A systematic review is a structured review that pools the results of multiple studies on a topic using meta-analysis. It aims to summarize evidence from studies addressing a specific clinical question in a rigorous, unbiased manner to explain differences among studies on the same question. Systematic reviews are considered the highest level of evidence and are needed because individual studies may have biases or low statistical power to detect effects.

1. Systematic reviews

4. Cook, D. J. et. al. Ann Intern Med 1997;126:376-380 Differences between Narrative Reviews and Systematic Reviews

5. QUESTION Broad Focused SOURCES/ Usually unspecified Comprehensive; SEARCH Possibly biased explicit SELECTION Unspecified; biased?Criterion-based; uniformly applied APPRAISAL Variable Rigourous SYNTHESIS Usually qualitative Quantitative INFERENCE Sometimes Usually evidence- evidence-based based NARRATIVE SYSTEMATIC Cook, D. J. et. al. Ann Intern Med 1997;126:376-380

13. Graphic Display: ß blockers in secondary prevention after myocardial infarction .

16. Cumulative Meta-analysis

20. Abstract Background Objectives Criteria for considering studies for this review Types of participants Types of intervention Types of outcome measures Types of studies Search strategy for identification of studies Methods of the review Description of the studies Methodological qualities of included studies Results Discussion Conclusions Implications for practice Implications for research Internal sources of support to the review External sources of support to the review Potential conflict of interest Acknowledgements Contribution of Reviewer(s) Synopsis Characteristics of included studies Table 01 results References to studies included in this review Additional references Typical Systematic Review “Skeleton”

27. Publication Bias

31. R.R

34. Keep in mind Evidence may change with more trials

42. Thank You