Evidence based health care workbook : understanding research : for individual and group learning : based on the book how to read a paper

(BMJ Books) Workbook developed from the course material prepared for the London Workshops on teaching Evidence Based Health Care. These workshops have been running since February 1996 and are based on a model originally developed by McMaster University in the early 1990s. Uses previously published papers in the British Medical Journal. Softcover. Contents 5 Preface 7 Acknowledgements 8 UNIT 1 Using this book in learning and teaching 9 BEFORE YOU START – DEFINE YOUR AIMS AND OBJECTIVES 9 AIMS 9 LEARNING OBJECTIVES 10 SET ARTICLES 10 LEARNING IN A GROUP 10 LEARNING ON YOUR OWN 12 FURTHER READING 13 Problem based, small group learning 14 Workshops for teaching evidence-based practice 16 UNIT 2: The principles and practice of evidence based health care 19 SUGGESTED AIM FOR THIS SESSION 19 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 19 SET ARTICLES 19 SUGGESTIONS FOR GROUP EXERCISES 19 SUGGESTIONS FOR INDIVIDUAL STUDY 20 FURTHER READING 20 Evidence based medicine: what it is and what it isn't 22 Evidence based medicine: an approach to clinical problem-solving 25 EVIDENCE BASED MEDICINE IN PRACTICE 26 OTHER REQUIREMENTS FOR PRACTISING EVIDENCE BASED MEDICINE 29 DOES IT WORK? 30 ADVANTAGES 30 DISADVANTAGES 31 "Is my practice evidence based?" 34 Medicine based evidence, a prerequisite for evidence based medicine 38 Narrative based medicine in an evidence based world 41 UNIT 3 Approaching the literature 45 SUGGESTED AIM FOR THIS SESSION 45 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 45 SET ARTICLES 45 THE FOUR-PART CLINICAL QUESTION 45 SUGGESTIONS FOR GROUP EXERCISE 46 SUGGESTIONS FOR INDIVIDUAL STUDY 46 FURTHER READING 47 How to read a paper: The Medline database 48 Introduction 48 The Medline database 48 Acknowledgements 55 References 55 Appendix 1: Evidence based quality filters for everyday use 56 Appendix 2: Maximally sensitive search strings (to be used mainly for research) 57 Finding information on clinical effectiveness 59 Evidence based information already available 60 Strategies for finding and filtering information 63 Improving dissemination 63 Acknowledgments 65 References 65 UNIT 4 Papers that report drug trials (randomised controlled trials of therapy) 67 BACKGROUND 67 SUGGESTED AIM FOR THIS SESSION 67 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 67 SET ARTICLE 67 ADDITIONAL REPRINT 67 SUGGESTIONS FOR GROUP EXERCISES 68 SUGGESTION FOR INDIVIDUAL STUDY 68 FURTHER READING 68 Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 70 The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials 81 UNIT 5 Numbers needed to treat, odds ratios, and confidence intervals 87 BACKGROUND 87 SUGGESTED AIM FOR THIS SESSION 87 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 87 SET ARTICLES 87 WORKED EXAMPLE:THE FIRST EVER RANDOMISED CONTROLLED TRIAL (SEE REFERENCE LIST FOR DETAILS) 88 A NOTE ON CONFIDENCE INTERVALS 89 FURTHER READING 90 EBM NOTEBOOK On some clinically useful measures of the effects of treatment 91 EBM NOTEBOOK Down with odds ratios! 93 UNIT 6 Papers that address prognosis or harm (cohort studies) 97 BACKGROUND 97 SUGGESTED AIM FOR THIS SESSION 97 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 97 SET ARTICLE 97 SUGGESTIONS FOR GROUP EXERCISES 98 SUGGESTION FOR INDIVIDUAL STUDY 98 FURTHER READING 99 Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46000 women from Royal College 100 UNIT 7 Papers that report diagnostic or screening tests 105 BACKGROUND 105 SUGGESTED AIM FOR THIS SESSION 105 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 105 SET ARTICLE 105 SUGGESTIONS FOR GROUP EXERCISES 106 SUGGESTION FOR INDIVIDUAL STUDY 106 CALCULATIONS 