How to Read a Paper: The Basics of Evidence-Based Medicine / Edition 4

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How to Read a Paper is one of the bestselling texts on evidence-based medicine, used by health care professionals and medical students worldwide. Trisha Greenhalgh's ability to explain the basics of evidence-based medicine in an accessible and readable way means the book is an ideal introduction for all, from first year students to experienced practitioners. This is a text that explains the meaning of critical appraisal and terms such as numbers needed to treat, how to search the literature, evaluate the different types of papers and put the conclusions to clinical use.

What's new for the third edition? New discussion putting evidence-based medicine into the current context, with more emphasis on patient perspectives, Increased coverage of qualitative research in evidence-based medicine, New information on literature sources and search mechanisms.

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Editorial Reviews

Doody's Review Service
Reviewer: Martha L Carvour, MD, PhD (University of Iowa College of Public Health)
Description: In only 230 pages, this book (a revision of the third edition of 2006) accomplishes efficiently what many similar books cannot. The author offers a practical, readable summary of the principles of evidence-based medicine for practicing physicians and physicians-in-training.
Purpose: The author aims to provide an accessible introduction to evidence-based medicine and a framework for evaluating the medical literature. She tightly adheres to these objectives, addressing the practical and pressing need for clinicians to read and understand clinical evidence. In a field full of dense methodological texts and frustrated learners, this represents both a worthy aim and a complex undertaking. The author successfully deconstructs what is complex to reveal what is relevant to her readers.
Audience: This is a commendable and practical introduction to the field of evidence-based medicine. Medical students, residents, and fellows will all benefit from the author's approach, and the book fits neatly in the white coat pocket, rendering it both a valuable and portable reference. Practicing physicians wishing to acquaint themselves with the developing field of evidence-based medicine and instructors searching for classroom resources also may want add this book to their professional libraries.
Features: The book successfully covers the basic, practical principles of evidence-based medicine. Although this book does not serve as a primary methodological discussion of study design and data analysis (nor was it intended to do so), readers will learn enough about both of these topics — tailored to the specific types of research most commonly encountered in the clinical literature (systematic reviews, meta-analyses, clinical trials, observational designs, etc.) — to enable a thoughtful review of the medical evidence. Importantly, the author also offers a primer for critical appraisal of the literature — that is, not just the details of study design but the skills required to think critically about it. Sections on economic analyses, qualitative outcomes, and complex interventions help to round out the book. Each section is readable and succinct. Summary tables and appendixes provide quick reference tools, although the number of illustrations is limited.
Assessment: In the rapidly evolving field of evidence-based medicine, this book is an updated yet solid introduction, which both medical practitioners and medical learners can read, understand, and appreciate. Few authors can present such complex and important information in such an efficient and palatable format. Here, Dr. Greenhalgh also expands upon previous editions to include worthwhile discussions of quality improvement research and studies of complex interventions, making this an excellent addition to any medical library.
From the Publisher
"It becomes phenomenal in the transition of empirical medicine to evidence-based medicine
(EBM) ... Even though the book titles the word ‘basics' it is fit enough for advanced level of EBM. (Riper Pdic Bulletin, 1December 2011)

"It is an essential read for all occupational health practitioners in training and those participating in a systematic evidence review or the development of evidence-based practice guidelines." (Occupational Medicine, 11 December 2011)

"To some extent forget the "evidence-based medicine" tag; while some chapters are specific to medical research, many others have generic value for any field of research ... This is a useful supplement that will aid anyone new to the assessment game." (Online Information Review, 2011)

"In summary, this book presents with not only some interesting research material itself, but also provides valuable insight into the reading and interpretation of technical and research papers. As a laboratory professional, this text can help to move you from merely a reader to papers to a user of papers. This step can take you to a new level in your laboratory career. Definitely worth the read or at least the scan." (Advance for Medical Laboratory Professionals, 10 October 2011)

"It will be a great tool for students, teachers and others in the world of academia, as well as patients who want to find out more about their condition, and who are new to reading journal papers and other documents which consider evidence-based medicine . . . It is good to see this book in its 4th edition and this reviewer hopes it continues to be revised as it really does provide a basic one-stop shop if you are new to evidence-based medicine." (The Encephalitis Society, 2011)

"Writing for health students and professionals, and anyone wanting to assess the validity of articles, Greenhalgh (primary health care, Queen Mary, U. of London, UK) explains the principles of evidencebased medicine and how to critically evaluate clinical research papers. She details how to evaluate different types of papers, such as papers on drug treatments and simple interventions, diagnostic and screening tests, those that summarize other papers, guidelines, economic analyses, and qualitative research." (Book News, September 2010)Trisha Greenhalgh is a doctor, not a statistician, and she is writing about a topic, Evidence-Based Medicine (EBM) that might appear at first to be irrelevant to us statisticians. It is not irrelevant. Any statistician who works extensively with health care professionals should embrace the EBM movement." (Journal of Biopharmaceutical Statistics , 2011)

"The book does show you how to put your brain into thinking gear and not just absorb information without thinking about it making this an excellent book. If I can react so strongly in this review, then it has to be worth something." (, July 2010)

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Product Details

  • ISBN-13: 9781444334364
  • Publisher: Wiley
  • Publication date: 6/15/2010
  • Series: HOW - How To Series , #8
  • Edition number: 4
  • Pages: 256
  • Product dimensions: 5.40 (w) x 8.40 (h) x 0.60 (d)

Meet the Author

Trisha Greenhalgh OBE, FRCGP, FRCP, Professor of Primary Health Care and Dean for Research Impact, Barts and the London School of Medicine and Dentistry, London, UK

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Table of Contents

Foreword to the First Edition by Professor Sir David Weatherall.

