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What is the difference between a systematic review and a systematic literature review?

By Carol Hollier on 07-Jan-2020 14:23:00

For those not immersed in systematic reviews, understanding the difference between a systematic review and a systematic literature review can be confusing.  It helps to realise that a “systematic review” is a clearly defined thing, but ambiguity creeps in around the phrase “systematic literature review” because people can and do use it in a variety of ways. 

A systematic review is a research study of research studies.  To qualify as a systematic review, a review needs to adhere to standards of transparency and reproducibility.  It will use explicit methods to identify, select, appraise, and synthesise empirical results from different but similar studies.  The study will be done in stages:  

• In stage one, the question, which must be answerable, is framed
• Stage two is a comprehensive literature search to identify relevant studies
• In stage three the identified literature’s quality is scrutinised and decisions made on whether or not to include each article in the review
• In stage four the evidence is summarised and, if the review includes a meta-analysis, the data extracted; in the final stage, findings are interpreted. [1]

Some reviews also state what degree of confidence can be placed on that answer, using the GRADE scale.  By going through these steps, a systematic review provides a broad evidence base on which to make decisions about medical interventions, regulatory policy, safety, or whatever question is analysed.   By documenting each step explicitly, the review is not only reproducible, but can be updated as more evidence on the question is generated.

Sometimes when people talk about a “systematic literature review”, they are using the phrase interchangeably with “systematic review”.  However, people can also use the phrase systematic literature review to refer to a literature review that is done in a fairly systematic way, but without the full rigor of a systematic review. 

For instance, for a systematic review, reviewers would strive to locate relevant unpublished studies in grey literature and possibly by contacting researchers directly.  Doing this is important for combatting publication bias, which is the tendency for studies with positive results to be published at a higher rate than studies with null results.  It is easy to understand how this well-documented tendency can skew a review’s findings, but someone conducting a systematic literature review in the loose sense of the phrase might, for lack of resource or capacity, forgo that step. 

Another difference might be in who is doing the research for the review. A systematic review is generally conducted by a team including an information professional for searches and a statistician for meta-analysis, along with subject experts.  Team members independently evaluate the studies being considered for inclusion in the review and compare results, adjudicating any differences of opinion.   In contrast, a systematic literature review might be conducted by one person. 

Overall, while a systematic review must comply with set standards, you would expect any review called a systematic literature review to strive to be quite comprehensive.  A systematic literature review would contrast with what is sometimes called a narrative or journalistic literature review, where the reviewer’s search strategy is not made explicit, and evidence may be cherry-picked to support an argument.

FSTA is a key tool for systematic reviews and systematic literature reviews in the sciences of food and health.

The patents indexed help find results of research not otherwise publicly available because it has been done for commercial purposes.

The FSTA thesaurus will surface results that would be missed with keyword searching alone. Since the thesaurus is designed for the sciences of food and health, it is the most comprehensive for the field. 

All indexing and abstracting in FSTA is in English, so you can do your searching in English yet pick up non-English language results, and get those results translated if they meet the criteria for inclusion in a systematic review.

FSTA includes grey literature (conference proceedings) which can be difficult to find, but is important to include in comprehensive searches.

FSTA content has a deep archive. It goes back to 1969 for farm to fork research, and back to the late 1990s for food-related human nutrition literature—systematic reviews (and any literature review) should include not just the latest research but all relevant research on a question. 

You can also use FSTA to find literature reviews.

FSTA allows you to easily search for review articles (both narrative and systematic reviews) by using the subject heading or thesaurus term “REVIEWS" and an appropriate free-text keyword.

On the Web of Science or EBSCO platform, an FSTA search for reviews about cassava would look like this: DE "REVIEWS" AND cassava.

On the Ovid platform using the multi-field search option, the search would look like this: reviews.sh. AND cassava.af.

In 2011 FSTA introduced the descriptor META-ANALYSIS, making it easy to search specifically for systematic reviews that include a meta-analysis published from that year onwards.

On the EBSCO or Web of Science platform, an FSTA search for systematic reviews with meta-analyses about staphylococcus aureus would look like this: DE "META-ANALYSIS" AND staphylococcus aureus.

On the Ovid platform using the multi-field search option, the search would look like this: meta-analysis.sh. AND staphylococcus aureus.af.

Systematic reviews with meta-analyses published before 2011 are included in the REVIEWS controlled vocabulary term in the thesaurus.

An easy way to locate pre-2011 systematic reviews with meta-analyses is to search the subject heading or thesaurus term "REVIEWS" AND meta-analysis as a free-text keyword AND another appropriate free-text keyword.

On the Web of Science or EBSCO platform, the FSTA search would look like this: DE "REVIEWS" AND meta-analysis AND carbohydrate*

On the Ovid platform using the multi-field search option, the search would look like this: reviews .sh. AND meta-analysis.af. AND carbohydrate*.af.  

Related resources:

• Literature Searching Best Practise Guide
• Predatory publishing: Investigating researchers’ knowledge & attitudes
• The IFIS Expert Guide to Journal Publishing

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Systematic Literature Review or Literature Review?

• 3 minute read
• 57.4K views

Table of Contents

As a researcher, you may be required to conduct a literature review. But what kind of review do you need to complete? Is it a systematic literature review or a standard literature review? In this article, we’ll outline the purpose of a systematic literature review, the difference between literature review and systematic review, and other important aspects of systematic literature reviews.

What is a Systematic Literature Review?

The purpose of systematic literature reviews is simple. Essentially, it is to provide a high-level of a particular research question. This question, in and of itself, is highly focused to match the review of the literature related to the topic at hand. For example, a focused question related to medical or clinical outcomes.

The components of a systematic literature review are quite different from the standard literature review research theses that most of us are used to (more on this below). And because of the specificity of the research question, typically a systematic literature review involves more than one primary author. There’s more work related to a systematic literature review, so it makes sense to divide the work among two or three (or even more) researchers.

Your systematic literature review will follow very clear and defined protocols that are decided on prior to any review. This involves extensive planning, and a deliberately designed search strategy that is in tune with the specific research question. Every aspect of a systematic literature review, including the research protocols, which databases are used, and dates of each search, must be transparent so that other researchers can be assured that the systematic literature review is comprehensive and focused.

Most systematic literature reviews originated in the world of medicine science. Now, they also include any evidence-based research questions. In addition to the focus and transparency of these types of reviews, additional aspects of a quality systematic literature review includes:

• Clear and concise review and summary
• Comprehensive coverage of the topic
• Accessibility and equality of the research reviewed

Systematic Review vs Literature Review

The difference between literature review and systematic review comes back to the initial research question. Whereas the systematic review is very specific and focused, the standard literature review is much more general. The components of a literature review, for example, are similar to any other research paper. That is, it includes an introduction, description of the methods used, a discussion and conclusion, as well as a reference list or bibliography.

A systematic review, however, includes entirely different components that reflect the specificity of its research question, and the requirement for transparency and inclusion. For instance, the systematic review will include:

• Eligibility criteria for included research
• A description of the systematic research search strategy
• An assessment of the validity of reviewed research
• Interpretations of the results of research included in the review

As you can see, contrary to the general overview or summary of a topic, the systematic literature review includes much more detail and work to compile than a standard literature review. Indeed, it can take years to conduct and write a systematic literature review. But the information that practitioners and other researchers can glean from a systematic literature review is, by its very nature, exceptionally valuable.

This is not to diminish the value of the standard literature review. The importance of literature reviews in research writing is discussed in this article . It’s just that the two types of research reviews answer different questions, and, therefore, have different purposes and roles in the world of research and evidence-based writing.

Systematic Literature Review vs Meta Analysis

It would be understandable to think that a systematic literature review is similar to a meta analysis. But, whereas a systematic review can include several research studies to answer a specific question, typically a meta analysis includes a comparison of different studies to suss out any inconsistencies or discrepancies. For more about this topic, check out Systematic Review VS Meta-Analysis article.

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Literature Review Research

Literature review vs. systematic review.

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It is common to confuse literature and systematic reviews because both are used to provide a summary of the existing literature or research on a specific topic. Despite this commonality, these two reviews vary significantly. The table below highlights the differences.

Kysh, Lynn (2013). Difference between a systematic review and a literature review. figshare. Poster. https://doi.org/10.6084/m9.figshare.766364.v1

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Literature Review vs Systematic Review

Literature review vs. systematic review, your librarian.

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

Primary vs. Secondary Research

Parts of the Article

• Last Updated: Jun 3, 2024 2:30 PM
• URL: https://libguides.sjsu.edu/LitRevVSSysRev

Systematic Review vs Literature Review

It is quite common to confuse between a systematic review and a literature review because both are types of evidence synthesis in research. This article aims to elucidate what is a systematic review vs literature review. To facilitate comprehension, a comprehensive definition of each review type will be provided, followed by a succinct summary encapsulated in a tabular format.

Table of Contents

I. What is a Systematic Review?

A systematic review is a meticulous and structured synthesis of existing literature that employs explicit and reproducible methods to identify, select, and critically appraise relevant research studies. The overarching objective is to provide a comprehensive and unbiased summary of the current evidence pertaining to a specific research question or topic. Systematic reviews often involve a systematic search strategy, inclusion and exclusion criteria, and a rigorous evaluation of study quality, thus contributing to the establishment of evidence-based practice.

II. What is a Literature Review?

In contrast, a literature review is a more expansive exploration and synthesis of published material encompassing a particular subject or field. While it lacks the stringent methodology of a systematic review, a literature review offers a broader perspective, examining the evolution of ideas, theories, and research across various sources. Its primary goal is to present a holistic overview of the existing literature on a chosen topic, facilitating a nuanced understanding of the subject’s historical context, theoretical foundations, and current state of knowledge.

III. Systematic Review vs. Literature Review Summary

IV. Conclusion

In conclusion, while both systematic and literature reviews serve crucial roles in academic inquiry, their distinctive methodologies, objectives, and scopes set them apart. A systematic review prioritizes precision and objectivity in addressing specific research questions, whereas a literature review offers a more expansive exploration of a subject’s broader context. This systematic review vs literature review analysis aims to elucidate these differences, aiding scholars and researchers in selecting the most appropriate review approach based on their research goals.

References:

Living systematic review: 1. Introduction—the why, what, when, and how

Approaching literature review for academic purposes: The Literature Review Checklist

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Systematic Review vs. Literature Review

• 4-minute read
• 28th October 2023

If you’ve been reading research papers, chances are you’ve come across two commonly used approaches to synthesizing existing knowledge: systematic reviews and literature reviews. Although they share similarities, it’s important to understand their differences to help you choose the most appropriate method for your research needs.

In this blog post, we’ll outline the key distinctions between systematic reviews and literature reviews, so that you can make an informed decision about which approach to include in your research plan . Let’s begin!

Objective and Purpose

The primary objective of a literature review is to provide an overview and summary of the existing literature on a specific topic to set the stage for your own critical evaluation . A literature review aims to identify key concepts, theories, and research findings, as well as gaps in knowledge, to establish a foundation for further studies.

On the other hand, systematic reviews have a more focused purpose. They aim to address a particular research question using a predefined methodology and criteria for study selection. Systematic reviews seek to provide a comprehensive and objective summary of the available evidence in order to draw significant conclusions.

Methodology and Process

Literature reviews often adopt a flexible and iterative approach. They utilize the analysis, evaluation, and summarization of relevant research or scholarly literature, such as journal articles, books, and conference proceedings. Researchers use various search strategies and sources to gather the material; selection criteria may be loosely defined. When undertaking the literature review, qualitative techniques are often used to identify patterns and themes.

