Users’ Guides to the Medical Literature

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The Users’ Guides to the Medical Literature is a series of articles originally published in the Journal of the American Medical Association[1], now rewritten and compiled in a textbook format[2]. The guides provide practical, clinician-friendly advice on all aspects of Evidence-based medicine.

Contents

[edit] The Evolution of the Users’ Guides

During the late 1970s, a group of clinical epidemiologists at McMaster University including Dr. David Sackett prepared a series of articles to assist clinicians interpreting clinical research. These articles, introducing the term “critical appraisal”, appeared in the Canadian Medical Association Journal beginning in 1981 and were immensely popular.

In 1990, Dr. Gordon Guyatt introduced the term "Evidence-based medicine”, to describe a paradigm shift in medical practice that stresses the role of rigorous, systematic evidence from clinical research in conjunction with patients’ values and preferences in clinical decision-making[3]. A group of academic physicians subsequently formed the first international Evidence-based Medicine Working Group and published an article expanding on the concept of Evidence-based medicine[4].

The Evidence-based Medicine Working Group next decided to build on the popular series in the Canadian Medical Association Journal by creating a more practical approach to applying the medical literature to clinical practice. Championed by Dr. Drummond Rennie, an editor of the Journal of the American Medical Association, the result was the Users’ Guides. The guides originally consisted of 25 articles published in JAMA between 1993 and 2000, describing approaches to different types of medical questions and the study designs that may answer them [1].

More recently, Dr. Guyatt and Dr. Rennie have edited the articles and compiled them to form a book, titled “Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice”[2].

[edit] Format of the Users’ Guides Books

The Users’ Guides books come in two versions. The Essentials introduces the concepts of Evidence-based medicine, with which every practicing clinician should be familiar. The Manual provides a comprehensive, in-depth exploration of the EBM concepts for clinicians seeking a deeper understanding of EBM, or for those who wish to role-model and teach EBM.

The books teach a systematic approach to reading and applying the medical literature to individual patient care. It focuses on three questions: 1. Whether new information is likely to be true, 2. What the information says about patient care, and 3. How the information can be used. To demonstrate the clinical relevance of the suggested approach, each section begins with a practical clinical scenario. The chapter is then structured around identifying the best available evidence and applying the three key questions to the evidence, in the context of the clinical scenario. Each chapter concludes with a resolution of the scenario.

Most of the book chapters are based on specific types of clinical questions, including questions of therapy, harm, diagnosis, and prognosis. Other chapters deal with general skills that are important for all clinical questions, such as “Finding the Evidence”, “Summarizing the Evidence”, and “Moving From Evidence to Action”. This highly structured format allows readers to quickly locate the information they need to incorporate EBM into their practice. While readers will enjoy reading the book from cover to cover, they need not do so- the Users’ Guides functions equally well as a reference book to be called upon as needed.

The Users’ Guides is also available in Web-based formats for clinicians that prefer electronic material. The website includes a large number of additional aids for the practice of EBM.

[edit] Who Should Read This Book?

Readers of the British Medical Journal recently ranked Evidence-Based Medicine as one of the ten most important medical breakthroughs of the twentieth century[5]. Clinicians who wish to understand the medical literature, and use it effectively in solving patient problems must have a firm understanding of the principles of EBM. The Essentials Users’ Guides provides the optimal introduction to familiarize clinicians with the tools needed to practice EBM.

Individuals with a higher understanding of EBM will find the detailed discussions in Part 2 useful to teach others the practice of EBM and for themselves to reach a higher level of proficiency in using the medical literature.

In summary, all practitioners and educators will find this book useful in their daily practices. The Users’ Guides to the Medical Literature should be a fixture on every clinician’s bookshelf.

[edit] References

  1. ^ a b Guyatt GH, Rennie D. Users' guides to the medical literature. JAMA. 1993; 270:2096-2097.
  2. ^ a b Users' Guides to the Medical Literature: A Manual of Evidence-Based Clinical Practice. Guyatt GH, Rennie D, eds. Chicago, IL: AMA Press; 2002.
  3. ^ Guyatt GH. Evidence-based medicine. ACP Journal Club. 1991;114:A-16.
  4. ^ Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to the teaching of medicine. JAMA. 1992;268:2420-2425.
  5. ^ Medical Milestones 2007. BMJ. 334:s2.