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Glasziou PP, Irwig L, Bain C, et al. Systematic reviews in health care. Cambridge: Cambridge University Press, 2001. 148 p.
  1. Chris Cates, MA, FRCGP
  1. St George’s Hospital Medical School
 London, UK

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    A key issue in carrying out systematic reviews is to clarify the question that we are seeking to answer. The first chapter of this book provides a clear description of the different types of question that may arise in relation to interventions, risks, prognosis, diagnostic accuracy, and phenomena. The subsequent sections go on to discuss the processes involved in carrying out a systematic review of the literature in order to try to answer these questions, including the considerable challenges of finding, appraising, and possibly synthesising suitable studies. I found the chapter on applying the results particularly thought provoking, as this is often a major challenge in clinical practice.

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    As well as the more established methods in relation to systematic reviews of interventions, the book goes on to cover the emerging fields of systematic reviews of diagnostic tests, prognosis, and aetiology. The structured approach is very helpful, but inevitably there are times when it feels as if there are more questions than answers. I think it is unrealistic to expect a clinician or student in public health to be able to undertake a good review after merely reading this book. Perhaps the comment in the introduction that it may take 30 person-weeks of full time work to complete a systematic review should serve as a warning in this respect. The book provides appendices to help with literature searching and some guides to available software, but unless the reader has considerable experience in these areas, it would be wise to consider enlisting the help of an information scientist in planning and carrying out literature searches and a statistician to assist with the analysis of the study results.

    Before embarking on a review yourself, I would agree with the authors’ recommendation to at least check the Cochrane Library to see if someone has already done the hard work for you (especially if the question relates to an intervention). Moreover the Cochrane Review Groups can provide help and support in carrying out reviews, so it is worth getting in touch before trying to go it alone. In my experience, the best systematic reviews are carried out by a team of reviewers who cover clinical and methodological expertise.

    There are plenty of nuggets for those who are interested in the challenges involved in carrying out systematic reviews of important issues in clinical practice and in public health. Reading this book is likely to help anyone trying to use the results of reviews to guide their practice. It will also help those who are asked to be peer reviewers, but I think it is pitched a bit higher than the introduction suggests, and some of the book is well beyond the basics.


    Clinical usefulness ★★★★☆

    Methods ★★★☆☆

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