In contrast, systematic reviews follow a more structured and replicable process. After your key research question has been fully developed, it can often be helpful to follow an analytic framework to guide your research. Extensive literature searches across multiple databases are conducted using predefined search terms and strict inclusion and exclusion criteria. Researchers critically assess the quality of research and risk of bias in each study, systematically extract and analyze the data, and may employ statistical methods, such as meta-analysis , to synthesize the findings.

Outcomes and Findings

The outcomes of literature reviews primarily include a summary of the existing literature, key findings, useful methodologies, and identified research gaps . These reviews provide a broad understanding of the current state of knowledge in a particular area and can help researchers identify directions for future studies. Literature reviews aim to describe and analyze the existing research rather than providing definitive conclusions or making recommendations.

Systematic reviews, however, produce more conclusive results. They statistically analyze the data from selected studies, often incorporating meta-analysis, in order to answer the key research question. Systematic review findings often include a summary of findings table to communicate the main outcomes as well as information about the materials that were covered in the review.

Applicability and Utility

Due to their broad nature, literature reviews are useful for researchers looking to gain an overview of a specific field or topic. They provide a foundation for understanding existing knowledge, identifying gaps, and generating research questions. Literature reviews tend to be used in the early stages of research projects or when developing theoretical frameworks for a thesis or dissertation.

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With their rigorous methodology, systematic reviews are valuable for informing evidence-based practice and decision-making. They can be used as stand-alone scientific publications to illustrate the current state of scientific evidence, set a research agenda, or inform policy-making.

If you’re trying to decide whether a systematic review or literature review is the best approach for your project, consider the main distinctions:

1. Literature reviews offer a broad overview of the existing literature and identify research gaps, while systematic reviews focus on answering a specific research question.

2. Literature reviews commonly adopt a flexible and iterative approach, while systematic reviews use a structured and rigorous approach.

3. Literature reviews identify key findings, useful methodologies, and identified research gaps. Systematic reviews, on the other hand, produce conclusive results to answer the key research question.

4. Literature reviews are often carried out early on in a thesis or dissertation to identify existing research gaps, whereas systematic reviews can stand on their own as a conclusive analysis.

Once you understand these differences, you’re ready to choose the best approach for your own research paper.

And if you’re interested in getting help with proofreading your research paper, consider our research paper editing services . You can even try a sample of our services for free . Good luck reviewing and researching!

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Systematic Review vs. Literature Review: Some Essential Differences

Most budding researchers are confused between systematic review vs. literature review. As a PhD student or early career researcher, you must by now be well versed with the fact that literature review is the most important aspect of any scientific research, without which a study cannot be commenced. However, literature review is in itself an ‘umbrella term’, and there are several types of reviews, such as systematic literature reviews , that you may need to perform during your academic publishing journey, based upon their specific relevance to each study.   

Your research goal, approach, and design will finally influence your choice of systematic review vs literature review . Apart from systematic literature review , some other common types of literature review are 1 :   

• Narrative literature review – used to identify gaps in the existing knowledge base  
• Scoping literature review – used to identify the scope of a particular study  
• Integrative literature review – used to generate secondary data that upon integration can be used to define new frameworks and perspectives  
• Theoretical literature review – used to pool all kinds of theories associated with a particular concept  

The most commonly used form of review, however, is the systematic literature review . Compared to the other types of literature reviews described above, this one requires a more rigorous and well-defined approach. The systematic literature review can be divided into two main categories: meta-analysis and meta-synthesis. Meta-analysis is related to identifying patterns and relationships within the data, by using statistical procedures. Meta-synthesis on the other hand, is concerned with integrating findings of multiple qualitative research studies, not necessarily needing statistical procedures.  

Table of Contents

Difference between systematic review and literature review

In spite of having this basic understanding, however, there might still be a lot of confusion when it comes to finalizing between a systematic review vs literature review of any other kind. Since these two types of reviews serve a similar purpose, they are often used interchangeably and the difference between systematic review and literature review is overlooked.  In order to ease this confusion and smoothen the process of decision-making it is essential to have a closer look at a systematic review vs. literature review and the differences between them 2.3 :   

  Tips to keep in mind when performing a literature review  

While the above illustrated similarities and differences between systematic review and literature review might be helpful as an overview, here are some additional pointers that you can keep in mind while performing a review for your research study 4 :  

• Check the authenticity of the source thoroughly while using an article in your review.  
• Regardless of the type of review that you intend to perform, i t is important to ensure that the landmark literature, the one that first spoke about your topic of interest, is given prominence in your review. These can be identified with a simple Google Scholar search and checking the most cited articles.  
• Make sure to include all the latest literature that focuses on your research question.   
• Avoid including irrelevant data by revisiting your aims, objectives, and research questions as often as possible during the review process.  
• If you intend to submit your review in any peer-reviewed journal, make sure to have a defined structure based upon your selected type of review .  
• If it is a systematic literature review , make sure that the research question is clear and cri sp and framed in a manner that is subjected to quantitative analysis.  
• If it is a literature review of any other kind, make sure that you include enough checkpoints to minimize biases in your conclusions . You can use an integrative approach to show how different data points fit together, however, it is also essential to mention and describe data that doesn’t fit together in order to produce a balanced review. This can also help identify gaps and pave the way for designing future studies on the topic.   

We hope that the above article was helpful for you in understanding the basics of literature review and to know the use of systemic review vs. literature review.

Q: When to do a systematic review?

A systematic review is conducted to synthesize and analyze existing research on a specific question. It’s valuable when a comprehensive assessment of available evidence is required to answer a well-defined research question. Systematic reviews follow a predefined protocol, rigorous methodology, and aim to minimize bias. They’re especially useful for informing evidence-based decisions in healthcare and policy-making.

Q: When to do a literature review?

A literature review surveys existing literature on a topic, providing an overview of key concepts and findings. It’s conducted when exploring a subject, identifying gaps, and contextualizing research. Literature reviews are valuable at the beginning of a study to establish the research landscape and justify the need for new research.

Q: What is the difference between a literature review and a scoping review?

A literature review summarizes existing research on a topic, while a scoping review maps the literature to identify research gaps and areas for further investigation. While both assess existing literature, a scoping review tends to have broader inclusion criteria and aims to provide an overview of the available research, helping researchers understand the breadth of a topic before narrowing down a research question.

Q: What’ is the difference between systematic Literature Review and Meta Analysis?

A systematic literature review aims to comprehensively identify, select, and analyze all relevant studies on a specific research question using a rigorous methodology. It summarizes findings qualitatively. On the other hand, a meta-analysis is a statistical technique applied within a systematic review. It involves pooling and analyzing quantitative data from multiple studies to provide a more precise estimate of an effect size. In essence, a meta-analysis is a quantitative synthesis that goes beyond the qualitative summary of a systematic literature review.

References:  

• Types of Literature Review – Business Research Methodology. https://research-methodology.net/research-methodology/types-literature-review/  
• Mellor, L. The difference between a systematic review and a literature review. Covidence. https://www.covidence.org/blog/the-difference-between-a-systematic-review-and-a-literature-review \
• Basu, G. SJSU Research Guides – Literature Review vs Systematic Review.  https://libguides.sjsu.edu/LitRevVSSysRev/definitions  
• Jansen, D., Phair, D. Writing A Literature Review: 7 Common (And Costly) Mistakes To Avoid. Grad Coach, June 2021. https://gradcoach.com/literature-review-mistakes/  

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Know the Difference! Systematic Review vs. Literature Review

It is common to confuse systematic and literature reviews as both are used to provide a summary of the existent literature or research on a specific topic.  Even with this common ground, both types vary significantly.  Please review the following chart (and its corresponding poster linked below) for the detailed explanation of each as well as the differences between each type of review.

• What's in a name? The difference between a Systematic Review and a Literature Review, and why it matters by Lynn Kysh, MLIS, University of Southern California - Norris Medical Library
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Systematic Reviews

Definition of a systematic review, key differences: a literature review or a systematic review, types of reviews.

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“A systematic review attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question. Researchers conducting systematic reviews use explicit methods aimed at minimizing bias…”   - Cochrane Library

A systematic review uses robust methods to reduce bias in the gathering, summarizing, presenting, interpreting, and reporting of the research evidence. The key characteristics of a systematic review are:

• clearly stated objectives;
• pre-defined eligibility criteria;
• explicit, reproducible methodology;
• systematic search of the literature;
• assessment of validity of included studies;
• systematic synthesis and presentation of findings.

Cochrane Library. About Cochrane Reviews | Cochrane Library:    https://www.cochranelibrary.com/about/about-cochrane-reviews

As systematic reviews summarise the results of all original studies within a given field, it is commonly regarded as high quality evidence. Referring to the hierarchy of evidence shown below, we can see that as the rigour of scientific method increases, we can be more confident of the reliability and robustness of the methodology used.

Karolinska Institutet University Library (2022). Systematic reviews [ Evidence Based Pyramid]  :  https://kib.ki.se/en/search-evaluate/systematic-reviews

There are four essential criteria for a systematic review:

• It should be  exhaustive : all relevant literature in a research field should be included.
• A  rigorous methodology  must be followed throughout – from defining the research question, writing a protocol and searching the literature, to gathering, screening and analysing. The entire process should also be thoroughly documented.
• At least  two people  should be involved, particularly for screening articles and extracting data.
• Plenty of  time resources  are needed, but also in terms of availing yourself of others' expertise – for instance in database searching – and tools and software.

For a condensed overview, see the comparison below (from  Jesson, Matheson & Lacey, 2011, p. 105 ).

Karolinska Institutet University Library (2022). Systematic reviews :  https://kib.ki.se/en/search-evaluate/systematic-reviews

In an article from 2009,  Grant & Booth  described 14 review types, for example scoping reviews, and their associated methodologies.

Grant MJ, Booth A. [ Table 1 - Main review types characterized by methods used].  A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x. PMID: 19490148. .:  https://pubmed.ncbi.nlm.nih.gov/19490148/

Further Reading : 

Munn, Z., Stern, C., Aromataris, E., Lockwood, C., & Jordan, Z. (2018). What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences.  BMC Medical Research Methodology, 18 (1)5. (Open Access)  https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-017-0468-4

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors).  Cochrane Handbook for Systematic Reviews of Interventions   version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.

The Campbell Collaboration. Campbell systematic reviews: Policies and guidelines https://doi.org/10.4073/cpg.2016.1.

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• J Otolaryngol Head Neck Surg

Systematic and other reviews: criteria and complexities

Robert t. sataloff.

