reviews and narrative (also called expert or traditional) reviews. Narrative reviews are publications that describe and discuss the state of science on a specific topic or theme from a theoretical and contextual point of view with little explicit structure for gathering and presenting evidence. Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesizing the results of primary research studies using an explicit methodological approach. With the recent rise of evidence-based anatomy, important questions arise with respect to the utility of narrative reviews in clinical anatomy. The goal of this perspective article is to address the key differences between narrative and systematic reviews in the context of clinical anatomy, to provide guidance on which type of review is most appropriate for a specific issue, and to summarize how the two types of reviews can work in unison to enhance the quality of anatomical research and its delivery to clinicians and anatomists alike. Clin. Anat. 31:364-367, 2018. © 2018 Wiley Periodicals, Inc.
Keywords: clinical anatomy; evidence-based anatomy; literature review; methodology; systematic review.
© 2018 Wiley Periodicals, Inc.
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Literature Review vs Systematic Review
- Literature Review vs. Systematic Review
- Primary vs. Secondary Sources
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Subject Guide

Definitions
It’s common to confuse systematic and literature reviews because both are used to provide a summary of the existent literature or research on a specific topic. Regardless of this commonality, both types of review vary significantly. The following table provides a detailed explanation as well as the differences between systematic and literature reviews.
Kysh, Lynn (2013): Difference between a systematic review and a literature review. [figshare]. Available at: http://dx.doi.org/10.6084/m9.figshare.766364
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- DOI: 10.1590/S0103-21002007000200001
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Systematic literature review X narrative review
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Review Typologies
There are many types of evidence synthesis projects, including systematic reviews as well as others. The selection of review type is wholly dependent on the research question. Not all research questions are well-suited for systematic reviews.
- Review Typologies (from LITR-EX) This site explores different review methodologies such as, systematic, scoping, realist, narrative, state of the art, meta-ethnography, critical, and integrative reviews. The LITR-EX site has a health professions education focus, but the advice and information is widely applicable.
Review the table to peruse review types and associated methodologies. Librarians can also help your team determine which review type might be appropriate for your project.
Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91-108. doi:10.1111/j.1471-1842.2009.00848.x
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Systematic Reviews
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What Makes a Systematic Review Different from Other Types of Reviews?
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Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x
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What is a Systematic Review?
- What is a Rapid Review?
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- What is a Meta-Synthesis?
- What is a Mixed Methods Review?
- What is an Integrative Review?
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Systematic Review vs. Literature (Narrative) Review
Traditional literature review / narrative review:
Characteristics:
- Describes and appraises previous work but does not describe specific methods by which the reviewed studies were identified, selected and evaluated
- Overviews, discussions, critiques of previous work and the current gaps in knowledge
- Often used as rationale for new research
- To scope the types of interventions available to include in a review
Limitations:
- The writers assumptions and agenda often unknown
- Biases that occur in selecting and assessing the literature are unknown
- Cannot be replicated
Systematic review:
- The scope of the review is identified in advance (eg review question and sub‐questions and/or sub‐group analysis to be undertaken)
- Comprehensive search to find all relevant studies
- Use of explicit criteria to include / exclude studies
- Application of established standards to critically appraise study quality
- Explicit methods of extracting and synthesizing study findings (qualitative or quantitative)
- May include a meta-analysis (quantitative synthesis) *optional
- Identifies, appraises and synthesizes all available research that is relevant to a particular review question
- Collates all that is known on a given topic and identifies the basis of that knowledge
- Comprehensive report using explicit processes so that rationale, assumptions and methods are open to scrutiny by external parties
- Can be replicated / updated
- Systematic reviews with narrowly defined review questions provide specific answers to specific questions
- Alternative questions that have not been answered usually need to be reconstructed by the reader
Source: Cochrane. Background to Systematic Reviews
This link will open a PDF document.
https://ph.cochrane.org/sites/ph.cochrane.org/
files/public/uploads/Unit_One.pdf

A systematic review is defined as “a review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and analyze data from the studies that are included in the review.” The methods used must be reproducible and transparent.
Source: Undertaking Systematic Reviews of Research on Effectiveness. CRD’s Guidance for those Carrying Out or Commissioning Reviews. CRD Report Number 4 (2nd Edition). NHS Centre for Reviews and Dissemination, University of York. March 2001.
Image: EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of Dartmouth College and Yale University. All Rights Reserved. Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.
When is a Systematic Review the most appropriate study design?
When answering questions of effectiveness comparing two different treatments or interventions.
Is your review question a complex intervention? Learn more about Reviews of Complex Interventions .
Choosing a Review Type: This guide explains other comprehensive literature reviews of similar methodology to the systematic review.
Here is a helpful article about review types. ( Meeting the Review Family: Exploring review types and associated information retrieval requirements, 2019,Sutton et al.)
You may also find the Review Ready Reckoner helpful!
- What Review is Right for You -tool
- What Type of Review is Right for You?- Decision Tree
- Review Ready Reckoner - Assessment Tool (RRRsAT)1 Table of Review Types
7 Stages of Conducting a Systematic Review
1. Gathering your team (Minimum of two reviewers with a third to serve as a tiebreaker)
A systematic review must have a team of two or greater. A systematic review cannot be completed by one person. Choose team members wisely and based on areas of expertise. A third team member is sometimes called a tiebreaker. They are to resolve disagreements for reviewers 1 and 2 for stages of the review that are blinded (screening, data extraction, critical appraisal) and are completed by two independent reviewers.
2. Questioning (Define a narrow question, may use PICO)
The PICO format is commonly used to define the research question into one that is a searchable question. In some cases, the PICO format may not work and another format can be used. The P in PICO is Patient/Problem or Person. I is for Intervention/Exposure/Therapy or Treatment. C is optional and is for Comparison (such as a placebo or another drug/therapy) and O is for Outcome(s), what is the expected or anticipated outcome you will find in the literature? A systematic review question should be narrow in scope. The purpose of a systematic review is to draw conclusions based on the evidence to answer that one well-defined and narrow question.
3. Planning (Create a protocol, plan methods & strategies, register protocol) * This course focuses on the planning stage
Having a plan in place is essential to a good quality review and by spending more time planning before the review takes place, you could avoid issues or errors that may slow down the process or be detrimental to the review. Planning includes seeing if the review is feasible, checking to make sure there are no conflicting reviews and also ensuring that there is a plan to carry out each stage of the review. Setting goals and timelines for the review is important as well as mapping out how the review project will be managed. This is also put into a document called a protocol. Registering the protocol is optional but highly recommended. The protocol also includes defining a priori what the selection criteria will be for the review in terms of inclusion and exclusion criteria for what studies should be screened by for inclusion in the review.
4. Searching/Screening (Exhaustive, transparent & repeatable searching for evidence/selecting studies)
Includes searching multiple databases, grey literature/clinical trial registries and handsearching of the literature (performed by the subject matter expert). It is best practice to involve a librarian or an information specialist in creating the comprehensive search, translating the search for databases or grey literature, documenting the search and deduplicating the repeating references in a citation manager and writing the search methods for the review. However, librarians are usually not involved in grey literature searching unless they are an expert in the subject matter. The review team member with the most subject matter expertise is the one who is best equipped to handsearch. The search stage may also include contacting other experts in the field to identify publications that have not been published yet. Systematic reviews include both published and unpublished literature to avoid a type of publication bias, called positive outcomes bias since positive outcomes are more likely to be published. Screening is done in two phases. The first phase is screening titles/abstracts (together) and the second phase is screening full texts. Screening is done independently by two reviewers, with a third reviewer serving as a tiebreaker. Reviewers should not move on to the full text screening phase until they have screened all of the titles and abstracts and each is a clear Yes or No without maybes remaining. Once they are ready to screen full texts, they must acquire and read all of the full texts and screen them based on the studies selection criteria. Only Yes's are included in the review but all No's must have a reason listed for exclusion. The new PRISMA 2020 requires reporting of study Near Misses too. Near misses are any studies that did not meet inclusion in the review but were very close to being included. Refer to the PRISMA 2020 http://www.prisma-statement.org/PRISMAStatement/ for more guidance on this stage. There are tools designed specifically to assist with the systematic review screening phase.
