How to Read a Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

1. Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, China;2. West China School of Medicine, Sichuan University, Chengdu 610041, China;3. Department of Foreign Languages, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Systematic review; Literature reading; Evidence-based medicine

DOI：

10.7507/1672-2531.20090178

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To introduce the method of reading systematic reviews.
Methods 　Papers and books on reading and evaluating medical literature were searched comprehensively, and general principles and approaches of reading systematic reviews were summarized.
Results 　The following 10 points were summarized to help read systematic reviews in a scientific, rapid, and efficient way: ① Was there any overviews of reviews? ② Was there a recent update? ③ Were the previous relevant systematic reviews integrated? ④ Were sound searching strategies established and implemented? ⑤ Was quality evaluation done concerning the original research? ⑥ Were the results of the original research conflated properly? ⑦ Was there any explanation to the limitations or weaknesses of the systematic review? ⑧ Were the problems to be solved in the next stage put forward? ⑨ Were the abstracts and full-texts reported sufficiently? ⑩ Were the systematic reviews helpful in solving practical problems? Additionally, the readers were divided into the four groups based on their application of the systematic reviews: health policy makers, health care suppliers, researchers as well as patients and common people.
Conclusion 　The reading of the systematic reviews should be stressed in order to better guide decision-making and promote evidence-based practice.

Citation： CHEN Yaolong,WANG Mengshu,ZHANG Wenjuan,LIU Tinglan,WANG Ziwei,ZHAO YuHAO Wanjia,WU Yuanyuan,ZHANG Yuting,LI Youping. How to Read a Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(9): 1010-1017. doi: 10.7507/1672-2531.20090178 Copy

