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Abstract Healthcare decisions for individual patients and for public health policies should be informed by the best available research evidence. Primary care physicians need evidence for both clinical practice and for public health decision making. The evidence comes from good reviews which is a state-of-the-art synthesis of current evidence on a given research question.
Given the explosion of medical literature, and the fact that time is always scarce, review articles play a vital role in decision making in evidence-based medical practice.
Given that most clinicians and public health professionals do not have the time to track down all the original articles, critically read them, and obtain the evidence they need for their questions, systematic reviews and clinical practice guidelines may be their best source of evidence.
Systematic reviews aim to identify, evaluate, and summarize the findings of all relevant individual studies over a health-related issue, thereby making the available evidence more accessible to decision makers.
The objective of this article is to introduce the primary care physicians about the concept of systematic reviews and meta-analysis, outlining why they are important, describing their methods and terminologies used, and thereby helping them with the skills to recognize and understand a reliable review which will be helpful for their day-to-day clinical practice and research activities.
Evidence-based medicine, meta-analysis, primary care, systematic review Introduction Evidence-based healthcare is the integration of best research evidence with clinical expertise and patient values.
Ideally, clinical decision making ought to be based on the latest evidence available. However, to keep abreast with the continuously increasing number of publications in health research, a primary healthcare professional would need to read an insurmountable number of articles every day, covered in more than 13 million references and over biomedical and health journals in Medline alone.
With the view to address this challenge, the systematic review method was developed. Systematic reviews aim to inform and facilitate this process through research synthesis of multiple studies, enabling increased and efficient access to evidence.
Clinicians read them to keep up-to-date with their field and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research and some healthcare journals are moving in this direction.
The purpose of this article is to introduce readers to: The two approaches of evaluating all the available evidence on an issue i. Application What is the effect of antiviral treatment in dengue fever?
Most often a primary care physician needs to know convincing answers to questions like this in a primary care setting. To find out the solutions or answers to a clinical question like this, one has to refer textbooks, ask a colleague, or search electronic database for reports of clinical trials.
Doctors need reliable information on such problems and on the effectiveness of large number of therapeutic interventions, but the information sources are too many, i.
Because no study, regardless of its type, should be interpreted in isolation, a systematic review is generally the best form of evidence. There are two fundamental categories of research: Primary research and secondary research.
Primary research is collecting data directly from patients or population, while secondary research is the analysis of data already collected through primary research.
A review is an article that summarizes a number of primary studies and may draw conclusions on the topic of interest which can be traditional unsystematic or systematic. Terminologies Systematic review A systematic review is a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue.
It synthesizes the results of multiple primary studies related to each other by using strategies that reduce biases and random errors. The evidence-based practitioner, David Sackett, defines the following terminologies.
The general term for all attempts to synthesize the results and conclusions of two or more publications on a given topic. A specific statistical strategy for assembling the results of several studies into a single estimate.
Systematic reviews adhere to a strict scientific design based on explicit, pre-specified, and reproducible methods. Because of this, when carried out well, they provide reliable estimates about the effects of interventions so that conclusions are defensible.
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