Point Blank - aka Point Blanc

Required reading in many medical and healthcare institutions, How to Read a Paper is a clear and wide-ranging introduction to evidence-based medicine and healthcare, helping readers to understand its central principles, critically evaluate published data, and implement the results in practical settings. Author Trisha Greenhalgh guides readers through each fundamental step of inquiry, from searching the literature to assessing methodological quality and appraising statistics. How to Read a Paper addresses the common criticisms of evidence-based healthcare, dispelling many of its myths and misconceptions, while providing a pragmatic framework for testing the validity of healthcare literature. Now in its sixth edition, this informative text includes new and expanded discussions of study bias, political interference in published reports, medical statistics, big data and more. Offers user-friendly guidance on evidence-based healthcare that is applicable to both experienced and novice readers Authored by an internationally recognised practitioner and researcher in evidence-based healthcare and primary care Includes updated references, additional figures, improved checklists and more How to Read a Paper is an ideal resource for healthcare students, practitioners and anyone seeking an accessible introduction to evidence-based healthcare. Title Page 5 Copyright Page 6 Contents 9 Foreword to the first edition by Professor Sir David Weatherall 14 Preface to the sixth edition 16 Preface to the first edition: do you needto read this book? 18 Acknowledgements 20 Chapter 1 Why read papers at all? 23 Does ‘evidence-based medicine’ simply mean ‘reading papers in medical journals’? 23 Why do people sometimes groan when you mention evidence-based healthcare? 26 Decision-making by anecdote 27 Decision-making by press cutting 28 Decision-making by GOBSAT (good old boys sat around a table) 29 Decision-making by cost-minimisation 32 Before you start: formulate the problem 33 Exercises based on this chapter 35 References 36 Chapter 2 Searching the literature 38 What are you looking for? 39 Levels upon levels of evidence 40 Synthesised sources: systems, summaries and syntheses 41 Pre-appraised sources: synopses of systematic reviews and primary studies 44 Specialised resources 45 Primary studies – tackling the jungle 45 One-stop shopping: federated search engines 47 Asking for help and asking around 48 Online tutorials for effective searching 48 Exercises based on this chapter 49 References 49 Chapter 3 Getting your bearings: what is this paper about? 51 The science of ‘trashing’ papers 51 Three preliminary questions to get your bearings 53 Question One: Why was the study needed – and what was the research question? 53 Question Two: What was the research design? 54 Question Three: Was the research design appropriate to the question? 56 Randomised controlled trials 57 Cohort studies 60 Case–control studies 62 Cross-sectional surveys 63 Case reports 63 The traditional hierarchy of evidence 64 Exercises based on this chapter 65 References 65 Chapter 4 Assessing methodological quality 67 Was the study original? 67 Whom is the study about? 68 Was the design of the study sensible? 69 Was bias avoided or minimised? 71 Randomised controlled trials 71 Non-randomised controlled clinical trials 72 Cohort studies 73 Case–control studies 74 Was assessment ‘blind’? 75 Were preliminary statistical questions addressed? 76 Sample size 76 Duration of follow-up 78 Completeness of follow-up 78 A note on ethical considerations 79 Summing up 80 Exercises based on this chapter 81 References 82 Chapter 5 Statistics for the non-statistician 84 How can non-statisticians evaluate statistical tests? 84 Have the authors set the scene correctly? 86 Have they determined whether their groups are comparable, and, if necessary, adjusted for baseline differences? 86 What sort of data have they got, and have they used appropriate statistical tests? 86 If the statistical tests in the paper are obscure, why have the authors chosen to use them, and have they included a reference? 90 Have the data been analysed according to the original study protocol? 90 Paired data, tails and outliers 91 Were paired tests performed on paired data? 91 Was a two-tailed test performed whenever the effect of an intervention could conceivably be a negative one? 92 Were ‘outliers’ analysed with both common sense and appropriate statistical adjustments? 92 Correlation, regression and causation 93 Has correlation been distinguished from regression, and has the correlation coefficient (r‐value) been calculated and interpreted correctly? 93 Have assumptions been made about the nature and direction of causality? 