Write an evidence-based clinical literature review – Pubrica
                     How do you Write 
an  Evidence-
Based  Cl inical 
L i terature  
Review?
An Academic presentation by
Dr. Nancy Agnes, Head, Technical Operations, Pubrica 
 Group: www.pubrica.com
Email: [email protected]
02
TODAY'S 
DIInS briCef USSION
Introduction  
Topic 
Selection
Searching 
the Literature
Patient-Oriented vs Disease-Oriented 
Evidence  Levels of Evidence
Format of the 
Review  
Conclusion
About Pubrica
IN 
BRIEF
Systematic reviews and meta-analyses are not the 
same  as traditional clinical review papers, usually 
known as  updates. Updates evaluate the medical 
literature selectively  while covering a broad topic for 
Physician Writing.
Nonquantitative systematic reviews analyze the 
medical  literature in depth, attempting to find and 
synthesize all  relevant data to establish the optimal 
diagnostic or  treatment strategy.
Meta-analyses (systematic quantitative reviews) 
utilize  sophisticated statistical analysis of pooled 
research papers  to address a specific clinical 
question. The guidelines for  authoring an evidence-
based clinical review article for  physicians are 
presented in this article.
INTRODUC
TTIhOe mNost acceptable clinical review articles base their 
discussions  on current systematic reviews and meta-analy
ses, and they include  all relevant research results on how 
to treat a specific condition.
These evidence-based updates give readers concise 
summaries  as well as solid therapeutic advice.
Criteria for producing an evidence-based clinical review 
article,  particularly one intended for continuing medical 
education (CME)  and include CME objectives in its 
structure.
The article's bias, a lack of adequate supporting evidence, 
or other  considerations to conduct a study of the 
Literature review  methodologies and, when possible, 
assign a score to essential  pieces of evidence. This 
method helps to accentuate the article's  main themes.

TOPIC 
SEChLooEseCaTpIrOevaNlent clinical avoi
condition and  themes that are d  
presentartaiornes oorr thatu nacreo mmeroenly interestinilgln feosr 
the  sake of curiosity. s
Choose common issues for which there is new  
knowledge on diagnosis or therapy wherever  
possible.
Recent data indicating spironolactone 
medication  increases survival in patients with 
severe congestive  heart failure, for example, 
might drive a clinical  practice change if it is 
valid.
Contd...
Similarly, new evidence indicating that a narrative literature review of  
conventional treatment is no longer effective and may even be 
hazardous should  be reported.
Patching most acute corneal abrasions, for example, may exacerbate 
symptoms  and delay healing.
SEARCHING THE 
LITERATURE
Look for relevant
recommendations on the
condition  being discussed's diagnosis, 
treatment, or prevention.
Includeany high-quality suggestions
Look fotrhatareprimary reClalinteicda  ltoL tihteer aistusruee.
all  review
tshuegrgaepsyt iionn tshceo nincietiranli ndgraduiagghnt.osis and,
especially,
Attempt to ensurethat all
suggestions are based on  the 
most up-to-date evidence.
PATIENT-ORIENTED 
VS
DISEASE-ORIENTED 
Patient-Oriented Evidence that Matters (POEM) is  
EVconIcDerneEd NwitCh pEatient-relevant outcomes such as 
changes  in morbidity, mortality, or quality of life.
POEM-type evidence differs from disease-oriented  
evidence (DOE), which Systematic literature review  
focuses on surrogate endpoints such as test results 
or other  response indicators.
Indicate that foremost clinical advice lacks the 
backing of  outcomes evidence when DOE is the 
only guideline  provided.
LEVELS OF 
EVIDENCE
The quality of the evidence supporting the essential 
clinical  recommendations on diagnosis and therapy is 
critical information  for readers. In the medical literature, 
several different grading  systems of varying complexity 
and clinical usefulness are  reported.
Takes all significant outcomes Comprehensive search 
tactics  were used to conduct a high-quality meta-
analysis (systematic  quantitative review).
A comprehensive nonquantitative review with effective  
search tactics and well-supported findings.
Contd...
Awell-designed,nonrandomizedclinicalstudyisconsideredLevelB(other  
evidence).
Lower-quality RCTs, clinicalcohortstudies
,andcase-controlledstudieswith  non-biased participant selection 
and consistent findings are included.
Other data, such as well-designed epidemiologic studies with 
compelling findings  or high-quality, historical, uncontrolled 
investigations, is also included.
Level C (consensus/expert opinion): Expert opinion or consensus 
position.
FORMAT OF THE 
REVIEW
INTRODUCTION
The review's topic and objective should be 
defined in  the introduction and its relevance to 
family practice.
The natural way of achieving this is to talk about 
the  disease's epidemiology, which includes how 
many  individuals have it at any particular 
moment  (prevalence) and what percentage of 
the population is  projected to get it over time 
(incidence).
Contd...
A more exciting approach to accomplish this is
to show how many times a  regular family physician meet 
this problem in a week, month, year, or career.
Emphasize and summarise the review's primary CME objectives in a 
separate  table labelled "CME Objectives."
Contd...
METHODS
The methodology section should briefly describe how the 
literature  search was carried out and the primary evidence 
sources.
Indicate which studies were included or excluded based on 
predefined  criteria (e.g., studies had to be independently 
rated as high quality by  an established evaluation process, 
such as the Cochrane  Collaboration).
Make a thorough effort to locate all significant relevant 
research.
Avoid using solely the material that supports your findings as a 
 reference. If an issue is controversial, discuss the entire extent 
of the  argument.
Contd...
DISCUSSIONS
After then, the discussion might take on the 
shape of  a clinical review article.
It should cover aetiology, clinical presentation 
(signs  and symptoms), pathophysiology, 
diagnostic  evaluation (history, physical 
examination, diagnostic  imaging, laboratory 
evaluation, and), differential  diagnosis, 
treatment (goals, medical/surgical therapy,  
laboratory testing, patient education, and 
follow-up),  prognosis, prevention, and future 
directions).
Contd...
REFERENCES
The references should contain the most current 
and  essential sources of support (i.e., studies 
referred to,  controversial material, new 
information, specific  quantitative data, and 
information that would not  usually be found in 
most general reference textbooks).
These usually are significant evidence-based  
recommendations, meta-analyses, or Systematic  
literature reviews, 
seminal studies. While other journals  publish 
lengthy lists of reference citations, AFP prefers  
to provide a concise list of relevant references.
Contd...
CONCLUS
ION
Evidence-based evaluations may help select how 
to  deploy health-care services, particularly 
preventative  programmes, in some instances.
Some high-quality cost-effectiveness studies were 
 appropriate to assist understand the costs and 
health  benefits of various strategies for 
achieving a particular  health result.
In the discussion, highlight significant aspects  
concerning diagnosis and therapy. These points 
are  not always the same as the significant  
recommendations, which are ranked according to 
their  degree of evidence.
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