Systematic Reviews in Health Care: A Practical Guide. (Book Reviews).Authors:
Publisher: Cambridge University Press Cambridge University Press (known colloquially as CUP) is a publisher given a Royal Charter by Henry VIII in 1534, and one of the two privileged presses (the other being Oxford University Press). , December 2001. Paperback, $29.95.
International Standard Book Number
ISBN International Standard Book Number
ISBN n abbr (= International Standard Book Number) → ISBN m : 0-521-79962-7
The practice of medicine is rapidly shifting from an art to a science. Evidence-based medicine evidence-based medicine Decision-making 'The use of scientific data to confirm that proposed diagnostic or therapeutic procedures are appropriate in light of their high probability of producing the best and most favorable outcome'. See Meta-analysis. is rapidly gaining ground. But how strong is the evidence? Does the evidence presented apply to a particular clinician's patient population? Can the clinician reasonably extrapolate extrapolate - extrapolation the findings of a study to the patient in the office? Clinicians have to face these vexing questions every day. They receive a large number of publications and review articles (many unsolicited), and they often see several pharmaceutical company representatives every day. Each encounter can last only a few minutes. During that time representatives try to present evidence that the medication promoted is better than the competition. Clinicians listen halfheartedly, are often distracted, and just glance at the glossy brochures presented. This fleeting furtive fur·tive
1. Characterized by stealth; surreptitious.
2. Expressive of hidden motives or purposes; shifty. See Synonyms at secret. glance, however, is often sufficient for a well-conceived and eye-catching chart or diagram to be imprinted in the clinician's mind and to influence prescribing habits.
Over the past few years there has been a proliferation of clinical studies. An entirely new vocabulary has emerged: retrospective studies, observational studies observational studies,
n.pl an investigational method involving description of the associations be-tween interventions and outcomes. Outcomes research and practice audits are examples of this investigational method. , case-control studies, prospective randomized clinical trials randomized clinical trial,
n a clinical study where volunteer participants with comparable characteristics are randomly assigned to different test groups to compare the efficacy of therapies. , and meta-analyses are but a few examples. The sheer volume of medical journals (over 22,000), the need for physicians employed by academic institutions to publish, and the ease with which one's mind can be swayed when presented with "statistically significant results" make clinicians particularly vulnerable to information overload A symptom of the high-tech age, which is too much information for one human being to absorb in an expanding world of people and technology. It comes from all sources including TV, newspapers, magazines as well as wanted and unwanted regular mail, e-mail and faxes. and at times misinformation mis·in·form
tr.v. mis·in·formed, mis·in·form·ing, mis·in·forms
To provide with incorrect information.
mis . Clinicians are so busy with their clinical work that they have neither the time nor the inclination to thoroughly appraise studies they come across. Besides, they often do not understand the statistical jargon used and cannot appreciate all the nuances of the statistical analysis. So many clinicians rely on review articles, the opinion of "specialists," and the pharmaceutical industry to provide them with the "bottom line" findings o f studies. Unfortunately, for a number of reasons, this information is not always objectively presented.
Clinicians should be able to independently analyze and appraise various studies they come across and place them in the larger context of their own knowledge base and personal experience. In approximately 100 pages, Glasziou and colleagues provide the means of achieving this difficult task. The contents of the book accurately reflect the title, Systematic Reviews in Health Care: A Practical Guide. The book is very well written and extremely easy to read. It is a true practical guide through the maze of clinical studies. Complex issues are presented in a clear, concise, logical, and easy-to-follow manner. The book is well divided, and the customer-friendly layout and presentation make it very easy to find the needed section or paragraph long after the book has been read. I believe this book should be essential reading for all practicing clinicians and should be prominently displayed in every medical library.