Book Reviews
Book Reviews
Clinical Evidence, from the BMJ Publishing Group, focuses on clinical interventions and provides a summary of the evidence available. Topics include many of the most common problems encountered in in-patient and primary care. For each topic, such as depression, preterm birth, or stroke prevention, a series of questions regarding intervention is generated that emphasizes outcomes important to patients: How effective are various antidepressants? What is the effect of corticosteroids on lung maturity? How do carotid endarterectomy and antiplatelet agents compare? Only evidence of high quality is included. Systematic reviews of randomized controlled trials are given first priority, but individual randomized controlled trials that pass critical appraisal of methods are also used. Where convincing evidence is not available--a common situation--such is stated and left as a gap rather than resorting to speculation.
Although many authors have contributed various chapters, they all follow a single organizational structure, which facilitates finding the answers sought. Each chapter starts with the questions posed, which are followed by a list of interventions grouped by efficacy (or harm). Next come the key messages, a brief review of epidemiologic factors, and finally the details of the studies cited. Where a number of studies are included, a summary evidence table or figure often concludes the chapter.
This book is not easy reading. The distillation of the world's literature on a given question into a few pages results in a thick broth, dense with relative and absolute risks, confidence intervals, numbers needed to treat, and P values. Data I am used to seeing in tables are generally within the small-font text, but to have done otherwise would make an already thick text unmanageable. The consistency of organization is a big help, and I found the book became easier to read with each use.
The questions posed are definitely relevant to family practice. I could find information about many of the problems I encounter in the clinic. Sometimes the evidence is robust and relevant, immediately applicable to the case at hand. At other times the book simply lets you know that data are lacking, so that judgment, experience, or mitigating factors will need to play the leading role in decision making. Clinical Evidence does not offer care guidelines or expert opinions, but sticks to the evidence and its boundaries.
Of course each patient is unique, and no number of randomized controlled trials will prove the best intervention for all circumstances. This book provides a most useful service focus--finding, grading, analyzing, and summarizing an enormous body of literature to inform better those clinical decisions we must then make. Published every 6 months to maintain its freshness, this book will be one of the most often used on my shelf, but with the realization that often the answer found will be that unfortunately the evidence is lacking.
Fred Heidrich, MD, MPH, Group Health Family Practice Residency, Seattle
Clinical Evidence, from the BMJ Publishing Group, focuses on clinical interventions and provides a summary of the evidence available. Topics include many of the most common problems encountered in in-patient and primary care. For each topic, such as depression, preterm birth, or stroke prevention, a series of questions regarding intervention is generated that emphasizes outcomes important to patients: How effective are various antidepressants? What is the effect of corticosteroids on lung maturity? How do carotid endarterectomy and antiplatelet agents compare? Only evidence of high quality is included. Systematic reviews of randomized controlled trials are given first priority, but individual randomized controlled trials that pass critical appraisal of methods are also used. Where convincing evidence is not available--a common situation--such is stated and left as a gap rather than resorting to speculation.
Although many authors have contributed various chapters, they all follow a single organizational structure, which facilitates finding the answers sought. Each chapter starts with the questions posed, which are followed by a list of interventions grouped by efficacy (or harm). Next come the key messages, a brief review of epidemiologic factors, and finally the details of the studies cited. Where a number of studies are included, a summary evidence table or figure often concludes the chapter.
This book is not easy reading. The distillation of the world's literature on a given question into a few pages results in a thick broth, dense with relative and absolute risks, confidence intervals, numbers needed to treat, and P values. Data I am used to seeing in tables are generally within the small-font text, but to have done otherwise would make an already thick text unmanageable. The consistency of organization is a big help, and I found the book became easier to read with each use.
The questions posed are definitely relevant to family practice. I could find information about many of the problems I encounter in the clinic. Sometimes the evidence is robust and relevant, immediately applicable to the case at hand. At other times the book simply lets you know that data are lacking, so that judgment, experience, or mitigating factors will need to play the leading role in decision making. Clinical Evidence does not offer care guidelines or expert opinions, but sticks to the evidence and its boundaries.
Of course each patient is unique, and no number of randomized controlled trials will prove the best intervention for all circumstances. This book provides a most useful service focus--finding, grading, analyzing, and summarizing an enormous body of literature to inform better those clinical decisions we must then make. Published every 6 months to maintain its freshness, this book will be one of the most often used on my shelf, but with the realization that often the answer found will be that unfortunately the evidence is lacking.
Fred Heidrich, MD, MPH, Group Health Family Practice Residency, Seattle
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