literature review vs systematic

Literature Review vs Systematic Review

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Definitions

It’s common to confuse systematic and literature reviews because both are used to provide a summary of the existent literature or research on a specific topic. Regardless of this commonality, both types of review vary significantly. The following table provides a detailed explanation as well as the differences between systematic and literature reviews. 

Kysh, Lynn (2013): Difference between a systematic review and a literature review. [figshare]. Available at:  http://dx.doi.org/10.6084/m9.figshare.766364

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Systematic Literature Review or Literature Review?

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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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With Elsevier’s Language Editing Plus services , you can relax with our complete language review of your systematic literature review or literature review, or any other type of manuscript or scientific presentation. Our editors are PhD or PhD candidates, who are native-English speakers. Language Editing Plus includes checking the logic and flow of your manuscript, reference checks, formatting in accordance to your chosen journal and even a custom cover letter. Our most comprehensive editing package, Language Editing Plus also includes any English-editing needs for up to 180 days.

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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, Scoping, and Other Literature Reviews: Overview

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What Is a Systematic Review?

Regular literature reviews are simply summaries of the literature on a particular topic. A systematic review, however, is a comprehensive literature review conducted to answer a specific research question. Authors of a systematic review aim to find, code, appraise, and synthesize all of the previous research on their question in an unbiased and well-documented manner. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) outline the minimum amount of information that needs to be reported at the conclusion of a systematic review project. 

Other types of what are known as "evidence syntheses," such as scoping, rapid, and integrative reviews, have varying methodologies. While systematic reviews originated with and continue to be a popular publication type in medicine and other health sciences fields, more and more researchers in other disciplines are choosing to conduct evidence syntheses. 

This guide will walk you through the major steps of a systematic review and point you to key resources including Covidence, a systematic review project management tool. For help with systematic reviews and other major literature review projects, please send us an email at  [email protected] .

Getting Help with Reviews

Organization such as the Institute of Medicine recommend that you consult a librarian when conducting a systematic review. Librarians at the University of Nevada, Reno can help you:

• Understand best practices for conducting systematic reviews and other evidence syntheses in your discipline
• Choose and formulate a research question
• Decide which review type (e.g., systematic, scoping, rapid, etc.) is the best fit for your project
• Determine what to include and where to register a systematic review protocol
• Select search terms and develop a search strategy
• Identify databases and platforms to search
• Find the full text of articles and other sources
• Become familiar with free citation management (e.g., EndNote, Zotero)
• Get access to you and help using Covidence, a systematic review project management tool

Doing a Systematic Review

• Plan - This is the project planning stage. You and your team will need to develop a good research question, determine the type of review you will conduct (systematic, scoping, rapid, etc.), and establish the inclusion and exclusion criteria (e.g., you're only going to look at studies that use a certain methodology). All of this information needs to be included in your protocol. You'll also need to ensure that the project is viable - has someone already done a systematic review on this topic? Do some searches and check the various protocol registries to find out. 
• Identify - Next, a comprehensive search of the literature is undertaken to ensure all studies that meet the predetermined criteria are identified. Each research question is different, so the number and types of databases you'll search - as well as other online publication venues - will vary. Some standards and guidelines specify that certain databases (e.g., MEDLINE, EMBASE) should be searched regardless. Your subject librarian can help you select appropriate databases to search and develop search strings for each of those databases.  
• Evaluate - In this step, retrieved articles are screened and sorted using the predetermined inclusion and exclusion criteria. The risk of bias for each included study is also assessed around this time. It's best if you import search results into a citation management tool (see below) to clean up the citations and remove any duplicates. You can then use a tool like Rayyan (see below) to screen the results. You should begin by screening titles and abstracts only, and then you'll examine the full text of any remaining articles. Each study should be reviewed by a minimum of two people on the project team. 
• Collect - Each included study is coded and the quantitative or qualitative data contained in these studies is then synthesized. You'll have to either find or develop a coding strategy or form that meets your needs. 
• Explain - The synthesized results are articulated and contextualized. What do the results mean? How have they answered your research question?
• Summarize - The final report provides a complete description of the methods and results in a clear, transparent fashion. 

Adapted from

Types of reviews, systematic review.

These types of studies employ a systematic method to analyze and synthesize the results of numerous studies. "Systematic" in this case means following a strict set of steps - as outlined by entities like PRISMA and the Institute of Medicine - so as to make the review more reproducible and less biased. Consistent, thorough documentation is also key. Reviews of this type are not meant to be conducted by an individual but rather a (small) team of researchers. Systematic reviews are widely used in the health sciences, often to find a generalized conclusion from multiple evidence-based studies. 

Meta-Analysis

A systematic method that uses statistics to analyze the data from numerous studies. The researchers combine the data from studies with similar data types and analyze them as a single, expanded dataset. Meta-analyses are a type of systematic review.

Scoping Review

A scoping review employs the systematic review methodology to explore a broader topic or question rather than a specific and answerable one, as is generally the case with a systematic review. Authors of these types of reviews seek to collect and categorize the existing literature so as to identify any gaps.

Rapid Review

Rapid reviews are systematic reviews conducted under a time constraint. Researchers make use of workarounds to complete the review quickly (e.g., only looking at English-language publications), which can lead to a less thorough and more biased review. 

Narrative Review

A traditional literature review that summarizes and synthesizes the findings of numerous original research articles. The purpose and scope of narrative literature reviews vary widely and do not follow a set protocol. Most literature reviews are narrative reviews. 

Umbrella Review

Umbrella reviews are, essentially, systematic reviews of systematic reviews. These compile evidence from multiple review studies into one usable document. 

Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal , vol. 26, no. 2, 2009, pp. 91-108. doi: 10.1111/j.1471-1842.2009.00848.x .

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The difference between a systematic review and a literature review

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Covidence takes a look at the difference between the two

Most of us are familiar with the terms systematic review and literature review. Both review types synthesise evidence and provide summary information. So what are the differences? What does systematic mean? And which approach is best 🤔 ?

‘ Systematic ‘ describes the review’s methods. It means that they are transparent, reproducible and defined before the search gets underway. That’s important because it helps to minimise the bias that would result from cherry-picking studies in a non-systematic way. 

This brings us to literature reviews. Literature reviews don’t usually apply the same rigour in their methods. That’s because, unlike systematic reviews, they don’t aim to produce an answer to a clinical question. Literature reviews can provide context or background information for a new piece of research. They can also stand alone as a general guide to what is already known about a particular topic. 

Interest in systematic reviews has grown in recent years and the frequency of ‘systematic reviews’ in Google books has overtaken ‘literature reviews’ (with all the usual Ngram Viewer warnings – it searches around 6% of all books, no journals). 

Let’s take a look at the two review types in more detail to highlight some key similarities and differences 👀.

🙋🏾‍♂️ What is a systematic review?

Systematic reviews ask a specific question about the effectiveness of a treatment and answer it by summarising evidence that meets a set of pre-specified criteria. 

The process starts with a research question and a protocol or research plan. A review team searches for studies to answer the question using a highly sensitive search strategy. The retrieved studies are then screened for eligibility using the inclusion and exclusion criteria (this is done by at least two people working independently). Next, the reviewers extract the relevant data and assess the quality of the included studies. Finally, the review team synthesises the extracted study data and presents the results. The process is shown in figure 2 .

The results of a systematic review can be presented in many ways and the choice will depend on factors such as the type of data. Some reviews use meta-analysis to produce a statistical summary of effect estimates. Other reviews use narrative synthesis to present a textual summary.

Covidence accelerates the screening, data extraction, and quality assessment stages of your systematic review. It provides simple workflows and easy collaboration with colleagues around the world.

When is it appropriate to do a systematic review?

If you have a clinical question about the effectiveness of a particular treatment or treatments, you could answer it by conducting a systematic review. Systematic reviews in clinical medicine often follow the PICO framework, which stands for:

👦 Population (or patients)

💊 Intervention

💊 Comparison

Here’s a typical example of a systematic review title that uses the PICO framework: Alarms [intervention] versus drug treatments [comparison] for the prevention of nocturnal enuresis [outcome] in children [population]

Key attributes

• Systematic reviews follow prespecified methods
• The methods are explicit and replicable
• The review team assesses the quality of the evidence and attempts to minimise bias
• Results and conclusions are based on the evidence

🙋🏻‍♀️ What is a literature review?