5. Managing & reporting
All methods must be fully reported, transparent and reproducible. The methods reported must also follow the recommended reporting guidance such as the PRISMA 2020. Reporting guidance can be identified by searching the Equator Network https://www.equator-network.org/ . Reporting guidance may be modified for review types similar to the systematic review. Refer to the many PRISMA 2020 extensions http://www.prisma-statement.org/Extensions/ for more information.
6. Data Extraction/Synthesizing the evidence
This stage includes appraising the evidence, interpreting results, performing a qualitative (narrative analysis) and/or a quantitative/meta-analysis. A meta-analysis is optional and is only done if it is feasible. A biostatistician or advanced training in statistics is recommended if doing a meta-analysis. There are many tools designed to assist with this process.
Evidence from studies is assessed using critical appraisal or Risk of Bias tools and/or checklists by study design.
Critical appraisal tools from Temple University, Systematic Review Research Libguide
More tools for critical appraisal and other stages of the review from the National Collaborating Centre for Methods and Tools
Data from all studies must also be extracted and put into tables/charts such as the Summary of Findings (SOF) table and is reported as a narrative synthesis. Data is collected from all studies if conducting a meta-analysis and its numerical findings are reported.
Here are some more detailed elaborations and examples:
Synthesis: Provide a narrative synthesis of the included studies individually and when combined (What are the differences and the commonality between studies?) or what can be demonstrated from the research when combining the studies together? A meta-analysis is optional. Create a data abstraction/extraction form for the purposes of collecting data that is similar across all included studies, include a ‘Characteristics of Studies’ table to show this data (see table example and this example (opens a PDF document) on page 48. Summary of Findings tables are provided starting on page 8 of the same document. Data extraction must be done using data extraction forms and independently/blinded by two reviewers, with a 3rd reviewer serving as a tiebreaker.
7. Drawing Conclusions, Writing & Publishing
After completing these steps, the results of the review must be shared. What is the level of evidence? Is there evidence in support of the question or are more studies needed to draw conclusions? What are your recommendations for future studies? What are the limitations to your systematic review? How do these findings from your review change what is known on the topic or question?
Conclusions/Recommendations:
Discuss what contribution this review makes and how your review answers or addresses the original question. Discuss any gaps found in the research. Make recommendations for needed research to address these gaps and the importance of addressing them. Discuss the overall strength of evidence in support of your original question (strong, moderate or weak).
For more guidance on the systematic review stages, refer to the Cochrane Handbook (medicine/health sciences), the JBI Manual (health sciences/nursing) or the methods guides for Campbell Collaboration Systematic Reviews (Business, education, social welfare, criminal & justice topics and more).
Where to register your Systematic Review Protocol?
- PROSPERO -registry for medical/health systematic reviews
- OSF Preregistration Register a systematic review protocol, including non-medical/health topics. Choose to affiliate with Temple University.
- TUScholarShare-Temple IR
- SYREAF-systematic reviews for animals and food
- Joanna Briggs Institute Systematic Review Register
- Inclusive Systematic Review Registration Form This form, therefore, is a fall-back for more specialized forms and can be used if no specialized form or registration platform is available. Can be used for a variety of disciplines and review types.
Moller AM, Myles PS. What makes a good systematic review and meta-analysis? BJA. 2016. 117(4):428-430.
- How to do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses
- JBI Manual: Systematic Reviews of Effectiveness
- JBI Manual: Systematic Reviews of Prevalence and Incidence
- JBI Manual: Systematic Reviews for Etiology and Risk
- JBI Manual: Systematic Reviews of Measurement Properties
- JBI manual: Systematic Reviews of Text and Opinion
- How to review the evidence: Systematic identification and review of the scientific literature
- BMJ OPEN Systematic Reviews Systematic Review articles published in the BMJ Open (Open-Access) medical journal.
- Lockwood, Geum. Systematic reviews: Guidelines, tools and checklists for authors (2017)
Systematic Review Standards
- Finding What Works in Healthcare: Standards for Systematic Reviews National Academies of Science, Engineering, & Medicine (Formerly Institute of Medicine (IOM)) Standards for systematic reviews.
- Equator Reporting Guidelines Decision Tree A tool to select the appropriate reporting guideline for your review. This link will open a PDF document.
- PRISMA: Transparent Reporting of Reviews and Meta-Analyses Reporting guidelines for reviews of Interventions.
- PRISMA Checklist
- PRISMA Flow Diagram
- PRISMA-S extension for search reporting
- MOOSE (Meta-analysis of Observational Studies in Epidemiology) Guidelines Reporting guidelines for observational reviews of cohort, case-control or cross-sectional studies. This link will open a PDF document.
- Cochrane Handbook of Systematic Reviews for Interventions A guide for Cochrane reviewers, explains the Cochrane systematic review process in great detail.
- MECIR-Updated Cochrane Methodological Expectations of Cochrane Intervention Reviews
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Depression and its phytopharmacotherapy—a narrative review.

1. Introduction
2. epidemiology, 3. pathophysiology, 4. symptomatology, 5. treatment—pharmacotherapy and non-pharmacological management of depression, 6. depression phytopharmacotherapy as an alternative to classical antidepressant treatment/examples of preparations and general reasons for their antidepressant effect, 7. side effects of herbal antidepressants discussed in this review, 8. a brief description of the phytopharmacodynamics of plant-derived compounds with antidepressant activity with particular emphasis on their anti-inflammatory effect, 9. conclusions and future research directions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest, abbreviations.
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Share and Cite
Dobrek, L.; Głowacka, K. Depression and Its Phytopharmacotherapy—A Narrative Review. Int. J. Mol. Sci. 2023 , 24 , 4772. https://doi.org/10.3390/ijms24054772
Dobrek L, Głowacka K. Depression and Its Phytopharmacotherapy—A Narrative Review. International Journal of Molecular Sciences . 2023; 24(5):4772. https://doi.org/10.3390/ijms24054772
Dobrek, Lukasz, and Krystyna Głowacka. 2023. "Depression and Its Phytopharmacotherapy—A Narrative Review" International Journal of Molecular Sciences 24, no. 5: 4772. https://doi.org/10.3390/ijms24054772

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Narrative vs systematic vs scoping review: What’s the difference?

I often get asked what the difference between a narrative review and a systematic review is, or what the difference between a narrative review and a scoping review is. This is also something I wondered about when I was new to the world of research.
Let’s first look at what a systematic review and scoping review are. A systematic review is done to identify research studies published on a certain topic, with the primary aim to recommend best practice on a certain topic and inform policy. This is very useful if there are discrepancies in the way in which a certain practice is performed, but also to recommend new approaches to practice. A scoping review is done to determine the research out there on a certain topic. Scoping reviews do not involve a critical appraisal process like systematic reviews do, but they are also conducted using a rigorous and systematic process. This video elaborates on the difference between systematic and scoping reviews.
