To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This chapter discusses systematic reviews as a cornerstone of evidence-based practice. Systematic reviews use explicit, reproducible methods to identify, appraise, and synthesise research evidence, thereby reducing bias compared to narrative reviews. The methodology is outlined step by step, including formulation of a research question, development of a protocol, comprehensive literature searching, study selection, data extraction, quality appraisal, and evidence synthesis. Quantitative synthesis through meta-analysis is explained, including the calculation of pooled estimates and assessment of heterogeneity. The importance of assessing publication bias and sensitivity analyses is highlighted. The chapter also considers qualitative synthesis and mixed-methods reviews, broadening the scope of systematic approaches beyond purely quantitative data. Strengths of systematic reviews include their transparency, reproducibility, and utility in informing guidelines and policy decisions. Limitations include potential bias in the underlying studies, the need for rigorous methods, and the time and expertise required. Practical examples illustrate their impact in shaping clinical practice, public health interventions, and resource allocation. The chapter concludes by underscoring the role of systematic reviews in consolidating knowledge, guiding practice, and identifying gaps for future research. This chapter maps to syllabus section 3.6.6, which requires understanding of systematic reviews, meta-analysis, and reporting standards such as QUORUM and PRISMA.
Adverse childhood experiences are critical contributors to the development of psychiatric disorders. Despite its pervasive impact on mental health, childhood neglect remains underexplored. Here, we performed a first comprehensive synthesis of the association between neglect subtypes and psychiatric disorders.
Aims
The primary aim was to quantify the overall association between neglect and psychiatric disorders, by estimating the odds ratios from clinical and control groups. The secondary aim was to examine the association between unspecified, physical and emotional neglect, and specific psychiatric disorders.
Method
Studies were systematically selected from three databases (PubMed, EMBASE and PsycINFO), focusing on adult populations with diagnosed psychiatric disorders and corresponding control groups. Meta-analyses assessed overall associations between neglect and psychiatric disorders, as well as subtypes-specific associations with distinct psychiatric conditions. Multiple meta-regressions were performed to explore moderating factors.
Results
Strong associations were found between neglect and psychiatric disorders across all subtypes (unspecified neglect: odds ratio 3.63, 95% CI 2.19–6.01; physical neglect: odds ratio 3.27, 95% CI 2.51–4.25; emotional neglect: odds ratio 3.36, 95% CI 2.58–4.38). Subgroup analyses showed the strongest associations between unspecified neglect and bipolar disorder, physical neglect and schizophrenia spectrum disorders, and emotional neglect and major depressive disorder. Other associations emerged, although their interpretation was limited by a small number of studies and high heterogeneity levels.
Conclusions
Neglect is significantly associated with psychiatric disorders, with distinct patterns across neglect subtypes and mental health outcomes. These findings highlight the need for early identification and tailored interventions to mitigate neglect’s long-term burden on mental health.
Dementia affects approximately 6–13% of adults aged 65 years and older, with Alzheimer’s disease accounting for most cases. Established symptomatic therapies, including acetylcholinesterase inhibitors and memantine, provide limited benefit and do not modify disease progression. Multiple monoclonal antibodies (mABs) targeting different amyloid-β species have been developed as potential disease-modifying therapies; because some agents have entered clinical use whereas others remain investigational, a continuously updated synthesis of their efficacy and safety is needed.
Aims
To evaluate the efficacy and safety of all anti-amyloid mABs for adults with Alzheimer’s disease, using a living systematic review and meta-analysis.
Method
We will conduct a living systematic review and meta-analysis in accordance with the Cochrane Handbook, Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 and the PRISMA extension for living systematic reviews. Randomised controlled trials comparing any approved or investigational anti-amyloid mAB with placebo, standard care or active comparators will be included. Searches of Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be updated every 6 months. Meta-analyses will be conducted separately for each antibody molecule using random-effects models. Critical outcomes include global clinical change and disease severity, cognitive abilities, functional ability and dependency, and safety (serious adverse events, treatment discontinuation and amyloid-related imaging abnormalities). Important outcomes include neuropsychiatric symptoms, quality of life and health system outcomes. Certainty of evidence will be assessed using the methodology Grading of Recommendations, Assessment, Development and Evaluation.
