# Discipline Skeleton -- Systematic Review

**Library:** Public RAM. **Authored by:** Epistemic Output Layer (S4). **Consumed by:** S4 at Phase D overlay.

Use when the invoked Librarian discipline is `systematic-review`. Preserve the PRISMA-style structure below and attach the three-axis block per included-study finding at the overlay step.

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## Native Skeleton (preserve)

1. **Review Question and Eligibility Criteria** -- PICO/PECO statement, inclusion/exclusion, language and date windows.
2. **Search Strategy Summary** -- databases, strings, dates (NOTE: the full per-query record is rendered in the top-level Search Ledger section; this block is a summary of strategy only).
3. **PRISMA Flow** -- identification, screening, eligibility, inclusion counts. Exclusion reasons.
4. **Study Characteristics Table** -- per included study: design, sample, intervention/exposure, comparator, outcomes, country/setting.
5. **Risk-of-Bias Assessment** -- per study using RoB 2 (RCTs) or ROBINS-I (non-randomized). Per domain.
6. **Synthesis** -- per outcome; meta-analysis where appropriate (heterogeneity, forest/funnel), narrative synthesis otherwise.
7. **GRADE Certainty per Outcome** -- risk of bias, inconsistency, indirectness, imprecision, publication bias.
8. **Conclusions and Implications** -- per outcome.

## Overlay Hooks (where S4 attaches three-axis)

- Each **outcome-level finding** is a claim slot. Attach evidence / transportability / decision block.
- Typical claim type: causal (effectiveness question). Transportability slot: `mechanism_context_coupling`, PIET-T full 44.
- Surprise Register and Search Ledger render as top-level sections AFTER Conclusions.
- Methodology trace: systematic-review tag, PRISMA adherence notes, protocol registration ID if available.

## Native elements that MUST survive overlay
- PRISMA flow counts (identification/screening/eligibility/inclusion).
- RoB 2 / ROBINS-I per-study per-domain grid.
- GRADE certainty rating per outcome (note: GRADE grade is UPSTREAM fitness/integrity input; the three-axis block is the FINAL output).

The GRADE rating is NOT the three-axis confidence. Do not fuse them. GRADE feeds the evidence axis as one input; transportability and decision remain independent.