1 Editor-in-Chief, Journal of Voice, Philadephia, USA

2 Editor Emeritus, Ear, Nose and Throat Journal, Philadephia, USA

Matthew L. Bush

3 Assistant Editor, Otology & Neurotology, Lexington, USA

Rakesh Chandra

4 Editor-in-Chief, Ear, Ear, Nose and Throat Journal, Nashville, USA

Douglas Chepeha

5 Editor-in-Chief, Journal of Otolaryngology – Head & Neck Surgery, Toronto, Canada

Brian Rotenberg

6 Editor-in-Chief, Journal of Otolaryngology – Head & Neck Surgery, London, Canada

Edward W. Fisher

7 Senior Editor, Journal of Laryngology and Otology, Birmingham, UK

David Goldenberg

8 Editor-in-Chief, Operative Techniques in Otolaryngology – Head and Neck Surgery, Hershey, USA

Ehab Y. Hanna

9 Editor-in-Chief, Head & Neck, Houston, USA

Joseph E. Kerschner

10 Editor-in-Chief, International Journal of Pediatric Otorhinolaryngology, Milwaukee, USA

Dennis H. Kraus

11 Co-Editor-in-Chief, Journal of Neurological Surgery Part B: Skull Base, New York, USA

John H. Krouse

12 Editor-in-Chief, Otolaryngology – Head and Neck Surgery, Philadelphia, USA

13 Editor-in-Chief, OTO-Open, Philadelphia, USA

14 Editor-in-Chief, Journal for Oto-Rhino-Laryngology, Head and Neck Surgery, Philadelphia, USA

15 Editor-in-Chief, World Journal of Otorhinolaryngology – Head and Neck Surgery, Philadelphia, USA

Michael Link

16 Co-Editor-in-Chief, Journal of Neurological Surgery Part B: Skull Base, Rochester, USA

Lawrence R. Lustig

17 Editor-in-Chief, Otology & Neurotology, New York, USA

Samuel H. Selesnick

18 Editor-in-Chief, The Laryngoscope, New York, USA

Raj Sindwani

19 Editor-in-Chief, American Journal of Rhinology & Allergy, Cleveland, USA

Richard J. Smith

20 Editor-in-Chief, Annals of Otology, Rhinology & Laryngology, Iowa City, USA

James Tysome

21 Editor-in-Chief, Clinical Otolaryngology, Cambridge, UK

Peter C. Weber

22 Editor-in-Chief, American Journal of Otolaryngology, Boston, USA

D. Bradley Welling

23 Editor-in-Chief, Laryngoscope Investigative Otolaryngology, Boston, USA

Review articles can be extremely valuable. They synthesize information for readers, often provide clarity and valuable insights into a topic; and good review articles tend to be cited frequently. Review articles do not require Institutional Review Board (IRB) approval if the data reviewed are public (including private and government databases) and if the articles reviewed have received IRB approval previously. However, some institutions require IRB review and exemption for review articles. So, authors should be familiar with their institution’s policy. In assessing and interpreting review articles, it is important to understand the article’s methodology, scholarly purpose and credibility. Many readers, and some journal reviewers, are not aware that there are different kinds of review articles with different definitions, criteria and academic impact [ 1 ]. In order to understand the importance and potential application of a review article, it is valuable for readers and reviewers to be able to classify review articles correctly.

Systematic reviews

Authors often submit articles that include the term “systematic” in the title without realizing that that term requires strict adherence to specific criteria. A systematic review follows explicit methodology to answer a well-defined research question by searching the literature comprehensively, evaluating the quantity and quality of research evidence rigorously, and analyzing the evidence to synthesize an answer to the research question. The evidence gathered in systematic reviews can be qualitative or quantitative. However, if adequate and comparable quantitative data are available then a meta-analysis can be performed to assess the weighted and summarized effect size of the studies included. Depending on the research question and the data collected, systematic reviews may or may not include quantitative meta-analyses; however, meta-analyses should be performed in the setting of a systematic review to ensure that all of the appropriate data were accessed. The components of a systematic review can be found in an important article by Moher et al. published in 2009 that defined requirements for systematic reviews and meta-analyses [ 2 ].

In order to optimize reporting of meta-analyses, an international group developed the Quality of Reporting of Meta-Analyses (QUOROM) statement at a meeting in 1996 that led to publication of the QUOROM statement in 1999 [ 3 ]. Moher et al. revised that document and re-named the guidelines the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PRISMA statement included both meta-analyses and systematic reviews, and the authors incorporated definitions established by the Cochrane Collaboration [ 4 ]. The PRISMA statement established the current standard for systematic reviews. To qualify as a systematic review, the methods section should acknowledge use of the PRISMA guidelines, and all PRISMA components should be incorporated strictly in all facets of the paper from the research question to the discussion. The PRISMA statement includes a checklist of 27 items that must be included when reporting a systematic review or meta-analysis [ 2 ]. A downloadable version of this checklist can be used by authors, reviewers, and journal editorial staff to ensure compliance with recommended components [ 5 ]. All 27 will not be listed in this brief editorial (although authors and reviewers are encouraged to consult the article by Moher et al. and familiarize themselves with all items), but a few will be highlighted.

The research question, as reflected in the title, should be a hypothesis-based specific research inquiry. The introduction must describe the rationale for the review and provide a specific goal or set of goals to be addressed. The type of systematic review, according to the Cochrane Collaboration, is based on the research question being asked and may assess diagnostic test accuracy, review prognostic studies evidence, evaluate intervention effect, scrutinize research methodology, or summarize qualitative evidence [ 6 ].

In the methods section, the participants, interventions, comparisons, outcomes and study design (PICOS) must be put forward. In addition to mentioning compliance with PRISMA, the methods section should state whether a review protocol exists and, if so, where it can be accessed (including a registration number). Systematic reviews are eligible for registration in the International Prospective Register of Systematic Reviews (PROSPERO) as established at the University of York (York, UK). When PROSPERO is used (it is available but not required for systematic reviews), registration should occur at the initial protocol stage of the review, and the final paper should direct to the information in the register. The methods section also must include specific study characteristics including databases used, years considered, languages of articles included, specific inclusion and exclusion criteria for studies; and rationale for each criterion must be included. Which individuals specifically performed searches should be noted. Electronic search strategy (with a full description of at least one electronic search strategy sufficient to allow replication of the search), process for article selection, data variables sought, assumptions and simplifications, methods for assessing bias risk of each individual study (such as selective reporting in individual studies) and utilization of this information in data synthesis, principal summary measures (risk ratio, hazard ratio, difference in means, etc.), methods of data management and combining study results, outcome level assessment, and other information should be reported.

The results section should include the number of studies identified, screened, evaluated for eligibility (including rationale for exclusion), and those included in the final synthesis. A PRISMA flow diagram should be included to provide this information succinctly [ 7 ]. The results also should include the study characteristics, study results, risk of bias within and across studies, and a qualitative or quantitative synthesis of the results of the included studies. This level of rigor in acquiring and evaluating the evidence of each individual study is one of the criteria that distinguishes systematic reviews from other categories. If the systematic review involves studies with paired samples and quantitative data, a summary of data should be provided for each intervention group along with effect estimates and confidence intervals for all outcomes of each study. If a meta-analysis is performed, then synthesized effect size should be reported with confidence intervals and measures of consistency (i.e. – data heterogeneity such as I 2 ) for each meta-analysis, and assessment of bias risk across studies. A forest plot, which provides a graphical presentation of the meta-analysis results, should be included.

The discussion section should summarize the main findings commenting on the strength of evidence for each outcome, as well as relevance to healthcare providers, policymakers and other key stake-holders; limitations of the study and outcomes; and conclusions highlighting the interpretation of results in the context of other research, and implications for future research.

Without adhering to of all of these criteria and the others listed in the PRISMA statement and checklist, the review does not qualify to be classified as “systematic”.

Meta-analyses

Meta-analyses, when feasible based on available and comparable quantitative data, supplement a systematic review evaluation, by adding a secondary statistical analysis of the pooled weighted outcomes of similar studies. This adds a level of objectivity in the synthesis of the review’s findings. Meta-analyses are appropriate when at least 2 individual studies contain paired samples (experimental group and control group) and provide quantitative outcome data and sample size. Studies that lack a control group may over-estimate the effect size of the experimental intervention or condition being studied and are not ideal for meta-analyses [ 8 ]. It also should be remembered that the conclusions of a meta-analysis are only as valid as the data on which the analysis is based. If the articles included are flawed, then the conclusions of the meta-analysis also may be flawed. Systematic reviews and meta-analyses are the most rigorous categories of review.

Other types of reviews

Mixed methods reviews.

Systematic reviews typically contain a single type of data, either qualitative or quantitative; however, mixed methods reviews bring together a combination of data types or study types. This approach may be utilized when quantitative data, in the setting of an intervention study, only provide a narrow perspective of the efficacy or effectiveness of the intervention. The addition of qualitative data or qualitative studies may provide a more complete picture of the knowledge, attitudes, and behaviors of clinicians, patients or researchers regarding that intervention. This type of review could involve collecting either the quantitative or the qualitative data using systematic review methodology, but often the qualitative data are gathered using a convenience sampling. Many qualitative studies provide useful insights into clinical management and/or implementation of research interventions; and incorporating them into a mixed methods review may provide valuable perspective on a wide range of literature. Mixed methods reviews are not necessarily systematic in nature; however, authors conducting mixed methods reviews should follow systematic review methodology, when possible.

Literature and narrative reviews

Literature reviews include peer-reviewed original research, systematic reviews, and meta-analyses, but also may include conference abstracts, books, graduate degree theses, and other non-peer reviewed publications. The methods used to identify and evaluate studies should be specified, but they are less rigorous and comprehensive than those required for systematic reviews. Literature reviews can evaluate a broad topic but do not specifically articulate a specific question, nor do they synthesize the results of included studies rigorously. Like mixed method reviews, they provide an overview of published information on the topic, although they may be less comprehensive than integrative reviews; and, unlike systematic reviews, they do not need to support evidence-based clinical or research practices, or highlight high-quality evidence for the reader. Narrative reviews are similar to literature reviews and evaluate the same scope of literature. The terms sometimes are used interchangeably, and author bias in article selection and data interpretation is a potential concern in literature and narrative reviews.

Umbrella reviews

An umbrella review integrates previously published, high-quality reviews such as systematic reviews and meta-analyses. Its purpose is to synthesize information in previously published systematic reviews and meta-analyses into one convenient paper.

Rapid review

A rapid review uses systematic review methodology to evaluate existing research. It provides a quick synthesis of evidence and is used most commonly to assist in emergent decision-making such as that required to determine whether COVID-19 vaccines should receive emergent approval.

Scoping, mapping, and systematized reviews

If literature has not been reviewed comprehensively in a specific subject that is varied and complex, a mapping review (also called scoping review) may be useful to organize initial understanding of the topic and its available literature. While mapping reviews may be helpful in crystallizing research findings and may be published, they are particularly useful in helping to determine whether a topic is amenable to systematic review, and to help organize and direct the approach of the systematic review or other reviews of the subject. Systematized reviews are used most commonly by students. The systematized review provides initial assessment of a topic that is potentially appropriate for a systematic review, but a systematized review does not meet the rigorous criteria of a systematic review and has substantially more limited value. Additional types of reviews exist including critical review, state-of-the-art review, and others.

Reviews can be invaluable; but they also can be misleading. Systematic reviews and meta-analyses provide readers with the greatest confidence that rigorous efforts have attempted to eliminate bias and ensure validity, but even they have limitations based upon the strengths and weaknesses of the literature that they have assessed (and the skill and objectivity with which the authors have executed the review). Risks of bias, incomplete information and misinformation increase as the rigor of review methodology decreases. While review articles may summarize research related to a topic for readers, non-systematic reviews lack the rigor to answer adequately hypothesis-driven research questions that can influence evidence-based practice. Journal authors, reviewers, editorial staff, and should be cognizant of the strengths and weaknesses of review methodology and should consider them carefully as they assess the value of published review articles, particularly as they determine whether the information presented should alter their patient care.

Authors’ contributions

The author(s) read and approved the final manuscript.

Declarations

The authors declare no competing interests.

This article is co-published in the following journals: Journal of Voice, Otology & Neurotology, Ear, Nose and Throat Journal, Journal of Laryngology and Otology, Operative Techniques in Otolaryngology – Head and Neck Surgery, Head & Neck, International Journal of Pediatric Otorhinolaryngology, Journal of Neurological Surgery Part B: Skull Base, Otolaryngology – Head and Neck Surgery, World Journal of Otorhinolaryngology – Head and Neck Surgery, The Laryngoscope, American Journal of Rhinology & Allergy, Annals of Otology, Rhinology & Laryngology, Clinical Otolaryngology, American Journal of Otolaryngology, Laryngoscope Investigative Otolaryngology.