Results
This article describes a protocol; therefore, no review findings are available at this stage.
Conclusions
This living systematic review will provide an up-to-date synthesis of the benefits and harms of anti-amyloid monoclonal antibodies to inform clinical decision-making and health-system planning in Alzheimer’s disease.
Self-harm and suicide are major public health concerns and leading causes of mortality worldwide, highlighting a pressing need for policymakers to identify and implement cost-effective interventions. This systematic review (PROSPERO registration #CRD42023460339) followed the PRISMA guidelines and aimed to synthesize the available cost-effectiveness evidence for the prevention of self-harm and suicide. Systematic searches were performed in MEDLINE, Embase, PsycINFO, CINAHL, Econlit, and ProQuest to identify full economic evaluations and return-on-investment studies on preventive interventions for self-harm and suicide published up to January 15, 2026. Methodological quality was assessed using Drummond’s 10-item checklist, and findings were synthesized narratively. A total of 69 eligible studies evaluated 22 types of interventions: three universal, five selective, five indicated, and nine multi-level. Most studies were rated as high-quality (n = 61/69) and conducted in high-income countries (HICs) (n = 63/69), primarily assessing the cost-effectiveness of universal interventions like means restriction (n = 6), selective and indicated interventions like psychotherapy (n = 30), support services (n = 15), and medication (n = 5). Evidence consistently found that interventions for self-harm and suicide prevention were generally cost-effective or cost-saving. Strong evidence supported the cost-effectiveness of several universal (e.g. awareness training), selective (e.g. psychotherapy, support services), indicated (e.g. suicide risk screening, support services, psychotherapy for adults in HICs like Australia, US, Canada), and multi-level interventions. However, more economic evaluations are needed for interventions targeting older adults and children in all countries, especially in low- and middle-income countries, where evidence is lacking.
Meta-analysis is a widely used statistical tool for estimating the diagnostic accuracy of tests across multiple studies. Existing methods and available R packages primarily focus on a single diagnostic test, typically under the assumption that all studies include a gold standard. Greater efficiency can be achieved by modeling multiple diagnostic tests together and drawing on studies with or without a gold standard reference test across diverse designs. To address this challenge, recent work has extended both the Bayesian hierarchical model and the Bayesian hierarchical summary receiver operating characteristic model to the framework of network meta-analysis of diagnostic tests, enabling simultaneous comparison of multiple tests when some data are missing. Despite the importance of these methods, their computational complexity has limited their broad application. This article introduces NMADTA, an R package that implements these models with user-friendly functions. The package allows researchers to evaluate the accuracy of multiple diagnostic tests simultaneously and provides comprehensive graphical displays of the results.
Twin studies provide a powerful framework to identify genetic and environmental influences on health and development, particularly during infancy, childhood, and adolescence. Although twin research has expanded globally, evidence from South Asia remains limited and poorly characterized. This systematic review aimed to synthesize health research involving infant, child, and adolescent twins conducted in South Asia and to identify methodological patterns and research gaps relevant to future twin research in the region. A systematic review was conducted according to a registered protocol (PROSPERO: CRD42018105704) using the PICOS framework. Multiple international and regional databases were searched from inception to September 2025. Studies recruiting twins aged 0–19 years within the South Asian Association for Regional Cooperation (SAARC) countries were included. Study selection, data extraction, and quality appraisal were conducted independently, with study quality assessed using Joanna Briggs Institute critical appraisal tools. Results were synthesized narratively due to heterogeneity across study designs and outcomes. Eighteen studies were included from 1245 identified records. Most studies focused on twin pregnancy and neonatal outcomes (61%), followed by dentistry, ocular health, and gut microbiota. Twin pregnancies were consistently associated with increased risks of low birth weight, preterm birth, and perinatal morbidity and mortality. A limited number of studies applied classical twin designs to investigate genetic and environmental contributions. Twin research involving infants, children, and adolescents in South Asia remains limited in scope and methodological depth. Strengthening twin registries, methodological standardization, and collaborations is essential to advance genetically informative research and enhance the global representativeness of twin studies.
