How to Read a Paper : The Basics of Evidence-Based Medicine

by Greenhalgh, Trisha

• ISBN13: 9781444334364
• ISBN10: 1444334360
• Edition: 4th
• Format: Paperback
• Copyright: 2010-05-24
• Publisher: B M J Books

Summary

The book that health professionals turn to for a full and clear explanation of the principles of evidence-based medicine.

The author's descriptions of clinical research papers and how to critically appraise them are so simply presented as to be understandable by readers at all levels, from student to specialist. Chapters on searching the literature and implementing the evidence provide guidance on using evidence-based medicine in clinical practice.

This fourth edition retains the winning style, and takes in the recent developments and shifts of emphasis in evidence-based medicine and now includes:

-Thoroughly revised and updated chapters on searching, qualitative research, systematic review, and implementing evidence-based practice

-2 new chapters on quality improvement and the emerging field of complex interventions

This new edition will be welcomed by those who teach and those needing to learn the basics of evidence-based medicine.

How to Read a Paper describes the different types of clinical research reporting, and explains how to critically appraise the publications. The book provides the tools to find and evaluate the literature, and implement the findings in an evidence-based, patient-centered way. Written for anyone in the health care professions who has little or no knowledge of evidence-based medicine, it provides a clear understanding of the concepts and how to put them into practice at the basic, clinical level.

Changes for the 4th edition

The fourth edition will include two new chapters on important developments in health care research and delivery, but otherwise retains its original style, size, and scope.

-New chapter on quality improvement – describing papers on quality improvement projects using ebm methods; this will extend the readership to non clinical health care professionals working in hospitals and family practice, and to nurse specialists and practice nurses working in this field

-New chapter on complex interventions - how to set up research projects involving both qualitative and quantitative methodology (known as mixed methods)

-Thorough revision and updating of existing chapters and references

-New illustrations – diagrammatic representations of ebm concepts

Table of Contents

Foreword to the First Edition	p. ix
Preface to the First Edition: do you need to read this book?	p. xii
Preface to the Fourth Edition	p. xiv
Acknowledgements	p. xvi
Why read papers at all?	p. 1
Does 'evidence-based medicine' simply mean 'reading papers in medical journals'?	p. 1
Why do people sometimes groan when you mention EBM?	p. 3
Before you start: formulate the problem	p. 9
Searching the literature	p. 15
What are you looking for?	p. 16
Levels upon levels of evidence	p. 18
Synthesised sources: systems, summaries and syntheses	p. 19
Pre-appraised sources: synopses of systematic reviews and primary studies	p. 23
Specialised resources	p. 23
Primary studies - tackling the jungle	p. 24
One-stop shopping: federated search engines	p. 28
Asking for help and asking around	p. 28
Getting your bearings - what is this paper about?	p. 31
The science of 'trashing' papers	p. 31
Three preliminary question to get your bearings	p. 33
Randomised controlled trials	p. 36
Cohort studies	p. 40
Case-control studies	p. 41
Cross-sectional surveys	p. 42
Case reports	p. 42
The traditional hierarchy of evidence	p. 43
A note on ethical considerations	p. 44
Assessing methodological quality	p. 47
Was the study original?	p. 47
Whom is the study about?	p. 48
Was the design of the study sensible?	p. 49
Was systematic bias avoided or minimised?	p. 51
Was assessment 'blind'?	p. 54
Were preliminary statistical questions addressed?	p. 55
Summing up	p. 58
Statistics for the non-statistician	p. 61
How can non-statisticians evaluate statistical tests?	p. 61
Have the authors set the scene correctly?	p. 62
Paired data, tails, and outliers	p. 68
Correlation, regression and causation	p. 70
Probability and confidence	p. 72
The bottom line	p. 74
Summary	p. 76
Papers that report trials of drug treatments and other simple interventions	p. 78
'Evidence' and marketing	p. 78
Making decisions about therapy	p. 80
Surrogate endpoints	p. 81
What information to expect in a paper describing an RCT: the CONSORT statement	p. 84
Getting worthwhile evidence out of a pharmaceutical representative	p. 84
Papers that report trials of complex interventions	p. 90
Complex interventions	p. 90
Ten questions to ask about a paper describing a complex intervention	p. 92
Papers that report diagnostic or screening tests	p. 98
Ten men in the dock	p. 98
Validating diagnostic tests against a gold standard	p. 99
Ten questions to ask about a paper that claims to validate a diagnostic or screening test	p. 103
Likelihood ratios	p. 108
Clinical prediction rules	p. 109
Papers that summarise other papers (systematic reviews and meta-analyses)	p. 113
When is a review systematic?	p. 113
Evaluating systematic reviews	p. 116
Meta-analysis for the non-statistician	p. 121
Explaining heterogeneity	p. 125
New approaches to systematic review	p. 128
Papers that tell you what to do (guidelines)	p. 132
The great guidelines debate	p. 132
How can we help ensure that evidence-based guidelines are followed?	p. 135
Ten questions to ask about a clinical guideline	p. 139
Papers that tell you what things cost (economic analyses)	p. 149
What is an economic analysis?	p. 149
Measuring the costs and benefits of health interventions	p. 151
Ten questions to ask about an economic analysis	p. 156
Conclusion	p. 160
Papers that go beyond numbers (qualitative research)	p. 163
What is qualitative research?	p. 163
Evaluating papers that describe qualitative research	p. 167
Conclusion	p. 174
Papers that report questionnaire research	p. 177
The rise and rise of questionnaire research	p. 177
Ten questions to ask about a paper describing a questionnaire study	p. 178
Papers that report quality improvement case studies	p. 188
What are quality improvement studies - and how should we research them?	p. 188
Ten questions to ask about a paper describing a quality improvement initiative	p. 190
Conclusion	p. 197
Getting evidence into practice	p. 199
Why are health professionals slow to adopt evidence-based practice?	p. 199
How much avoidable suffering is caused by failing to implement evidence?	p. 201
How can we influence health professionals' behaviour to promote evidence-based practice?	p. 202
What does an 'evidence-based organisation' look like?	p. 208
How can we help organisations develop the appropriate structures, systems and values to support evidence-based practice?	p. 209
Why is it so hard to get evidence into policymaking?	p. 214
Checklists for finding, appraising and implementing evidence	p. 221
Assessing the effects of an intervention	p. 230
Index	p. 231
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