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4.	陈耀龙, 杜亮, 何丹端,等. 《中国循证医学杂志》作者阅读习惯调查. 中国循证医学杂, 2008, 5(5): 312-314.
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8.	McKibbon KA, Wilczynski NL, Haynes RB. What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals? BMC Med, 2004, 2: 33.
9.	陈耀龙, 艾昌林, 李幼平. “循证”冠名的医学期刊比较研究. 中国循证医学杂志, 2007, 7(4): 289-295.
10.	Sackett DL, Haynes RB. 13 steps, 100 people, and 1 000 000 thanks [Editorial]. ACP J Club, 1997, 127: A14.
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19.	Shojania KG, Sampson M, Ansari MT, et al. How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med, 2007,147:224-233.
20.	Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, DC: U.S. Department of Health and Human Services; 2008. http://aidsinfo.nih.gov/contentfiles/ adultandadolescentgl.pdf on 1 December 2008.
21.	LeLorier J, Grégoire G, Benhaddad A, et al. Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med, 1997, 337(8): 536-542.
22.	Yusuf S, Teo K, Woods K. Intravenous magnesium in acute myocardial infarction. An effective, safe, simple, and inexpensive intervention. Circulation, 1993, 87(6): 2043-2046.
23.	ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. Lancet, 1995, 345(8951): 669-685.
24.	Moher D, Tsertsvadze A. Systematic reviews: when is an update an update? Lancet, 2006, 367: 881-883.
25.	Moher D, Tsertsvadze A, Tricco A, et al. When and how to update systematic reviews. Cochrane Database of Systematic Reviews. 2008, Issue 1. Art. No.: MR000023. DOI: 10.1002/14651858.MR000023. pub3.
26.	Whitlock EP, Lin JS, Chou R, et al. Using existing systematic reviews in complex systematic reviews. Ann Intern Med, 2008, 148: 776-782.
27.	Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ, 1994, 309: 1286-1291.
28.	Mallett S, Hopewell S, Clarke M. Grey literature in systematic reviews: The first 1000 Cochrane systematic reviews. Fourth Symposium on Systematic Reviews: Pushing the Boundaries, Oxford (UK), 2002.
29.	Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. quality of reporting of meta-analyses. Lancet, 1999, 354(9193): 1896-1900.
30.	Smith ML. Publication bias and meta-analysis. Eval Educ,1980, 4: 22-24.
31.	McAuley L, Moher D, Tugwell P. The influence of grey literature on meta-analysis. MSc Thesis: University of Ottawa, 1999.
32.	Moher D, Pham B, Klassen TP, et al. Does the language of publication of reports of randomized trials influence the estimates of intervention effectiveness reported in meta-analyses? 6th Cochrane Colloquium; 1998.
33.	Grégoire G, Derderian F, Le Lorier J. Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias? J Clin Epidemiol, 1995, 48(1): 159-163.
34.	Moher D, Fortin P, Jadad AR, et al. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews. Lancet, 1996, 347: 363-366.
35.	Egger M, Zellweger-Zähner T, Schneider M, et al. Language bias in randomised controlled trials published in English and German. Lancet, 1997, 350: 326-359.
36.	Moher D, Jadad AR, Nichol G, et al. Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists. Control Clin Trials, 1995, 16(1): 62-73.
37.	李静, 李幼平. 不断完善与发展的Cochrane系统评价. 中国循证医学杂志, 2008, 8(9): 742-743.
38.	孙玉亮, 赵今, 吴泰相等. 口腔扁平苔藓治疗的系统评价. 中国循证医学杂志, 2009, 9(3): 323-330.
39.	Bero L, Rennie D. The Cochrane Collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care. J Am Med Ass, 1995, 274(24): 1935-1938.
40.	Sacks HS, Berrier J, Reitman D, et al. Meta-analyses of randomized controlled trials. N Engl J Med, 1987, 316: 450-455.
41.	Sacks HS, Reitman D, Pagano D, et al. Meta-analysis: an update. Mt Sinai J Med, 1996; 63: 216-224.
42.	Unknown. Available from: http://group.bmj.com/products/evidencecentre/ evidence-based-medicine-resources/20-10-08.pdf/view. Accessed on 2009-4-5.
43.	Hopewell S, Clarke M, Moher D, et al. CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration. PLoS Med, 5(1): e20.
44.	Drummond MF, Sculpher MJ, Torrance GW, 等. 卫生保健项目经济学评估方法. 第3版. 李士雪, 主译. 北京:人民卫生出版社. 2008. 320.
45.	Swingler GH, Volmink J, Ioannidis JP. Number of published systematic reviews and global burden of disease: database analysis. BMJ, 2003, 327(7423): 1083-1084.
