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Knowledge
Base

Knowledge Synthesis

This is referred to as the 'second-generation knowledge': it represents the aggregation of existing knowledge, a summary of the medical literature that uses explicit methods to perform a comprehensive literature search as well as critical appraisal of individual studies, and appropriate statistical techniques to combine these valid studies. The process of aggregation involves application of explicit and reproducible methods to identify, appraise, and then synthesize studies relevant to a specific question. Examples of knowledge synthesis include systematic reviews, meta-analyses, meta-syntheses, scoping reviews, and realist reviews. Knowledge synthesis, such as systematic reviews, minimizes both bias (usually by not restricting itself to randomized trials, but also seeking published and unpublished reports in every language) and random error (by amassing very large numbers of individuals). Systematic reviews may, but need not, include some statistical method for combining the results of individual studies (meta-analyses). In contrast, traditional literature reviews usually do not include an exhaustive literature search or synthesis of studies.

How to Conduct a Systematic Review

  1. State objectives of the review of RCTs and outline eligibility criteria.
  2. Search for trials that seem to meet eligibility criteria.
  3. Tabulate characteristics of each trial identified and assess its methodological quality.
  4. Apply eligibility criteria, and justify any exclusions.
  5. Assemble the most complete dataset feasible, with assistance from investigators, if possible.
  6. Analyse results of eligible RCTs, using statistical synthesis of data (meta-analysis) if appropriate and possible.
  7. Compare alternative analyses if appropriate and possible.
  8. Prepare a critical summary of the review, stating aims, describing materials and methods, and reporting results.

Useful sources for second-generation knowledge:

Cochrane Collaboration
The Cochrane Collaboration is an international not-for-profit and independent organization, dedicated to providing up-to-date, accurate information about the effects of healthcare readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. The major product of the Collaboration is the Cochrane Database of Systematic Reviews which is published quarterly as part of The Cochrane Library. Those who prepare the reviews are mostly healthcare professionals who volunteer to work in one of the many Cochrane Review Groups, with editorial teams overseeing the preparation and maintenance of the reviews, as well as application of quality standards. One of such Cochrane Review Groups is the Cochrane Effective Practice and Organisation of Care Group (EPOC). EPOC produces systematic reviews of educational, behavioural, financial, regulatory and organisational interventions designed to improve health professional practice and the organisation of health care services, potentially spanning any clinical area.
UpToDate
UpToDate is an evidence-based and literature-driven updating system; more than 430 journals are monitored by editors and authors, and anytime something of importance is published, it is incorporated into the program. UpToDate is not a journal watch. New studies are not simply added, but rather they are placed in the context of what has already been published in that field. More than 4,000 physician authors and editors, who are experts in their respective fields, write topic reviews that cover all the major aspects of a particular condition, including symptoms, tests and diagnosis, and treatment options. All topics are also subjected to rigorous peer review. UpToDate covers more than 7,700 topics in 14 medical specialties.
Ovid's Evidence-Based Medicine Reviews (EBMR)
EBMR is a resource for electronic information in the evidence based medicine (EBM) movement that combines 7 of the most trusted EBM resources into a single, fully-searchable database. EBMR helps clinicians practice EBM through a combination of resources that provide: systematic reviews of topics; article reviews; access to definitive controlled trials; and comprehensive integration with MEDLINE.
BMJ Clinical Evidence
Clinical Evidence is an international peer reviewed journal publishing systematic reviews of important clinical conditions. The reviews published are constantly being updated and integrated with a range of additional evidence based medicine (EBM) resources to provide clinicians with access to the very latest and most relevant medical knowledge for treatment decisions. Clinical Evidence systematic reviews summarize the current state of knowledge and uncertainty about the prevention and treatment of clinical conditions, based on thorough searches and appraisal of the literature. It describes the best available evidence from systematic reviews, RCTs, and observational studies where appropriate, and if there is no good evidence it says so.
MacPLUS Federated Search
MacPLUS Federated Search is a product of the McMaster Health Knowledge Refinery. It is a continuously updated resource for evidence-based clinical decisions. Searching MacPLUS FS yields content that is hierarchically organized as Systems (providing patient-specific computerized decision support), Summaries (providing the best summarization of evidence for clinical topics), Synopses (brief abstracts of high quality original studies and systematic reviews), Syntheses (systematic reviews of original studies), and Studies (published original studies).
Systematic Review Tool
RevMan
Review Manager (RevMan) provides a platform for preparing and maintaining Cochrane Reviews, including protocols and full reviews. It is most useful when the question for the review has been formulated. In this case, it allows you to prepare the text, build the tables showing the characteristics of studies and the comparisons in the review, and add study data. It can perform meta-analyses and present the results graphically.

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