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With the continual increase in the volume of medical literature being produced health care providers are finding it increasingly difficult to keep up to date with the latest evidence. For example a search for “ACE inhibitors” in PubMed produced 1588 possible articles in 2009 alone. Traditionally, people referred to review articles in the hope that these will provide the latest evidence and hence reduce the need for them to perform exhaustive personal appraisal of the available literature. However, review articles are susceptible to bias as they (potentially) convey only the authors' views on the topic; furthermore, unless authors perform a comprehensive literature review, the article may not include contemporaneous, practice changing papers. Systemic reviews aim to reduce bias in review articles by providing readers with the best available information on the topic and, with meta-analysis, try to combine data from several studies to produce a single result. In this chapter we will describe how a systematic review is produced and how to critically appraise a systematic review. The systematic approach is also useful when trying to answer day-to-day clinical questions in your own clinical practice. Detailed guidance on producing a systematic review can be found at the Cochrane Collaboration's Website where their handbook can be downloaded. A checklist to ensure all important information is reported in a systematic review was produced by the QUOROM collaboration and provides a useful tool for guiding the appraisal of systematic reviews; a modified version is presented in Table 72-1.

Table 72-1 The Quorum Statement on How to Report a Systematic Review

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