A narrative review, also referred to as a traditional review, summarises and presents the available research on a topic. You will commonly see a traditional or narrative review as part of a thesis or dissertation. A narrative review is more biased than systematic and scoping reviews as it relies on the author’s background knowledge on a topic.
Zachary Munn, and his colleagues, all of them systematic review experts, alludes to the difference in a very useful article published in 2018 . Munn et al list the differences between scoping reviews and narrative reviews, but the same goes for the difference between systematic reviews and narrative reviews. Scoping reviews:
1. “Are informed by an a priori protocol;
2. Are systematic and often include exhaustive searching for information;
3. Aim to be transparent and reproducible;
4. Include steps to reduce error and increase reliability (such as the inclusion of multiple reviewers);
5. Ensure data is extracted and presented in a structured way”.
In Table 1 of this article , the difference between the three types of review becomes clear.
How do you know if an article is a narrative review or a systematic review or scoping review? These three look different to one another. In the video below, we look at an example of each.
Now that you know the difference between a narrative review, a scoping and a systematic review, you are ready to decide if a narrative review needs to be done or should it be a systematic or scoping review. If you know that you need to do a systematic review or scoping review, but you are not sure what the difference is, or if you can’t decide what type of systematic review you want to do, or even if you want to figure out the difference between a systematic review and meta-analysis, have a look at the Systematic Reviews playlist on the Research Masterminds YouTube channel to get your questions answered. And while you are at it, subscribe to the Research Masterminds YouTube channel .
One last thing, if you are a (post)graduate student working on a masters or doctoral research project, and you are passionate about life, adamant about completing your studies successfully and ready to get a head-start on your academic career, this opportunity is for you! An awesome membership site - a safe haven offering you coaching, community and content to boost your research experience and productivity. Check it out! https://researchmasterminds.com/academy
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Q: What is the difference between a narrative review and a descriptive review?
Are these terms used interchangeably or is there a slight difference in methodology?
Asked on 14 Jul, 2020
At a lay level, they seem to be used interchangeably. However, at the academic/scientific level, a ‘narrative review’ is actually a literature review and a ‘descriptive review’ is a systematic review.
A literature review , as the name suggests, is a review of existing literature around a particular topic . It involves discussing and possibly even critiquing existing studies. Note that this is a stand-alone paper, and therefore, different from the literature review that is done as a part of a primary research paper. Here, you discuss each study: what it says, where it falters, and so on. In the review that is a part of the main paper, you merely cite the key findings of papers relevant to your study. A (stand-alone) literature review also differs in how it is organized or structured: thematically, chronologically, or alphabetically. [Learn about the difference between the two kinds of literature review in this piece: How to write the literature review of your research paper ]
A systematic review is a more rigorous review of existing literature. There is extensive synthesizing done of the various studies – how the findings from one study pertain to those from another – which is typically not done in a literature review. However, more importantly, a systematic review is done around a clearly formulated research question . A literature review is simply done around curated relevant literature.
To answer your second query, the differences between the two may dissolve when you have a very sophisticated literature review that approximates a systematic review. However, from an academic perspective, there is a clear demarcation between them. To know more about the two types of review and the differences between them, you may go through the following resources:
- Secondary research – the basics of narrative reviews, systematic reviews, and meta-analysis
- A young researcher's guide to writing a literature review
- A young researcher's guide to a systematic review
Additionally, you may look up papers online. They are typically indicated by the type of review mentioned after the colon (:), which features the topic of the study before it. A systematic review is titled ‘a systematic review.’ A literature review is often simply titled ‘a review.' Here are examples for each: Literature review and Systematic review
Hope that helps. And all the best for your review, in case you are planning one. In which case, you may also learn about how our Literature Search service can help power your review paper.

Answered by Irfan Syed on 14 Jul, 2020
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- Systematic Review | Definition, Example, & Guide
Systematic Review | Definition, Example & Guide
Published on June 15, 2022 by Shaun Turney . Revised on December 7, 2022.
A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.
They answered the question “What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?”
In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.
Table of contents
What is a systematic review, systematic review vs. meta-analysis, systematic review vs. literature review, systematic review vs. scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, frequently asked questions about systematic reviews.
A review is an overview of the research that’s already been completed on a topic.
What makes a systematic review different from other types of reviews is that the research methods are designed to reduce bias . The methods are repeatable, and the approach is formal and systematic:
- Formulate a research question
- Develop a protocol
- Search for all relevant studies
- Apply the selection criteria
- Extract the data
- Synthesize the data
- Write and publish a report
Although multiple sets of guidelines exist, the Cochrane Handbook for Systematic Reviews is among the most widely used. It provides detailed guidelines on how to complete each step of the systematic review process.
Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.
Systematic reviews typically answer their research question by synthesizing all available evidence and evaluating the quality of the evidence. Synthesizing means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.
Systematic reviews often quantitatively synthesize the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.
A meta-analysis is a technique to synthesize results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .
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A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarize and evaluate previous work, without using a formal, explicit method.
Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.
Similar to a systematic review, a scoping review is a type of review that tries to minimize bias by using transparent and repeatable methods.
However, a scoping review isn’t a type of systematic review. The most important difference is the goal: rather than answering a specific question, a scoping review explores a topic. The researcher tries to identify the main concepts, theories, and evidence, as well as gaps in the current research.
Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.
A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.
To conduct a systematic review, you’ll need the following:
- A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
- If you’re doing a systematic review on your own (e.g., for a research paper or thesis ), you should take appropriate measures to ensure the validity and reliability of your research.
- Access to databases and journal archives. Often, your educational institution provides you with access.
- Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
- Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.
A systematic review has many pros .
- They minimize research bias by considering all available evidence and evaluating each study for bias.
- Their methods are transparent , so they can be scrutinized by others.
- They’re thorough : they summarize all available evidence.
- They can be replicated and updated by others.
Systematic reviews also have a few cons .
- They’re time-consuming .
- They’re narrow in scope : they only answer the precise research question.
The 7 steps for conducting a systematic review are explained with an example.
Step 1: Formulate a research question
Formulating the research question is probably the most important step of a systematic review. A clear research question will:
- Allow you to more effectively communicate your research to other researchers and practitioners
- Guide your decisions as you plan and conduct your systematic review
A good research question for a systematic review has four components, which you can remember with the acronym PICO :
- Population(s) or problem(s)
- Intervention(s)
- Comparison(s)
You can rearrange these four components to write your research question:
- What is the effectiveness of I versus C for O in P ?
Sometimes, you may want to include a fifth component, the type of study design . In this case, the acronym is PICOT .
- Type of study design(s)
- The population of patients with eczema
- The intervention of probiotics
- In comparison to no treatment, placebo , or non-probiotic treatment
- The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
- Randomized control trials, a type of study design
Their research question was:
- What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?
Step 2: Develop a protocol
A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.
Your protocol should include the following components:
- Background information : Provide the context of the research question, including why it’s important.
- Research objective (s) : Rephrase your research question as an objective.
- Selection criteria: State how you’ll decide which studies to include or exclude from your review.
- Search strategy: Discuss your plan for finding studies.
- Analysis: Explain what information you’ll collect from the studies and how you’ll synthesize the data.
If you’re a professional seeking to publish your review, it’s a good idea to bring together an advisory committee . This is a group of about six people who have experience in the topic you’re researching. They can help you make decisions about your protocol.
It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .
Step 3: Search for all relevant studies
Searching for relevant studies is the most time-consuming step of a systematic review.
To reduce bias, it’s important to search for relevant studies very thoroughly. Your strategy will depend on your field and your research question, but sources generally fall into these four categories:
- Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
- Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
- Gray literature: Gray literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of gray literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of gray literature.
- Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.
At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .
- Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
- Handsearch: Conference proceedings and reference lists of articles
- Gray literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
- Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics
Step 4: Apply the selection criteria
Applying the selection criteria is a three-person job. Two of you will independently read the studies and decide which to include in your review based on the selection criteria you established in your protocol . The third person’s job is to break any ties.
To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.
If you’re writing a systematic review as a student for an assignment, you might not have a team. In this case, you’ll have to apply the selection criteria on your own; you can mention this as a limitation in your paper’s discussion.
You should apply the selection criteria in two phases:
- Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
- Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.
It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarize what you did using a PRISMA flow diagram .
Next, Boyle and colleagues found the full texts for each of the remaining studies. Boyle and Tang read through the articles to decide if any more studies needed to be excluded based on the selection criteria.
When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.
Step 5: Extract the data
Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:
- Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
- Your judgment of the quality of the evidence, including risk of bias .
You should collect this information using forms. You can find sample forms in The Registry of Methods and Tools for Evidence-Informed Decision Making and the Grading of Recommendations, Assessment, Development and Evaluations Working Group .
Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.
They also collected data about possible sources of bias, such as how the study participants were randomized into the control and treatment groups.
Step 6: Synthesize the data
Synthesizing the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesizing the data:
- Narrative ( qualitative ): Summarize the information in words. You’ll need to discuss the studies and assess their overall quality.
- Quantitative : Use statistical methods to summarize and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.
Generally, you should use both approaches together whenever possible. If you don’t have enough data, or the data from different studies aren’t comparable, then you can take just a narrative approach. However, you should justify why a quantitative approach wasn’t possible.
Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analyzed the effect sizes within each group.
Step 7: Write and publish a report
The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.
Your article should include the following sections:
- Abstract : A summary of the review
- Introduction : Including the rationale and objectives
- Methods : Including the selection criteria, search method, data extraction method, and synthesis method
- Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
- Discussion : Including interpretation of the results and limitations of the review
- Conclusion : The answer to your research question and implications for practice, policy, or research
To verify that your report includes everything it needs, you can use the PRISMA checklist .
Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.
A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .
It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.
A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other academic texts , with an introduction , a main body, and a conclusion .
An annotated bibliography is a list of source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a paper .
A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.
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Systematic Reviews
Breakdown of systematic reviews, other reviews, what review is right for you.
- The Process
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Timeline Table
- Systematic Review Timeline Table PDF
What Is a Systematic Review?
A systematic review is a comprehensive literature review that seeks to answer a specific clinical question using existing research as evidence. According to Cook et. al (1997) , systematic reviews "can help practitioners keep abreast of the medical literature by summarizing large bodies of evidence and helping to explain differences among studies on the same question."
Systematic reviews are designed to:
- Locate all relevant published and unpublished sources of evidence
- Specify inclusion and exclusion criteria for selected studies
- Evaluate each selected study for quality and bias
- Synthesize findings from selected sources of evidence without bias
- Provide a balanced and unbiased summary of findings while accounting for flaws or limitations within the evidence
For more information on systematic reviews and meta-analyses, visit Systematic reviews and meta-analyses: a step-by-step guide by Kate McAllister .
For reporting guidelines for systematic reviews and meta-analyses, visit PRISMA Transparent Reporting of Systematic Reviews and Meta-Analyses and the Equator Network .
How Long Do They Take to Complete?
Systematic reviews require a significant time commitment because of their standards and methodology requirements. Systematic reviews may take a review team an estimated 9-12 months to complete.
The average timeline for a systematic review is estimated below, as outlined in the Cochrane Handbook for Systematic Reviews of Interventions 2011:
Adapted from Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Meta-Analysis
A meta-analysis is a type of systematic review that uses statistical methods to summarize the results of studies that meet the criteria for inclusion within the review.
For reporting guidelines for systematic reviews and meta-analyses, visit PRISMA Transparent Reporting of Systematic Reviews and Meta-Analyses .
For more information on analyzing data for systematic reviews, see Part 2 - Chapter 10 of the Cochrane Handbook for Systematic Reviews of Interventions .
Scoping Review
A scoping review provides an assessment of the potential size and scope of available research on a particular topic. Similar to a systematic review, a scoping review follows a predetermined search methodology and reporting process. Scoping reviews questions are often broader than systematic review questions, as they are designed to identify the "nature and extent of research evidence (usually including ongoing research)" (Grant and Booth, 2009). Scoping reviews can highlight areas where future systematic reviews can be conducted, or be used as standalone reviews when systematic reviews are not feasible to share findings, identify research gaps and make recommendations for future research (Peters et. al, 2015).
For more information on scoping reviews, please see the following articles:
Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal , 26 (2), 91-108. DOI: 10.1111/j.1471-1842.2009.00848.x.
Peters, M. D., Godfrey, C. M., Khalil, H., McInerney, P., Parker, D., & Soares, C. B. (2015). Guidance for conducting systematic scoping reviews. JBI Evidence Implementation , 13 (3), 141-146. DOI: 10.1097/XEB.0000000000000050.
For reporting requirements for scoping reviews, please visit PRISMA for Scoping Reviews .
Rapid Review
A rapid review uses systematic review methods to provide quick yet thorough assessments of existing evidence surrounding a policy or practice issue. While a rapid review is designed to be conducted in less time than a systematic review, a rapid review incorporates systematic review methods to critically appraise research finding within included studies. A rapid review may use specified techniques to shorten the review timeframe, and the reviewer(s) must specifically report which stages to limit and the likely effects of those limitations (Grant and Booth, 2009).
For more information on rapid reviews, please see the following articles:
Garritty, C., Gartlehner, G., Nussbaumer-Streit, B., King, V. J., Hamel, C., Kamel, C., Affengruber, L., & Stevens, A. (2021). Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews. Journal of clinical epidemiology , 130 , 13–22. https://doi.org/10.1016/j.jclinepi.2020.10.007.
Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health information & libraries journal , 26 (2), 91-108. DOI: 10.1111/j.1471-1842.2009.00848.x.
Integrative Review
An integrative review summarizes both experimental, non-experimental, and theoretical literature to expand understanding surrounding a specific healthcare problem or phenomenon. According to Whittemore & Knafl (2005), integrative reviews have the potential to impact evidence-based practice for nursing because it is the only approach that allows for the combination of diverse methodologies.
For more information surrounding integrative reviews, please explore the following articles:
Toronto, C. E., & Remington, R. (Eds.). (2020). A step-by-step guide to conducting an integrative review . Cham, Swizterland: Springer International Publishing.
Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. Journal of advanced nursing , 52 (5), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
Narrative (Literature) Review
A narrative (literature) review is a form of knowledge synthesis surrounding a specific research question or issue. A narrative review does not require a systematic search of the literature and does not require included studies to be assessed for risk or bias. According to Ferrari (2015), narrative (literature) reviews are helpful for exploring general topics or debates, addressing more than one question, and identifying knowledge gaps and areas for future research.
For more information regarding narrative (literature) reviews, please see the following articles:
Ferrari, R. (2015). Writing narrative style literature reviews. Medical writing (Leeds), 24( 4), 230–235. https://doi.org/10.1179/2047480615Z.000000000329.
Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health information & libraries journal , 26 (2), 91-108. DOI: 10.1111/j.1471-1842.2009.00848.x.
- What Type of Review is Right for You? - Cornell University Library This Review Decision Tree created by Cornell University Library is a helpful tool when determining which type of review is appropriate for your research topic or clinical question.
