Current issues of ACP Journal Club are published in Annals of Internal Medicine


Resource Corner

Essential Evidence-based Medicine

PDF

ACP J Club. 2005 Mar-Apr;142:A12. doi:10.7326/ACPJC-2005-142-2-A12



Essential Evidence-based Medicine is of interest to both basic and advanced students of evidence-based medicine (EBM). The book has 31 chapters and 6 appendices and comes with a CD-ROM. Each chapter starts with several learning objectives and a brief paragraph summarizing the content of the chapter. The first 10 chapters deal with basic epidemiology, including such topics as searching the medical literature, different types of medical literature, study design, strength of evidence, precision and validity of instruments, types of bias, basic statistics, and principles of hypothesis testing. Chapters 11 to 17 address critical appraisal and use of articles on therapy. Chapters 18 to 26 discuss evidence-based diagnosis, including usefulness of diagnostic tests, screening tests, likelihood ratios, receiver-operating characteristic curves, Bayes' theorem, and the critical appraisal of diagnostic articles. Chapters 27 to 31 deal with prediction rules, decision analysis, outcome analyses, cost-effectiveness analysis, and meta-analysis. The book contains 39 tables and 118 figures that highlight key points in the chapters.

The accompanying CD-ROM contains multiple-choice questions, short essay questions, and questions requiring calculations and filling out a worksheet. The exercise is interactive and prompts the reader to check the correct answer.

Essential Evidence-based Medicine has an extensive bibliography of relevant references, including other EBM textbooks, and lists important free Web sites related to EBM. The appendices provide additional information, especially grades of evidence, formulas, and critical appraisal questionnaires.

The author is an EBM expert who provides an excellent overview and practical approach to the topic. The book includes a history of medicine and statistics and a thought-provoking essay on what constitutes EBM. Several chapters are dedicated to topics that would normally require reading in additional textbooks, thereby making this an all-in-one resource.

The narrative text of chapters, clinical relevance of the topics, and user-friendly layout make reading this book a pleasure. The chapter on literature searching provides a useful description of MEDLINE and PubMed. The author has taken elaborate care in dedicating separate chapters to number needed to treat, risk assessment, screening tests, and uses of diagnostic tests, which makes reading easy and explains the concept of using EBM in clinical practice. Separate chapters also address evaluation of negative studies and sources of errors in clinical encounters. The chapters on decision making and Bayes' theorem provide a detailed review of the tenets of clinical decision making with its uncertainties and details of probabilistic reasoning.

When we used the SQ3R study method (Survey, Question, Read, Recite, Review) to peruse the contents of each chapter, we found that by converting the headings into questions, we could read each of the paragraphs to answer the question. Students could recite the answers, write key points, and review their notes to revise major points quite easily from the information presentation in this book.

Several chapters on instruments and measurements, incremental gain, and the threshold approach to diagnostic testing, multivariate analysis, type II errors, cost-effectiveness analysis, and outcome analyses may be reserved for advanced learners.

A few limitations are worth noting. In an attempt to combine such a vast amount of information into one book, a few chapters tend to be lengthy. Chapters on the uses of diagnostic tests and sources of bias could be improved by the addition of tables. Finally, despite the book's 2004 publication date, there are few general references more recent than 2002.

In summary, the text is well organized and offers comprehensive information on EBM that would serve both basic and advanced students.

Amit K. Ghosh, MD
Narayana S. Murali, MD
Mayo Clinic College of Medicine
Rochester, Minnesota, USA

Ratings

Methods/Quality of Information: 3 of 5 stars

Clinical Usefulness: 4 of 5 stars

Essential Evidence-based Medicine can be purchased online at www.us.cambridge.org for U.S. $34.99 (softcover) and $80.00 (hardcover).

Meyer D. Essential Evidence-based Medicine. New York: Cambridge University Press; 2004.