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• Open access
• Published: 19 November 2018

Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach

• Zachary Munn   ORCID: orcid.org/0000-0002-7091-5842 1 ,
• Micah D. J. Peters 1 ,
• Cindy Stern 1 ,
• Catalin Tufanaru 1 ,
• Alexa McArthur 1 &
• Edoardo Aromataris 1  

BMC Medical Research Methodology volume  18 , Article number:  143 ( 2018 ) Cite this article

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Scoping reviews are a relatively new approach to evidence synthesis and currently there exists little guidance regarding the decision to choose between a systematic review or scoping review approach when synthesising evidence. The purpose of this article is to clearly describe the differences in indications between scoping reviews and systematic reviews and to provide guidance for when a scoping review is (and is not) appropriate.

Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions.

Conclusions

Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there will be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.

Peer Review reports

Systematic reviews in healthcare began to appear in publication in the 1970s and 1980s [ 1 , 2 ]. With the emergence of groups such as Cochrane and the Joanna Briggs Institute (JBI) in the 1990s [ 3 ], reviews have exploded in popularity both in terms of the number conducted [ 1 ], and their uptake to inform policy and practice. Today, systematic reviews are conducted for a wide range of purposes across diverse fields of inquiry, different evidence types and for different questions [ 4 ]. More recently, the field of evidence synthesis has seen the emergence of scoping reviews, which are similar to systematic reviews in that they follow a structured process, however they are performed for different reasons and have some key methodological differences [ 5 , 6 , 7 , 8 ]. Scoping reviews are now seen as a valid approach in those circumstances where systematic reviews are unable to meet the necessary objectives or requirements of knowledge users. There now exists clear guidance regarding the definition of scoping reviews, how to conduct scoping reviews and the steps involved in the scoping review process [ 6 , 8 ]. However, the guidance regarding the key indications or reasons why reviewers may choose to follow a scoping review approach is not as straightforward, with scoping reviews often conducted for purposes that do not align with the original indications as proposed by Arksey and O’Malley [ 5 , 6 , 7 , 8 , 9 , 10 ]. As editors and peer reviewers for various journals we have noticed that there is inconsistency and confusion regarding the indications for scoping reviews and a lack of clarity for authors regarding when a scoping review should be performed as opposed to a systematic review. The purpose of this article is to provide practical guidance for reviewers on when to perform a systematic review or a scoping review, supported with some key examples.

Indications for systematic reviews

Systematic reviews can be broadly defined as a type of research synthesis that are conducted by review groups with specialized skills, who set out to identify and retrieve international evidence that is relevant to a particular question or questions and to appraise and synthesize the results of this search to inform practice, policy and in some cases, further research [ 11 , 12 , 13 ]. According to the Cochrane handbook, a systematic review ‘uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made.’ [ 14 ] Systematic reviews follow a structured and pre-defined process that requires rigorous methods to ensure that the results are both reliable and meaningful to end users. These reviews may be considered the pillar of evidence-based healthcare [ 15 ] and are widely used to inform the development of trustworthy clinical guidelines [ 11 , 16 , 17 ].

A systematic review may be undertaken to confirm or refute whether or not current practice is based on relevant evidence, to establish the quality of that evidence, and to address any uncertainty or variation in practice that may be occurring. Such variations in practice may be due to conflicting evidence and undertaking a systematic review should (hopefully) resolve such conflicts. Conducting a systematic review may also identify gaps, deficiencies, and trends in the current evidence and can help underpin and inform future research in the area. Systematic reviews can be used to produce statements to guide clinical decision-making, the delivery of care, as well as policy development [ 12 ]. Broadly, indications for systematic reviews are as follows [ 4 ]:

Uncover the international evidence

Confirm current practice/ address any variation/ identify new practices

Identify and inform areas for future research

Identify and investigate conflicting results

Produce statements to guide decision-making

Despite the utility of systematic reviews to address the above indications, there are cases where systematic reviews are unable to meet the necessary objectives or requirements of knowledge users or where a methodologically robust and structured preliminary searching and scoping activity may be useful to inform the conduct of the systematic reviews. As such, scoping reviews (which are also sometimes called scoping exercises/scoping studies) [ 8 ] have emerged as a valid approach with rather different indications to those for systematic reviews. It is important to note here that other approaches to evidence synthesis have also emerged, including realist reviews, mixed methods reviews, concept analyses and others [ 4 , 18 , 19 , 20 ]. This article focuses specifically on the choice between a systematic review or scoping review approach.

Indications for scoping reviews

True to their name, scoping reviews are an ideal tool to determine the scope or coverage of a body of literature on a given topic and give clear indication of the volume of literature and studies available as well as an overview (broad or detailed) of its focus. Scoping reviews are useful for examining emerging evidence when it is still unclear what other, more specific questions can be posed and valuably addressed by a more precise systematic review [ 21 ]. They can report on the types of evidence that address and inform practice in the field and the way the research has been conducted.

The general purpose for conducting scoping reviews is to identify and map the available evidence [ 5 , 22 ]. Arskey and O’Malley, authors of the seminal paper describing a framework for scoping reviews, provided four specific reasons why a scoping review may be conducted [ 5 , 6 , 7 , 22 ]. Soon after, Levac, Colquhoun and O’Brien further clarified and extended this original framework [ 7 ]. These authors acknowledged that at the time, there was no universally recognized definition of scoping reviews nor a commonly acknowledged purpose or indication for conducting them. In 2015, a methodological working group of the JBI produced formal guidance for conducting scoping reviews [ 6 ]. However, we have not previously addressed and expanded upon the indications for scoping reviews. Below, we build upon previously described indications and suggest the following purposes for conducting a scoping review:

To identify the types of available evidence in a given field

To clarify key concepts/ definitions in the literature

To examine how research is conducted on a certain topic or field

To identify key characteristics or factors related to a concept

As a precursor to a systematic review.

To identify and analyse knowledge gaps

Deciding between a systematic review and a scoping review approach

Authors deciding between the systematic review or scoping review approach should carefully consider the indications discussed above for each synthesis type and determine exactly what question they are asking and what purpose they are trying to achieve with their review. We propose that the most important consideration is whether or not the authors wish to use the results of their review to answer a clinically meaningful question or provide evidence to inform practice. If the authors have a question addressing the feasibility, appropriateness, meaningfulness or effectiveness of a certain treatment or practice, then a systematic review is likely the most valid approach [ 11 , 23 ]. However, authors do not always wish to ask such single or precise questions, and may be more interested in the identification of certain characteristics/concepts in papers or studies, and in the mapping, reporting or discussion of these characteristics/concepts. In these cases, a scoping review is the better choice.

As scoping reviews do not aim to produce a critically appraised and synthesised result/answer to a particular question, and rather aim to provide an overview or map of the evidence. Due to this, an assessment of methodological limitations or risk of bias of the evidence included within a scoping review is generally not performed (unless there is a specific requirement due to the nature of the scoping review aim) [ 6 ]. Given this assessment of bias is not conducted, the implications for practice (from a clinical or policy making point of view) that arise from a scoping review are quite different compared to those of a systematic review. In some cases, there may be no need or impetus to make implications for practice and if there is a need to do so, these implications may be significantly limited in terms of providing concrete guidance from a clinical or policy making point of view. Conversely, when we compare this to systematic reviews, the provision of implications for practice is a key feature of systematic reviews and is recommended in reporting guidelines for systematic reviews [ 13 ].

Exemplars for different scoping review indications

In the following section, we elaborate on each of the indications listed for scoping reviews and provide a number of examples for authors considering a scoping review approach.

Scoping reviews that seek to identify the types of evidence in a given field share similarities with evidence mapping activities as explained by Bragge and colleagues in a paper on conducting scoping research in broad topic areas [ 24 ]. Chambers and colleagues [ 25 ] conducted a scoping review in order to identify current knowledge translation resources (and any evaluations of them) that use, adapt and present findings from systematic reviews to suit the needs of policy makers. Following a comprehensive search across a range of databases, organizational websites and conference abstract repositories based upon predetermined inclusion criteria, the authors identified 20 knowledge translation resources which they classified into three different types (overviews, summaries and policy briefs) as well as seven published and unpublished evaluations. The authors concluded that evidence synthesists produce a range of resources to assist policy makers to transfer and utilize the findings of systematic reviews and that focussed summaries are the most common. Similarly, a scoping review was conducted by Challen and colleagues [ 26 ] in order to determine the types of available evidence identifying the source and quality of publications and grey literature for emergency planning. A comprehensive set of databases and websites were investigated and 1603 relevant sources of evidence were identified mainly addressing emergency planning and response with fewer sources concerned with hazard analysis, mitigation and capability assessment. Based on the results of the review, the authors concluded that while there is a large body of evidence in the field, issues with its generalizability and validity are as yet largely unknown and that the exact type and form of evidence that would be valuable to knowledge users in the field is not yet understood.

To clarify key concepts/definitions in the literature

Scoping reviews are often performed to examine and clarify definitions that are used in the literature. A scoping review by Schaink and colleagues 27 was performed to investigate how the notion of “patient complexity” had been defined, classified, and understood in the existing literature. A systematic search of healthcare databases was conducted. Articles were assessed to determine whether they met the inclusion criteria and the findings of included articles were grouped into five health dimensions. An overview of how complexity has been described was presented, including the varying definitions and interpretations of the term. The results of the scoping review enabled the authors to then develop a complexity framework or model to assist in defining and understanding patient complexity [ 27 ].

Hines et al. [ 28 ] provide a further example where a scoping review has been conducted to define a concept, in this case the condition bronchopulmonary dysplasia. The authors revealed significant variation in how the condition was defined across the literature, prompting the authors to call for a ‘comprehensive and evidence-based definition’. [ 28 ]

To examine how research is conducted on a certain topic

Scoping reviews can be useful tools to investigate the design and conduct of research on a particular topic. A scoping review by Callary and colleagues 29 investigated the methodological design of studies assessing wear of a certain type of hip replacement (highly crosslinked polyethylene acetabular components) [ 29 ]. The aim of the scoping review was to survey the literature to determine how data pertinent to the measurement of hip replacement wear had been reported in primary studies and whether the methods were similar enough to allow for comparison across studies. The scoping review revealed that the methods to assess wear (radiostereometric analysis) varied significantly with many different approaches being employed amongst the investigators. The results of the scoping review led to the authors recommending enhanced standardization in measurements and methods for future research in this field [ 29 ].

There are other examples of scoping reviews investigating research methodology, with perhaps the most pertinent examples being two recent scoping reviews of scoping review methods [ 9 , 10 ]. Both of these scoping reviews investigated how scoping reviews had been reported and conducted, with both advocating for a need for clear guidance to improve standardization of methods [ 9 , 10 ]. Similarly, a scoping review investigating methodology was conducted by Tricco and colleagues 30 on rapid review methods that have been evaluated, compared, used or described in the literature. A variety of rapid review approaches were identified with many instances of poor reporting identified. The authors called for prospective studies to compare results presented by rapid reviews versus systematic reviews.

Scoping reviews can be conducted to identify and examine characteristics or factors related to a particular concept. Harfield and colleagues (2015) conducted a scoping review to identify the characteristics of indigenous primary healthcare service delivery models [ 30 , 31 , 32 ]. A systematic search was conducted, followed by screening and study selection. Once relevant studies had been identified, a process of data extraction commenced to extract characteristics referred to in the included papers. Over 1000 findings were eventually grouped into eight key factors (accessible health services, community participation, culturally appropriate and skilled workforce, culture, continuous quality improvement, flexible approaches to care, holistic health care, self-determination and empowerment). The results of this scoping review have been able to inform a best practice model for indigenous primary healthcare services.

