Applying the results of quantitative systematic reviews to clinical practice.

Abstract

ystematic reviews provide the best estimates ofthe true effects (both beneficial and adverse) ofmedical interventions (1). In this era of evidence-based medicine, clinicians are increasingly using sys-tematic reviews to keep up with new evidence and toguide their clinical decision-making. Yet the mainchallenges for clinicians are to translate the results ofsystematic reviews into clinical practice and to pro-vide optimal patient care. This concept is known as“applicability.” Applicability addresses whether aparticular treatment that showed an overall benefit ina study or systematic review can be expected to con-vey the same benefit to an individual patient (2).This paper outlines a framework for how quantita-tive systematic reviews (meta-analyses) should be re-ported and how they may be used to identify thoseindividuals in whom the treatment is likely to do moregood than harm. We illustrate the concepts by usingdata from systematic reviews of ondansetron for thetreatment and prevention of postoperative nausea andvomiting (PONV). Throughout this paper, we use theterms “baseline” and “underlying risk” interchange-ably. Underlying risk is defined as the risk of event fora patient under the control condition; it indicates theaverage risk of a patient if not treated (3).