Literature reviews provide an overview of what is known about a particular topic. They evaluate the material, rather than simply restating it, but the methods used to do this are not usually prespecified and they are not described in detail in the review. The search might be comprehensive but it does not aim to be exhaustive. Literature reviews are also referred to as narrative reviews.

Literature reviews use a topical approach and often take the form of a discussion. Precision and replicability are not the focus, rather the author seeks to demonstrate their understanding and perhaps also present their work in the context of what has come before. Often, this sort of synthesis does not attempt to control for the author’s own bias. The results or conclusion of a literature review is likely to be presented using words rather than statistical methods.

When is it appropriate to do a literature review?

We’ve all written some form of literature review: they are a central part of academic research ✍🏾. Literature reviews often form the introduction to a piece of writing, to provide the context. They can also be used to identify gaps in the literature and the need to fill them with new research 📚.

• Literature reviews take a thematic approach
• They do not specify inclusion or exclusion criteria
• They do not answer a clinical question
• The conclusions might be influenced by the author’s own views

🙋🏽 Ok, but what is a systematic literature review?

A quick internet search retrieves a cool 200 million hits for ‘systematic literature review’. What strange hybrid is this 🤯🤯 ?

Systematic review methodology has its roots in evidence-based medicine but it quickly gained traction in other areas – the social sciences for example – where researchers recognise the value of being methodical and minimising bias. Systematic review methods are increasingly applied to the more traditional types of review, including literature reviews, hence the proliferation of terms like ‘systematic literature review’ and many more.

Beware of the labels 🚨. The terminology used to describe review types can vary by discipline and changes over time. To really understand how any review was done you will need to examine the methods critically and make your own assessment of the quality and reliability of each synthesis 🤓.

Review methods are evolving constantly as researchers find new ways to meet the challenge of synthesising the evidence. Systematic review methods have influenced many other review types, including the traditional literature review. 

Covidence is a web-based tool that saves you time at the screening, selection, data extraction and quality assessment stages of your systematic review. It supports easy collaboration across teams and provides a clear overview of task status.

Get a glimpse inside Covidence and how it works

Laura Mellor. Portsmouth, UK

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Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

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Systematic Review vs. Literature Review

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• 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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Literature Review Research

Literature review vs. systematic review.

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Resources for Systematic Reviews

• NIH Systematic Review Protocols and Protocol Registries Systematic review services and information from the National Institutes of Health.
• Purdue University Systematic Reviews LibGuide Purdue University has created this helpful online research guide on systematic reviews. Most content is available publicly but please note that some links are accessible only to Purdue students.

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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Module 1: Types of Reviews

Literature vs Systematic Reviews

Both literature and systematic reviews are aimed at assembling, critically evaluating and reviewing existing research on a central topic or research question. Some differences between them include the method for determining what research to include or exclude, the extent or scope of the review, and the duration of time required to complete the process. To help you determine which review is most appropriate, please see Table 1.1 below for a detailed explanation of each as well as the differences between each type of review.

Adapted from Kysh, Lynn (2013): Difference between a systematic review and a literature review. Figshare (Poster), https://doi.org/10.6084/m9.figshare.766364.v1 . Licensed under Creative Commons CC BY 4.0 /order and some words changed.

Note on Table 1.1.

There are two ways to present a literature review: it can be one section in an original study, or it can be a standalone full review. More examples are given in the section on Literature Reviews .

Clinical research is a branch of healthcare science that determines the safety and effectiveness (efficacy) of medications, devices, diagnostic products and treatment regimens intended for human use.

Advanced Research Skills: Conducting Literature and Systematic Reviews Copyright © 2021 by Kelly Dermody; Cecile Farnum; Daniel Jakubek; Jo-Anne Petropoulos; Jane Schmidt; and Reece Steinberg is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Detailed Comparison: Systematic Review vs Literature Review

Systematic review vs literature review. Discover the unique characteristics of each type of review and determine which suits your research needs.

Table of Contents

What Is Systematic Review?

How is a systematic review different from a literature review, related reading, what is literature review, systematic review vs literature review comparison, eliminating bias through comprehensive study, summarizing research for informed insights, systematic review components, literature review components, unriddle allows you to read faster and write better., when to use systematic review vs literature review, systematic review, literature review, what are the key characteristics of a systematic review vs literature review, read faster & write better with unriddle for free today, efficient literature review, seamless citation management, enhanced writing with unriddle's ai autocomplete suggestions, collaborative workspace: unriddle's platform for teamwork, streamlining literature reviews.

• Protocol development
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• Systematic Literature Review
• Literature Review Example
• Literature Review Outline Example
• How To Write A Literature Review
• Thematic Literature Review
• How To Write An Abstract For A Literature Review
• Literature Review Generator

• Pre-specified eligibility criteria
• Systematic search strategy
• Assessment of the validity of findings
• Interpretation and presentation of results
• Reference list
• Introduction
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What is the difference between a systematic review and a systematic literature review?

By Carol Hollier on 07-Jan-2020 12:42:03

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 .s h. AND meta-analysis.af. AND carbohydrate*.af.  

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

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Traditional reviews vs. systematic reviews

Posted on 3rd February 2016 by Weyinmi Demeyin

Millions of articles are published yearly (1) , making it difficult for clinicians to keep abreast of the literature. Reviews of literature are necessary in order to provide clinicians with accurate, up to date information to ensure appropriate management of their patients. Reviews usually involve summaries and synthesis of primary research findings on a particular topic of interest and can be grouped into 2 main categories; the ‘traditional’ review and the ‘systematic’ review with major differences between them.

Traditional reviews provide a broad overview of a research topic with no clear methodological approach (2) . Information is collected and interpreted unsystematically with subjective summaries of findings. Authors aim to describe and discuss the literature from a contextual or theoretical point of view. Although the reviews may be conducted by topic experts, due to preconceived ideas or conclusions, they could be subject to bias.

Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesising results of primary research studies using an explicit, methodological approach(3). They aim to summarise the best available evidence on a particular research topic.

The main differences between traditional reviews and systematic reviews are summarised below in terms of the following characteristics: Authors, Study protocol, Research question, Search strategy, Sources of literature, Selection criteria, Critical appraisal, Synthesis, Conclusions, Reproducibility, and Update.

Traditional reviews

• Authors: One or more authors usually experts in the topic of interest
• Study protocol: No study protocol
• Research question: Broad to specific question, hypothesis not stated
• Search strategy: No detailed search strategy, search is probably conducted using keywords
• Sources of literature: Not usually stated and non-exhaustive, usually well-known articles. Prone to publication bias
• Selection criteria: No specific selection criteria, usually subjective. Prone to selection bias
• Critical appraisal: Variable evaluation of study quality or method
• Synthesis: Often qualitative synthesis of evidence
• Conclusions: Sometimes evidence based but can be influenced by author’s personal belief
• Reproducibility: Findings cannot be reproduced independently as conclusions may be subjective
• Update: Cannot be continuously updated

Systematic reviews

• Authors: Two or more authors are involved in good quality systematic reviews, may comprise experts in the different stages of the review
• Study protocol: Written study protocol which includes details of the methods to be used
• Research question: Specific question which may have all or some of PICO components (Population, Intervention, Comparator, and Outcome). Hypothesis is stated
• Search strategy: Detailed and comprehensive search strategy is developed
• Sources of literature: List of databases, websites and other sources of included studies are listed. Both published and unpublished literature are considered
• Selection criteria: Specific inclusion and exclusion criteria
• Critical appraisal: Rigorous appraisal of study quality
• Synthesis: Narrative, quantitative or qualitative synthesis
• Conclusions: Conclusions drawn are evidence based
• Reproducibility: Accurate documentation of method means results can be reproduced
• Update: Systematic reviews can be periodically updated to include new evidence

Decisions and health policies about patient care should be evidence based in order to provide the best treatment for patients. Systematic reviews provide a means of systematically identifying and synthesising the evidence, making it easier for policy makers and practitioners to assess such relevant information and hopefully improve patient outcomes.