Scoping reviews conducted as precursors to systematic reviews may enable authors to identify the nature of a broad field of evidence so that ensuing reviews can be assured of locating adequate numbers of relevant studies for inclusion. They also enable the relevant outcomes and target group or population for example for a particular intervention to be identified. This can have particular practical benefits for review teams undertaking reviews on less familiar topics and can assist the team to avoid undertaking an “empty” review [ 33 ]. Scoping reviews of this kind may help reviewers to develop and confirm their a priori inclusion criteria and ensure that the questions to be posed by their subsequent systematic review are able to be answered by available, relevant evidence. In this way, systematic reviews are able to be underpinned by a preliminary and evidence-based scoping stage.

A scoping review commissioned by the United Kingdom Department for International Development was undertaken to determine the scope and nature of literature on people’s experiences of microfinance. The results of this scoping review were used to inform the development of targeted systematic review questions that focussed upon areas of particular interest [ 34 ].

In their recent scoping review on the conduct and reporting of scoping reviews, Tricco and colleagues 10 reveal only 12% of scoping reviews contained recommendations for the development of ensuing systematic reviews, suggesting that the majority of scoping review authors do not conduct scoping reviews as a precursor to future systematic reviews.

To identify and analyze gaps in the knowledge base

Scoping reviews are rarely solely conducted to simply identify and analyze gaps present in a given knowledge base, as examination and presentation of what hasn’t been investigated or reported generally requires exhaustive examination of all of what is available. In any case, because scoping reviews tend to be a useful approach for reviewing evidence rapidly in emerging fields or topics, identification and analysis of knowledge gaps is a common and valuable indication for conducting a scoping review. A scoping review was recently conducted to review current research and identify knowledge gaps on the topic of “occupational balance”, or the balance of work, rest, sleep, and play [ 35 ]. Following a systematic search across a range of relevant databases, included studies were selected and in line with predetermined inclusion criteria, were described and mapped to provide both an overall picture of the current state of the evidence in the field and to identify and highlight knowledge gaps in the area. The results of the scoping review allowed the authors to illustrate several research ‘gaps’, including the absence of studies conducted outside of western societies, the lack of knowledge around peoples’ levels of occupational balance, as well as a dearth of evidence regarding how occupational balance may be enhanced. As with other scoping reviews focussed upon identifying and analyzing knowledge gaps, results such as these allow for the identification of future research initiatives.

Scoping reviews are now seen as a valid review approach for certain indications. A key difference between scoping reviews and systematic reviews is that in terms of a review question, a scoping review will have a broader “scope” than traditional systematic reviews with correspondingly more expansive inclusion criteria. In addition, scoping reviews differ from systematic reviews in their overriding purpose. We have previously recommended the use of the PCC mnemonic (Population, Concept and Context) to guide question development [ 36 ]. The importance of clearly defining the key questions and objectives of a scoping review has been discussed previously by one of the authors, as a lack of clarity can result in difficulties encountered later on in the review process [ 36 ].

Considering their differences from systematic reviews, scoping reviews should still not be confused with traditional literature reviews. Traditional literature reviews have been used as a means to summarise various publications or research on a particular topic for many years. In these traditional reviews, authors examine research reports in addition to conceptual or theoretical literature that focuses on the history, importance, and collective thinking around a topic, issue or concept. These types of reviews can be considered subjective, due to their substantial reliance on the author’s pre-exiting knowledge and experience and as they do not normally present an unbiased, exhaustive and systematic summary of a topic [ 12 ]. Regardless of some of these limitations, traditional literature reviews may still have some use in terms of providing an overview of a topic or issue. Scoping reviews provide a useful alternative to literature reviews when clarification around a concept or theory is required. If traditional literature reviews are contrasted with scoping reviews, the latter [ 6 ]:

Are informed by an a priori protocol

Are systematic and often include exhaustive searching for information

Aim to be transparent and reproducible

Include steps to reduce error and increase reliability (such as the inclusion of multiple reviewers)

Ensure data is extracted and presented in a structured way

Another approach to evidence synthesis that has emerged recently is the production of evidence maps [ 37 ]. The purpose of these evidence maps is similar to scoping reviews to identify and analyse gaps in the knowledge base [ 37 , 38 ]. In fact, most evidence mapping articles cite seminal scoping review guidance for their methods [ 38 ]. The two approaches therefore have many similarities, with perhaps the most prominent difference being the production of a visual database or schematic (i.e. map) which assists the user in interpreting where evidence exists and where there are gaps [ 38 ]. As Miake-Lye states, at this stage ‘it is difficult to determine where one method ends and the other begins.’ [ 38 ] Both approaches may be valid when the indication is for determining the extent of evidence on a particular topic, particularly when highlighting gaps in the research.

A further popular method to define and scope concepts, particularly in nursing, is through the conduct of a concept analysis [ 39 , 40 , 41 , 42 ]. Formal concept analysis is ‘a process whereby concepts are logically and systematically investigated to form clear and rigorously constructed conceptual definitions,’ [ 42 ] which is similar to scoping reviews where the indication is to clarify concepts in the literature. There is limited methodological guidance on how to conduct a concept analysis and recently they have been critiqued for having no impact on practice [ 39 ]. In our opinion, scoping reviews (where the purpose is to systematically investigate a concept in the literature) offer a methodologically rigorous alternative to concept analysis with their results perhaps being more useful to inform practice.

Comparing and contrasting the characteristics of traditional literature reviews, scoping reviews and systematic reviews may help clarify the true essence of these different types of reviews (see Table 1 ).

Rapid reviews are another emerging type of evidence synthesis and a substantial amount of literature have addressed these types of reviews [ 43 , 44 , 45 , 46 , 47 ]. There are various definitions for rapid reviews, and for simplification purposes, we define these review types as ‘systematic reviews with shortcuts.’ In this paper, we have not discussed the choice between a rapid or systematic review approach as we are of the opinion that perhaps the major consideration for conducting a rapid review (as compared to a systematic or scoping review) is not the purpose/question itself, but the feasibility of conducting a full review given financial/resource limitations and time pressures. As such, a rapid review could potentially be conducted for any of the indications listed above for the scoping or systematic review, whilst shortening or skipping entirely some steps in the standard systematic or scoping review process.

There is some overlap across the six listed purposes for conducting a scoping review described in this paper. For example, it is logical to presume that if a review group were aiming to identify the types of available evidence in a field they would also be interested in identifying and analysing gaps in the knowledge base. Other combinations of purposes for scoping reviews would also make sense for certain questions/aims. However, we have chosen to list them as discrete reasons in this paper in an effort to provide some much needed clarity on the appropriate purposes for conducting scoping reviews. As such, scoping review authors should not interpret our list of indications as a discrete list where only one purpose can be identified.

It is important to mention some potential abuses of scoping reviews. Reviewers may conduct a scoping review as an alternative to a systematic review in order to avoid the critical appraisal stage of the review and expedite the process, thinking that a scoping review may be easier than a systematic review to conduct. Other reviewers may conduct a scoping review in order to ‘map’ the literature when there is no obvious need for ‘mapping’ in this particular subject area. Others may conduct a scoping review with very broad questions as an alternative to investing the time and effort required to craft the necessary specific questions required for undertaking a systematic review. In these cases, scoping reviews are not appropriate and authors should refer to our guidance regarding whether they should be conducting a systematic review instead.

This article provides some clarification on when to conduct a scoping review as compared to a systematic review and clear guidance on the purposes for conducting a scoping review. We hope that this paper will provide a useful addition to this evolving methodology and encourage others to review, modify and build upon these indications as the approach matures. Further work in scoping review methods is required, with perhaps the most important advancement being the recent development of an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for scoping reviews [ 48 ] and the development of software and training programs to support these reviews [ 49 , 50 ]. As the methodology advances, guidance for scoping reviews (such as that included in the Joanna Briggs Institute Reviewer’s Manual) will require revision, refining and updating.

Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Researchers may preference the conduct of a scoping review over a systematic review where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts, investigate research conduct, or to inform a systematic review. Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there will be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.

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ZM: Led the development of this paper and conceptualised the idea for a paper on indications for scoping reviews. Provided final approval for submission. MP: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. CS: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. CT: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. AM: Contributed conceptually to the paper and reviewed and provided feedback on all drafts. Provided final approval for submission. EA: Contributed conceptually to the paper and reviewed and provided feedback on all drafts. Provided approval and encouragement for the work to proceed. Provided final approval for submission.

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Munn, Z., Peters, M.D.J., Stern, C. et al. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 18 , 143 (2018). https://doi.org/10.1186/s12874-018-0611-x

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About Systematic Reviews

Understanding an Integrative Review vs Systematic Review

Automate every stage of your literature review to produce evidence-based research faster and more accurately.

Each type of review has its unique advantages and drawbacks that you need to be aware of before you begin a review. Your intention of doing the research should define the type of review you choose to use. Many online resources discuss the difference between a rapid review vs systematic review , as well as randomized controlled trial vs systematic review , which can help you gain a deeper understanding of the different approaches. In this article, we’ll compare integrative reviews with systematic reviews.

Integrative Reviews

An integrative review summarizes past experimental and theoretical data to help develop a broad understanding of concepts and healthcare issues. This type of review has the potential to shape nursing science, informative research, clinical practice, and policy actions. If conducted properly, an integrative review will contribute immensely to theory-development processes, present the standing of science related to the issue, and help apply this information to practice and strategy.

Integrative reviews allow for the incorporation of various approaches, including experimental and non-experimental methods of review. They are suitable for reviewing experimental and theoretical studies concurrently. Experimental studies involve a setting where intervention is provided to the experimental group and not the control group. The effects of this intervention are then evaluated to come up with new conclusions. On the other hand, a theoretical study does not use experimental or empirical evidence, rather it involves the use of interviews, observations, or a combination of theoretical data to develop its findings. These findings are then used to develop new theories. Integrative reviews thus by involving both experimental ad theoretical studies are able to point out research gaps and examine systematic issues.

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Systematic Reviews

A systematic review of literature is a form of evidence evaluation that uses reproducible, analytical approaches to gather information and assess its validity and applicability. This type of review involves formulating research questions (broad or focused in scope) and then identifying and synthesizing information related to the research questions. Systematic reviews are suitable for biomedical and healthcare studies, but they can also be used in other areas that require an evaluation of a specifically defined subject. These are business, political science, social science, behavioral science, etc.

This type of review can be used to evaluate clinical tests, environmental interventions, qualitative-evidence synthesis, public-health interventions, procedural reviews, policy reviews, and economic assessments. It summarizes the results of well-designed studies, especially in healthcare, to offer highly effective and unbiased evidence. Using this evidence, you’re able to make recommendations and influence policies in healthcare. However, systematic reviews are quite complex and can take months, if not years, to complete. Depending on the type of review, and the amount of literature involved, a systematic review can take up to two years.

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The difference between a systematic review & scoping review

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Home | Blog | Best Practice | The difference between a systematic review & scoping review

Covidence explains the two study designs

Research: there’s a lot of it! So much, in fact, that keeping track gets harder by the day – even within a narrow specialism or subject area. 

Evidence synthesis is a type of secondary research that brings together information from a range of sources to inform decision making. It attempts to review the research in a rigorous and systematic way so that it can be used to support evidence-based practice.