46.	Waters E, Doyle J. Systematic reviews of public health in developing countries are in train. BMJ, 2004, 328(7439): 585.
47.	Chinnock P, Siegfried N, Clarke M. Is evidence-based medicine relevant to the developing world? PLoS Med, 2005, 2(5): e107.
48.	West S, King V, Carey TS, et al. Systems to Rate the Strength of Scientific Evidence. Evidence Report/Technology Assessment No.
49.	(Prepared by the Research Triangle Institute–University of North Carolina Evidence-based Practice Center under Contract No. 290-97-0011). AHRQ Publication No. 02-E016. Rockville, MD: Agency for Healthcare Research and Quality. April 2002.
50.	Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44: 1271-1278.
51.	Oxman AD, Guyatt GH, Singer J, et al. Agreement among reviewers of review articles. J Clin Epidemiol, 1991, 44: 91-98.
52.	Irwig L, Tosteson AN, Gatsonis C, et al. Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med, 1994, 120: 667-676.
53.	Sacks HS, Reitman D, Pagano D, et al. Meta-analysis: an update. Mt Sinai J Med, 1996, 63: 216-224.
54.	Auperin A, Pignon JP, Poynard T. Review article: critical review of meta-analyses of randomized clinical trials in hepatogastroenterology. Alimentary Pharmacol Ther, 1997, 11: 215-225.
55.	Beck CT. Use of meta-analysis as a teaching strategy in nursing research courses. J Nurs Educ, 1997, 36: 87-90.
56.	Smith AF. An analysis of review articles published in four anaesthesia journals. Can J Anaesth, 1997, 44: 405-409.
57.	Barnes DE, Bero LA. Why review articles on the health effects of passive smoking reach different conclusions. JAMA, 1998, 279: 1566-1570.
58.	Clarke M, Oxman AD. Cochrane Reviewer’s Handbook 4.0. The Cochrane Collaboration; 1999.
59.	Khan KS, Ter Riet G, Glanville J, et al. Undertaking Systematic Reviews of Research on Effectiveness. CRD’s Guidance for Carrying Out or Commissioning Reviews: York, England: University of York, NHS Centre for Reviews and Dissemination; 2000.
60.	New Zealand Guidelines Group. Tools for Guideline Development & Evaluation. http://www.nzgg.org.nz/.
61.	Harbour R, Miller J. A new system [Scottish Intercollegiate Guidelines Network (SIGN)] for grading recommendations in evidence based guidelines. BMJ, 2001, 323: 334-336.
62.	Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med, 1997, 126: 376-380.
63.	Hunt DL, McKibbon KA. Locating and appraising systematic reviews. Ann Intern Med, 1997, 126: 532-538.
64.	McQuay HJ, Moore A. Using numerical results from systematic reviews in clinical practice. Ann Intern Med, 1997, 126: 712-720.
65.	Badgett RG, O’Keefe M, Henderson MC. Using systematic reviews in clinical education. Ann Intern Med, 1997, 126: 886-891.
66.	Bero LA, Jadad AR. How consumers and policymakers can use systematic reviews for decision making. Ann Intern Med, 1997, 127: 37-42.
67.	Cook DJ, Greengold NL, Ellrodt AG, et al. The relation between systematic reviews in practice guidelines. Ann Intern Med, 1997, 127: 210-216.
68.	Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med, 1997, 127: 380-387.
69.	Meade MO, Richardson WS. Selecting and appraising studies for a systematic review. Ann Intern Med, 1997, 127: 531-537.
70.	Lau J, Ioannidis JP, Schmid CH. Quantitative synthesis in systematic reviews. Ann Intern Med, 1997, 127: 820-826.
71.	Cooper HM. Chief editor.The analysis and interpretation stage. In: The Integrative Research Review: A Systematic Approach. Beverly Hills, CA: Sage. 1984: 79-113.
72.	Bero LA, Jadad AR. How consumers and policymakers can use systematic reviews for decision making. Ann Intern Med, 1997, 127(1):37-42.
73.	Mulrow C, Langhorne P, Grimshaw J. Integrating Heterogeneous Pieces of Evidence in Systematic Reviews. Ann Intern Med, 127(11): 989-995.
74.	Leeflang MM, Deeks JJ, Gatsonis C, et al. Systematic reviews of diagnostic test accuracy. Ann Intern Med, 2008, 149(12): 889-897.
75.	Hayden JA, Côté P, Bombardier C. Evaluation of the Quality of Prognosis Studies in Systematic Reviews. Ann Intern Med, 2006, 144(6): 427-437.

