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
“This book adds much to the evidence-based practice debates. After discussing the mechanics of the evidence, it analyzes why it is difficult to change practice habits and how to address these issues. This is a valuable book for every academic library.” (Doody's, 23 January 2015)

“I would recommend this to anyone who is interested in reading and understanding published research papers but who does not have a scientific background. Enjoy the read then keep for later reference.” (Occupational Medicine, 1 March 2015)

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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   Professor Sir David Weatherall     ix
Preface to the Third Edition     xi
Preface to the First Edition: do you need to read this book?     xiii
Acknowledgements     xv
Why read papers at all?     1
Does 'evidence-based medicine' simply mean 'reading papers in medical journals'?     1
Why do people often groan when you mention evidence-based medicine?     3
Before you start: formulate the problem     9
Searching the literature     15
Searching for evidence: key principles     15
Medline and other 'raw' databases     17
Databases with search filters     20
Databases of pre-appraised articles     21
Databases of synthesised evidence     23
Databases of ongoing research     24
Citation searching     24
Human contact sources     25
Worked examples of search problems     26
Getting your bearings: what is this paper about?     40
The science of 'trashing' papers     40
Three preliminary questions to get your bearings     42
Randomised controlled trials     44
Cohort studies     49
Case-control studies     50
Cross-sectional surveys     51
Case reports     52
The traditional hierarchy of evidence     53
A note on ethical considerations     53
Assessing methodological quality     59
Was the study original?     59
Whom is the study about?     60
Was the design of the study sensible?     61
Was systematic bias avoided or minimised?     62
Was assessment 'blind'?     66
Were preliminary statistical questions addressed?     67
Summing up     70
Statistics for the non-statistician     73
How can non-statisticians evaluate statistical tests?     73
Have the authors set the scene correctly?     74
Paired data, tails and outliers     79
Correlation, regression and causation     81
Probability and confidence     83
The bottom line     86
Summary     88
Papers that report drug trials     90
'Evidence' and marketing     90
Making decisions about therapy     92
Surrogate end points     93
How to get evidence out of a 'drug rep'     96
Papers that report diagnostic or screening tests      100
Ten men in the dock     100
Validating diagnostic tests against a gold standard     101
Ten questions to ask about a paper which claims to validate a diagnostic or screening test     105
A note on likelihood ratios     110
Papers that summarise other papers (systematic reviews and meta-analyses)     114
When is a review systematic?     114
Evaluating systematic reviews     117
Meta-analysis for the non-statistician     122
Explaining heterogeneity     126
New approaches to systematic review     130
Papers that tell you what to do (guidelines)     134
The great guidelines debate     134
How can we help ensure that evidence-based guidelines are followed?     137
Ten questions to ask about a clinical guideline     142
Papers that tell you what things cost (economic analyses)     152
What is economic analysis?     152
Measuring costs and benefits of health interventions     154
Ten questions to ask about an economic analysis     159
Conclusion     163
Papers that go beyond numbers (qualitative research)     166
What is qualitative research?     166
Evaluating papers that describe qualitative research      170
Conclusion     177
Papers that report questionnaire research     180
The rise and rise of questionnaire research     180
Ten questions to ask about a paper describing a questionnaire study     181
Getting evidence into practice     191
Why are health professionals slow to adopt evidence-based practice?     191
How can we influence health professionals' behaviour to promote evidence-based practice?     193
What does an 'evidence-based organisation' look like?     198
What evidenced-based interventions are there for achieving organisational change to support evidence-based practice?     200
Why is it so hard to yet evidence into policy making?     205
Checklists for finding, appraising and implementing evidence     212
Assessing the effects of an intervention     220
Index     221
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