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One of the most difficult challenges for physicians involved in clinical practice is to efficiently organize the vast amount of data concerning medical therapeutics. Most of these data come from observational research (i.e. patient medical charts), which are usually useful to standardize clinical practice and therapeutic decisions, however, due to intrinsic biases, are less helpful when used to compare reliability of a particular treatment. Randomized controlled clinical trials have thus been proposed as an effective method to compare treatment results, in an attempt to reduce biases . Conversely, even randomized clinical trials may not be reliable enough to present specific answers, due to weak methodological design, or rather, they may be too small to detect modest differences, which can, on the other hand, be clinically important and realistically expected. Overviews of clinical trials have been essential for physicians to successfully manage he huge amount of written or electronic clinical information, as well as to identify potential areas for scientific research. Although clinical overviews can be very useful, they display a great diversity, ranging from anedoctal reviews to systematic overviews of well conducted trials with appropriate statistic design. An alternative method to analyze the wide range of differences among clinical reviews is to divide in reliable and unreliable, weak and robust, clinical practice modifiers and confounding factors. Performing systematic overviews implies in a formal training in this specific field, not only regarding overview conduction, but mainly analysis of correct clinical information and understanding intrinsic and/or potential limitations. The topic will be discussed thus in a practical way, based on firm methodological grounds which can influence clinical practice. We believe that epidemiological and methodological understanding are essential for medical formation, and are only useful when properly applied to clinical practice, influencing clinical decision-making on daily patient care. Background In the seventies decade, psychologists drew attention to the fact that there was a need to standardize the necessary steps to reduce systematic bias and random errors (chance) in clinical trials overviews. In 1987, Yusuf and Peto outlined the importance of systematic overviews of randomized studies to obtain clinically significant results . It was also in 1987 that Mulrow remarked the poor quality of clinical trials . In 1988, Oxman and Guyatt published guidelines to help physicians to critically evaluate systematic overviews, concerning reliability, results and applicability .

Systematic overviews and meta-analyses in cardiology. Evidence-based cardiology VIII