- Next: The Process >>
- Last Updated: Nov 4, 2022 11:52 AM
- URL: https://libguides.utk.edu/systematicreviews

Which review is that? A guide to review types.
- Which review is that?
- Review Comparison Chart
- Decision Tool
- Critical Review
- Integrative Review
- Narrative Review
- State of the Art Review
- Narrative Summary
- Systematic Review
- Meta-analysis
- Comparative Effectiveness Review
- Diagnostic Systematic Review
- Network Meta-analysis
- Prognostic Review
- Psychometric Review
- Review of Economic Evaluations
- Systematic Review of Epidemiology Studies
- Umbrella Review
- Review of Reviews
- Rapid Review
- Rapid Evidence Assessment
- Rapid Realist Review
- Qualitative Evidence Synthesis
- Qualitative Interpretive Meta-synthesis
- Qualitative Meta-synthesis
- Qualitative Research Synthesis
- Framework Synthesis - Best-fit Framework Synthesis
- Meta-aggregation
- Meta-ethnography
- Meta-interpretation
- Meta-narrative Review
- Meta-summary
- Thematic Synthesis
- Mixed Methods Synthesis
- Narrative Synthesis
- Bayesian Meta-analysis
- EPPI-Centre Review
- Critical Interpretive Synthesis
- Realist Synthesis - Realist Review
- Scoping Review
- Mapping Review
- Systematised Review
- Concept Synthesis
- Expert Opinion - Policy Review
- Technology Assessment Review
- Methodological Review
- Systematic Search and Review

Narrative’ synthesis’ refers to an approach to the systematic review and synthesis of findings from multiple studies that relies primarily on the use of words and text to summarise and explain the findings of the synthesis. Whilst narrative synthesis can involve the manipulation of statistical data, the defining characteristic is that it adopts a textual approach to the process of synthesis to ‘tell the story’ of the findings from the included studies. As used here ‘narrative synthesis’ refers to a process of synthesis that can be used in systematic reviews focusing on a wide range of questions, not only those relating to the effectiveness of a particular intervention. (Popay et al. 2006)
Guidelines Campbell, M., McKenzie, J. E., Sowden, A., Katikireddi, S. V., Brennan, S. E., Ellis, S., ... & Thomson, H. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. bmj , 368 . Full Text Other
Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., ... & Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version , 1 (1), b92. Full Text
Thomson H, Campbell M. “Narrative synthesis” of quantitative effect data in Cochrane reviews: Current issues and ways forward [Internet]. Cochrane Learning Live Webinar Series 2020 Feb. Full Text
Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2019). What is 'moral distress'? A narrative synthesis of the literature. Nursing ethics , 26 (3), 646–662. https://doi.org/10.1177/0969733017724354 Full Text PDF
References Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., ... & Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version , 1 (1), b92. Full Text
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The difference between a systematic review and a literature review
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Home | Blog | Best Practice | The difference between a systematic review and a literature review
Covidence takes a look at the difference between the two
Most of us are familiar with the terms systematic review and literature review. Both review types synthesise evidence and provide summary information. So what are the differences? What does systematic mean? And which approach is best 🤔 ?
‘ Systematic ‘ describes the review’s methods. It means that they are transparent, reproducible and defined before the search gets underway. That’s important because it helps to minimise the bias that would result from cherry-picking studies in a non-systematic way.
This brings us to literature reviews. Literature reviews don’t usually apply the same rigour in their methods. That’s because, unlike systematic reviews, they don’t aim to produce an answer to a clinical question. Literature reviews can provide context or background information for a new piece of research. They can also stand alone as a general guide to what is already known about a particular topic.
Interest in systematic reviews has grown in recent years and the frequency of ‘systematic reviews’ in Google books has overtaken ‘literature reviews’ (with all the usual Ngram Viewer warnings – it searches around 6% of all books, no journals).

Let’s take a look at the two review types in more detail to highlight some key similarities and differences 👀.
🙋🏾♂️ What is a systematic review?
Systematic reviews ask a specific question about the effectiveness of a treatment and answer it by summarising evidence that meets a set of pre-specified criteria.
The process starts with a research question and a protocol or research plan. A review team searches for studies to answer the question using a highly sensitive search strategy. The retrieved studies are then screened for eligibility using the inclusion and exclusion criteria (this is done by at least two people working independently). Next, the reviewers extract the relevant data and assess the quality of the included studies. Finally, the review team synthesises the extracted study data and presents the results. The process is shown in figure 2 .

The results of a systematic review can be presented in many ways and the choice will depend on factors such as the type of data. Some reviews use meta-analysis to produce a statistical summary of effect estimates. Other reviews use narrative synthesis to present a textual summary.
Covidence accelerates the screening, data extraction, and quality assessment stages of your systematic review. It provides simple workflows and easy collaboration with colleagues around the world.
When is it appropriate to do a systematic review?
If you have a clinical question about the effectiveness of a particular treatment or treatments, you could answer it by conducting a systematic review. Systematic reviews in clinical medicine often follow the PICO framework, which stands for:
👦 Population (or patients)
💊 Intervention
💊 Comparison
Here’s a typical example of a systematic review title that uses the PICO framework: Alarms [intervention] versus drug treatments [comparison] for the prevention of nocturnal enuresis [outcome] in children [population]
Key attributes
- Systematic reviews follow prespecified methods
- The methods are explicit and replicable
- The review team assesses the quality of the evidence and attempts to minimise bias
- Results and conclusions are based on the evidence
🙋🏻♀️ What is a literature review?
Literature reviews provide an overview of what is known about a particular topic. They evaluate the material, rather than simply restating it, but the methods used to do this are not usually prespecified and they are not described in detail in the review. The search might be comprehensive but it does not aim to be exhaustive. Literature reviews are also referred to as narrative reviews.
Literature reviews use a topical approach and often take the form of a discussion. Precision and replicability are not the focus, rather the author seeks to demonstrate their understanding and perhaps also present their work in the context of what has come before. Often, this sort of synthesis does not attempt to control for the author’s own bias. The results or conclusion of a literature review is likely to be presented using words rather than statistical methods.
When is it appropriate to do a literature review?
We’ve all written some form of literature review: they are a central part of academic research ✍🏾. Literature reviews often form the introduction to a piece of writing, to provide the context. They can also be used to identify gaps in the literature and the need to fill them with new research 📚.
- Literature reviews take a thematic approach
- They do not specify inclusion or exclusion criteria
- They do not answer a clinical question
- The conclusions might be influenced by the author’s own views
🙋🏽 Ok, but what is a systematic literature review?
A quick internet search retrieves a cool 200 million hits for ‘systematic literature review’. What strange hybrid is this 🤯🤯 ?
Systematic review methodology has its roots in evidence-based medicine but it quickly gained traction in other areas – the social sciences for example – where researchers recognise the value of being methodical and minimising bias. Systematic review methods are increasingly applied to the more traditional types of review, including literature reviews, hence the proliferation of terms like ‘systematic literature review’ and many more.
Beware of the labels 🚨. The terminology used to describe review types can vary by discipline and changes over time. To really understand how any review was done you will need to examine the methods critically and make your own assessment of the quality and reliability of each synthesis 🤓.
Review methods are evolving constantly as researchers find new ways to meet the challenge of synthesising the evidence. Systematic review methods have influenced many other review types, including the traditional literature review.
Covidence is a web-based tool that saves you time at the screening, selection, data extraction and quality assessment stages of your systematic review. It supports easy collaboration across teams and provides a clear overview of task status.
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Laura Mellor. Portsmouth, UK
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How to Conduct a Systematic Review: A Narrative Literature Review
Nusrat jahan.