Whether you are writing a literature review or working on a research paper, literature research is an important factor. Nowadays, you can conveniently use the internet from your own home or workplace to retrieve an enormous amount of information along with consulting books and physical resources.
In this chapter, we first describe different kinds of reference materials. We also provide a list of reference materials that may be useful for your research. We then give you an introduction to literature research and some of the databases that you are likely to use. Afterward, a section on internet research gives you an overview of search engines, how best to search for keywords, types of information available on the internet, and how to evaluate the information you find online. Last, we elaborate on the function of bibliographical software and its use for your research.
Up to 60 per cent of patients with enlarged vestibular aqueduct syndrome experience sudden hearing loss. This review analyses treatment options and outcomes when sudden hearing loss occurs.
Methods
Embase, Ovid MEDLINE and Web of Science databases were the data sources. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. The number of patients, episodes, treatments, baseline hearing and change in hearing thresholds after intervention and return to baseline were extracted.
Results
The final analysis included 60 episodes of hearing loss from 11 studies, from a search of 1,064 studies. The treatment groups were: 1, no treatment; 2, systemic steroids; 3, salvage hyperbaric oxygen therapy in steroid partial or non-responders. The hearing improvement across the groups was 9.1 per cent, 50 per cent and 89.5 per cent, respectively.
Conclusion
Enlarged vestibular aqueduct patients with sudden hearing loss may first be treated with systemic steroids. Salvage hyperbaric oxygen therapy can be considered in steroid non-responders to improve further chances of recovery.
As rheumatoid arthritis of the cricoarytenoid joint can be life-threatening, this study aimed to provide a comparison of survival and decannulation after tracheostomy for those with this condition.
Methods
Following Preferred Reporting Items for Systematic Review and Meta-Analyses (‘PRISMA’) guidelines, PubMed, Web of Science, Scopus, Embase and MEDLINE library databases were queried to find all reported cases of rheumatoid arthritis of the cricoarytenoid joint.
Results
A total of 55 articles with 82 patients were included in the analysis. The mean age at diagnosis was 60.1 ± 11.2 years. In cases of bilateral involvement, 71.2 per cent of patients required a tracheostomy. For those who had bilateral cricoarytenoid joint involvement and a tracheostomy, there was a significant relationship between having a primary laryngeal surgery, with or without medical management, and overall survival with ultimate decannulation compared with those with just medical management (p = 0.0022).
Conclusion
Tracheostomy is often necessary for acute symptom management of rheumatoid arthritis of the cricoarytenoid joint, and laryngeal surgery may be offered to facilitate ultimate decannulation.
People with intellectual disabilities experience higher rates of mental disorders, contributing to restrictive practices and premature mortality. Prevalence data are essential to understanding the patterns of disease, and for the development of tailored interventions.
Aims
To systematically examine the burden and pattern of mental disorders in people with intellectual disabilities across the lifespan.
Method
We searched six databases (inception to 17 October 2024), and conducted a manual search up to 15 December 2024, for systematic reviews on the prevalence of mental disorders in people with intellectual disabilities with or without neurodevelopmental conditions. We conducted a narrative synthesis of prevalence rates, including those stratified by intellectual disability level, sex, age and autism, where available, and compared these with published prevalence rates in people without intellectual disabilities (International Prospective Register of Systematic Reviews, no. CRD42024610611).