1. Unknown. Available from: http://www.ulrichsweb.com/ulrichsweb, accessed on 2009-03-15.
2. How to read clinical journals: I. why to read them and how to start reading them critically. Can Med Assoc J, 1981, 124(5): 555-558.
3. Sackett DL, Richardson WS, Rosenberg W, et al. Evidence-based medicine. How to practice and teach EBM. Edinburgh: Chrurchill Livingston, 1997, 1-60.
4. 陈耀龙, 杜亮, 何丹端,等. 《中国循证医学杂志》作者阅读习惯调查. 中国循证医学杂, 2008, 5(5): 312-314.
5. Boseley S. News report. The Guardian, June 24, 1998.
6. 0000 articles or 120? Evid. Based Med, 2006, 11: 40.
7. Mike Wilson. Evidence-Based Medicine: would you rather read.
8. McKibbon KA, Wilczynski NL, Haynes RB. What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals? BMC Med, 2004, 2: 33.
9. 陈耀龙, 艾昌林, 李幼平. “循证”冠名的医学期刊比较研究. 中国循证医学杂志, 2007, 7(4): 289-295.
10. Sackett DL, Haynes RB. 13 steps, 100 people, and 1 000 000 thanks [Editorial]. ACP J Club, 1997, 127: A14.
11. Trisha Greenhalgh. How to Read a Paper: The Basics of Evidence- Based Medicine. 3 edition. 2006. 114-134.
12. Unknown. Available from http://www.systematic-reviews.com. Available .Accessed on 2009-3-15.
13. Unknown. Available from http://www.unitedbiosource.comhttp:// www.systematic-reviews.com.Accessed on 2009-3-15.
14. Becker LA, Oxman AD. Chapter 22: Overviews of reviews. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www. cochranehandbook.org.
15. Russell K, Kiddoo D. The Cochrane Library and nocturnal enuresis: an umbrella review. Evid-Based Child Health, 2006, 1: 5-8.
16. Unknown. Available from http://clinicalevidence.bmj.com/ceweb/ conditions/chd/0305/0305.jsp.Accessed on 2009-3-15.
17. Unknown. Available from http://www3.interscience.wiley.com/ journal/112100413/home,Accessed on 2009-3-15.
18. Moher D, Tetzlaff J, Tricco AC, et al. Epidemiology and reporting characteristics of systematic reviews. PLoS Med, 2007, 4(3): e78.
19. Shojania KG, Sampson M, Ansari MT, et al. How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med, 2007,147:224-233.
20. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, DC: U.S. Department of Health and Human Services; 2008. http://aidsinfo.nih.gov/contentfiles/ adultandadolescentgl.pdf on 1 December 2008.
21. LeLorier J, Grégoire G, Benhaddad A, et al. Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med, 1997, 337(8): 536-542.
22. Yusuf S, Teo K, Woods K. Intravenous magnesium in acute myocardial infarction. An effective, safe, simple, and inexpensive intervention. Circulation, 1993, 87(6): 2043-2046.
23. ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. Lancet, 1995, 345(8951): 669-685.
24. Moher D, Tsertsvadze A. Systematic reviews: when is an update an update? Lancet, 2006, 367: 881-883.
25. Moher D, Tsertsvadze A, Tricco A, et al. When and how to update systematic reviews. Cochrane Database of Systematic Reviews. 2008, Issue 1. Art. No.: MR000023. DOI: 10.1002/14651858.MR000023. pub3.
26. Whitlock EP, Lin JS, Chou R, et al. Using existing systematic reviews in complex systematic reviews. Ann Intern Med, 2008, 148: 776-782.
27. Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ, 1994, 309: 1286-1291.
28. Mallett S, Hopewell S, Clarke M. Grey literature in systematic reviews: The first 1000 Cochrane systematic reviews. Fourth Symposium on Systematic Reviews: Pushing the Boundaries, Oxford (UK), 2002.
29. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. quality of reporting of meta-analyses. Lancet, 1999, 354(9193): 1896-1900.
30. Smith ML. Publication bias and meta-analysis. Eval Educ,1980, 4: 22-24.
31. McAuley L, Moher D, Tugwell P. The influence of grey literature on meta-analysis. MSc Thesis: University of Ottawa, 1999.
32. Moher D, Pham B, Klassen TP, et al. Does the language of publication of reports of randomized trials influence the estimates of intervention effectiveness reported in meta-analyses? 6th Cochrane Colloquium; 1998.
33. Grégoire G, Derderian F, Le Lorier J. Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias? J Clin Epidemiol, 1995, 48(1): 159-163.
34. Moher D, Fortin P, Jadad AR, et al. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews. Lancet, 1996, 347: 363-366.
35. Egger M, Zellweger-Zähner T, Schneider M, et al. Language bias in randomised controlled trials published in English and German. Lancet, 1997, 350: 326-359.
36. Moher D, Jadad AR, Nichol G, et al. Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists. Control Clin Trials, 1995, 16(1): 62-73.
37. 李静, 李幼平. 不断完善与发展的Cochrane系统评价. 中国循证医学杂志, 2008, 8(9): 742-743.
38. 孙玉亮, 赵今, 吴泰相等. 口腔扁平苔藓治疗的系统评价. 中国循证医学杂志, 2009, 9(3): 323-330.
39. Bero L, Rennie D. The Cochrane Collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care. J Am Med Ass, 1995, 274(24): 1935-1938.
40. Sacks HS, Berrier J, Reitman D, et al. Meta-analyses of randomized controlled trials. N Engl J Med, 1987, 316: 450-455.