1 Psychiatry, Mount Sinai Chicago
Sadiq Naveed
2 Psychiatry, KVC Prairie Ridge Hospital
Muhammad Zeshan
3 Department of Psychiatry, Bronx Lebanon Hospital Icahn School of Medicine at Mount Sinai, Bronx, NY
Muhammad A Tahir
4 Psychiatry, Suny Upstate Medical University, Syracuse, NY
Systematic reviews are ranked very high in research and are considered the most valid form of medical evidence. They provide a complete summary of the current literature relevant to a research question and can be of immense use to medical professionals. Our goal with this paper is to conduct a narrative review of the literature about systematic reviews and outline the essential elements of a systematic review along with the limitations of such a review.
Introduction and background
A literature review provides an important insight into a particular scholarly topic. It compiles published research on a topic, surveys different sources of research, and critically examines these sources [ 1 ]. A literature review may be argumentative, integrative, historical, methodological, systematic, or theoretical, and these approaches may be adopted depending upon the types of analysis in a particular study [ 2 ].
Our topic of interest in this article is to understand the different steps of conducting a systematic review. Systematic reviews, according to Wright, et al., are defined as a “review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and analyze data from the studies that are included in the review” [ 3 ]. A systematic review provides an unbiased assessment of these studies [ 4 ]. Such reviews emerged in the 1970s in the field of social sciences. Systematic reviews, as well as the meta-analyses of the appropriate studies, can be the best form of evidence available to clinicians [ 3 ]. The unsystematic narrative review is more likely to include only research selected by the authors, which introduces bias and, therefore, frequently lags behind and contradicts the available evidence [ 5 ].
Epidemiologist Archie Cochrane played a vital role in formulating the methodology of the systematic review [ 6 ]. Dr. Cochrane loved to study patterns of disease and how these related to the environment. In the early 1970s, he found that many decisions in health care were made without reliable, up-to-date evidence about the treatments used [ 6 ].
A systematic review may or may not include meta-analysis, depending on whether results from different studies can be combined to provide a meaningful conclusion. David Sackett defined meta-analysis as a “specific statistical strategy for assembling the results of several studies into a single estimate” [ 7 - 8 ].
While the systematic review has several advantages, it has several limitations which can affect the conclusion. Inadequate literature searches and heterogeneous studies can lead to false conclusions. Similarly, the quality of assessment is an important step in systematic reviews, and it can lead to adverse consequences if not done properly.
The purpose of this article is to understand the important steps involved in conducting a systematic review of all kinds of clinical studies. We conducted a narrative review of the literature about systematic reviews with a special focus on articles that discuss conducting reviews of randomized controlled trials. We discuss key guidelines and important terminologies and present the advantages and limitations of systematic reviews.
Narrative reviews are a discussion of important topics on a theoretical point of view, and they are considered an important educational tool in continuing medical education [ 9 ]. Narrative reviews take a less formal approach than systematic reviews in that narrative reviews do not require the presentation of the more rigorous aspects characteristic of a systematic review such as reporting methodology, search terms, databases used, and inclusion and exclusion criteria [ 9 ]. With this in mind, our narrative review will give a detailed explanation of the important steps of a systematic review.
Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) checklist
Systematic reviews are conducted based on predefined criteria and protocol. The PRISMA-P checklist, developed by Moher, et al., contains 17 items (26 including sub-items) comprising the important steps of a systematic review, including information about authors, co-authors, their mailing and email addresses, affiliations, and any new or updated version of a previous systematic review [ 9 ]. It also identifies a plan for documenting important protocol amendments, registry names, registration numbers, financial disclosures, and other support services [ 10 ]. Moher, et al. also state that methods of systematic reviews involve developing eligibility criteria and describing information sources, search strategies, study selection processes, outcomes, assessment of bias in individual studies, and data synthesis [ 10 ].
Research question
Writing a research question is the first step in conducting a systematic review and is of paramount importance as it outlines both the need and validity of systematic reviews (Nguyen, et al., unpublished data). It also increases the efficiency of the review by limiting the time and cost of identifying and obtaining relevant literature [ 11 ]. The research question should summarize the main objective of a systematic review.
An example research question might read, “How does attention-deficit/hyperactivity disorder (ADHD) affect the academic performance of middle school children in North America?” The question focuses on the type of data, analysis, and topic to be discussed (i.e., ADHD among North American middle school students). Try to avoid research questions that are too narrow or broad—they can lead to the selection of only a few studies and the ability to generalize results to any other populations may be limited. An example of a research question that is too narrow would be, “What is the prevalence of ADHD in children and adolescents in Chicago, IL?” Alternately, if the research question is too broad, it can be difficult to reach a conclusion due to poor methodology. An example of a research question that is too broad in scope would be, “What are the effects of ADHD on the functioning of children and adolescents in North America?”
Different tools that can be used to help devise a research question, depending on the type of question, are: population, intervention, comparator, and outcomes (PICO); sample, phenomenon of interest, design, evaluation, and research type (SPIDER); setting, perspective, intervention, comparison, and evaluation (SPICE); and expectation, client group, location, impact, professionals, and service (ECLIPSE).
The PICO approach is mostly used to compare different interventions with each other. It helps to formulate a research question related to prognosis, diagnosis, and therapies [ 12 ].
Scenario: A 50-year-old white woman visited her psychiatrist with a diagnosis of major depressive disorder. She was prescribed fluoxetine, which she feels has been helpful. However, she experienced some unpleasant side effects of nausea and abdominal discomfort. She has recently been told by a friend about the use of St. John’s wort in treating depression and would like to try this in treating her current depression. (Formulating research questions, unpublished data).
In the above-mentioned scenario, the sample population is a 50-year-old female with major depressive disorder; the intervention is St. John’s wort; the comparison is fluoxetine; and the outcome would be efficacy and safety. In order to see the outcome of both efficacy and safety, we will compare the efficacy and safety of both St. John’s wort and fluoxetine in a sample population for treating depression. This scenario represents an example where we can apply the PICO approach to compare two interventions.
In contrast, the SPIDER approach is focused more on study design and samples rather than populations [ 13 ]. The SPIDER approach can be used in this research question: “What is the experience of psychiatry residents attending a transgender education?” The sample is psychiatry residents; the phenomenon of interest is transgender education; the design is a survey; the evaluation looks at the experience; and the research type is qualitative.
The SPICE approach can be used to evaluate the outcome of a service, intervention, or project [ 14 ]. The SPICE approach applies to the following research question: “In psychiatry clinics, does the combined use of selective serotonin reuptake inhibitor (SSRI) and psychotherapy reduce depression in an outpatient clinic versus SSRI therapy alone?” The setting is the psychiatry clinic; the perspective/population is the outpatient; the intervention is combined psychotherapy and SSRI; the comparison is SSRI alone; and the evaluation is reduced depression.
The ECLIPSE approach is useful for evaluating the outcome of a policy or service (Nguyen, et al., unpublished data). ECLIPSE can apply in the following research question: “How can a resident get access to medical records of patients admitted to inpatient from other hospitals?” The expectation is: “What are you looking to improve/change to increase access to medical records for patients admitted to inpatient?” The client group is the residents; the location is the inpatient setting; the impact would be the residents having easy access to medical records from other hospitals; and the professionals in this scenario would be those involved in improving the service experiences such as hospital administrators and IT staff.
