The Importance of Scholarly Reviews in Medical Literature

Medicine is an ever-changing science. With every original research publication, new data pour in that accumulate with time, inviting newer ideas and perspectives, research outcomes, insights into methodology, and refined understanding. They provide us the luxury, as well as obligation, to consider a problem so that our own research and care delivery remain congruent with the changing state of the art and keep us in sync with evidence-based information. The mass of data is challenging for an inherently heterogeneous and fast-evolving subject like otolaryngology, and distilling this overwhelming influx of information into a kernel of practical value, unbiased and depersonalized, is a tedious job. We therefore stop and ask ourselves, “Where do we stand?”, “How much have we learned?”, and “Where and how far do we still need to venture?” The obvious need for this introspection sows the seeds for scholarly reviews that crystallize the culled information in a comprehensive, updated, holistic manner. To ensure best-of-evidence care, scholarly reviews streamline the information and adjust the coordinates of our knowledge grid.

A scholarly review is a “research within research”—a macrocosm of pooled data that can be retrieved as processed and reliable source material for further studies. Such a review must be distinguished from an exhaustive literature search of the sort we used to see in case reports/series, by its property of being methodical, oriented, expansive, assimilative, targeted, and evidence based. It deals with research papers in a masterly fashion, defining the sources reviewed and methods used to select papers, but it is not intended to provide any opinion of its own, although the summary of opinions and outcomes might be imbued with subtle directions to follow. In the process, it executes mini-reviews of component research papers, points out their strengths and limitations, addresses their mutual heterogeneity in outcomes, and indicates their relative role in dealing with the review question. Thus, one great advantage of a good review is the availability of unbiased data following evidential hierarchy, providing the readers options from which to choose.

As our knowledge expands, we witness how this art of scholarly reviews can be bettered and classified, suiting the need for present and future research. Such variations follow the need to interpret a given problem according to its priority, weightage, dynamicity, evidential strength, and contemporary clinical circumstances. Accordingly, there are systematic reviews that quantitatively or qualitatively analyze information through a protocol, beginning with framing a review question following a suitable recommended format (eg, PICO (Population, Intervention, Comparator, Outcomes], PICo [Population, phenomena of Interest, Context], SPICE [Setting, Perspective, Intervention, Comparison, method of Evaluation], etc), setting up the selection criteria, and progressing through systematic keyword-based search in electronic databases, adhering to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; http://www.prisma-statement.org/). While they are selective and exclusive in approach to narrow down to the review question, a formal narrative review is rather a statement of fact—a detailed but focused, updated overview with properly selected candidate articles. Narrative reviews, sometimes called state-of-the-art reviews or advances in diagnosis and treatment reviews, impose a time frame for the review span, say 5 years. They primarily highlight and discuss the recent advances in the field. Another form of such review is the contemporary review, which concentrates on a comparative yet resourceful account of conflicting views on a topic supported by evidence-based literature. Contrary to the general principle, systematic reviews like evidence-based reviews often adopt the liberty to express recommendations on the question of interest based on the strength of evidence of the pooled articles. The so-called umbrella reviews constitute the “review of the reviews” as they derive information on a subject only from preexisting review articles, thereby obviating the laborious process of analyzing individual research papers. However, the greatest impact of a review comes through a meta-analysis that occupies the summit of the evidence pyramid. Unlike other forms of reviews, it executes detailed statistical analysis on its own on the qualitative and quantitative outcome data derived systematically from homogeneous, independent research papers, pooled together as its own study cohort. It is a virtual study design laid upon a hopefully robust collective platform with greater statistical significance, and an authoritative, quantitative outcome, without delving into actual, real-life study-settings. Outcomes from meta-analyses often have the highest strength of evidence but it must be remembered that a meta-analysis is only as good as the papers it includes. If their information is flawed, the meta-analysis may be statistically strong but invalid, nevertheless.

For the authors of a resourceful review paper, it is the call from their analytic faculty that prompts them to introspect and explore how the problem stands and its future trend shaping up. Being outside a primary study setting, the preparation of a scholarly review is thoroughly methodical, executed through protocols like the MOOSE (Meta-analysis Of Observational Studies in Epidemiology; https://www.editorialmanager.com/jognn/account/MOOSE.pdf) and PRISMA. There are also instructions from dedicated institutes like the Joanna Briggs (System for the Unified Management, Assessment and Review of Information; http://joannabriggs.org/), and the umbrella organization of Equator Network (http://www.equator-network.org/) to guide authors through the process. Compared to other article types, reviews generally involve fewer authors, who are usually the experts in their fields. Preparing a scholarly review might be an academically gratifying project but it can often be an arduous task. Not only is it time consuming, but also unrestricted access to metadata and full texts through electronic databases is obligatory for systematic literature search and proper interpretation of data. Most major biomedical databases (Embase, Scopus, EBSCO, Gale, etc) are not free to access, even the friendly PubMed provides only the abstracts as free content and this is a serious hindrance for researchers from developing and poor nations where institutional/library subscriptions might not be affordable. This problem needs urgent attention.

From a journal’s perspective, publishing well-written scholarly reviews on regular basis is valuable. Meta-analyses and other review forms, being comprehensive and instructive, address a problem with authority and breadth. With updated reviews on important topics of practical importance, the journal acts as a source of important and core medical information, and consequently provides readers with valuable and practical information. Moreover, the chances of such articles being cited are high, which may influence the journal’s impact factor. Despite criticisms on its true utility as a yardstick for quality and the alleged scope for potential manipulations, and notwithstanding the theoretically better metrics for the purpose, the impact factor (Journal Citation Reports) still affects a journal’s prestige. Quality reviews are welcomed by most journals and there are even journals that publish only review papers (the “review journals”), like the Current Opinion and the Clinics Review Article series.

As fresh data and new innovations are introduced, our specialty is evolving fast, and it is difficult to keep up for both researchers and clinicians-in-practice. Hence, the need for scholarly reviews has never been greater. Ear Nose & Throat Journal encourages scholarly review papers. Unlike the review journals and some others in our specialty in which submissions are commissioned and often theme-based, our journal is happy to consider insightful, unsolicited reviews on high-priority, clinically relevant topics. Well-prepared scholarly reviews are valued greatly by our Editorial Board and, most importantly, by our readers whom we encourage to also become our authors.