94 Probability and confidence 95 Have p-values been calculated and interpreted appropriately? 95 Have confidence intervals been calculated, and do the authors’ conclusions reflect them? 96 The bottom line 97 Have the authors expressed the effects of an intervention in terms of the likely benefit or harm that an individual patient can expect? 97 Summary 99 Exercises based on this chapter 99 References 100 Chapter 6 Papers that report trials of drug treatments and other simple interventions 101 ‘Evidence’ and marketing 101 Making decisions about therapy 104 Surrogate endpoints 104 What information to expect in a paper describing a randomised controlled trial: the CONSORT statement 108 Getting worthwhile evidence from pharmaceutical representatives 108 Exercises based on this chapter 111 References 111 Chapter 7 Papers that report trials of complex interventions 114 Complex interventions 114 Ten questions to ask about a paper describing a complex intervention 116 Exercises based on this chapter 121 References 122 Chapter 8 Papers that report diagnostic or screening tests 123 Ten men in the dock 123 Validating diagnostic tests against a gold standard 124 Ten questions to ask about a paper that claims to validate a diagnostic or screening test 129 Likelihood ratios 133 Clinical prediction rules 135 Exercises based on this chapter 136 References 137 Chapter 9 Papers that summarise other papers (systematic reviews and meta‐analyses) 139 When is a review systematic? 139 Evaluating systematic reviews 142 Meta-analysis for the non‐statistician 147 Explaining heterogeneity 152 New approaches to systematic review 154 Exercises based on this chapter 155 References 155 Chapter 10 Papers that tell you what to do (guidelines) 159 The great guidelines debate 159 Ten questions to ask about a clinical guideline 163 Exercises based on this chapter 169 References 170 Chapter 11 Papers that tell you what things cost (economic analyses) 172 What is economic analysis? 172 Measuring the costs and benefits of health interventions 174 A note on ‘Choosing Wisely’ 179 Ten questions to ask about an economic analysis 179 Conclusions 184 Exercises based on this chapter 184 References 184 Chapter 12 Papers that go beyond numbers (qualitative research) 187 What is qualitative research? 187 Ten questions to ask about a qualitative research paper 191 Conclusions 198 Exercises based on this chapter 198 References 199 Chapter 13 Papers that report questionnaire research 201 The rise and rise of questionnaire research 201 Ten questions to ask about a paper describing a questionnaire study 202 Conclusions 210 Exercises based on this chapter 211 References 211 Chapter 14 Papers that report quality improvement case studies 213 What are quality improvement studies, and how should we research them? 213 Ten questions to ask about a paper describing a quality improvement initiative 215 Conclusions 222 Exercises based on this chapter 222 References 223 Chapter 15 Papers that describe genetic association studies 225 The three eras of human genetic studies (so far) 225 What is a genome-wide association study (GWAS)? 226 Clinical applications of GWAS 229 Direct-to-consumer genetic testing 231 Mendelian randomisation studies 232 Epigenetics – a space to watch 233 Ten questions to ask about a genetic association study 234 Conclusions 238 Exercises based on this chapter 238 References 238 Chapter 16 Applying evidence with patients 241 The patient perspective 241 Patient-reported outcome measures (PROMs) 243 Shared decision-making 244 Option grids 245 N of 1 trials and other individualised approaches 249 Exercises based on this chapter 250 References 251 Chapter 17 Criticisms of evidence-based healthcare 254 What’s wrong with EBHC when it’s done badly? 254 What’s wrong with EBHC when it’s done well? 257 Why is ‘evidence-based policymaking’ so hard to achieve? 260 Exercises based on this chapter 261 References 262 Appendix 1 Checklists for finding, appraising and implementing evidence 264 Is my practice evidence-based? – a context-sensitive checklist for individual clinical encounters (see Chapter 1) 264 Checklist for searching (see Chapter 2) 265 Checklist to determine what a paper is about (see Chapter 3) 265 Checklist for the methods section of a paper (see Chapter 4) 266 Checklist for the statistical aspects of a paper (see Chapter 5) 266 Checklist for material provided by a pharmaceutical company representative (see Chapter 6) 267 Checklist for a paper describing a study of a complex intervention (see Chapter 7) 268 Checklist for a paper that claims to validate a diagnostic or screening test (see Chapter 8) 268 Checklist for a systematic