• Fletcher RH, Fletcher SW. Evidence-Based Approach to the Medical Literature. Journal of General Internal Medicine. 1997; 12(Suppl 2):S5-S14. doi:10.1046/j.1525-1497.12.s2.1.x. Available from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497222/
• Rother ET. Systematic literature review X narrative review. Acta paul. enferm. [Internet]. 2007 June [cited 2015 Dec 25]; 20(2): v-vi. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002007000200001&lng=en. http://dx.doi.org/10.1590/S0103-21002007000200001
• Khan KS, Ter Riet G, Glanville J, Sowden AJ, Kleijnen J. Undertaking systematic reviews of research on effectiveness: CRD’s guidance for carrying out or commissioning reviews. NHS Centre for Reviews and Dissemination; 2001.

Weyinmi Demeyin

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THE INFORMATION IS VERY MUCH VALUABLE, A LOT IS INDEED EXPECTED IN ORDER TO MASTER SYSTEMATIC REVIEW

Thank you very much for the information here. My question is : Is it possible for me to do a systematic review which is not directed toward patients but just a specific population? To be specific can I do a systematic review on the mental health needs of students?

Hi Rosemary, I wonder whether it would be useful for you to look at Module 1 of the Cochrane Interactive Learning modules. This is a free module, open to everyone (you will just need to register for a Cochrane account if you don’t already have one). This guides you through conducting a systematic review, with a section specifically around defining your research question, which I feel will help you in understanding your question further. Head to this link for more details: https://training.cochrane.org/interactivelearning

I wonder if you have had a search on the Cochrane Library as yet, to see what Cochrane systematic reviews already exist? There is one review, titled “Psychological interventions to foster resilience in healthcare students” which may be of interest: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013684/full You can run searches on the library by the population and intervention you are interested in.

I hope these help you start in your investigations. Best wishes. Emma.

La revisión sistemática vale si hay solo un autor?

HI Alex, so sorry for the delay in replying to you. Yes, that is a very good point. I have copied a paragraph from the Cochrane Handbook, here, which does say that for a Cochrane Review, you should have more than one author.

“Cochrane Reviews should be undertaken by more than one person. In putting together a team, authors should consider the need for clinical and methodological expertise for the review, as well as the perspectives of stakeholders. Cochrane author teams are encouraged to seek and incorporate the views of users, including consumers, clinicians and those from varying regions and settings to develop protocols and reviews. Author teams for reviews relevant to particular settings (e.g. neglected tropical diseases) should involve contributors experienced in those settings”.

Thank you for the discussion point, much appreciated.

Hello, I’d like to ask you a question: what’s the difference between systematic review and systematized review? In addition, if the screening process of the review was made by only one author, is still a systematic or is a systematized review? Thanks

Hi. This article from Grant & Booth is a really good one to look at explaining different types of reviews: https://onlinelibrary.wiley.com/doi/10.1111/j.1471-1842.2009.00848.x It includes Systematic Reviews and Systematized Reviews. In answer to your second question, have a look at this Chapter from the Cochrane handbook. It covers the question about ‘Who should do a systematic review’. https://training.cochrane.org/handbook/current/chapter-01

A really relevant part of this chapter is this: “Systematic reviews should be undertaken by a team. Indeed, Cochrane will not publish a review that is proposed to be undertaken by a single person. Working as a team not only spreads the effort, but ensures that tasks such as the selection of studies for eligibility, data extraction and rating the certainty of the evidence will be performed by at least two people independently, minimizing the likelihood of errors.”

I hope this helps with the question. Best wishes. Emma.

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Systematic Review Process: Types of Reviews

• Definitions of a Systematic Review

Types of Reviews

• Systematic Review Planning Process
• Resources Needed to Conduct a Review
• Reporting Guidelines
• Where to Search
• How to Search
• Screening and Study Selection
• Data Extraction
• Appraisal and Analysis
• Citation Management
• Additional Resources: Guides and Books
• Using Covidence for Your Systematic Review
• Librarian Collaboration

Narrative vs. Systematic Reviews

People often confuse systematic and literature (narrative) reviews. They both are used to provide a summary of the existing literature or research on a specific topic.

A narrative or traditional literature review is a comprehensive, critical, and objective analysis of the current knowledge on a topic. They are an essential part of the research process and help to establish a theoretical framework and focus or context for your research. A literature review will help you to identify patterns and trends in the literature so that you can identify gaps or inconsistencies in a body of knowledge. This should lead you to a sufficiently focused research question that justifies your research.

A systematic review is comprehensive and has minimal bias. It is based on a specific question and uses eligibility criteria and a pre-planned protocol. This type of study evaluates the quality of evidence. 

A systematic review can be either quantitative or qualitative:

• If quantitative, the review will include studies that have numerical data.
• If qualitative, the review derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants. It will include focus groups, interviews, observations and diaries.

Narrative reviews in comparison provide a perspective on topic (like a textbook chapter), may have no specified search strategy, might have significant bias issues, and may not evaluate quality of evidence.

This table provides a detailed comparison of systematic and literature (narrative) reviews.

Tools to Help You Choose a Review Type

There are other comprehensive literature reviews of similar methodology to the systematic review. These tools can help you determine which type of review you may want to conduct. 

• The Review Ready Reckoner - Assessment Tool (RRRsAT) is a chart created as an adaptation of Andrew Booth's article on review typology. The chart that describes the features of multiple review types listing characteristics that distinguish each type and including sample of each type of review.
• The What Review is Right for You tool asks five short questions to help you identify the most appropriate method for a review.

Use this chart  to determine the type of review you are interested in writing and to learn the differences in the stages and processes of various reviews compared to systematic reviews.

Source: Yale University

The type of review you conduct will depend on the purpose of the review, your question, your resources, expertise, and type of data.

Here are two suggested articles to consult if you want to know more about review types:

Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies.   Health information & libraries journal ,  26 (2), 91-108. This article defines 14 types of reviews. There is a helpful summary table on pp.94-95

Sutton A, Clowes M, Preston L, Booth A.  Meeting the review family: exploring review types and associated information retrieval requirements.   Health information & libraries journal . 2019;36(3):202–222. doi:10.1111/hir.12276

This Comparison table is derived from a guide which is licensed under Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license , and was originally included in a workbook by Amanda Wanner at Plymouth University for Systematic Reviews and Scoping Reviews. Stephanie Roth at Temple University remixed the original version. Many thanks and much appreciation to Amanda Wanner and Stephanie Roth for allowing me to create a derivative of their work.

Funaro, M., Nyhan, K., & Brackett, A. (n.d.).   What type of review could you write?  Yale Harvey Cushing/John Hay Whitney Medical Library.

• << Previous: Definitions of a Systematic Review
• Next: Systematic Review Planning Process >>
• Last Updated: Dec 27, 2023 12:48 PM
• URL: https://library.aah.org/guides/systematicreview

Systematic Reviews & Literature Reviews

Evidence synthesis: part 1.

This blog post is the first in a series exploring Evidence Synthesis . We’re going to start by looking at two types of evidence synthesis: literature reviews and systemic reviews . To help me with this topic I looked at a number of research guides from other institutions, e.g., Cornell University Libraries.

The Key Differences Between a Literature Review and a Systematic Review

Overall, while both literature reviews and systematic reviews involve reviewing existing research literature, systematic reviews adhere to more rigorous and transparent methods to minimize bias and provide robust evidence to inform decision-making in education and other fields. If you are interested in learning about other evidence synthesis this decision tree created by Cornell Libraries (Robinson, n.d.) is a nice visual introduction.

Along with exploring evidence synthesis I am also interested in generative A.I.   I want to be transparent about how I used A.I. to create the table above. I fed this prompt into ChatGPT:

“ List the differences between a literature review and a systemic review for a graduate student of education “

I wanted to see what it would produce. I reformatted the list into a table so that it would be easier to compare and contrast these two reviews much like the one created by Cornell University Libraries (Kibbee, 2024). I think ChatGPT did a pretty good job. I did have to do quite a bit of editing, and make sure that what was created matched what I already knew. There are things ChatGPT left out, for example time frames, and how many people are needed for a systemic review, but we can revisit that in a later post.