107 FURTHER READING 107 Efficacy of the alcohol use of disorders identification test as a screening tool for hazardous alcohol intake and related 109 Abstract 109 Introduction 110 Subjects and method 110 Results 113 Discussion 114 Acknowledgements 115 Appendix 115 References 116 UNIT 8 Papers that summarise other papers (systematic review and meta-analysis) 119 BACKGROUND 119 SUGGESTED AIM FOR THIS SESSION 119 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 119 SET ARTICLE 119 ADDITIONAL REPRINT 119 SUGGESTIONS FOR GROUP EXERCISES 120 SUGGESTION FOR INDIVIDUAL STUDY 120 FURTHER READING 120 House dust mite control measures in the management of asthma: meta-analysis 122 Meta-analysis: Unresolved issues and future developments 128 Introduction 128 Should unpublished data be included in meta-analyses? 128 Subjectivity in data analysis and reporting 130 Individual patient data or summary statistics—which should be included in a meta-analysis? 131 Value of "failed" meta-analyses 132 The Cochrane Collaboration 133 Clinical application of results from meta-analyses 134 Outlook 135 Acknowledgements 135 References 135 UNIT 9: Papers that go beyond numbers (qualitative research) 139 BACKGROUND 139 SUGGESTED AIM FOR THIS SESSION 139 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 139 SET ARTICLES 139 ADDITIONAL REPRINT 140 SUGGESTIONS FOR GROUP EXERCISES 140 SUGGESTIONS FOR INDIVIDUAL STUDY 140 FURTHER READING 142 Patients' action during their cardiac event: qualitative study exploring differences and modifiable factors 143 Qualitative research and evidence based medicine 149 UNIT 10 Papers that analyse very rare events (case control studies) 153 BACKGROUND 153 SUGGESTED AIM FOR THIS SESSION 153 SUGGESTED LEARNING OBJECTIVES FOR THIS SESSION 153 SET ARTICLE 153 SUGGESTIONS FOR GROUP EXERCISES 154 SUGGESTION FOR INDIVIDUAL STUDY 154 FURTHER READING 155 Notes for tutors 161 UNIT 1 161 UNIT 2 161 UNIT 3 162 UNIT 4 162 UNIT 5 162 UNIT 6 162 UNIT 7 163 UNIT 8 163 UNIT 9 163 UNIT 10 164 Model answers for checklists 165 UNIT 4: RANDOMISED CONTROLLED TRIALS OF THERAPY 165 UNIT 5:THE FIRST EVER RANDOMISED CONTROLLED TRIAL 166 UNIT 6: COHORT STUDIES 166 UNIT 7: DIAGNOSTIC OR SCREENING TESTS 167 UNIT 8: SYSTEMATIC REVIEWS 168 UNIT 9: QUALITATIVE RESEARCH 169 UNIT 10: CASE CONTROL STUDIES 170 Index 171 0-7279-1447-2 Contents......Page 5 Preface......Page 7 Acknowledgements......Page 8 AIMS......Page 9 LEARNING IN A GROUP......Page 10 LEARNING ON YOUR OWN......Page 12 FURTHER READING......Page 13 Problem based, small group learning......Page 14 Workshops for teaching evidence-based practice......Page 16 SUGGESTIONS FOR GROUP EXERCISES......Page 19 FURTHER READING......Page 20 Evidence based medicine: what it is and what it isn't......Page 22 Evidence based medicine: an approach to clinical problem-solving......Page 25 EVIDENCE BASED MEDICINE IN PRACTICE......Page 26 OTHER REQUIREMENTS FOR PRACTISING EVIDENCE BASED MEDICINE......Page 29 ADVANTAGES......Page 30 DISADVANTAGES......Page 31 "Is my practice evidence based?"......Page 34 Medicine based evidence, a prerequisite for evidence based medicine......Page 38 Narrative based medicine in an evidence based world......Page 41 THE FOUR-PART CLINICAL QUESTION......Page 45 SUGGESTIONS FOR INDIVIDUAL STUDY......Page 46 FURTHER READING......Page 47 The Medline database......Page 48 References......Page 55 Appendix 1: Evidence based quality filters for everyday use......Page 56 Appendix 2: Maximally sensitive search strings (to be used mainly for research)......Page 57 Finding information on clinical effectiveness......Page 59 Evidence based information already available......Page 60 Improving dissemination......Page 63 References......Page 65 ADDITIONAL REPRINT......Page 67 FURTHER READING......Page 