Preface to the First Edition: do you need to read this book?

Preface to the Fourth Edition.


1 Why read papers at all?

1.1 Does 'evidence-based medicine' simply mean 'reading papers in medical journals'?

1.2 Why do people sometimes groan when you mention EBM?

1.3 Before you start: formulate the problem.

2 Searching the literature.

2.1 What are you looking for?

2.2 Levels upon levels of evidence.

2.3 Synthesised sources: systems, summaries and syntheses.

2.4 Pre-appraised sources: synopses of systematic reviews and primary studies.

2.5 Specialised resources.

2.6 Primary studies – tackling the jungle.

2.7 One-stop shopping: federated search engines.

2.8 Asking for help and asking around.

3 Getting your bearings – what is this paper about?

3.1 The science of 'trashing' papers.

3.2 Three preliminary questions to get your bearings.

3.3 Randomised controlled trials.

3.4 Cohort studies.

3.5 Case-control studies.

3.6 Cross-sectional surveys.

3.7 Case reports.

3.8 The traditional hierarchy of evidence.

3.9 A note on ethical considerations.

4 Assessing methodological quality.

4.1 Was the study original?

4.2 Whom is the study about?

4.3 Was the design of the study sensible?

4.4 Was systematic bias avoided or minimised?

4.5 Was assessment 'blind'?

4.6 Were preliminary statistical questions addressed?

4.7 Summing up.

5 Statistics for the non-statistician.

5.1 How can non-statisticians evaluate statistical tests?

5.2 Have the authors set the scene correctly?

5.3 Paired data, tails, and outliers.

5.4 Correlation, regression and causation.

5.5 Probability and confidence.

5.6 The bottom line.

5.7 Summary.

6 Papers that report trials of drug treatments and other simple interventions.

6.1 ‘Evidence’ and marketing.

6.2 Making decisions about therapy.

6.3 Surrogate endpoints.

6.4 What information to expect in a paper describing an RCT: the CONSORT statement.

6.5 Getting worthwhile evidence out of a pharmaceutical representative.

7 Papers that report trials of complex interventions.

7.1 Complex interventions.

7.2 Ten questions to ask about a paper describing a complex intervention.

8 Papers that report diagnostic or screening tests.

8.1 Ten men in the dock.

8.2 Validating diagnostic tests against a gold standard.

8.3 Ten questions to ask about a paper that claims to validate a diagnostic or screening test.

8.4 Likelihood ratios.

8.5 Clinical prediction rules.

9 Papers that summarise other papers (systematic reviews and meta-analyses).

9.1 When is a review systematic?

9.2 Evaluating systematic reviews.

9.3 Meta-analysis for the non-statistician.

9.4 Explaining heterogeneity.

9.5 New approaches to systematic review.

10 Papers that tell you what to do (guidelines).

10.1 The great guidelines debate.

10.2 How can we help ensure that evidence-based guidelines are followed?

10.3 Ten questions to ask about a clinical guideline.

11 Papers that tell you what things cost (economic analyses).

11.1 What is an economic analysis?

11.2 Measuring the costs and benefits of health interventions.

11.3 Ten questions to ask about an economic analysis.

11.4 Conclusion.

12 Papers that go beyond numbers (qualitative research).

12.1 What is qualitative research?

12.2 Evaluating papers that describe qualitative research.

12.3 Conclusion.

13 Papers that report questionnaire research.

13.1 The rise and rise of questionnaire research.

13.2 Ten questions to ask about a paper describing a questionnaire study.

14 Papers that report quality improvement case studies.

14.1 What are quality improvement studies – and how should we research them?

14.2 Ten questions to ask about a paper describing a quality improvement initiative.

14.3 Conclusion.

15 Getting evidence into practice.

15.1 Why are health professionals slow to adopt evidence-based practice?

15.2 How much avoidable suffering is caused by failing to implement evidence?

15.3 How can we influence health professionals' behaviour to promote evidence-based practice?

15.4 What does an 'evidence-based organisation' look like?

15.5 How can we help organisations develop the appropriate structures, systems and values to support evidence-based practice?

15.6 Why is it so hard to get evidence into policymaking?

Appendix 1 Checklists for finding, appraising and implementing evidence.

Appendix 2 Assessing the effects of an intervention.


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