Kibbee, M. (2024, April 10). Libguides: A guide to evidence synthesis: Cornell University Library Evidence Synthesis Service. Cornell University Library. https://guides.library.cornell.edu/evidence-synthesis/intro

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• Published: 25 April 2024

Surgery is associated with better long-term outcomes than pharmacological treatment for obesity: a systematic review and meta-analysis

• Leonardo Zumerkorn Pipek 1 ,
• Walter Augusto Fabio Moraes 2 ,
• Rodrigo Massato Nobetani 2 ,
• Vitor Santos Cortez 2 ,
• Alberto Santos Condi 2 ,
• João Victor Taba 2 ,
• Rafaela Farias Vidigal Nascimento 3 ,
• Milena Oliveira Suzuki 2 ,
• Fernanda Sayuri do Nascimento 2 ,
• Vitoria Carneiro de Mattos 2 ,
• Leandro Ryuchi Iuamoto 4 ,
• Wu Tu Hsing 4 ,
• Luiz Augusto Carneiro-D’Albuquerque 5 ,
• Alberto Meyer 5 &
• Wellington Andraus 5  

Scientific Reports volume  14 , Article number:  9521 ( 2024 ) Cite this article

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• Endocrine system and metabolic diseases
• Gastrointestinal diseases

Obesity is a highly prevalent disease with numerous complications. Both intensive medical treatment with the use of pharmacological drugs and bariatric surgery are current options. The objective of this meta-analysis was to compare, in the long-term, intensive medical treatment and surgery based on twelve parameters related to weight loss, cardiovascular and endocrine changes. A review of the literature was conducted in accordance with the PRISMA guidelines (PROSPERO: CRD42021265637). The literature screening was done from inception to October 2023 through PubMed, EMBASE and Web of Science databases. We included randomized clinical trials that had separate groups for medical treatment and bariatric surgery as an intervention for obesity. The risk of bias was assessed through RoB2. A meta-analysis was performed with measures of heterogeneity and publication bias. Subgroup analysis for each surgery type was performed. Data is presented as forest-plots. Reviewers independently identified 6719 articles and 6 papers with a total 427 patients were included. All studies were randomized controlled trials, three had a follow up of 5 years and two had a follow up of 10 years. Both groups demonstrated statistical significance for most parameters studied. Surgery was superior for weight loss (− 22.05 kg [− 28.86; − 15.23), total cholesterol (− 0.88 [− 1.59; − 0.17]), triglycerides (− 0.70 [− 0.82; − 0.59]), HDL (0.12 [0.02; 0.23]), systolic pressure (− 4.49 [− 7.65; − 1.33]), diastolic pressure (− 2.28 [− 4.25; − 0.31]), Hb glycated (− 0.97 [− 1.31; − 0.62]), HOMA IR (− 2.94; [− 3.52; − 2.35]) and cardiovascular risk (− 0.08; [− 0.10; − 0.05]). Patient in the surgical treatment group had better long term outcomes when compared to the non-surgical group for most clinical parameters.

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Introduction.

Obesity has been a known condition for over 2000 years 1 but that has become much more prevalent in recent decades. Despite great efforts to prevent this disease, the prevalence in adults in the United States has increased in recent decades and reached 42.4% in 2018. The GBD Obesity Study 2 Collaborators 2015 showed that this increasing trend occurred in more than 70 countries and is highly expressive in adolescents.

The classification of obesity is defined by a body mass index (BMI) greater than 30 kg/m 2 . The psychological damage that many of these patients suffer in a society governed by aesthetic standards is just one of the most visible and immediate consequences of obesity. Mortality from cardiovascular causes and its relationship with BMI has already been widely studied 3 , showing that the risk increases progressively with the increase of the index. Similarly, obesity was associated with a higher incidence of cancer 4 , respiratory 5 and metabolic 6 diseases.

In this context, the importance of effective treatment of this condition is clear, reducing mortality and improving the quality of life of these patients. While some benefits are evident with a loss of just 5% 6 of their weight, many patients require a more expressive loss to reduce the risks associated with obesity.

There are several treatments available for weight loss. Lifestyle changes, low calorie diet and increasing physical activity are the mainstay treatment for all patients 7 , 8 . Specific weight loss diets and exercise programs have also been developed for this purpose, yielding varying results. Finally, pharmacological, and surgical treatment has gained more attention in recent years for selected patients in whom other measures were insufficient.

Several studies have demonstrated the effectiveness of bariatric surgery in the short and medium term for the treatment of obesity. More recent studies have also shown that new drugs developed for weight loss may be a viable option for the treatment of this disease 8 , 9 . Comparison of these new drugs with surgical treatment is scarce in the literature and aimed only at evaluating changes related to weight loss in a short period of time.

This systematic review evaluated the hypothesis whether surgical treatment is superior than non-surgical treatment for patients with obesity. We evaluated the long-term effect of these treatments on anthropometric measures (weight, waist circumference, BMI) and on obesity related pathologies (triglycerides, LDL, HDL, total cholesterol, cardiovascular risk, systolic and diastolic blood pressure, HOMA and glycated hemoglobin).

Materials and methods

This systematic review was carried out in accordance with the items of Preferred Reports for Systematic Reviews and Protocol Meta-Analysis (PRISMA-P) 10 and assessing the methodological quality of systematic reviews (AMSTAR-2) guidelines 11 . This study was registered by the Prospective Register of Systematic Reviews (PROSPERO, 258667) before the research was carried out.

Drafting of the research question was based on the PICO strategy 12 , considering: P (Patients with obesity with indication for bariatric surgery based on BMI); I (Bariatric Surgery); C (Pharmacological treatment); O (Long term morbidity/mortality—at least 5 years of follow up).

Eligibility criteria

Inclusion criteria.

Types of studies: Randomized clinical trials.

Types of participants: Patients eligible for bariatric surgery, according to the American Society for Metabolic and Bariatric Surgery (ASMBS).

Types of intervention: Bariatric surgery or medical treatment.

Exclusion criteria

Studies were excluded if they: (1) did not have one group for each type of intervention (surgery or pharmacologic treatment); (2) had a heterogeneous population; (3) did not use a standard assessment method for the entire duration of the study, or did not have pre-assessment; (4) were not related to the question in the review; (5) were in a language other than English, Portuguese or Spanish; (6) were incomplete, unpublished or inaccessible to the authors.

Types of variables/parameters analyzed

Data was collected and arranged in tables, including the authors name, date and country of publication, number of participants included in the final analysis, sex, age, and body mass index.

Literature revision

The survey was from inception to October 10, 2023, without language restrictions, in the Medline database (via PubMed), EMBASE and Web of Science.

Using the search tool, we selected MeSH terms from the most relevant publications to conduct a new search to obtain articles that could be included in this systematic review. In addition, a manual search of theses, meetings, references, study records and contact with experts in the field was carried out.

Search strategy

The same keywords were used in all databases, according to each database input format.

The search strategy was:

(Bariatric Surgery) AND ((nonsurgical) OR (Orlistat) OR (phentermine) OR (topiramate) OR (lorcaserin) OR (naltrexone) OR (bupropion) OR (liraglutide) OR (conservative) OR (conventional) OR (Anti-Obesity Agents) OR (Intensive medical)) AND (obesity) → 3024.

(Bariatric Surgery) AND ((nonsurgical) OR (conservative) OR (Anti-Obesity Agents) OR (Intensive medical)) AND (obesity) → 4732.

Web of Science:

(Bariatric Surgery) AND ((nonsurgical) OR (conservative) OR (Anti-Obesity Agents) OR (Intensive medical)) AND (obesity) → 1772.

Data extraction

The data for each study was extracted independently by two authors. Disagreements were resolved by consensus. If no consensus was reached, a third author was consulted. Data extraction was carried out using the Rayyan tool— https://rayyan.qcri.org/ 13 .

All studies were analyzed by their titles and abstracts, according to inclusion and exclusion criteria. If the eligibility criteria was met, the full text would be extracted. All studies eligible for qualitative analysis are described in the “Results” section.

Missing data was clarified by contacting the authors directly.

Data validation

The risk of bias for intervention-type studies was analyzed using the guidelines of the Cochrane Back Review Group (CBRG) 14 .