Results
We included 26 systematic reviews: 7 meta-analyses and 19 narrative reviews. Compared with the general population, the prevalence of schizophrenia (3.55–4.80%), anxiety (5.4–5.5%) and obsessive–compulsive disorders (2.4%) appeared higher, whereas that of mood (6–7%), personality and post-traumatic stress disorders appeared lower. Study quality was moderate to critically low. For syndromic intellectual disabilities we noted high anxiety rates in fragile-X, Williams and 22q11.2 deletion syndromes, and in those with co-occurring autism. We found gaps on dementia, bipolar, substance use and eating disorders, and limited data stratified by intellectual disability level, sex and age.
Conclusions
This umbrella review confirms the high prevalence of mental disorders among people with intellectual disabilities, and highlights limited evidence for several conditions and population subgroups, including for minoritised ethnic groups. Standardised, high-quality epidemiological research is needed to shape clinical care and public mental health policy.
To evaluate the efficacy and safety of stellate ganglion block for persistent and refractory sensorineural olfactory dysfunction.
Methods
A systematic search of PubMed, Scopus, Embase, Web of Science, Google Scholar and the Cochrane Library was conducted for studies published before December 2025. Eligible studies assessed subjective and/or objective olfactory outcomes before and after stellate ganglion block and, when available, compared stellate ganglion block with placebo or no treatment.
Results
Nine studies involving 441 participants were included. Stellate ganglion block was associated with greater improvements in olfactory composite, identification and subjective scores than controls, but between-group differences were not statistically significant. Subjective and objective improvement rates following stellate ganglion block were 68.9 and 63.4 per cent, respectively. No major adverse events were reported.
Conclusion
Stellate ganglion block appears safe and may provide modest olfactory improvement, but its superiority over control treatments remains unproven, warranting further randomised controlled trials.
People with schizophrenia spectrum disorders (SSDs) experience high rates of obesity and metabolic dysfunction, contributing substantially to excess morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide and tirzepatide have demonstrated substantial efficacy for weight and glycaemic outcomes in the general population, but evidence in people with SSDs remains limited.
Aims
To synthesise all placebo-controlled, randomised controlled trials (RCTs) examining semaglutide and/or tirzepatide in people with SSDs.
Method
A preregistered systematic review and meta-analysis of RCTs examining the efficacy and safety of semaglutide and/or tirzepatide in adults with SSDs was conducted. Outcomes and adverse events were pooled using random-effects meta-analysis. Certainty of evidence was assessed using the GRADE criteria.
Results
Three trials (n = 258) met inclusion criteria, examining semaglutide dosages of 1.0–2.0 mg over 26–36 weeks. No trials examining tirzepatide were found. Semaglutide significantly reduced body weight (−11.32 kg; 95% CI −15.35 to −7.29), body mass index (−3.58 kg/m2; 95% CI −4.86 to −2.30), haemoglobin A1c (−0.37%; 95% CI −0.51 to −0.22) and fasting glucose (−0.54 mmol/L; 95% CI −0.94 to −0.13). In adverse event analyses, semaglutide was associated with increased risks of abdominal pain (risk ratio 2.93; 95% CI 1.13–7.60), vomiting (risk ratio 2.57; 95% CI 1.39–4.77) and constipation (risk ratio 3.23; 95% CI 1.14–9.18). There was no evidence of increased risk of serious adverse events.
Conclusions
Semaglutide produces clinically meaningful improvements in weight and glycaemic outcomes in people with SSDs, with an adverse event profile consistent with known gastrointestinal effects of GLP-1 RAs in the general population. These findings support semaglutide as a promising adjunctive metabolic intervention in this population, although larger and longer trials, specifically those testing tirzepatide, are needed to better characterise heterogeneity of effects and long-term safety of these promising pharmacological treatments.
Care for bipolar spectrum disorders is often delayed, and these delays are associated with a poorer prognosis. However, little is known about the specific factors that contribute to these delays. Bipolar disorder onset peaks in adolescents and young adults, where barriers to care may be distinct from younger or older populations.
