Sweet smell of success | |
Users’ guides to the medical literature: essentials of evidence-based clinical practice. Gordon Guyatt and Drummond Rennie (editors). Chicago: AMA Press, 2001 (496 pp [includes CD-ROM]). ISBN 1-57947-191-9.
Users’ guide to the medical literature: a manual for evidence-based clinical practice. Gordon Guyatt and Drummond Rennie (editors). Chicago: AMA Press, 2002. (xxiii + 706 pp + CD-ROM). ISBN 1 57947 174 9. |
In the preface to each of these volumes, Gordon Guyatt quotes David Sackett, famously extolling the value of appraising original sources. Sackett wrote: "Textbooks don’t smell as their contents rot. So readers will have to develop alternative crap detectors in order to avoid robbing their patients of best care.” How, then, do these textbooks rank on this scale? In a word, superbly! It is startling to note that the first of the articles on which these books are based appeared in the Canadian Medical Association Journal 20 years ago. Updated, these articles later became a JAMA series of 25 “Users’ guides to the medical literature”, published between 1993 and 2000. They have always provided the best introduction available to the practical skills required for evidence-based clinical practice. Now, updated once again, collected in single volumes, illustrated by numerous carefully chosen and informative clinical examples, and enriched by additional contributions from the Evidence-Based Medicine Working Group, these are the best single reference works I know in this field. The shorter Essentials volume contains the core material about how to find evidence and rigorously appraise it in different clinical contexts. It is engaging, well written and presents the concepts in an approachable and practical way. It also contains a brief “Beyond the basics” section; a CD-ROM containing an expanded version of the text; and four laminated reference cards useful for the practical tasks of evidence-based care. It comes in a small, pocket-size format for those readers who can’t remember the location of their bookcase. The Manual has a larger format and an expanded “Beyond the basics” section. This is particularly aimed at teachers of evidence-based practice and to me it contained the most compelling material of all. The chapters on “Criticisms of evidence-based medicine”, “Outcomes of health services”, “Clinical prediction rules”, and the whole section on “Moving from evidence to action: incorporating patient values”, provide stimulating, well referenced accounts, not covered as comprehensively in other general texts. The “N of 1 randomised clinical trials” section provides an excellent practical guide designed to encourage clinicians to use this technique as a tool for explicit shared decision making with their patients. Buyers of the shorter Essentials volume receive all the extra material on the CD-ROM, which is identical in both versions and clearly enhances the hard copy through an excellent search facility, comprehensive hyperlinks and expanded bibliographic materials. This provides a clear choice for buyers: go for the abbreviated, less expensive Essentials with the full text available on CD-ROM; or pay an extra $A31 for the complete hard copy text in the Manual, with a highly portable digital version as an extra. Are these texts ideal? As a general introduction and a practical guide they come close, but I would have preferred more detailed comment on the philosophical and ethical issues about evidence-based practice and its limits, and more about getting best evidence into practice. Are these criticisms important? Probably not. At this point these are the best medical literature crap detectors around. Jeremy Anderson
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