Statistical analysis

As several studies of sufficient quality were available, a meta-analysis was carried out with measures of heterogeneity and publication bias. The data was presented through forest-plots, according to their statistical relevance.

Characteristics of study participants are presented as means, minimum and maximum values for quantitative variables, and as frequencies and percentages for qualitative variables. The prevalence values and 95% confidence intervals was calculated using the Wilson method To assess the global heterogeneity between the studies, Cochran's Q test was calculated, as well as the I2 (percentage of variation). The results of the studies' association measures and their respective 95% confidence intervals are presented in forest-plots.

Statistical analysis were performed using the Stata/MP 14.0 software for Windows.

Study selection

The electronic search found 9528 results for the keywords used. After removing 2809 duplicates and screening through abstract, we considered 55 potentially eligible studies for full-text analysis. Of these, 49 did not respect the exclusion criteria. Only 6 studies were considered eligible for qualitative analysis and 6 articles were eligible for meta-analysis [Fig.  1 ].

PRISMA 2020 flow diagram for new systematic reviews.

Many studies were excluded due to lack of description for the intervention in the non-surgical group.

Study characteristics

The following articles were included in the systematic review and meta-analysis 15 , 16 , 17 , 18 , 19 , 20 . In total, there were 427 participants. All studies were RCT. Four had a follow up of five years 15 , 16 , 19 and two had a follow up of 10 years 17 , 18 . Of the six eligible studies, two were undertaken in the United States of America 15 , 16 , two in Italy 17 , 19 , one in Australia 18 , and one in Singapore 20 . Study characteristics and detailed demographics can be found in Tables 1 and 2 . All studies included a group treated exclusively with intensive medical treatment (IMT). The definition of IMT differed between them but were considered if the patients had frequent follow up visits and were instructed on health habits including exercise and diet, with or without the use of pharmacological treatment.

There were four modalities of surgery used for weight loss: Roux-en-Y Gastric Bypass (RYGB) 15 , 17 , 18 , 19 , 20 ; Biliopancreatic diversion (BPD) 17 , 19 ; Laparoscopic Sleeve Gastrectomy (LSG) 15 , 16 ; Laparoscopic Adjustable Gastric Band (LAGB) 18 . The subgroup analysis for outcomes separated studies in RYGB, LSG and other types of surgery. The non-surgical treatment for obesity included one or the combination of the following medications: Orlistat, Phentermine, Naltrexone, Bupropion, Liraglutide, Lorcaserin, Sibutramine.

Risk of bias

After reading the articles included in the systematic review, the following elements were analyzed to determine the level of evidence: study design and selection, detection, loss, reporting and information bias. The summary of the risk of bias analysis for each of the included articles is presented in Fig.  2

Risk of bias analysis.

All studies had a low risk of bias for most criteria. In three of the studies, assessors were aware of the intervention received by study participants or the information was not available 16 , 17 , 20 . Three other studies 15 , 18 , 19 had bias regarding deviations from intended interventions due to the fact that an appropriate analysis to estimate the effects of assignment to intervention was not performed 15 ; patients assigned to the control group crossed over to the intervention group, and no measures were reportedly taken to balance that deviation 19 ; there was a significant loss of follow-up for all groups 20 .

All six studies had data on weight loss after treatment. Mean difference values and their respective 95% confidence intervals (95% CI) were calculated. In Fig.  3 A, the forest plot is shown. All publications found that surgical procedures were more efficient for long term weight loss. The global MD value was − 22.1 kg (95% CI [− 28.9; − 15.2). The measure of heterogeneity I2 (Higgins heterogeneity measure) was 77.8%, a value considered as high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.01).The subgroup analysis showed that there was not a significant difference between the types of surgery ( p  = 0.30).

(A ) Weight outcomes; ( B ) Waist circumference outcomes; ( C ) BMI outcomes.

Waist circumference

Four studies had data on waist circumference 16 , 17 , 19 , 20 . In Fig.  3 B, the forest plot is shown. Patients treated with surgery had a mean difference of − 12.3 (95% CI [− 15.0; − 9.6]) compared to IMT. The measure of heterogeneity I2 (Higgins heterogeneity measure) was 0%, a value considered as low heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did not allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.99).

The subgroup analysis showed that there was not a significant difference between the types of surgery ( p  = 0.99).

Five studies had data on BMI 16 , 17 , 18 , 19 , 20 . In Fig.  3 C, the forest plot is shown. Patients treated with surgery had a mean difference of − 8.0 (95% CI [− 10.5; − 5.5]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 84%, a value considered high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.01).

The subgroup analysis showed that there was a significant difference between the types of surgery ( p  = 0.01). The group with LAGB and BPD surgery had the highest decrease in BMI, with a mean of − 10.0.

Triglycerides

Three studies had data on tryglycerides 17 , 19 , 20 . In Fig.  4 A, the forest plot is shown. Patients treated with surgery had a mean difference of − 0.7 (95% CI [− 0.8; − 0.6]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 50.4%, a value considered high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did not allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.08).

(A ) Triglycerides outcomes; ( B ) LDL outcomes; ( C ) HDL outcome; ( D ) Cholesterol outcomes.

The subgroup analysis showed that there was a significant difference between the types of surgery ( p  = 0.01), with a worse outcome for RYGB.

Four studies had data on LDL 16 , 17 , 19 , 20 . In Fig.  4 B, the forest plot is shown. Patients treated with surgery had a mean difference of − 0.5 (95% CI [− 1.0; 0.0]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 92.7%, a value considered high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.01).

The subgroup analysis showed that there was a significant difference between the types of surgery ( p  = 0.01). There was an increase of 0.5 in LDL for the LSG group. The group with LAGB and BPD surgery had the highest decrease in LDL, with a mean of − 1.3.

Four studies had data on HDL 16 , 17 , 19 , 20 . In Fig.  4 C, the forest plot is shown. Patients treated with surgery had a mean difference of 0.1 (95% CI [0.0; 0.2]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 90.5%, a value considered high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.01).

The subgroup analysis showed that there was a significant difference between the types of surgery ( p  = 0.01). The group with RYGB surgery had the highest significant increase in HDL, with a mean of 0.2.

Cholesterol

Three studies had data on cholesterol 17 , 19 , 20 . In Fig.  4 D, the forest plot is shown. Patients treated with surgery had a mean difference of − 0.9 (95% CI [− 1.6; − 0.2]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 94.8%, a value considered as high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.01).

The subgroup analysis showed that there was a significant difference between the types of surgery ( p  = 0.01). The group with LAGB and BPD surgery had the highest decrease in cholesterol, with a mean of − 1.7.

Cardiovascular risk

Two studies had data on cardiovascular risk 17 , 19 . In Fig.  5 A, the forest plot is shown. Patients treated with surgery had a mean difference of − 0.08 (95% CI [− 0.10; − 0.05]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 0%, a value considered as low heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did not allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.44).

(A ) Cardiovascular risk outcomes; ( B ) Systolic blood pressure outcomes; ( C ) Diastolic blood pressure outcomes; ( D ) HOMA outcomes; ( E ) Glycated Hemoglobin outcomes.

The subgroup analysis showed that there was no significant difference between the types of surgery ( p  = 0.36).

Systolic blood pressure

Four studies had data on systolic blood pressure 16 , 17 , 19 , 20 . In Fig.  5 B, the forest plot is shown. Patients treated with surgery had a mean difference of − 4.49 (95% CI [− 7.65; − 1.33]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 71%, a value considered as high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.01).

The subgroup analysis showed that there was not a significant difference between the types of surgery ( p  = 0.79).

Diastolic blood pressure

Four studies had data on diastolic blood pressure 16 , 17 , 19 , 20 . In Fig.  5 C, the forest plot is shown. Patients treated with surgery had a mean difference of − 2.28 (95% CI [− 4.25; − 0.31]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 60.5%, a value considered as high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.01).

The subgroup analysis showed that there was not a significant difference between the types of surgery ( p  = 0.66).

Three studies had data on HOMA 15 , 17 , 19 . In Fig.  5 D, the forest plot is shown. Patients treated with surgery had a mean difference of − 2.94 (95% CI [− 3.52; − 2.35]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 14%, a value considered as low heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did not allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.32).