Aims
To identify the available evidence on factors contributing to delays in care for adolescents and young adults with bipolar disorder.
Method
We performed a pre-registered systematic search of the literature on delays in the care of 13- to 24-year olds diagnosed with bipolar disorder. Our search yielded n = 5991 unique articles published between 2000 and 2025. Two independent reviewers screened abstracts and full texts for eligibility according to a priori inclusion criteria. Findings from included studies (n = 27) were summarised in a narrative synthesis, organised according to patient, disease and systemic factors within the Model of Pathways to Treatment.
Results
Findings were limited to observational levels of evidence. There was a relative paucity of research in the appraisal and help-seeking intervals. Some factors in delays to care were consistently identified across multiple studies. However, there were also contradictions or a lack of replication around identified factors.
Conclusions
Research in this area has been declining in the past decade despite contradictory findings and ongoing significant delays in bipolar disorder care. Factors contributing to delays in bipolar disorder care can be effectively organised according to appraisal, help-seeking, diagnostic and pre-treatment intervals. This enables a systematic approach to identifying areas in need of quality improvement and further research.
People with disabilities represent a large, underutilized labor force, and while disability employment is increasingly recognized as a strategic human resource opportunity, reports on its value are fragmented. Existing research often emphasizes benefits for firms or employees with disabilities, overlooking other stakeholders and potential accompanying costs. This systematic review synthesizes 45 empirical studies published between 2000 and 2025, examining both benefits and costs across multiple stakeholders, value dimensions, and organizational positions. Findings reveal that most reported values were gain-related and firm-centered. Meanwhile, patterns of intra-stakeholder clustering and inter-stakeholder linkages highlighted the complex dynamics of shared outcomes. Four benefit–cost dynamics were identified, alongside evidence of occupational segregation in low-value job roles. By applying a multi-stakeholder framework, this review advances the human resource management literature, showing how disability employment can be leveraged strategically to create interconnected values, foster inclusion, and support sustainable workforce practices.
Hospital surge capacity is pivotal for disaster response, yet the effectiveness of assessment and planning tools remains underexplored.
Objective
This systematic review evaluates the reliability, validity, and applicability of surge capacity tools across disaster scenarios.
Methods
Following PRISMA guidelines, we analyzed 24 Q1 studies (PubMed, Scopus) using the PICO framework. Risk of bias was assessed via ROBINS-E, and meta-analysis (random-effects model) quantified pooled effect sizes (ES). Subgroup analyses compared simulation tools, surveys, and resource strategies.
Results
The combined ES was 0.74 (95% CI: 0.67–0.82), indicating moderate improvement in preparedness. Simulation tools (Group A) showed the highest consistency (ES = 0.81, I2 = 0%), while resource strategies (Group C) had wider variability (ES = 0.71, I2 = 74.42%). Egger’s regression revealed publication bias (P = 0.004), and heterogeneity was substantial (I2 = 76.70%).
Conclusions
Simulation-based tools are most effective for surge capacity, whereas resource strategies require contextual adaptation. Policymakers should prioritize standardized benchmarks and DSS integration, with future research addressing equity and real-world implementation gaps.
Systematic reviews and meta-analysis, particularly of randomized trials, are considered the highest quality of evidence supporting causal associations. But they are not immune to bias, bias in the included studies themselves and in the process of synthesizing studies and pooling data. This chapter considers methods for systematically reviewing a complete body of literature, deciding if the data are amenable to meta-analysis, and appropriately conducting such an analysis.
Youth in low- and middle-income countries (LMICs) bear a disproportionate burden of mental health conditions, alongside low health-seeking behaviours and limited access to services. These gaps underscore the need for accessible strategies such as youth peer-based mental health programmes and supports (Y-PBMHPS).
Aims
To examine whether Y-PBMHPS can help address the mental health needs of LMIC youth.