Within evidence synthesis, different types of reviews have emerged to tackle the huge task of summarising the literature. It can be hard to keep track of these too! 

What’s the deal with scoping reviews, for example? How do they differ from systematic reviews? Both are types of evidence synthesis and each has a specific use. Let’s look at these two review types in turn to pick up on the key similarities and differences 🕵🏾‍♀️ . 

1. 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.

‘Systematic’ means that the methods used to search for and analyse the data are

transparent, reproducible and defined before searching begins. Systematic reviews strive to be as thorough and rigorous as possible to minimise the bias that would result from cherry-picking studies in a non-systematic way. 

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. The first systematic review published by Cochrane assessed the effectiveness of antenatal corticosteroids for accelerating fetal lung maturation in women at risk of preterm birth . Systematic review evidence is used in the development of guidelines by organisations such as the World Health Organization and the Agency for Healthcare Research and Quality in the US.

What guidelines should a systematic review follow?

The PRISMA guidelines set out the items that should be included in the reporting of a systematic review.

How can I get help with my systematic review?

Covidence is an online tool that saves time on the screening, data extraction and quality assessment stages of your systematic review 👍. Its simple workflows enable review teams to collaborate and track their progress easily and reliably. Covidence automatically populates a PRISMA flow diagram for each review. The flow diagram documents the decisions on the inclusion and exclusion of studies and can be added to the results section of the review.

2. What is a scoping review?

Systematic reviews are resource intensive. To find out whether starting work on one is a good idea, some researchers conduct a scoping review first to find out more about the body of evidence in a particular topic area. 

Scoping reviews are exploratory, and they typically address a broad question. Researchers conduct them to assess the extent of the available evidence, to organise it into groups and to highlight gaps. Sometimes scoping reviews are also used to decide whether or not it would be useful to conduct a systematic review 🤔.

The scoping review process is shown in figure 3. Like systematic reviews, scoping reviews define eligibility criteria, search the literature, screen the results and select evidence for inclusion. The data extraction stage, in which the review team creates a descriptive summary of the evidence, is called ‘charting’ 📊. The JBI Manual for evidence synthesis recommends that scoping reviews extract the following study information:

When is it appropriate to do a scoping review?

If you want to establish the full range of treatments in a particular area of health care or explore the health of a specific population, you could perform a scoping review. A recent scoping review looked at the health of adolescents in detention . The results of a scoping review can give review teams the information they need to be specific when they formulate their systematic review question 🎯. The scoping review might also give an indication of how long it would take to complete the systematic review. 

What guidelines should a scoping review follow?

The PRISMA extension for scoping reviews is a list of 20 essential reporting items for review teams when completing a scoping review.

How can I get help with my scoping review?

Scoping reviews can generate a large volume of citations, which can be a daunting task! Covidence supports review teams to screen citations quickly and efficiently. It can also help teams to set up standardised charting forms and ensure a consistent and rigorous approach to decision making throughout the project 😅.

Interest in systematic reviews and scoping reviews has grown rapidly in recent years. Review methods are evolving constantly as researchers find new ways to meet the challenge of synthesising the evidence. Whether you’re planning a systematic review, a scoping review, or both, Covidence can help you and your team keep your project on track. 

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Laura Mellor. Portsmouth, UK

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Open Access

Peer-reviewed

Research Article

Relevance of Mediterranean diet as a nutritional strategy in diminishing COVID-19 risk: A systematic review

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Visualization, Writing – original draft, Writing – review & editing

Affiliation Department of Center of Evidence Based Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia

Roles Data curation, Formal analysis, Investigation

Roles Data curation, Formal analysis, Validation, Writing – original draft

Roles Data curation, Formal analysis, Validation

Roles Funding acquisition, Project administration, Supervision, Writing – review & editing

* E-mail: [email protected]

Affiliation Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia

• Ceria Halim, 
• Miranda Howen, 
• Athirah Amirah Nabilah binti Fitrisubroto, 
• Timotius Pratama, 
• Indah Ramadhani Harahap, 
• Lacman Jaya Ganesh, 
• Andre Marolop Pangihutan Siahaan

• Published: August 21, 2024
• https://doi.org/10.1371/journal.pone.0301564
• Peer Review
• Reader Comments

Mediterranean Diet has been reported to possess immunomodulatory and anti-inflammatory properties. These properties are closely associated with the immunopathogenesis of COVID-19.

The present systematic review aimed to determine the association between Mediterranean Diet and COVID-19, COVID-19 symptoms, and COVID-19 severity.

The protocol for this systematic review was registered in International Prospective Register of Systematic Reviews (PROSPERO) with identification number CRD42023451794. The literature search was conducted through Pubmed, Proquest, and Google Scholar on August 2023. The inclusion criteria were studies with a population of human subjects, reported the association between Mediterranean diet adherence with risk of COVID-19 infection, COVID-19 symptoms, or COVID-19 severity, and full text must be available in English. The exclusion criteria were reviews, editorials, letters, replies, systematic reviews, meta-analyses, studies on animals, and duplicates. Risk of bias in included studies was assessed using Newcastle Ottawa Scale (NOS). Data was synthesized narratively. Each study was compared and a structured summary was developed.

After selection process, 6 articles were included, with a sample size of 55,489 patients. All studies were observational studies and assessed Mediterranean diet adherence using food frequency questionnaires (FFQ), with scoring system varied between each study. Four studies found a significant correlation between increased adherence to Mediterranean Diet and reduced COVID-19 risk, while one study indicated non-significant association. One study reported a significant association between higher adherence to Mediterranean Diet and COVID-19 symptoms, but three studies reported non-significant association. One study found that individuals with higher adherence to Mediterranean Diet had reduced likelihood of developing severe COVID-19, however, two studies yielded inconclusive findings.

Limitations

All studies used self-administrated food frequency questionnaires (FFQs), which were prone to biased responses, such as recall and estimation bias.

Lower trends of odds ratios (ORs) were consistently observed in higher Mediterranean diet adherence. In every outcome of the included studies, ORs ranged between 0.06–0.992, however, differing levels of significance were reported in each outcome.

Overall analyses suggest that high adherence to Mediterranean Diet is a protective factor against COVID-19, with unclear benefits against COVID-19 symptoms and severity.

Citation: Halim C, Howen M, Fitrisubroto AANb, Pratama T, Harahap IR, Ganesh LJ, et al. (2024) Relevance of Mediterranean diet as a nutritional strategy in diminishing COVID-19 risk: A systematic review. PLoS ONE 19(8): e0301564. https://doi.org/10.1371/journal.pone.0301564

Editor: Nour Amin Elsahoryi, University of Petra (UOP), JORDAN

Received: March 18, 2024; Accepted: July 22, 2024; Published: August 21, 2024

Copyright: © 2024 Halim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The coronavirus disease 2019 (COVID-19) was declared as a pandemic in March 2020 and had a widespread impact on individuals across the globe, with total infection cases reaching more than 775 million in 4 years [ 1 , 2 ]. Studies have reported main symptoms of COVID-19 including fever, cough, and shortness of breath. Other non-specific symptoms were also reported among COVID-19 patients, such as sore throat, nasal congestion, and shortness of breath. In addition to the typical respiratory symptoms, COVID-19 has also been associated with a range of atypical manifestation, such as headache, diarrhea, nausea, and vomiting [ 3 ]. The World Health Organization (WHO) has classified COVID-19 disease severity into four groups: mild, moderate, severe, or critical. This classification was based on a combination of symptoms, oxygen saturation, and inflammatory biomarkers [ 3 ]. COVID-19 severity largely played a role in COVID-19 mortality, as reflected from recent data that reported COVID-19 mortality ranged from 6.3% in average population [ 4 ], to 13.2% in inpatient population, and drastically increased to 55.9% in patients requiring mechanical ventilation [ 5 ]. Until this article was written, more than 7 million total deaths by COVID-19 were recorded [ 2 ].

Inflammation has been widely recognized as a critical factor in the development and the degree of severity in COVID-19. After the initial innate immune response, a potent uncontrolled inflammatory response called cytokine storm may follow. Cytokine storm, characterized by excessive inflammation caused by high levels of cytokines, particularly IL-6, IL-1, and TNF-α, can lead to advanced disease, multiorgan involvement, and serious consequences [ 6 ]. Cytokine storm has been identified as a potential target for therapeutic interventions, and multiple approaches. Immunomodulatory drugs, including dexamethasone and tocilizumab, as well as exosomes generated from mesenchymal stem cells and plasmapheresis, have been employed as ways to regulate this hyperinflammatory response [ 7 ]. These studies were just a few out of others that cemented the important role of inflammation in COVID-19.

The Mediterranean diet is a dietary pattern that consists primarily of plant-derived nutritional components, such as fruits, vegetables, legumes, nuts, and olive oil, and has been linked to anti-inflammatory properties and a reduced likelihood of developing cardiovascular disease [ 8 ]. Mediterranean diet is rich sources of polyphenols and polyunsaturated fatty acids (PUFAs), which are well-known antioxidants [ 9 ]. Adherence to Mediterranean diet has been reported to lower the expression of pro-inflammatory molecules, such as TNF-α, IL-1, IL-6 and CRP, as well as a reduction in the overall systemic inflammatory status, while also exerting antiviral effects by decreasing nuclear transcription factor kappa B (NF-κB) expression [ 10 – 12 ]. Mediterranean diet has been reported to benefit those with various disorders associated with persistent low-grade inflammation [ 10 ]. Researchers had suggested the potential association between diet and viral infections [ 13 ]. Fruits and fish oil, both vital components of Mediterranean diet, contain vitamin A, C, and D. These vitamins are effective antioxidant against reactive oxygen species (ROS) which are secreted by immune cells and help maintain body cells integrity, while also supporting epithelial barriers integrity. Vitamin D, which stimulate polymorphonuclear (PMN) and natural killer cells (NK) cells in producing potent anti-microbial peptides. The resulting effect are decreased risk of infection and increased viral clearance [ 13 ]. This has led to the growing proposition of the protective effects of Mediterranean diet towards COVID-19 [ 9 , 11 ].

Based on the properties of Mediterranean diet that have been described above, this systematic review aims to address the association between Mediterranean diet and COVID-19 risk, COVID-19 symptoms, and COVID-19 severity.

Materials and methods

Protocol writing and registration.

The protocol for this systematic review was registered on 15 th September 2023 with the International Prospective Register of Systematic Reviews (PROSPERO) with identification number CRD42023451794. This systematic review was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [ 14 ].

Search strategy

Literature search was conducted on 3 search engines, Pubmed, Proquest and Google Scholar, on 16th August 2023. Literature search was done using the keyword "Mediterranean diet and COVID-19", with detailed search strategy and medical subject headings (MeSH) described below ( S1 File ). No additional article or abstract was selected from other sources.

Study selection

The inclusion criteria for this systematic review were studies with a population of human subjects, and reported the association between Mediterranean diet adherence with COVID-19 infection, COVID-19 symptoms, or severe COVID-19. No study design nor publication date restriction were applied. Full-text must be available in English. The exclusion criteria were reviews, editorials, letters, replies, systematic reviews, meta-analyses, studies on animals, and duplicates.

Deduplication was carried out using the Rayyan application [ 15 ]. The remaining articles were screened based on title and abstract manually by two reviewers working individually. No automation tool was used in the process. Each article would be sought for further review if at least one reviewer considered it to fulfill the criteria and was within the scope of this systematic review. Studies that passed the initial screening would be sought for retrieval. Two reviewers working together further reviewed the full-text of each literature for its eligibility.