The subgroup analysis showed that there was no significant difference between the types of surgery ( p  = 0.33).

Glycated Hemoglobin

Five studies had data on glycated haemoglobin 15 , 16 , 17 , 19 , 20 . In Fig.  5 E, the forest plot is shown. Patients treated with surgery had a mean difference of − 1.0(95% CI [− 1.3; − 0.6]) compared to IMT. The measure of heterogeneity I2 (Higgins’s heterogeneity measure) was 79.8%, a value considered as high heterogeneity. According to Cochran’s Q heterogeneity test, the sample evidence did allow us to reject the null hypothesis of non-heterogeneity ( p  = 0.01).

The subgroup analysis showed that there was no significant difference between the types of surgery ( p  = 0.98).

Obesity is defined as a BMI greater than or equal to 30 by the CDC and is currently among the most prevalent diseases in the world, in addition to being an important risk factor for many other diseases. It has high rates of morbidity and mortality 21 , 22 and, in this context, weight loss can bring countless positive impacts to the individual. Currently, there are several treatments for obesity, and we can divide them into non-surgical or surgical.

Non-surgical treatments include non-drug and drug treatments. Among the non-medicated, we can highlight the change in eating habits, regular physical exercise, and cognitive behavioral therapy 8 . Ideally, these measures should be implemented for all patients living with obesity, even for those who will undergo drug or surgical treatment. Recently, in addition to lifestyle change, neuromodulation with deep transcranial stimulation has also been studied and has shown effectiveness in weight loss reduction 23 .

A systematic review carried out in 2021, which analyzed 64 articles concluded that among the most effective non-surgical interventions are low-carbohydrate or low-fat diets and combined therapies. This study also showed that non-drug interventions, such as physical exercise, when used alone, are not very effective in reducing the weight of these patients Therefore, a combination of two or more therapies should be chosen 24 .

Pharmacological treatment must be chosen together with the patient. One or more drugs can be used, the main ones used being: Liraglutide, Semaglutide, Tirzepatide, Orlistat, Phentermine and Sibutramine 25 .

Liraglutide was recently approved for the treatment of obesity and is now one of the most widely used drugs. It acts as a GLP-1 receptor agonist 26 , 27 , 28 , enhancing its effects. This group of drugs is already known in the treatment of Type 2 Diabetes Mellitus, a condition that can often be associated with obesity 29 , 30 , since its pathophysiology involves increased insulin resistance. The main actions of this drug are: increased satiety due to a reduction in the speed of gastric emptying, increased insulin release and decreased glucagon release. Semaglutide is a drug with a similar mechanism of action who demonstrated not only a substantial weight loss 31 , but was also associated with a lower 10-year T2D risk in people with overweight or obesity after 2 years of follow up 32 . More recently, a new drug that combines GLP-1 and GIP receptor agonist, Tirzepatide, has shown even better results in the short term 33 .

Orlistat, in turn, reversibly inhibits the lipase enzyme 34 , which has the function of breaking down fat from food for its absorption, as well as inhibiting the absorption of ingested triglycerides. Thus, there is elimination of fat in the feces 35 . The main adverse effects are gastrointestinal symptoms, however this can be beneficial as it leads to a change in behavior, for example causing a lower consumption of foods rich in fat 36 .

Phentermine, an amphetamine analogue, can be used in conjunction with topiramate for the treatment of obesity. The mechanism of action of the drugs is not yet known, however, significant weight loss has already been observed, in addition to a reduction in the consumption of hypercaloric foods and a decrease in the speed of gastric emptying with the use of this combination of drugs 37 , 38 .

Sibutramine, widely used in the 1990s, acts to inhibit the reuptake of serotonin, norepinephrine, and dopamine 34 . Serotonin, in turn, activates POMC system neurons and inhibits NPY neurons, thereby promoting reduced appetite and increased satiety. Despite generating weight reduction 39 , some data show increased cardiovascular risk 40 , and therefore, it is no longer used as a first-line drug.

Among the possible surgeries, the most performed today are: Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic diversion (BPD), Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Adjustable Gastric Band (LAGB). According to the NIH and the American Bariatric Society 41 , 42 , some indications for performing bariatric surgery are adults with BMI greater than or equal to 40 and adults with BMI greater than 35 accompanied by some comorbidity such as type 2 diabetes mellitus, obstructive sleep apnea or hypertension.

RYGB is one of the best-known procedures and its complications vary according to the surgical technique used. Some complications include gastric distention, ulcers, cholelithiasis, hernias, dumping syndrome, and hyperammonaemia encephalopathy.

BPD presents long-term nutritional complications, such as anemia, bone diseases and fat-soluble vitamin deficiency. This technique has high mortality rates, mainly due to the complexity of the technique.

Among the procedures described, LSG is the one with the fewest complications, being described in the literature bleeding or stenosis of the stoma. An alternative technique using endoscopy for sleeve gastroplasty has shown to be safe and efficient for weight loss after 104 weeks, with important improvements in metabolic comorbidities 43 .

The procedure with the lowest mortality rate is the LAGB 44 . Despite this, it can present complications such as obstruction, band erosion, band slippage and gastric prolapse, esophagitis, hernia, in addition to having a high rate of reoperation, reaching 50% of patients who underwent this surgery 45 .

In this article, we compare data on weight loss through intensive drug treatment, which includes changes in eating habits, physical exercise, and medications, and through surgical treatment. Both treatments showed that weight loss caused an improvement in the lipid panel, with a reduction in total cholesterol, triglycerides and LDL, an increase in HDL, improvement in systolic and diastolic blood pressure, decrease in glycated hemoglobin and insulin resistance (accessed through HOMA), in addition to reducing the risk for cardiovascular diseases.

Our systematic review confirmed the findings of individual studies that bariatric surgery has a greater potential for weight reduction, BMI and waist circumference, as already described in individual articles and widely in the literature. It should be noted that even in the long term, this difference remained. Similarly, a 2014 Cochrane systematic review 46 comparing RCT with more than 1 year of follow-up showed that all 7 articles included demonstrated an advantage of the surgical group. An article 47 on the use of pharmacological treatment for obesity showed that even recent drugs approved, including GLP 1 agonists, are not able to reduce weight to levels similar to those of bariatric surgery to date, despite the emergence of new drugs still in initial phase 48 . It is worth mentioning that in these studies the comparison time is relatively short (12 months) and that we do not have data on the long-term impact. Thus, in relation to long term weight loss, bariatric surgery is still the best option.

Most articles were not able to individually demonstrate that surgical treatment is superior to non-surgical in terms of pressure reduction. However, the result of the meta-analysis showed a superiority of the surgical group in relation to both systolic and diastolic pressure, more pronounced in the BPD group. Wang 49 performed a systematic review focused on the impact on pressure and demonstrated that there was a reduction in systolic and diastolic values, but the subgroup analysis showed that this occurs only in the RYGB groups for systolic pressure. Similarly, Schiavon also demonstrated a significant reduction in the need of blood pressure medication after 3 years in the RYGB group when compared intensive medical treatment for obesity 50 . This difference found in only one subtype of surgery seems to be just a reflection of the sample size, which can be interpreted that surgical treatment in general tends to reduce pressure to a greater extent than non-surgical treatment. The fact that different types of surgery are significant may reflect the studies selected in our meta-analysis, which have longer follow-ups.

In relation to both HOMA-IR and glycated Hb, there was a more significant improvement in the group that underwent surgery. The way in which the data on diabetes remission was reported in the articles did not allow a meta-analysis to be carried out with these data and, therefore, it was not included. However, individual data from the Mingrone 2015, Mingrone 2021 and Schauer articles showed that the surgery group had better results. A network meta-analysis from 2021 51 comparing the different types of metabolic surgery for the treatment of obesity and diabetes showed that RYGB was 20% more likely to result in remission of type 2 diabetes compared to SG. There was no significant difference between the other groups. Moreover, the effects of bariatric surgery on diabetes is not exclusive for patients with obesity, as shown by a study with patients with a BMI of 27–32 kg/m 2 that had a better glycemic control when treated with RYGB 20 . Regarding the lipid profile, Schauer's study was not able to demonstrate superiority in relation to LDL and HDL parameters. However, by combining the data from Mingrone's articles, it is possible to demonstrate that surgical treatment is superior. Regarding cholesterol reduction, Mingrone's studies showed that although RYGB and BDP were better in relation to non-surgical treatment, the BDP technique had a statistically greater reduction in relation to RYGB. This can be explained by the greater intestinal exclusion in BDP and, therefore, having a greater impact on lipid absorption. Despite Sayeed's study 52 et al. was not included in this meta-analysis due to the inadequate way of separating the groups for analysis, the results regarding the lipid profile showed that the group that received both interventions was superior to the exclusive non-surgical treatment. It is important to point out that despite a statistically significant difference between the groups, the effect size of this difference is probably not clinically significant.

