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June 2001

Systematic ReviewsA Critical First Step

Author Affiliations

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Arch Pediatr Adolesc Med. 2001;155(6):636. doi:10.1001/archpedi.155.6.636

CONSISTENT and mounting data indicate that physicians are failing to implement the latest and best evidence in the care of patients—a disturbing indictment of the current practice of medicine. There is a myriad of reasons for this failure, but one of the most fundamental is a paucity of formal summaries of existing data specific to the clinical decisions we are faced with. Archie Cochrane, famed British epidemiologist and patron saint of the Cochrane collaboration once wrote, "It is surely a great criticism of our profession that we have not organized a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials."1 Billions of research dollars are now spent annually to improve health and health care. The burgeoning information superhighway increasingly improves access to the findings of research. But all of the money spent and all of the technology developed may ultimately be of no avail if providers of medical care are expected to individually or collectively process and summarize the state of medical knowledge. It is simply too daunting an endeavor to be foisted on busy practitioners. The undoing of the evidence-based medicine movement may be its implicit expectation that physicians devote time and resources to answering questions on their own entirely from primary sources. That task should rightly fall to those of us committed to the notion that research can improve practice. We must summarize and synthesize the state of medical knowledge so that our colleagues can have quick and ready access to it as needed.

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