Data extraction

Data were collected by two reviewers working separately using data collection standards set previously. This included name of the first author, year of publication, study location, study design, total and characteristics of participants. Mediterranean diet association with COVID-19 infection, symptoms, and severity, Mediterranean diet adherence and outcome definition were also recorded. All results that were compatible with each outcome domain in each study were sought. Missing data were not sought further.

Quality assessment

Non-randomized studies were assessed using Newcastle-Ottawa Scale (NOS) [ 16 ]. NOS criteria in cross-sectional studies were adapted from cohort criteria [ 17 ]. The NOS criteria were scored based on three categories: selection, comparability, and outcome, with each category consisted of 1–4 items. NOS score ranged from 0 (lowest quality) to 9 (highest quality). Randomized studies were assessed using revised Cochrane risk of bias tool for randomized trials (RoB2) [ 18 ]. Each successfully retrieved full-text article will be evaluated and scored by two reviewers working independently. Disagreement between reviewers’ judgement was resolved by soliciting a third reviewer’s opinion.

Data synthesis

Data was synthesized narratively. The minimum number of studies was two for each analysis. The outcome was measured with odds ratio (OR) for COVID-19 infection, symptoms, and severity. Study characteristics, risk of bias, and study findings, and other relevant data were reported and tabulated. Similarities, differences, strengths, and limitations were compared across studies. A structured summary was also presented, to further elaborate the extracted data [ 19 ]. No subgroup nor sensitivity analyses were carried out.

Reporting bias and certainty assessment

Reporting bias was evaluated using a tool by Page et al. [ 20 ] and RoBANS 2: A Revised Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions [ 21 ]. We used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to define the certainty in the body of evidence [ 22 ].

Literature search

A total of 325 records were identified across Pubmed, Proquest and Google Scholar. Duplicates were removed, with 209 records remained and screened. Thirteen articles were sought for retrieval and were further reviewed for eligibility. Six articles were deemed eligible and were included in this systematic review. A flow chart of selection process and exclusion reasons is provided below ( Fig 1 ).

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0301564.g001

The study by Mohajeri et al. [ 23 ] appear to meet the inclusion criteria, but were excluded, as the outcome of COVID-19, COVID-19 symptoms, or COVID-19 severity were not reported. The study only reported outcome of inflammatory biomarkers.

Study characteristics

All 6 articles were observational studies, published in 2020–2023 [ 24 – 29 ]. The total sample was 55,489 patients, with study location across 5 countries. The majority of the studies had a prospective cohort design. Five studies reported the association between Mediterranean diet adherence and COVID-19 infection, four reported the association between Mediterranean diet adherence and COVID-19 symptoms, and three reported the association between Mediterranean diet adherence and severe COVID-19.

All studies measured the Mediterranean diet adherence using questionnaires, with scoring system varying between study to study. All Mediterranean diet adherence included categories such as, vegetables, fruits and nuts, cereals, legumes, fish, red meat, dairy, and alcohol consumption. Monounsaturated to saturated fat ratio was also an essential component in Mediterranean diet score, although four studies replaced monounsaturated fat to saturated fat ratio with olive oil intake [ 24 – 27 ]. The reason behind this was that the ratio of monounsaturated to saturated fats does not correspond to a specific food and the fact that olive oil is also the main source of monounsaturated fats in the traditional Mediterranean diet [ 25 ]. Newcastle Ottawa Scale (NOS), used to assess risk of bias was presented along the study characteristics in Table 1 .

https://doi.org/10.1371/journal.pone.0301564.t001

Mediterranean diet and COVID-19

A total of five studies investigated the association between Mediterranean diet adherence and COVID-19 [ 24 – 28 ] with a sample size of 55,239 patients as listed in Table 2 . Three studies analyzed Mediterranean diet adherence as continuous variable of 1-point increment, one study analyzed Mediterranean diet adherence as categorical variable in a cut-off determined by the respective study, and one study analyzed Mediterranean diet adherence as both categorical variable in quartiles and continuous variable of 1-SD increment. Four studies relied on self-report of previous history of COVID-19 to determine COVID-19 cases, while one study relied on both serologic testing and self-report.

https://doi.org/10.1371/journal.pone.0301564.t002

Three out of five studies reported Mediterranean diet adherence significantly lower risk of COVID-19, while two studies stated non-significant results. All five studies reported OR ranging between 0.75–0.948. The study by El Khoury et al., [ 24 ] reported the OR of being non infected by COVID-19 (OR = 1.055, 95%CI: 1.013–1.099, p = 0.01). This data was then inverted to properly reflect the odds of COVID-19 as noted in Table 2 . Three studies adjusted for potential confounding variables. Three studies analyzed the association of Mediterranean diet individual components with COVID-19 risk. Among the food categories, higher olive oil consumption, lower red meat consumption, lower cereal consumption, moderate amounts of alcohol, and higher intake of fruit and nuts were reported to lower risk against COVID-19.

Mediterranean diet and COVID-19 symptoms

Four studies reported the association between Mediterranean diet adherence and COVID-19 symptoms [ 24 , 25 , 28 , 29 ] with a sum of 53,069 patients. Differing comparison of Mediterranean diet adherence score was reported across studies with one each of, continuous variable of 1-point increment, categorical variable in a cut-off determined by the authors of the study, categorical variable in tertiles, and as both categorical variable in quartiles and continuous variable of 1-SD increment, as detailed in Table 3 . All studies depended on self-report for the presence of COVID-19 symptoms, and analyzed the odds ratio using logistic regression with yes/no type outcome. Two studies analyzed for symptomatic COVID-19 outcome [ 25 , 28 ], one study for moderate COVID-19 burden (defined as presence of 5–10 symptoms) [ 24 ], and one study analyzed for each COVID-19 symptom [ 29 ].

https://doi.org/10.1371/journal.pone.0301564.t003

The study by Zargarzadeh et al. [ 29 ] found that higher Mediterranean diet adherence significantly decrease the odds for all reported COVID-19 symptoms, with OR varied between 0.06–0.34 for each symptom. Three studies reported insignificant association, with OR of each study ranging between 0.84–0.992, and p value >0.05, although the result from Yue et al. [ 28 ] did reach the limit of statistical significance (OR = 0.89, 95% CI: 0.80–0.99; P-trend = 0.0549). Perez-Araluce et al. analyzed the relation of individual components of Mediterranean diet with COVID-19 symptoms, yet no food categories were found to be significant [ 25 ].

Mediterranean diet and COVID-19 severity

The association between Mediterranean diet adherence and COVID-19 severity were analyzed in three observational studies [ 25 , 28 , 29 ], as listed in Table 4 . The total sample was 52,670 patients, relatively similar with the previous two outcomes. Self-report of hospitalization due to COVID-19 was the main method to determine severe COVID-19 cases. One study examined the medical records of the participants for severe COVID-19, in accordance with the National Institute of Health’s Coronavirus Disease 2019 (COVID 19) Treatment Guidelines.

https://doi.org/10.1371/journal.pone.0301564.t004

The study by Zargarzadeh et al. [ 29 ] found that participants with top tertile Mediterranean diet score were less likely to have severe COVID-19 (OR = 0.23; 95% CI: 0.11–0.50, P <0.001) than the bottom tertile. Two studies reported insignificant association with OR ranging 0.22–0.89, and p value > 0.05. Two studies analyzed the effects of Mediterranean diet individual components against COVID-19 severity. One study found no individual components were significant, while the study by Zargarzadeh et al. [ 29 ] reported higher consumption of vegetables, fruits, legumes, nuts, whole grains, and fish lower odds of severe COVID-19.

Reporting bias and evidence grading

Using the tool by Page et al. [ 20 ] and RoBANS 2 [ 21 ] for evaluating reporting bias, we considered the included studies were of low-to-moderate risk for reporting bias. A detailed assessment is attached ( S2 File ). To grade the quality of evidence, the tool Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used. On the outcome of COVID-19 risk, the authors considered the overall grading of the evidence to be of moderate certainty, meaning the true effect is probably close to the estimated effect. This was primarily because of the large number of patients for the outcome analyzed, similar effect estimates trend between studies (all outcome analyses reported OR <1), and adjustment for multiple confounding factors. For the outcome of COVID-19 symptoms and COVID-19 severity, we rated the evidence to be of low certainty, meaning the true effect might be markedly different from the estimated effect. Certainty for these outcomes was rated down for imprecision and that there were too few available studies included in the analyses.

The protective mechanism of diet against viral respiratory disease progression has been acknowledged by several studies. A previous study found that healthy plant-based foods was associated with lower odds and severity of COVID-19 [ 30 ]. Another relevant finding was that the adoption of a Traditional Mediterranean Diet contributed towards to the improvement of patients with recurring colds and frequent inflammatory complications, with significantly reduced episodes and symptoms [ 31 ]. A previous systematic review found that Mediterranean diet was reported to lower inflammatory biomarker levels in obese/overweight adults [ 32 ]. Similarly, a precedent meta-analysis reported Mediterranean diet adherence effectively reduce SARS-CoV-2 infection by 78% (95% CI 69%–88%), although the authors recommended cautious interpretation due to the paucity of the included studies [ 33 ].

These previous studies were in line with our findings. For the outcome of COVID-19, interestingly, all studies reported OR<1, although there were differing reports on the significance of this association. Another interesting thing to note was the studies that didn’t adjust for confounding factors reported significant association, while two studies that adjusted for confounding factors reported non-significant association. An exception to this was the study with the largest number of participants. The study by Yue et al. [ 24 ] adjusted for multiple confounding factors and reported higher Mediterranean diet adherence proved to be significant in lowering odds of COVID-19. These results indicated that higher Mediterranean diet adherence was a protective factor against COVID-19, although the magnitude of the effect estimate was probably minor and thus was only observable in a larger population.

For the outcomes of COVID-19 symptoms and severity, all studies were adjusted for confounding variables, and almost all studies recorded non-significant association. Only the study by Zargarzadeh et al. [ 29 ] reported significant association for both outcomes. These differences could be explained by a few reasons. First, the study had a cross-sectional design, and as stated by its authors, the results cannot infer a causative association. In addition, although the study scored a high NOS score, this score was obtained by using a form adapted for cross-sectional study, and may not be comparable to the NOS from cohort studies. It bears mentioning that, despite the difference in significance, the effect estimates for both COVID-19 symptoms and severity outcomes across all studies showed a consistent trend of OR <1. It was necessary to put into consideration that the consistent effect of Mediterranean diet adherence in all studies may be more critical than the statistically insignificant p-value [ 34 ]. In fact, a nonsignificant result does not mean that there is no effect [ 34 ], albeit it might be too presumptive to assume a protective effect of higher Mediterranean diet adherence against COVID-19 symptoms and severity without conclusive evidence. Although a meta-analysis could produce a higher statistical power for this purpose, there were a few considerations as to why it was not performed. Multiple assessment index for Mediterranean diet adherence were used between studies. In addition, most studies assigned points for Mediterranean diet adherence depending on sex-specific median consumption in the respective study. Hence, we deemed a meta-analysis was not appropriate for the diverse data.