The choice of treatment for obesity can also have an impact on several other patient comorbidities. Hossain et al. 53 performed a systematic review with 26 studies that showed that bariatric surgery appears to be more effective in the treatment of asthma. Similarly, a study by Crawford et al. 15 showed that there is a greater increase in bone turnover in groups undergoing bariatric surgery in relation to pharmacological treatment. Other than that, bariatric surgery is also demonstrated to be superior in the treatment of other obesity related pathologies, such as Non-Alcoholic Steatohepatitis (NASH), and in the treatment of obesity in adolescents 54 , 55 .

The effect of major cardiovascular adverse events (MACE) and mortality 56 have also been promising for bariatric surgery. A recent cohort comparing bariatric surgery in patients with obesity and use of GLP1-agonists inpatients with diabetes showed a lower risk of MACE in the surgical group 57 . The surgical treatment has also shown superiority when compared to medical treatment regarding the prevention of diabetic kidney disease in 5 years for patients with diabetes and obesity 58 . Boyers et al. evaluated the cost-effectiveness of surgical and pharmacological treatment in the treatment of obesity and found that RYGB should be the treatment of choice only if the optimization of health system costs is considered 59 .

Another important consideration is the fact that pharmacological and surgical treatment for obesity are not mutually exclusive. Most clinicians choose to combine both treatment modalities in practice to improve results. Weight gain after bariatric surgery is a known possibility, and for those patients, two-thirds of the weight regain can be safely lost with GLP1 agonist, providing clinicians with a therapeutic option for this clinical challenge.

Methodologies and limitations of the studies

Despite the large number of articles in the literature on the treatment of obesity, there are few RCTs comparing non-surgical and surgical treatment, and most of them only follow up in the short term. In addition, many articles do not adequately describe the strategy used in non-surgical treatment. This lack of data and standardization in this type of treatment can lead to bias and possibly the formation of extremely heterogeneous groups for analysis.

Most of the studies included in our systematic review have diabetes as an inclusion criteria. In this circumstance, our findings may not be generalized to patients with obesity without diabetes.

Another important limitation of our systematic review refers to pharmacological treatment in the non-surgical group. The use of GLP 1 agonists has great potential in the treatment of obesity, but they have only started to be used recently. As the purpose of our article is to assess the long-term impact, there are still few articles available that used this drug. The use of the most recent medications, such as Tirzepatide, could not be evaluated in our study, once there are no RCTs in the literature presenting its long-term effects. Those drugs proved to be very efficient and might have similar effect in the long term. Future systematic reviews may reveal a different results when including the new generation of weight loss medication.

Finally, choosing the most appropriate treatment often involves individual characteristics of each patient, and the impact on quality of life can be extremely subjective and difficult to assess.

Obesity is a disease that increases the morbidity and mortality of patients, contributing to several secondary diseases. This systematic review evaluated the impact on the main variables related to obesity in the long term. The findings indicated that both treatment modalities are efficacious in managing obesity; however, the surgical group demonstrated superior outcomes in comparison to the non-surgical group across most variables. Nonetheless, the advent of novel pharmacological treatments has shown promising potential. Further studies focusing on the long-term impacts of these new drug treatments should be undertaken to allow for a comprehensive comparison with non-surgical treatment methods.

Data availability

Data is provided within the manuscript or supplementary information files.

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Acknowledgements

The authors are thankful to Justin Axel-Berg for the English corrections and Rossana V. Mendoza López for the statistical analysis.

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Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil

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Leandro Ryuchi Iuamoto & Wu Tu Hsing

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Luiz Augusto Carneiro-D’Albuquerque, Alberto Meyer & Wellington Andraus

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Conceptualization: L.Z.P., A.M. Methodology: L.Z.P., L.R.I., A.M. Formal analysis: L.Z.P., R.F.V.N., A.M. Data Curation: L.Z.P., W.A.F.B., R.M.N., V.S.C., A.S.C., J.V.T., R.F.V.N., M.O.S., F.S.N., V.C.M. Writing—Original Draft: L.Z.P., W.A.F.B., R.M.N., V.S.C., A.S.C., J.V.T., R.F.V.N., M.O.S., F.S.N., V.C.M. Writing—Review and Editing: L.Z.P., R.F.V.N., L.R.I., W.T.H., L.A.C., A.M., W.A. Visualization: L.Z.P., R.F.V.N., A.M. Supervision: L.R.I., W.T.H., L.A.C., A.M., W.A. Project administration: L.R.I., W.T.H., L.A.C., A.M., W.A.

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Personal data filtering: a systematic literature review comparing the effectiveness of XSS attacks in web applications vs cookie stealing

• Published: 18 April 2024

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Cross-site scripting (XSS) attacks pose a significant threat to the security of web applications, as they compromise personal information by stealing cookies. This study investigates the relationship between XSS attacks targeting websites versus XSS attacks aimed at stealing cookies to leak personal information. A systematic literature review has been conducted, analyzing 96 scientific articles from 2018 to 2023. Three complementary research questions have been proposed to address trends in methods and tools to detect vulnerabilities or mitigate XSS attacks, techniques to steal cookies, and leakage of personal data through cookie theft. Rayyan Intelligent Systematic Literature, Atlas.ti, and Research Rabbit tool supported our analysis, using sources such as IEEE Digital Xplore, ACM Digital Library, Springer Link, Web of Science, and Mendeley. The snowballing technique was applied using the Research Rabbit tool to find related articles, avoid inconsistent parameters and publications, and reduce the risk of bias. The ratio between XSS attacks on websites and cookie theft through XSS attacks is 5:1. It is crucial to persist in studying and introducing novel methods or tools to address this problem and provide better protection against cookie hijacking through XSS attacks. The research gap lies in understanding how our personal information is filtered by the theft of cookies through XSS attacks. More research is needed to fill this gap and to develop novel techniques or tools that teach the end user how their personal information is leaked by stealing cookies using XSS attacks.

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Secsix: security engine for csrf, sql injection and xss attacks.

DataCookie: Sorting Cookies Using Data Mining for Prevention of Cross-Site Scripting (XSS)

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Jenny Torres contributed equally to this work.

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Facultad de Ingeniería de Sistemas, Escuela Politécnica Nacional, Ladrón de Guevara E11-253, Quito, Ecuador

Germán Rodríguez-Galán & Jenny Torres

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G.R wrote the first version of the article, applied the snowballing technique to refine the search and inclusion of new articles, systematically analyzed each article, and obtained the results according to the proposed methodology. G.R created all the images and tables of the document J.T modified and updated the properties of all the graphs and tables to have a more scientific format. J.T modified the tables with the information of each article analyzed, contributed with the analysis of new variables included in the methodology. J.T reviewed the grammatical part and modified the first version of the article to obtain the second version formatted according to the journal’s requirements. All the authors prepared the figures and tables and improved the preliminary versions for a better visualization of the collected data.