Method
We conducted a rapid review of peer-reviewed literature, searching Medline, PsycINFO, CINAHL, CAB Global Health, Science Citation Index and Social Sciences Citation Index for studies of Y-PBMHPS in LMICs published in English between 1 January 2002 and 19 September 2025. Two review authors performed title/abstract screening and full-text review. Study quality was assessed by one review author using Joanna Briggs Institute critical appraisal tools. The primary outcome was change in mental health status, expressed in standardised difference units.
Results
Of 6105 unique records identified, 329 studies were reviewed in full and 34 were included. All studies were conducted in Asia or Africa; 17 were quantitative studies (including randomised controlled trials), 9 were qualitative studies and 8 used quantitative designs with qualitative findings. Y-PBMHPS included counselling, psychotherapy, psychoeducation and self-help groups, with peers acting as leaders, facilitators, educators or service providers. Quantitative studies most frequently assessed anxiety and depression, reporting negligible to moderate effects. Qualitative findings indicated good fidelity, adherence and acceptability, alongside some feasibility challenges.
Conclusions
Y-PBMHPS can broaden youth mental health support and services in LMICs. Clearer guidelines on peer selection, training and supervision and further research in other LMICs, including cost-effectiveness evaluations, would strengthen the evidence base.
To examine the extent to which information sources other than journal articles are sought for systematic reviews. Cross-sectional study of published systematic reviews. We examined all published systematic reviews included in MEDLINE in a 4-week period in 2019. Both systematic reviews and protocols of reviews were eligible for inclusion. (1) Number and types of information sources sought in systematic reviews; (2) proportion of reviews that explicitly searched for study reports other than journal articles; (3) proportion of reviews that searched resources containing study reports other than journal articles. A total of 1,262 systematic reviews fulfilled the eligibility criteria. The median number of information resources searched for all systematic reviews was 4. Of the 1,262 reviews, study reports other than journal articles were sought in 40% (n = 502) of systematic reviews (97% (n = 64) of Cochrane reviews and 37% (n = 438) of non-Cochrane reviews). Trial registers were searched in 88% of Cochrane reviews and 21% of non-Cochrane reviews. In 99.3% (n = 1,253) of all the systematic reviews, the searches performed had the potential to identify study reports other than journal articles. Between a third and a half of systematic reviews search for study reports other than journal articles. Systematic review searches often search resources that include study reports other than journal articles, whether or not the reviewers explicitly sought them.
This chapter reviews the principles of evidence-based medicine and evidence-based radiology as they apply to child maltreatment clinical care and research. Common pitfalls and the rise of “predatory publishing” are discussed as important challenges to rigorous medical literature appraisal and its application to clinical care and research. An approach to critical appraisal is given, to help you determine whether a study is of high quality or not. A detailed discussion of the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) report is included as a particular example of the misuse of evidence-based edicine principles.
While pedagogical translanguaging (PT) has gained prominence as an approach for bridging learners’ multilingual repertoires and monolingual teaching paradigms, secondary English as a Foreign Language (EFL) contexts remain underexamined, particularly following recent shifts in classroom diversity. This systematic review synthesizes 25 empirical studies of PT in secondary EFL education published between January 2023 and August 2025. Based on Reflexive Thematic Analysis, four interconnected themes were identified: (1) barriers to PT implementation due to structural, ideological, and teacher preparation constraints within institutional environments; (2) pedagogical rationales that integrate cognitive, affective, and sociocultural justifications; (3) observable classroom practices organized by pedagogical function, revealing strategic deployment of more-enabled and less-enabled languages; and (4) learning outcomes across cognitive, affective, and sociocultural domains. These themes reveal a fundamental tension: although translanguaging proves pragmatically necessary for effective EFL teaching, it remains systematically unsupported at the institutional level. Teachers justify and enact sophisticated multilingual practices, but without formal preparation, they tend to implement PT covertly within unsupportive structures, relying on knowledge that remains tacit and difficult to share. The review shows that PT has outpaced institutional recognition, calling for systems that treat it as professional expertise rather than tolerated improvisation.