Several subtypes of food were inversely associated with COVID-19 risk. Higher olive oil consumption, lower red meat consumption, lower cereal consumption, moderate amounts of alcohol, and higher intake of fruit and nuts reduced COVID-19 risk, and higher consumption of vegetables, fruits, legumes, nuts, whole grains, and fish lowered odds of severe COVID-19. The presence of flavonoids, an antiviral and immunostimulatory compounds, linked fruit consumption to a reduced risk of SARS-CoV-2 infection [ 35 ]. Vitamin C, a major vitamin in fruits and vegetables, took part in inhibiting NLRP3 inflammasome pathway, decreasing pro-inflammatory cytokines, and improving neutrophil chemotaxis [ 35 , 36 ]. These resulted in minimizing viral pathogenesis, enhancing recovery, while also preventing respiratory viral infection [ 36 , 37 ]. Olive oil and fish were excellent sources of monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs), which had been known to exhibit immunomodulatory properties [ 38 ]. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) bind to peroxisome proliferator-activated receptors (PPARs), inhibiting cytokine expression by NF-κB inflammatory transcription factor [ 38 ]. Other pathways include decreasing lipid rafts and augmenting major histocompatibility complex 1 (MHC 1) expression [ 38 ]. In addition, virgin olive oil contained phenolic compounds, such as oleocanthal, that exerted potent anti-inflammatory actions, similar to ibuprofen [ 39 ]. Likewise, legumes possess bioactive compounds, such as peptides, polyphenols and saponins, which showed anti-inflammatory activity, inhibiting cyclooxygenase-1 (COX-1) and cyclooxygenase-1 (COX-2) enzyme expression [ 40 ]. Red wine, a prevalent alcoholic drink in Mediterranean diet, contains many types of antioxidants which neutralize free oxygen radicals released by neutrophils, minimizing cellular damage [ 41 ]. The overall beneficial anti-inflammatory properties of these food groups explained their effects in diminishing risk of COVID-19 and severe COVID-19.

Strengths and limitations

We further reviewed the strengths and limitations of each study, as listed in Table 5 . The study by Sharma et al. used objective serology data coupled with self-reported data to define COVID-19 cases [ 27 ]. The study by Yue et al. had a large number of participants, and all participants were health professionals which ensured high-quality health information [ 28 ]. Most of the studies included were adjusted for multiple confounding variables.

https://doi.org/10.1371/journal.pone.0301564.t005

The major limitation was that Mediterranean diet adherence of all studies was self-reported. Measurement errors in FFQs are known to affect results of studies and may have biased the observed effect estimates. FFQs were prone to biased responses, such as recall and estimation bias. However, FFQs were often used in large cohort studies because it is realistic and is logistically feasible. Two of the studies stated they had inadequate cases for observed outcome to produce a significant result [ 27 , 28 ].

To our knowledge, this systematic review is the first to specifically investigate the relationship between Mediterranean diet and COVID-19 risk, symptoms, and severity. Additionally, each of the study selection and bias assessment process was conducted by multiple reviewers to ensure minimal bias. This was done in accordance with the Cochrane guidelines [ 42 ].

This systematic review has some limitations that should be considered when interpreting the results. First, there were few studies included in this systematic review. Second, as a meta-analysis is not performed, the magnitude of the effects could not be precisely measured.

Public health implications

This systematic review provides an up-to-date summary of the available evidence. As more and more countries have loosened on personal protective equipment (PPE) and social distancing regulations, a nutritional strategy may be more feasible and beneficial long-term. The results of the present study may shed some light on additional benefits of Mediterranean diet against COVID-19. The findings also suggest that specific food groups in the Mediterranean diet may be more important in reducing COVID-19 odds. More studies should be conducted before definitive conclusions can be drawn.

Overall, the analyses suggest higher Mediterranean diet adherence significantly reduced odds of COVID-19, with non-significant results against COVID-19 symptoms and severity.

Supporting information

S1 checklist. prisma 2020 abstract checklist..

https://doi.org/10.1371/journal.pone.0301564.s001

S2 Checklist. PRISMA 2020 main checklist.

https://doi.org/10.1371/journal.pone.0301564.s002

S1 File. Detailed search strategies and MeSH.

https://doi.org/10.1371/journal.pone.0301564.s003

S2 File. Reporting bias risk assessment.

https://doi.org/10.1371/journal.pone.0301564.s004

Acknowledgments

We sincerely thank all researchers who have contributed their studies, without whom this systematic review would not be possible.

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Analysing near-miss incidents in construction: a systematic literature review.

1. Introduction

• Q 1 —Are near-miss events in construction industry the subject of scientific research?
• Q 2 —What methods have been employed thus far to obtain information on near misses and systems for recording incidents in construction companies?
• Q 3 —What methods have been used to analyse the information and figures obtained?
• Q 4 —What are the key aspects of near misses in the construction industry that have been of interest to the researchers?

2. Definition of Near-Miss Events

3. research methodology, 4.1. a statistical analysis of publications, 4.2. methods used to obtain information about near misses, 4.2.1. traditional methods.

• Traditional registration forms
• Computerized systems for the recording of events
• Surveys and interviews

4.2.2. Real-Time Monitoring Systems

• Employee-tracking systems
• Video surveillance systems
• Wearable technology
• Motion sensors

4.3. Methods Used to Analyse the Information and Figures That Have Been Obtained

4.3.1. quantitative and qualitative statistical methods, 4.3.2. analysis using artificial intelligence (ai), 4.3.3. building information modelling, 4.4. key aspects of near-miss investigations in the construction industry, 4.4.1. occupational risk assessment, 4.4.2. causes of hazards in construction, 4.4.3. time series of near misses, 4.4.4. material factors of construction processes, 4.5. a comprehensive overview of the research questions and references on near misses in the construction industry, 5. discussion, 5.1. interest of researchers in near misses in construction (question 1), 5.2. methods used to obtain near-miss information (question 2), 5.3. methods used to analyse the information and data sets (question 3), 5.4. key aspects of near-miss investigations in the construction industry (question 4), 6. conclusions.

• A quantitative analysis of the Q 1 question has revealed a positive trend, namely that there is a growing interest among researchers in studying near misses in construction. The greatest interest in NM topics is observed in the United States of America, China, the United Kingdom, Australia, Hong Kong, and Germany. Additionally, there has been a recent emergence of interest in Poland. The majority of articles are mainly published in journals such as Safety Science (10), Journal of Construction Engineering and Management (8), and Automation in Construction (5);
• The analysis of question Q 2 illustrates that traditional paper-based event registration systems are currently being superseded by advanced IT systems. However, both traditional and advanced systems are subject to the disadvantage of relying on employee-reported data, which introduces a significant degree of uncertainty regarding in the quality of the information provided. A substantial proportion of the data and findings presented in the studies was obtained through surveys and interviews. The implementation of real-time monitoring systems is becoming increasingly prevalent in construction sites. The objective of such systems is to provide immediate alerts in the event of potential hazards, thereby preventing a significant number of near misses. Real-time monitoring systems employ a range of technologies, including ultrasonic technology, radio frequency identification (RFID), inertial measurement units (IMUs), real-time location systems (RTLSs), industrial cameras, wearable technology, motion sensors, and advanced IT technologies, among others;
• The analysis of acquired near-miss data is primarily conducted through the utilisation of quantitative and qualitative statistical methods, as evidenced by the examination of the Q 3 question. In recent years, research utilising artificial intelligence (AI) has made significant advances. The most commonly employed artificial intelligence techniques include text mining, machine learning, and artificial neural networks. The growing deployment of Building Information Modelling (BIM) technology has precipitated a profound transformation in the safety management of construction sites, with the advent of sophisticated tools for the identification and management of hazardous occurrences;
• In response to question Q 4 , the study of near misses in the construction industry has identified several key aspects that have attracted the attention of researchers. These include the utilisation of both quantitative and qualitative methodologies for risk assessment, the analysis of the causes of hazards, the identification of accident precursors through the creation of time series, and the examination of material factors pertaining to construction processes. Researchers are focusing on the utilisation of both databases and advanced technologies, such as real-time location tracking, for the assessment and analysis of occupational risks. Techniques such as Analytic Hierarchy Process (AHP) and clustering facilitate a comprehensive assessment and categorisation of incidents, thereby enabling the identification of patterns and susceptibility to specific types of accidents. Moreover, the impact of a company’s safety climate and organisational culture on the frequency and characteristics of near misses represents a pivotal area of investigation. The findings of this research indicate that effective safety management requires a holistic approach that integrates technology, risk management and safety culture, with the objective of reducing accidents and enhancing overall working conditions on construction sites.

7. Gaps and Future Research Directions, Limitations

• Given the diversity and variability of construction sites and the changing conditions and circumstances of work, it is essential to create homogeneous clusters of near misses and to analyse the phenomena within these clusters. The formation of such clusters may be contingent upon the direct causes of the events in question;
• Given the inherently dynamic nature of construction, it is essential to analyse time series of events that indicate trends in development and safety levels. The numerical characteristics of these trends may be used to construct predictive models for future accidents and near misses;
• The authors have identified potential avenues for future research, which could involve the development of mathematical models using techniques such as linear regression, artificial intelligence, and machine learning. The objective of these models is to predict the probable timing of occupational accidents within defined incident categories, utilising data from near misses. Moreover, efforts are being made to gain access to the hazardous incident recording systems of different construction companies, with a view to facilitating comparison of the resulting data;
• One significant limitation of near-miss research is the lack of an integrated database that encompasses a diverse range of construction sites and construction work. A data resource of this nature would be of immense value for the purpose of conducting comprehensive analyses and formulating effective risk management strategies. This issue can be attributed to two factors: firstly, the reluctance of company managers to share their databases with researchers specialising in risk assessment, and secondly, the reluctance of employees to report near-miss incidents. Such actions may result in adverse consequences for employees, including disciplinary action or negative perceptions from managers. This consequently results in the recording of only a subset of incidents, thereby distorting the true picture of safety on the site.

Author Contributions

Institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Woźniak, Z.; Hoła, B. Analysing Near-Miss Incidents in Construction: A Systematic Literature Review. Appl. Sci. 2024 , 14 , 7260. https://doi.org/10.3390/app14167260

Woźniak Z, Hoła B. Analysing Near-Miss Incidents in Construction: A Systematic Literature Review. Applied Sciences . 2024; 14(16):7260. https://doi.org/10.3390/app14167260

Woźniak, Zuzanna, and Bożena Hoła. 2024. "Analysing Near-Miss Incidents in Construction: A Systematic Literature Review" Applied Sciences 14, no. 16: 7260. https://doi.org/10.3390/app14167260

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Laser Therapy for the Treatment of Morphea: A Systematic Review of Literature

Affiliation.

• 1 Chair and Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland.
• PMID: 34362192
• PMCID: PMC8347526
• DOI: 10.3390/jcm10153409

Morphea, also known as localized scleroderma (LoS), comprises a set of autoimmune sclerotic skin diseases. It is characterized by inflammation and limited thickening and induration of the skin; however, in some cases, deeper tissues might also be involved. Although morphea is not considered a life-threatening disease, the apparent cosmetic disfigurement, functional or psychosocial impairment affects multiple fields of patients' quality of life. Therapy for LoS is often unsatisfactory with numerous treatments that have only limited effectiveness or considerable side effects. Due to the advances in the application of lasers and their possible beneficial effects, the aim of this study is to review the reported usage of laser in morphea. We present a systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, Web of Science, and Google Scholar databases. We identified a total of twenty relevant studies (MEDLINE n = 10, Cinahl n = 1, Central n = 0, Scopus n = 2, Web of Science n = 5, Google Scholar n = 2) using laser therapy for LoS. Eight studies were focused on the use of PDL, six on fractional lasers (CO 2 and Er:YAG), four on excimer, and two on either alexandrite or Nd:YAG.

Keywords: laser therapy; localized scleroderma; morphea.

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Conflict of interest statement

The authors declare no conflict of interest.

Literature search based on PRISMA…

Literature search based on PRISMA protocol. * Articles were excluded due to their…

The mode of action of…

The mode of action of fractional lasers [32,44,47].

The use of various types…

The use of various types of lasers according to clinical stage of LoS.

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