41. Sacks HS, Reitman D, Pagano D, et al. Meta-analysis: an update. Mt Sinai J Med, 1996; 63: 216-224.
42. Unknown. Available from: http://group.bmj.com/products/evidencecentre/ evidence-based-medicine-resources/20-10-08.pdf/view. Accessed on 2009-4-5.
43. Hopewell S, Clarke M, Moher D, et al. CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration. PLoS Med, 5(1): e20.
44. Drummond MF, Sculpher MJ, Torrance GW, 等. 卫生保健项目经济学评估方法. 第3版. 李士雪, 主译. 北京:人民卫生出版社. 2008. 320.
45. Swingler GH, Volmink J, Ioannidis JP. Number of published systematic reviews and global burden of disease: database analysis. BMJ, 2003, 327(7423): 1083-1084.
46. Waters E, Doyle J. Systematic reviews of public health in developing countries are in train. BMJ, 2004, 328(7439): 585.
47. Chinnock P, Siegfried N, Clarke M. Is evidence-based medicine relevant to the developing world? PLoS Med, 2005, 2(5): e107.
48. West S, King V, Carey TS, et al. Systems to Rate the Strength of Scientific Evidence. Evidence Report/Technology Assessment No.
49. (Prepared by the Research Triangle Institute–University of North Carolina Evidence-based Practice Center under Contract No. 290-97-0011). AHRQ Publication No. 02-E016. Rockville, MD: Agency for Healthcare Research and Quality. April 2002.
50. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44: 1271-1278.
51. Oxman AD, Guyatt GH, Singer J, et al. Agreement among reviewers of review articles. J Clin Epidemiol, 1991, 44: 91-98.
52. Irwig L, Tosteson AN, Gatsonis C, et al. Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med, 1994, 120: 667-676.
53. Sacks HS, Reitman D, Pagano D, et al. Meta-analysis: an update. Mt Sinai J Med, 1996, 63: 216-224.
54. Auperin A, Pignon JP, Poynard T. Review article: critical review of meta-analyses of randomized clinical trials in hepatogastroenterology. Alimentary Pharmacol Ther, 1997, 11: 215-225.
55. Beck CT. Use of meta-analysis as a teaching strategy in nursing research courses. J Nurs Educ, 1997, 36: 87-90.
56. Smith AF. An analysis of review articles published in four anaesthesia journals. Can J Anaesth, 1997, 44: 405-409.
57. Barnes DE, Bero LA. Why review articles on the health effects of passive smoking reach different conclusions. JAMA, 1998, 279: 1566-1570.
58. Clarke M, Oxman AD. Cochrane Reviewer’s Handbook 4.0. The Cochrane Collaboration; 1999.
59. Khan KS, Ter Riet G, Glanville J, et al. Undertaking Systematic Reviews of Research on Effectiveness. CRD’s Guidance for Carrying Out or Commissioning Reviews: York, England: University of York, NHS Centre for Reviews and Dissemination; 2000.
60. New Zealand Guidelines Group. Tools for Guideline Development & Evaluation. http://www.nzgg.org.nz/.
61. Harbour R, Miller J. A new system [Scottish Intercollegiate Guidelines Network (SIGN)] for grading recommendations in evidence based guidelines. BMJ, 2001, 323: 334-336.
62. Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med, 1997, 126: 376-380.
63. Hunt DL, McKibbon KA. Locating and appraising systematic reviews. Ann Intern Med, 1997, 126: 532-538.
64. McQuay HJ, Moore A. Using numerical results from systematic reviews in clinical practice. Ann Intern Med, 1997, 126: 712-720.
65. Badgett RG, O’Keefe M, Henderson MC. Using systematic reviews in clinical education. Ann Intern Med, 1997, 126: 886-891.
66. Bero LA, Jadad AR. How consumers and policymakers can use systematic reviews for decision making. Ann Intern Med, 1997, 127: 37-42.
67. Cook DJ, Greengold NL, Ellrodt AG, et al. The relation between systematic reviews in practice guidelines. Ann Intern Med, 1997, 127: 210-216.
68. Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med, 1997, 127: 380-387.
69. Meade MO, Richardson WS. Selecting and appraising studies for a systematic review. Ann Intern Med, 1997, 127: 531-537.
70. Lau J, Ioannidis JP, Schmid CH. Quantitative synthesis in systematic reviews. Ann Intern Med, 1997, 127: 820-826.
71. Cooper HM. Chief editor.The analysis and interpretation stage. In: The Integrative Research Review: A Systematic Approach. Beverly Hills, CA: Sage. 1984: 79-113.
72. Bero LA, Jadad AR. How consumers and policymakers can use systematic reviews for decision making. Ann Intern Med, 1997, 127(1):37-42.
73. Mulrow C, Langhorne P, Grimshaw J. Integrating Heterogeneous Pieces of Evidence in Systematic Reviews. Ann Intern Med, 127(11): 989-995.
74. Leeflang MM, Deeks JJ, Gatsonis C, et al. Systematic reviews of diagnostic test accuracy. Ann Intern Med, 2008, 149(12): 889-897.
75. Hayden JA, Côté P, Bombardier C. Evaluation of the Quality of Prognosis Studies in Systematic Reviews. Ann Intern Med, 2006, 144(6): 427-437.

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How to Read a Systematic Review

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