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Rodríguez-Galán, G., Torres, J. Personal data filtering: a systematic literature review comparing the effectiveness of XSS attacks in web applications vs cookie stealing. Ann. Telecommun. (2024). https://doi.org/10.1007/s12243-024-01022-8

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ADHD Diagnosis and Treatment in Children and Adolescents

Comparative Effectiveness Review, No. 267

Investigators: Bradley S. Peterson , M.D., Joey Trampush , Ph.D., Margaret Maglione , M.P.P., Maria Bolshakova , B.S., Ph.D., Morah Brown , M.P.H., Mary Rozelle , P.A., Aneesa Motala , B.A., Sachi Yagyu , M.L.S., Jeremy Miles , Ph.D., Sheila Pakdaman , Ph.D., Mario Gastelum , M.P.H., Bich Thuy (Becky) Nguyen , M.P.H., Erin Tokutomi , M.P.H., Esther Lee , M.P.H. candidate, Jerusalem Z. Belay , M.P.H., Coleman Schaefer , M.P.H., Benjamin Coughlin , M.P.H., Karin Celosse , Psy.D, M.S.C.P., M.P.H., Sreya Molakalapalli , M.P.H., Brittany Shaw , M.P.H. candidate, Tanzina Sazmin , M.P.H., M.B.B.S., Anne N. Onyekwuluje , M.D., M.P.H., Danica Tolentino , M.S., and Susanne Hempel , Ph.D.

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The systematic review assessed evidence on the diagnosis, treatment, and monitoring of attention deficit hyperactivity disorder ( ADHD ) in children and adolescents to inform a planned update of the American Academy of Pediatrics ( AAP ) guidelines.

Data sources:

We searched PubMed ® , Embase ® , PsycINFO ® , ERIC, clinicaltrials.gov , and prior reviews for primary studies published since 1980. The report includes studies published to June 15, 2023.

Review methods:

The review followed a detailed protocol and was supported by a Technical Expert Panel. Citation screening was facilitated by machine learning; two independent reviewers screened full text citations for eligibility. We abstracted data using software designed for systematic reviews. Risk of bias assessments focused on key sources of bias for diagnostic and intervention studies. We conducted strength of evidence ( SoE ) and applicability assessments for key outcomes. The protocol for the review has been registered in PROSPERO (CRD42022312656).

Searches identified 23,139 citations, and 7,534 were obtained as full text. We included 550 studies reported in 1,097 publications (231 studies addressed diagnosis, 312 studies addressed treatment, and 10 studies addressed monitoring). Diagnostic studies reported on the diagnostic performance of numerous parental ratings, teacher rating scales, teen/child self-reports, clinician tools, neuropsychological tests, EEG approaches, imaging, and biomarkers. Multiple approaches showed promising diagnostic performance (e.g., using parental rating scales), although estimates of performance varied considerably across studies and the SoE was generally low. Few studies reported estimates for children under the age of 7. Treatment studies evaluated combined pharmacological and behavior approaches, medication approved by the Food and Drug Administration, other pharmacologic treatment, psychological/behavioral approaches, cognitive training, neurofeedback, neurostimulation, physical exercise, nutrition and supplements, integrative medicine, parent support, school interventions, and provider or model-of-care interventions. Medication treatment was associated with improved broadband scale scores and ADHD symptoms (high SoE) as well as function (moderate SoE), but also appetite suppression and adverse events (high SoE). Psychosocial interventions also showed improvement in ADHD symptoms based on moderate SoE. Few studies have evaluated combinations of pharmacological and youth-directed psychosocial interventions, and we did not find combinations that were systematically superior to monotherapy (low SoE). Published monitoring approaches for ADHD were limited and the SoE is insufficient.

Conclusion:

Many diagnostic tools are available to aid the diagnosis of ADHD , but few monitoring strategies have been studied. Medication therapies remain important treatment options, although with a risk of side effects, as the evidence base for psychosocial therapies strengthens and other nondrug treatment approaches emerge.

• Collapse All
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Main Points
• Background and Purpose
• Strengths and Limitations
• Implications and Conclusions
• 1.1. Background
• 1.2. Purpose and Scope of the Systematic Review
• 2.1. Review Approach
• 2.2. Study Selection
• 2.3. Data Extraction
• 2.4. Risk of Bias Assessment
• 2.5. Data Synthesis and Analysis
• 2.6. Grading the Body of Evidence
• 2.7. Peer Review and Public Commentary
• 3. Results: Description of Included Evidence
• 4.1. KQ1, ADHD Diagnosis Key Points
• 4.2. KQ1, ADHD Diagnosis Summary of Findings
• 4.3. Summary ADHD Diagnosis by Tests for All Age Groups
• 4.4. KQ1a. What is the comparative diagnostic accuracy of approaches that can be used in the primary care practice setting or by specialists to diagnose ADHD among individuals younger than 7 years of age?
• 4.5. KQ1b. What is the comparative diagnostic accuracy of EEG, imaging, or approaches assessing executive function that can be used in the primary care practice setting or by specialists to diagnose ADHD among individuals aged 7 through 17?
• 4.6. KQ1c. For both populations, how does the comparative diagnostic accuracy of these approaches vary by clinical setting, including primary care or specialty clinic, or patient subgroup, including age, sex, or other risk factors associated with ADHD?
• 4.7. KQ1d. What are the adverse effects associated with being labeled correctly or incorrectly as having ADHD?
• 4.8. Summary of Findings. KQ1a–d
• 5.1. KQ2, ADHD Treatment Key Points
• 5.2. KQ2, ADHD Treatment Results
• 5.3. Effects by Intervention
• 5.4. KQ2a. How do these outcomes vary by presentation (inattentive, hyperactive/impulsive, and combined) or other co-occurring conditions?
• 5.6. KQ2b. What is the risk of diversion of pharmacologic treatment?
• 5.7. Summary of Findings KQ2a and KQ2b
• 6.1. Key Question (KQ) 3 ADHD Monitoring Key Points
• 6.2. KQ 3 ADHD Monitoring Summary of Findings
• Findings in Relation to the Decisional Dilemma(s)
• Findings in Relation to Existing Research Syntheses and Practice Guidelines
• Implications
• Applicability
• Abbreviations and Acronyms
• Appendix A. Methods
• Appendix B. List of Excluded and Background Studies
• Appendix C. Evidence Tables
• Appendix D. Critical Appraisal and Applicability Tables
• Appendix E. List of Included Studies
• Appendix F. Expert Guidance and Review
• Appendix G. PCORI Checklist

Suggested citation:

Peterson BS, Trampush J, Maglione M, Bolshakova M, Brown M, Rozelle M, Motala A, Yagyu S, Miles J, Pakdaman S, Gastelum M, Nguyen BT, Tokutomi E, Lee E, Belay JZ, Schaefer C, Coughlin B, Celosse K, Molakalapalli S, Shaw B, Sazmin T, Onyekwuluje AN, Tolentino D, Hempel S. ADHD Diagnosis and Treatment in Children and Adolescents. Comparative Effectiveness Review No. 267. (Prepared by the Southern California Evidence-based Practice Center under Contract No. 75Q80120D00009.) AHRQ Publication No. 24-EHC003. PCORI Publication No. 2023-SR-03. Rockville, MD: Agency for Healthcare Research and Quality; March 2024. DOI: https://doi.org/ 10.23970/AHRQEPCCER267 . Posted final reports are located on the Effective Health Care Program search page .

This report is based on research conducted by the Southern California Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00009). The Patient-Centered Outcomes Research Institute ® (PCORI ® ) funded the report (PCORI ® Publication No. 2023-SR-03). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ or PCORI ® , its Board of Governors or Methodology Committee. Therefore, no statement in this report should be construed as an official position of PCORI ® , AHRQ, or the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. Most AHRQ documents are publicly available to use for noncommercial purposes (research, clinical or patient education, quality improvement projects) in the United States, and do not need specific permission to be reprinted and used unless they contain material that is copyrighted by others. Specific written permission is needed for commercial use (reprinting for sale, incorporation into software, incorporation into for-profit training courses) or for use outside of the U.S. If organizational policies require permission to adapt or use these materials, AHRQ will provide such permission in writing.

PCORI ® , AHRQ, or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.

AHRQ and PCORI ® appreciate appropriate acknowledgment and citation of their work. Suggested language for acknowledgment: This work was based on an evidence report, ADHD Diagnosis and Treatment in Children and Adolescents, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ) and funded by PCORI ® .

• Cite this Page Peterson BS, Trampush J, Maglione M, et al. ADHD Diagnosis and Treatment in Children and Adolescents [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Mar. (Comparative Effectiveness Review, No. 267.) doi: 10.23970/AHRQEPCCER267
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