Inclusion and exclusion criteria
Establishing inclusion and exclusion criteria come after formulating research questions. The concept of inclusion and exclusion of data in a systematic review provides a basis on which the reviewer draws valid and reliable conclusions regarding the effect of the intervention for the disorder under consideration [ 11 ]. Inclusions and exclusion are based on preset criteria for specific systematic review. It should be done before starting the literature search in order to minimize the possibility of bias.
Eligibility criteria provide the boundaries of the systematic review [ 15 ]. Participants, interventions, and comparison of a research question provide the basis for eligibility criteria [ 15 ]. The inclusion criteria should be able to identify the studies of interest and, if the inclusion criteria are too broad or too narrow, it can lead to an ineffective screening process.
Protocol registration
Developing and registering research protocol is another important step of conducting a systematic review. The research protocol ensures that a systematic review is carefully planned and explicitly documented before the review starts, thus promoting consistency in conduct for the review team and supporting the accountability, research integrity, and transparency of the eventually completed review [ 10 ]. PROSPERO and the Cochrane Database of Systematic Reviews are utilized for registering research protocols and research questions, and they check for prior existing duplicate protocols or research questions. PROSPERO is an international database of prospectively registered systematic reviews related to health care and social sciences (PRISMA, 2016). It is funded by the National Institute for Health Research. The Cochrane Collaboration concentrates on producing systematic reviews of interventions and diagnostic test accuracy but does not currently produce reviews on questions of prognosis or etiology [ 16 ].
A detailed and extensive search strategy is important for the systematic review since it minimizes bias in the review process [ 17 ].
Selecting and searching appropriate electronic databases is determined by the topic of interest. Important databases are: MEDLARS Online (MEDLINE), which is the online counterpart to the Medical Literature Analysis and Retrieval System (MEDLARS); Excerpta Medica Database (EMBASE); and Google Scholar. There are multiple electronic databases available based on the area of interest. Other important databases include: PsycINFO for psychology and psychiatry; Allied and Complementary Medicine Database (AMED) for complementary medicine; Manual, Alternative, and Natural Therapy Index System (MANTIS) for alternative medical literature; and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for nursing and allied health [ 15 ].
Additional studies relevant for the review may be found by looking at the references of studies identified by different databases [ 15 ]. Non-indexed articles may be found by searching the content of journals, conferences proceedings, and abstracts. It will also help with letters and commentaries which may not get indexed [ 15 ]. Reviewing clinical trial registries can provide information about any ongoing trials or unpublished research [ 15 ]. A gray literature search can access unpublished papers, reports, and conference reports, and it generally covers studies that are published in an informal fashion, rather than in an indexed journal [ 15 ]. Further search can be performed by selecting important key articles and going through in-text citations [ 15 ].
Using Boolean operators, truncation, and wildcards
Boolean operators use the relationship between different search words to help with the search strategy. These are simple words (i.e., AND, OR, and NOT) which can help with more focused and productive results (poster, Jahan, et al.: How to conduct a systematic review. APPNA 39th Summer Convention. Washington, DC. 2016). The Boolean operator AND finds articles with all the search words. The use of OR broadens the focus of the search, and it will include articles with at least one search term. The researchers can also ignore certain results from the records by using NOT in the search strategy.
An example of AND would be using “depression” AND “children” in the search strategy with the goal of studying depression in children. This search strategy will include all the articles about both depression and children. The researchers may use OR if the emphasis of the study is mood disorders or affective disorders in adolescents. In that case, the search strategy will be “mood disorders” OR “affective disorders” AND “adolescents.” This search will find all the articles about mood disorders or affective disorders in adolescents. The researchers can use NOT if they only want to study depression in children and want to ignore bipolar disorder from the search. An example search in this scenario would be “depression” NOT “bipolar disorder” AND “children.” This will help ignore studies related to bipolar disorder in children.
Truncation and wildcards are other tools to make search strategy more comprehensive and focused. While the researchers search a database for certain articles, they frequently face terminologies that have the same initial root of a word but different endings. An example would be "autism," "autistic," and "autism spectrum disorder." These words have a similar initial root derived from “autis” but they end differently in each case. The truncation symbol (*) retrieves articles that contain words beginning with “autis” plus any additional characters. Wildcards are used for words with the same meanings but different spellings due to various reasons. For the words with spelling variations of a single letter, wildcard symbols can be used. When the researcher inputs “M+N” in the search bar, this returns results containing both “man” or “men” as the wildcard accounts for the spelling variations between the letters M and N.
Study selection
Study selection should be performed in a systematic manner, so reviewers deal with fewer errors and a lower risk of bias (online course, Li T, Dickersin K: Introduction to systematic review and meta-analysis. 2016. https://www.coursera.org/learn/systematic-review #). Study selection should involve two independent reviewers who select studies using inclusion and exclusion criteria. Any disagreements during this process should be resolved by discussion or by a third reviewer [ 10 ]. Specific study types can be selected depending on the research question. For example, questions on incidence and prevalence can be answered by surveys and cohort studies. Clinical trials can provide answers to questions related to therapy and screening. Queries regarding diagnostic accuracy can be answered by clinical trials and cross-sectional studies (online course, Li T, Dickersin K: Introduction to systematic review and meta-analysis. 2016. https://www.coursera.org/learn/systematic-review #). Prognosis and harm-related questions should use cohort studies and clinical trials, and etiology questions should use case-control and cohort studies (online course, Li T, Dickersin K: Introduction to systematic review and meta-analysis. 2016. https://www.coursera.org/learn/systematic-review #).
Data screening and data extractions are two of the major steps in conducting a systematic review [ 18 ]. Data screening involves searching for relevant articles in different databases using keywords. The next step of data screening is manuscript selection by reviewing each manuscript in the search results to compare that manuscript against the inclusion criteria [ 18 ]. The researchers should also review the references of the papers selected before selecting the final paper, which is the last step of data screening [ 18 ].
The next stage is extracting and appraising the data of the included articles [ 18 ]. A data extraction form should be used to help reduce the number of errors, and more than one person should record the data [ 17 ]. Data should be collected on specific points like population type, study authors, agency, study design, humanitarian crisis, target age groups, research strengths from the literature, setting, study country, type(s) of public health intervention, and health outcome(s) addressed by the public health intervention. All this information should then be put into an electronic database [ 18 ].
Assessing bias
Bias is a systematic error (or deviation from the truth) in results or inferences. Biases can change the results of any study and lead to an underestimation or overestimation of the true intervention effect [ 19 ]. Biases can impact any aspect of a review, including selecting studies, collecting and extracting data, and making a conclusion. Biases can vary in magnitude; some are small, with negligible effect, but some are substantial to a degree where an apparent finding may be entirely due to bias [ 19 ]. There are different types of bias, including, but not limited to, selection, detection, attrition, reporting, and performance.
Selection bias occurs when a sample selected is not representative of the whole general population. If randomization of the sample is done correctly, then chances of selection bias can be minimized [ 20 ].
Detection bias refers to systematic differences between groups in how outcomes are determined. This type of bias is based on knowledge of the intervention provided and its outcome [ 19 ].
Attrition bias refers to systematic differences between groups in withdrawals from a study [ 19 ]. The data will be considered incomplete if some subjects are withdrawn or have irregular visits during data collection.
Reporting bias refers to systematic differences between reported and unreported findings, and it is commonly seen during article reviews. Reporting bias is based on reviewer judgment about the outcome of selected articles [ 20 ].
Performance bias develops due to the knowledge of the allocated interventions by participants and personnel during the study [ 20 ]. Using a double-blind study design helps prevent performance bias, where neither the experimenter nor the subjects know which group contains controls and which group contains the test article [ 14 ].
