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How to Read a Paper: The Basics of Evidence-Based Medicine, 5th Edition

April 2014, ©2014, BMJ Books
How to Read a Paper: The Basics of Evidence-Based Medicine, 5th Edition (EHEP003117) cover image


The best-selling introduction to evidence-based medicine

In a clear and engaging style, How to Read a Paper demystifies evidence-based medicine and explains how to critically appraise published research and also put the findings into practice.

An ideal introduction to evidence-based medicine, How to Read a Paper explains what to look for in different types of papers and how best to evaluate the literature and then implement the findings in an evidence-based, patient-centred way. Helpful checklist summaries of the key points in each chapter provide a useful framework for applying the principles of evidence-based medicine in everyday practice.

This fifth edition has been fully updated with new examples and references to reflect recent developments and current practice. It also includes two new chapters on applying evidence-based medicine with patients and on the common criticisms of evidence-based medicine and responses.

How to Read a Paper is a standard text for medical and nursing schools as well as a friendly guide for everyone wanting to teach or learn the basics of evidence-based medicine.

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Table of Contents

Foreword to the first edition by Professor Sir DavidWeatherall, xiii

Preface to the first edition: do you need to read this book? xvii

Preface to the fifth edition, xix

Acknowledgements, xxi

Chapter 1 Why read papers at all? 1

Does ‘evidence-based medicine’ simply mean ‘reading papers in medical journals’? 1

Why do people sometimes groan when you mention evidence-based medicine? 4

Before you start: formulate the problem, 10

References, 13

Chapter 2 Searching the literature, 15

What are you looking for? 16

Levels upon levels of evidence, 17

Synthesised sources: systems, summaries and syntheses, 17

Pre-appraised sources: synopses of systematic reviews and primary studies, 21

Specialised resources, 22

Primary studies – tackling the jungle, 23

One-stop shopping: federated search engines, 24

Asking for help and asking around, 25

Online tutorials for effective searching, 26

References, 26

Chapter 3 Getting your bearings: what is this paper about? 28

The science of ‘trashing’ papers, 28

Three preliminary questions to get your bearings, 30

Randomised controlled trials, 34

Cohort studies, 38

Case–control studies, 39

Cross-sectional surveys, 40

Case reports, 40

The traditional hierarchy of evidence, 41

A note on ethical considerations, 42

References, 43

Chapter 4 Assessing methodological quality, 45

Was the study original? 45

Whom is the study about? 46

Was the design of the study sensible? 47

Was systematic bias avoided or minimised? 49

Was assessment ‘blind’? 53

Were preliminary statistical questions addressed? 54

Summing up, 57

References, 58

Chapter 5 Statistics for the non-statistician, 60

How can non-statisticians evaluate statistical tests? 60

Have the authors set the scene correctly? 62

Paired data, tails and outliers, 68

Correlation, regression and causation, 70

Probability and confidence, 72

The bottom line, 74

Summary, 76

References, 76

Chapter 6 Papers that report trials of drug treatments and other simple interventions, 78

‘Evidence’ and marketing, 78

Making decisions about therapy, 80

Surrogate endpoints, 81

What information to expect in a paper describing a randomised controlled trial: the CONSORT statement, 84

Getting worthwhile evidence out of a pharmaceutical representative, 86

References, 88

Chapter 7 Papers that report trials of complex interventions, 90

Complex interventions, 90

Ten questions to ask about a paper describing a complex intervention, 92

References, 97

Chapter 8 Papers that report diagnostic or screening tests, 99

Ten men in the dock, 99

Validating diagnostic tests against a gold standard, 100

Ten questions to ask about a paper that claims to validate a diagnostic or screening test, 105

Likelihood ratios, 110

Clinical prediction rules, 111

References, 113

Chapter 9 Papers that summarise other papers (systematic reviews and meta-analyses), 116

When is a review systematic? 116

Evaluating systematic reviews, 119

Meta-analysis for the non-statistician, 124

Explaining heterogeneity, 128

New approaches to systematic review, 132

References, 132

Chapter 10 Papers that tell you what to do (guidelines), 135

The great guidelines debate, 135

How can we help ensure that evidence-based guidelines are followed? 138

Ten questions to ask about a clinical guideline, 141

References, 148

Chapter 11 Papers that tell you what things cost (economic analyses), 150

What is economic analysis? 150

Measuring costs and benefits of health interventions, 151

References, 162

Chapter 12 Papers that go beyond numbers (qualitative research), 164

What is qualitative research? 164

Evaluating papers that describe qualitative research, 168

References, 176

Chapter 13 Papers that report questionnaire research, 178

The rise and rise of questionnaire research, 178

Ten questions to ask about a paper describing a questionnaire study, 179

References, 188

Chapter 14 Papers that report quality improvement case studies, 190

What are quality improvement studies – and how should we research them? 190

Ten questions to ask about a paper describing a quality improvement initiative, 193

References, 200

Chapter 15 Getting evidence into practice, 202

Why are health professionals slow to adopt evidence-based practice? 202

How much avoidable suffering is caused by failing to implement evidence? 204

How can we influence health professionals’ behaviour to promote evidence-based practice? 205

What does an ‘evidence-based organisation’ look like? 210

How can we help organisations develop the appropriate structures, systems and values to support evidence-based practice? 212

References, 217

Chapter 16 Applying evidence with patients, 221

The patient perspective, 221

PROMs, 223

Shared decision-making, 224

Option grids, 226

n of 1 trials and other individualised approaches, 229

References, 230

Chapter 17 Criticisms of evidence-based medicine, 233

What’s wrong with EBM when it’s done badly? 233

What’s wrong with EBM when it’s done well? 235

Why is ‘evidence-based policymaking’ so hard to achieve? 238

References, 240

Appendix 1 Checklists for finding, appraising and implementing evidence, 242

Appendix 2 Assessing the effects of an intervention, 252

Index, 253

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Author Information

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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“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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