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

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

Table of Contents

Title Page



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 fifth edition


Chapter 1: Why read papers at all?

Does ‘evidence-based medicine’ simply mean ‘reading papers in medical journals’?
Why do people sometimes groan when you mention evidence-based medicine?
Before you start: formulate the problem

Chapter 2: Searching the literature

What are you looking for?
Levels upon levels of evidence
Synthesised sources: systems, summaries and syntheses
Pre-appraised sources: synopses of systematic reviews and primary studies
Specialised resources
Primary studies—tackling the jungle
One-stop shopping: federated search engines
Asking for help and asking around
Online tutorials for effective searching

Chapter 3: Getting your bearings: what is this paper about?

The science of ‘trashing’ papers
Three preliminary questions to get your bearings
Randomised controlled trials
Cohort studies
Case–control studies
Cross-sectional surveys
Case reports
The traditional hierarchy of evidence
A note on ethical considerations

Chapter 4: Assessing methodological quality

Was the study original?
Whom is the study about?
Was the design of the study sensible?
Was systematic bias avoided or minimised?
Was assessment ‘blind’?
Were preliminary statistical questions addressed?
Summing up

Chapter 5: Statistics for the non-statistician

How can non-statisticians evaluate statistical tests?
Have the authors set the scene correctly?
Paired data, tails and outliers
Correlation, regression and causation
Probability and confidence
The bottom line

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

‘Evidence’ and marketing
Making decisions about therapy
Surrogate endpoints
What information to expect in a paper describing a randomised controlled trial: the CONSORT statement
Getting worthwhile evidence out of a pharmaceutical representative

Chapter 7: Papers that report trials of complex interventions

Complex interventions
Ten questions to ask about a paper describing a complex intervention

Chapter 8: Papers that report diagnostic or screening tests

Ten men in the dock
Validating diagnostic tests against a gold standard
Ten questions to ask about a paper that claims to validate a diagnostic or screening test
Likelihood ratios
Clinical prediction rules

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

When is a review systematic?
Evaluating systematic reviews
Meta-analysis for the non-statistician
Explaining heterogeneity
New approaches to systematic review

Chapter 10: Papers that tell you what to do (guidelines)

The great guidelines debate
How can we help ensure that evidence-based guidelines are followed?
Ten questions to ask about a clinical guideline

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

What is economic analysis?
Measuring costs and benefits of health interventions

Chapter 12: Papers that go beyond numbers (qualitative research)

What is qualitative research?
Evaluating papers that describe qualitative research

Chapter 13: Papers that report questionnaire research

The rise and rise of questionnaire research
Ten questions to ask about a paper describing a questionnaire study

Chapter 14: Papers that report quality improvement case studies

What are quality improvement studies—and how should we research them?
Ten questions to ask about a paper describing a quality improvement initiative

Chapter 15: Getting evidence into practice

Why are health professionals slow to adopt evidence-based practice?
How much avoidable suffering is caused by failing to implement evidence?
How can we influence health professionals' behaviour to promote evidence-based practice?
What does an ‘evidence-based organisation’ look like?
How can we help organisations develop the appropriate structures, systems and values to support evidence-based practice?

Chapter 16: Applying evidence with patients

The patient perspective
Shared decision-making
Option grids
of 1 trials and other individualised approaches

Chapter 17: Criticisms of evidence-based medicine

What's wrong with EBM when it's done badly?
What's wrong with EBM when it's done well?
Why is ‘evidence-based policymaking’ so hard to achieve?

Appendix 1: Checklists for finding, appraising and implementing evidence

Is my practice evidence-based?—a context-sensitive checklist for individual clinical encounters (see Chapter 1)
Checklist for searching (see Chapter 2)
Checklist to determine what a paper is about (see Chapter 3)
Checklist for the methods section of a paper (see Chapter 4)
Checklist for the statistical aspects of a paper (see Chapter 5)
Checklist for material provided by a pharmaceutical company representative (see Chapter 6)
Checklist for a paper describing a study of a complex intervention (see Chapter 7)
Checklist for a paper that claims to validate a diagnostic or screening test (see Chapter 8)
Checklist for a systematic review or meta-analysis (see Chapter 9)
Checklist for a set of clinical guidelines (see Chapter 10)
Checklist for an economic analysis (see Chapter 11)
Checklist for a qualitative research paper (see Chapter 12)
Checklist for a paper describing questionnaire research (see Chapter 13)
Checklist for a paper describing a quality improvement study (see Chapter 14)
Checklist for health care organisations working towards an evidence-based culture for clinical and purchasing decisions (see Chapter 15)

Appendix 2: Assessing the effects of an intervention



This edition first published 2014, © 2010, 2014 by John Wiley & Sons Ltd

BMJ Books is an imprint of BMJ Publishing Group Limited, used under licence by John Wiley & Sons.

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