title: How to read a systematic review and meta-analysis and apply the results to patient care: users' guides to the medical literature.
abstract: Clinical decisions should be based on the totality of the best evidence and not the results of individual studies. When clinicians apply the results of a systematic review or meta-analysis to patient care, they should start by evaluating the credibility of the methods of the systematic review, ie, the extent to which these methods have likely protected against misleading results. Credibility depends on whether the review addressed a sensible clinical question; included an exhaustive literature search; demonstrated reproducibility of the selection and assessment of studies; and presented results in a useful manner. For reviews that are sufficiently credible, clinicians must decide on the degree of confidence in the estimates that the evidence warrants (quality of evidence). Confidence depends on the risk of bias in the body of evidence; the precision and consistency of the results; whether the results directly apply to the patient of interest; and the likelihood of reporting bias. Shared decision making requires understanding of the estimates of magnitude of beneficial and harmful effects, and confidence in those estimates.
authors.affiliation: Division of Preventive Medicine and Knowledge and Evaluation Research Unit, Mayo Clinic, Minnesota.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Departments of Medicine and Health Research and Policy, Stanford University School of Medicine; Department of Statistics, Stanford University School of Humanities and Sciences; and Meta-Research Innovation Center at Stanford (METRICS), Stanford University.
authors.forename: John P A
authors.initials: JP
authors.lastname: Ioannidis
authors.affiliation: Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.affiliation: Departments of Medicine and Clinical Epidemiology and Biostatistics and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.affiliation: All India Institute of Medical Sciences, New Delhi.
authors.forename: Kameshwar
authors.initials: K
authors.lastname: Prasad
authors.affiliation: Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Neumann
authors.affiliation: Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile, and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Alonso
authors.initials: A
authors.lastname: Carrasco-Labra
authors.affiliation: Department Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Agoritsas
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Rose
authors.initials: R
authors.lastname: Hatala
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Wyer
authors.affiliation: Departments of Medicine and Clinical Epidemiology and Biostatistics and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.affiliation: Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
mesh_terms: D006801:Humans; D015982:Bias; D003657:Decision Making; D055317:Evidence-Based Practice / Q000379:methods; D015201:Meta-Analysis as Topic; D005791:Patient Care / Q000592:standards; D015203:Reproducibility of Results; D000078202:Systematic Reviews as Topic