The book that health professionals turn to for a full and clear explanation of the principles of evidence-based medicine. The author's descriptions of clinical research papers and how to critically appraise them are so simply presented as to be understandable by readers at all levels, from student to specialist. Chapters on searching the literature and implementing the evidence provide guidance on using evidence-based medicine in clinical practice. This fourth edition retains the winning style, and takes in the recent developments and shifts of emphasis in evidence-based medicine and now includes: * Thoroughly revised and updated chapters on searching, qualitative research, systematic review, and implementing evidence-based practice *2 new chapters on quality improvement and the emerging field of complex interventions This new edition will be welcomed by those who teach and those needing to learn the basics of evidence-based medicine. Praise for previous editions "One of the greatest aspects of this book is the section relating to searching the literature and whilst we may think we may all practise this on a fairly regular basis under the assumption that we do a pretty decent job of it, this section holds the key to excelling." -From a review in Urology News "This clear and concise book provides an excellent starting point for those interested in finding their way through the medical literature." -From a review in Palliative Medicine

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. Acknowledgements. 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. Index.