Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice.

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice Guyatt G, Rennie D, eds. Chicago, IL 60610, AMA Press, 2002, paperback, 731 pp, illus, ISBN: 1-57947-174-9, $49.95.

Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice Guyatt G, Rennie D, eds. Chicago, IL 60610, AMA Press, 2002, paperback, 473 pp, illus, ISBN: 1-57947-191-9, $34.95.

These texts were written to help physicians expand their knowledge of the medical literature and use that knowledge to solve patient problems more effectively. This review will focus on the Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice (Manual). The Manual is divided into 2 parts. Part 1 is titled "The Basics: Using the Medical Literature" and is identical in both books. Part 2 is titled "Beyond the Basics: Using and Teaching the Principles of Evidence-Based Medicine." The second text (Essentials of Evidence-Based Clinical Practice [Essentials]) includes 4 of the 32 sections in part 2 of the Manual. The Essentials book is intended to be portable and is sized to fit in a clinician's pocket. Both books include a CD-ROM version of the text.

The Manual is the result of a compilation of a series of articles by a group of clinical epidemiologists at McMaster University led by David Sackett. They planned a series of articles designed to help clinicians go beyond merely browsing articles and toward developing more critical appraisals so that the information could be used in a scientific approach to clinical decision making. The group was linked to other academic physicians, and an Evidence-Based Working Group was formed. The group wrote 25 "User Guide" articles that were published in JAMA between 1993 and 2000. The Manual has incorporated the scientific advances made in recent years, which can be useful in the process of developing and interpreting medical literature.

Medicine is undergoing a paradigm shift from practice based fundamentally on pathophysiology and relatively unsystematic clinical experience and toward clinical decision making based on relevant scientific research. Evidence-based medicine (EBM) is the integration of the best research evidence coupled with the clinical expertise of the practitioner, and it also takes into account patient values. When the health care provider searches for evidence, there must be an established set of guidelines for finding that evidence and interpreting the results. The authors emphasize the practitioner's ability to use research rather than how to do research and the practitioner's ability to interpret statistical analyses rather than how to do the analyses.

Part 1 of the book describes the basics of reading medical literature. It covers the issues of accessing and using medical literature in order to obtain evidence relevant to clinical decision making. The authors suggest that the reader should examine an article to determine: (1) the validity of the information it contains, (2) what the results mean for patient care, and (3) how that information can be applied to the care of an individual patient. Part 1 can be viewed as a short course in using medical literature. Clinical scenarios are included, along with examples of a search for information to answer questions raised by the case. The reader is guided through a process to access appropriate resources and to distinguish the resources that provide the most credible and usable evidence.

Part 2 of the Manual goes beyond the basic discussion and expands on part 1. Although the content of this part is stated to be particularly useful for those teaching EBM, it is also directed at practitioners who want to increase their skills at providing evidence-based solutions to clinical problems. Part 2 covers areas such as bias, random error, hypothesis testing, treatment effects, and qualitative variables. The statistical tools are presented relative to their role in establishing meaningful clinical outcomes.

This book is a unique contribution to the health care field. It represents a definitive link between the conceptual scientific method described by statisticians and the application of that method to clinical decision making. Information from clinical cases is reviewed, and the practitioner is guided toward establishing hypotheses that become the focus of a methodical, scientific review of the relevant literature. The Manual also contains information related to key statistical criteria that the practitioner must consider in order to understand the literature's outcome relative to the case under consideration. The reader is guided through the application of those concepts. He or she should come away from the text with clear guidelines on how to obtain evidence for the solution of a clinical problem as well as an awareness of the method used to prioritize the information in practice effectively.

The principles of EBM apply to other health care providers. Although the Manual was written for the medical practitioner, it proposes a straightforward method to incorporate and use scientific evidence in clinical decision making. This method is consistent with the approach used by physical therapists in their clinical decision-making process. Physical therapists who engage in evidence-based practice will find this book informative and an excellent reference. As EBM becomes more widely used by medical practitioners, the physical therapist who engages in evidence-based practice will have an enhanced scientific approach to patient care. The book is highly recommended for all academic and clinical educators of physical therapists and for practitioners who are using or intend to use an evidence-based approach to clinical decision making.

Donna El-Din, PT, PhD Eastern Washington University Spokane, Wash

Dr El-Din is a Distinguished Professor in the Department of Physical Therapy, with major interests in professional education and administration.