Last step of systematic review: discussion
The discussion of a systematic review is where a summary of the available evidence for different outcomes is written and discussed [ 10 ]. The limitations of a systematic review are also discussed in detail. Finally, a conclusion is drawn after evaluating the results and considering limitations [ 10 ].
Discussion of the current article
Systematic reviews with or without a meta-analysis are currently ranked to be the best available evidence in the hierarchy of evidence-based practice [ 21 ]. We have discussed the methodology of a systematic review. A systematic review is classified in the category of filtered information because it appraises the quality of the study and its application in the field of medicine [ 21 ]. However, there are some limitations of the systematic review, as we mentioned earlier in our article. A large randomized controlled trial may provide a better conclusion than a systematic review of many smaller trials due to their larger sample sizes [ 22 ], which help the researchers generalize their conclusions for a bigger population. Other important factors to consider include higher dropout rates in large studies, co-interventions, and heterogeneity among studies included in the review.
As we discussed the limitations of the systematic review and its effect on quality of evidence, there are several tools to rate the evidence, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system [ 22 ]. GRADE provides a structured approach to evaluating the risk of bias, serious inconsistency between studies, indirectness, imprecision of the results, and publication bias [ 22 ]. Another approach used to rate the quality of evidence is a measurement tool to assess systematic reviews (AMSTAR) [ 23 ]. It is also available in several languages [ 23 ].
Conclusions
Despite its limitations, a systematic review can add to the knowledge of the scientific community especially when there are gaps in the existing knowledge. However, conducting a systematic review requires different steps that involve different tools and strategies. It can be difficult at times to access and utilize these resources. A researcher can understand and strategize a systematic review following the different steps outlined in this literature review. However, conducting a systematic review requires a thorough understanding of all the concepts and tools involved, which is an extensive endeavor to be summed up in one article.
The Cochrane Handbook for Systematic Reviews of Interventions and the Center for Reviews and Dissemination (CRD) provide excellent guidance through their insightful and detailed guidelines. We recommend consulting these resources for further guidance.
Given that our article is a narrative review of the scholarly literature, it contains the same limitations as noted for any narrative review. We hope that our review of the means and methods for conducting a systematic review will be helpful in providing basic knowledge to utilize the resources available to the scientific community.
The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.
The authors have declared that no competing interests exist.

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Reviews: From Systematic to Narrative: Narrative Review The Narrative Review At its most basic, narrative reviews are most useful for obtaining a broad perspective on a topic and are often more comparable to a textbook chapter including sections on the physiology and/or epidemiology of a topic.
The main objective of a systematic review is to formulate a well-defined research question and use qualitative and quantitative methods to analyze all the available evidence attempting to answer the question. In contrast, narrative reviews can address one or more questions with a much broader scope.
Most reviews fall into the following types: literature review, narrative review, integrative review, evidenced based review, meta-analysis and systematic review. This LibGuide will provide you a general overview of the specific review, offer starting points, and outline the reporting process.
How to Conduct a Systematic Review: A Narrative Literature Review Authors Nusrat Jahan 1 , Sadiq Naveed 2 , Muhammad Zeshan 3 , Muhammad A Tahir 4 Affiliations 1 Psychiatry, Mount Sinai Chicago. 2 Psychiatry, KVC Prairie Ridge Hospital. 3 Department of Psychiatry, Bronx Lebanon Hospital Icahn School of Medicine at Mount Sinai, Bronx, NY.
Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesizing the results of primary research studies using an explicit methodological approach. With the recent rise of evidence-based anatomy, important questions arise with respect to the utility of narrative reviews in clinical anatomy.
A systematic literature review is a well-planned review to answer specific research questions using an organised and explicit methodology to identify, select, and critically evaluate the...
Of course, there should be Pros and Cons between systematic and narrative reviews; for instance, the major advantage of systematic reviews is that they are based on the findings of comprehensive and systematic literature searches in all available resources, with minimization of selection bias avoiding subjective selection bias, while narrative …
Narrative reviews take a less formal approach than systematic reviews in that narrative reviews do not require the presentation of the more rigorous aspects characteristic of a systematic review such as reporting methodology, search terms, databases used, and inclusion and exclusion criteria [9].
It's common to confuse systematic and literature reviews because both are used to provide a summary of the existent literature or research on a specific topic. Regardless of this commonality, both types of review vary significantly.
Systematic literature review X narrative review. Acta Paulista de Enfermagem. ISSN 1982-0194. EN; PT; Home; About . About Acta Editorial Policy Editorial Board Editorial Responsibilities. ... Systematic literature review X narrative review. Acta Paul Enferm. [online]. 2007, vol. 20, n. 2, [cited 2023-02-27], pp.v-vi. Available from: <https ...
DOI: 10.1590/S0103-21002007000200001 Corpus ID: 116849838; Systematic literature review X narrative review @article{Rother2007SystematicLR, title={Systematic literature review X narrative review}, author={Edna Terezinha Rother}, journal={Acta Paulista De Enfermagem}, year={2007}, volume={20} }
Narrative reviews, also referred to as literature reviews, are a method used to identify and consolidate that which has been previously published on a specific topic; this consolidation...
Guidelines are available to help review authors to structure narrative syntheses of results in systematic reviews.2 These outline several steps that can help review authors to systematically analyse and then integrate the results across ... 2 A copy of the guidelines (Popay et al (2006) Guidance on the conduct of narrative synthesis in ...
Systematic Reviews Review Typologies There are many types of evidence synthesis projects, including systematic reviews as well as others. The selection of review type is wholly dependent on the research question. Not all research questions are well-suited for systematic reviews. Review Typologies (from LITR-EX)
Qualitative, narrative synthesis. Thematic analysis, may include conceptual models. Rapid review. Assessment of what is already known about a policy or practice issue, by using systematic review methods to search and critically appraise existing research. Completeness of searching determined by time constraints.
A systematic review is defined as "a review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and analyze data from the studies that are included in the review.". The methods used must be reproducible and transparent.
This narrative review results from a traditional, non-systematic literature review. It briefly discusses the pathophysiology, symptomatology and treatment of depression, with a particular focus on the role of phytopharmacology in its treatment. It provides the mechanisms of action revealed in experimental studies of active ingredients isolated ...
This video elaborates on the difference between systematic and scoping reviews. A narrative review, also referred to as a traditional review, summarises and presents the available research on a topic. You will commonly see a traditional or narrative review as part of a thesis or dissertation.
However, at the academic/scientific level, a 'narrative review' is actually a literature review and a 'descriptive review' is a systematic review. A literature review, as the name suggests, is a review of existing literature around a particular topic. It involves discussing and possibly even critiquing existing studies.
A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer. Example: Systematic review
A narrative review does not require a systematic search of the literature and does not require included studies to be assessed for risk or bias. According to Ferrari (2015), narrative (literature) reviews are helpful for exploring general topics or debates, addressing more than one question, and identifying knowledge gaps and areas for future ...
& Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version, 1(1), b92. Full Text. Thomson H, Campbell M. "Narrative synthesis" of quantitative effect data in Cochrane reviews: Current issues and ways forward [Internet].
Objectives: The goal of this systematic scoping review was to summarize and synthesize the literature on the use of physical and/or mixed-reality simulation in pre-service teacher training. Methods: A systematic scoping literature review combined with a textual narrative synthesis was undertaken.
The results of a systematic review can be presented in many ways and the choice will depend on factors such as the type of data. Some reviews use meta-analysis to produce a statistical summary of effect estimates. Other reviews use narrative synthesis to present a textual summary.. Covidence accelerates the screening, data extraction, and quality assessment stages of your systematic review.
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