review or meta-analysis (see Chapter 9) 269 Checklist for a set of clinical guidelines (see Chapter 10) 269 Checklist for an economic analysis (see Chapter 11) 269 Checklist for a qualitative research paper (see Chapter 12) 270 Checklist for a paper describing questionnaire research (see Chapter 13) 270 Checklist for a paper describing a quality improvement study (see Chapter 14) 271 Checklist for a paper describing a genetic association study (see Chapter 15) 272 Checklist for involving patients in clinical decision-making (see Chapter 16) 272 Appendix 2 Assessing the effects of an intervention 274 Acknowledgement 274 Index 275 EULA 285 Title Page ......Page 5 Copyright Page......Page 6 Contents......Page 9 Foreword to the first edition by Professor Sir David Weatherall......Page 14 Preface to the sixth edition......Page 16 Preface to the first edition: do you needto read this book?......Page 18 Acknowledgements......Page 20 Does ‘evidence-based medicine’ simply mean ‘reading papers in medical journals’? ......Page 23 Why do people sometimes groan when you mention evidence-based healthcare? ......Page 26 Decision-making by anecdote ......Page 27 Decision-making by press cutting ......Page 28 Decision-making by GOBSAT (good old boys sat around a table) ......Page 29 Decision-making by cost-minimisation ......Page 32 Before you start: formulate the problem......Page 33 Exercises based on this chapter......Page 35 References......Page 36 Chapter 2 Searching the literature......Page 38 What are you looking for?......Page 39 Levels upon levels of evidence......Page 40 Synthesised sources: systems, summaries and syntheses......Page 41 Pre-appraised sources: synopses of systematic reviews and primary studies ......Page 44 Primary studies – tackling the jungle......Page 45 One-stop shopping: federated search engines ......Page 47 Online tutorials for effective searching......Page 48 References......Page 49 The science of ‘trashing’ papers......Page 51 Question One: Why was the study needed – and what was the research question?......Page 53 Question Two: What was the research design?......Page 54 Question Three: Was the research design appropriate to the question?......Page 56 Randomised controlled trials......Page 57 Cohort studies......Page 60 Case–control studies......Page 62 Case reports......Page 63 The traditional hierarchy of evidence......Page 64 References......Page 65 Was the study original?......Page 67 Whom is the study about?......Page 68 Was the design of the study sensible?......Page 69 Randomised controlled trials......Page 71 Non-randomised controlled clinical trials......Page 72 Cohort studies......Page 73 Case–control studies......Page 74 Was assessment ‘blind’?......Page 75 Sample size......Page 76 Completeness of follow-up ......Page 78 A note on ethical considerations......Page 79 Summing up......Page 80 Exercises based on this chapter......Page 81 References......Page 82 How can non-statisticians evaluate statistical tests? ......Page 84 What sort of data have they got, and have they used appropriate statistical tests?......Page 86 Have the data been analysed according to the original study protocol?......Page 90 Were paired tests performed on paired data?......Page 91 Were ‘outliers’ analysed with both common sense and appropriate statistical adjustments?......Page 92 Has correlation been distinguished from regression, and has the correlation coefficient (r‐value) been calculated and interpreted correctly?......Page 93 Have assumptions been made about the nature and direction of causality?......Page 94 Have p-values been calculated and interpreted appropriately? ......Page 95 Have confidence intervals been calculated, and do the authors’ conclusions reflect them?......Page 96 Have the authors expressed the effects of an intervention in terms of the likely benefit or harm that an individual patient can expect?......Page 97 Exercises based on this chapter......Page 99 References......Page 100 ‘Evidence’ and marketing......Page 101 Surrogate endpoints......Page 104 Getting worthwhile evidence from pharmaceutical representatives......Page 108 References......Page 111 Complex interventions......Page 114 Ten questions to ask about a paper describing a complex intervention......Page 116 Exercises based on this chapter......Page 121 References......Page 122 Ten men in the dock......Page 123 Validating diagnostic tests against a gold standard......Page 124 Ten questions to ask about a paper that claims to validate a diagnostic or screening test......Page 129 Likelihood ratios......Page 133 Clinical prediction rules......Page 135 Exercises based on this chapter......Page 136 References......Page 137 When is a review