68 Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38......Page 70 The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials......Page 81 SET ARTICLES......Page 87 WORKED EXAMPLE:THE FIRST EVER RANDOMISED CONTROLLED TRIAL (SEE REFERENCE LIST FOR DETAILS)......Page 88 A NOTE ON CONFIDENCE INTERVALS......Page 89 FURTHER READING......Page 90 EBM NOTEBOOK On some clinically useful measures of the effects of treatment......Page 91 EBM NOTEBOOK Down with odds ratios!......Page 93 SET ARTICLE......Page 97 SUGGESTION FOR INDIVIDUAL STUDY......Page 98 FURTHER READING......Page 99 Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46000 women from Royal College......Page 100 SET ARTICLE......Page 105 SUGGESTION FOR INDIVIDUAL STUDY......Page 106 FURTHER READING......Page 107 Abstract......Page 109 Subjects and method......Page 110 Results......Page 113 Discussion......Page 114 Appendix......Page 115 References......Page 116 ADDITIONAL REPRINT......Page 119 FURTHER READING......Page 120 House dust mite control measures in the management of asthma: meta-analysis......Page 122 Should unpublished data be included in meta-analyses?......Page 128 Subjectivity in data analysis and reporting......Page 130 Individual patient data or summary statistics—which should be included in a meta-analysis?......Page 131 Value of "failed" meta-analyses......Page 132 The Cochrane Collaboration......Page 133 Clinical application of results from meta-analyses......Page 134 References......Page 135 SET ARTICLES......Page 139 SUGGESTIONS FOR INDIVIDUAL STUDY......Page 140 FURTHER READING......Page 142 Patients' action during their cardiac event: qualitative study exploring differences and modifiable factors......Page 143 Qualitative research and evidence based medicine......Page 149 SET ARTICLE......Page 153 SUGGESTION FOR INDIVIDUAL STUDY......Page 154 FURTHER READING......Page 155 UNIT 2......Page 161 UNIT 6......Page 162 UNIT 9......Page 163 UNIT 10......Page 164 UNIT 4: RANDOMISED CONTROLLED TRIALS OF THERAPY......Page 165 UNIT 6: COHORT STUDIES......Page 166 UNIT 7: DIAGNOSTIC OR SCREENING TESTS......Page 167 UNIT 8: SYSTEMATIC REVIEWS......Page 168 UNIT 9: QUALITATIVE RESEARCH......Page 169 UNIT 10: CASE CONTROL STUDIES......Page 170 Index......Page 171 Using this book in learning and teaching. The principles and practice of evidence based health care. Approaching the literature. Papers that report drug trials (randomized controlled trials of therapy). Numbers needed to treat, odds ratios, and confidence intervals. Papers that address prognosis or harm (cohort studies). Papers that report diagnostic or screening tests. Papers that summarize other papers (systematic review and meta-anlysis). Papers that go beyond numbers (qualitative research). Papers that analyze very rare events (case control studies). Based on Trisha Greenhalgh's course on teaching evidence based health care, this workbook can be used as a stand alone self learning book, either for groups or individuals. The different units covering areas such as decision analysis and diagnostic testing each contain a published paper with exercises for the user, and critical appraisal checklists. It will act as a complement to the best-selling How to Read a Paper . Based on Trisha Greenhalgh's course on teaching evidence-based health care, this workbook can be used as a stand alone self learning book. The different units cover areas such as decision analysis and diagnostic testing, and each contain a published paper with exercises for the user It ought to be self-evident that any formal educational experience - meeting, seminar, course, conference, lecture, learning set, journal club or whatever - should have clearly defined aims, i.e. broad goals for what the organisers hope to achieve.