systematic?......Page 139 Evaluating systematic reviews......Page 142 Meta-analysis for the non‐statistician ......Page 147 Explaining heterogeneity......Page 152 New approaches to systematic review......Page 154 References......Page 155 The great guidelines debate......Page 159 Ten questions to ask about a clinical guideline......Page 163 Exercises based on this chapter......Page 169 References......Page 170 What is economic analysis?......Page 172 Measuring the costs and benefits of health interventions......Page 174 Ten questions to ask about an economic analysis......Page 179 References......Page 184 What is qualitative research?......Page 187 Ten questions to ask about a qualitative research paper......Page 191 Exercises based on this chapter......Page 198 References......Page 199 The rise and rise of questionnaire research......Page 201 Ten questions to ask about a paper describing a questionnaire study......Page 202 Conclusions......Page 210 References......Page 211 What are quality improvement studies, and how should we research them?......Page 213 Ten questions to ask about a paper describing a quality improvement initiative......Page 215 Exercises based on this chapter......Page 222 References......Page 223 The three eras of human genetic studies (so far)......Page 225 What is a genome-wide association study (GWAS)? ......Page 226 Clinical applications of GWAS......Page 229 Direct-to-consumer genetic testing ......Page 231 Mendelian randomisation studies......Page 232 Epigenetics – a space to watch......Page 233 Ten questions to ask about a genetic association study......Page 234 References......Page 238 The patient perspective......Page 241 Patient-reported outcome measures (PROMs) ......Page 243 Shared decision-making ......Page 244 Option grids......Page 245 N of 1 trials and other individualised approaches......Page 249 Exercises based on this chapter......Page 250 References......Page 251 What’s wrong with EBHC when it’s done badly?......Page 254 What’s wrong with EBHC when it’s done well?......Page 257 Why is ‘evidence-based policymaking’ so hard to achieve? ......Page 260 Exercises based on this chapter......Page 261 References......Page 262 Is my practice evidence-based? – a context-sensitive checklist for individual clinical encounters (see Chapter 1)......Page 264 Checklist to determine what a paper is about (see Chapter 3)......Page 265 Checklist for the statistical aspects of a paper (see Chapter 5)......Page 266 Checklist for material provided by a pharmaceutical company representative (see Chapter 6)......Page 267 Checklist for a paper that claims to validate a diagnostic or screening test (see Chapter 8)......Page 268 Checklist for an economic analysis (see Chapter 11)......Page 269 Checklist for a paper describing questionnaire research (see Chapter 13)......Page 270 Checklist for a paper describing a quality improvement study (see Chapter 14)......Page 271 Checklist for involving patients in clinical decision-making (see Chapter 16)......Page 272 Acknowledgement......Page 274 Index......Page 275 EULA......Page 285 « This book addresses the common criticisms of evidence-based healthcare, dispelling many of its myths and misconceptions, while providing a pragmatic framework for testing the validity of healthcare literature. It also helps readers to understand the central principles of evidence-based medicine, critically evaluate published data, and implement the results in practical settings. The readers are guided through each fundamental step of inquiry, from searching the literature, to assessing methodological quality, and appraising statistics. »-- Résumé de l'éditeur This book addresses the common criticisms of evidence-based healthcare, dispelling many of its myths and misconceptions, while providing a pragmatic framework for testing the validity of healthcare literature. It also helps readers to understand the central principles of evidence-based medicine, critically evaluate published data, and implement the results in practical settings. The readers are guided through each fundamental step of inquiry, from searching the literature, to assessing methodological quality, and appraising statistics. -- Publisher description

Required reading in many medical and healthcare institutions, How to Read a Paper is a clear and wide-ranging introduction to evidence-based medicine and healthcare, helping readers to understand its central principles, critically evaluate published data, and implement the results in practical settings. Author Trisha Greenhalgh guides readers through each fundamental step of inquiry, from searching the literature to assessing methodological quality and appraising statistics.