Crash Course Evidence-Based Medicine: Reading and Writing Medical Papers

278 Pages·2013·8.64 MB·English

by  Amit Kaura

Evidence-Based Medicine: Reading
and Writing Medical Papers
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CRASH COURSE
SERIES EDITOR:
Dan Horton-Szar
BSc(Hons) MBBS(Hons) MRCGP
NorthgateMedicalPractice
Canterbury Kent, UK
FACULTY ADVISOR:
Andrew Polmear
MA MSc FRCP FRCGP
FormerSenior Research Fellow AcademicUnit
of PrimaryCare The Trafford Centre for
MedicalEducation and Research University of Sussex;
FormerGeneral Practitioner Brighton and Hove, UK
Evidence-Based
Medicine: Reading and
Writing Medical Papers
Amit Kaura
BSc(Hons) MB ChB
Academic Foundation Doctor,
North Bristol NHS Trust;
Honorary Research Fellow,
Department of Physiology,
University of Bristol,
Bristol, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2013
CommissioningEditor:JeremyBowes
DevelopmentEditor:SheilaBlack
ProjectManager:AndrewRiley
Designer:ChristianBilbow
IllustrationManager:JenniferRose
©2013ElsevierLtd.Allrightsreserved.
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asmaybenotedherein).
ISBN:978-0-7234-3735-2
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Notices
Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroadenour
understanding,changesinresearchmethods,professionalpractices,ormedicaltreatmentmaybecomenecessary.
Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingandusingany
information,methods,compounds,orexperimentsdescribedherein.Inusingsuchinformationormethodsthey
shouldbemindfuloftheirownsafetyandthesafetyofothers,includingpartiesforwhomtheyhaveaprofessional
responsibility.
Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthemostcurrent
informationprovided(i)onproceduresfeaturedor(ii)bythemanufacturerofeachproducttobeadministered,to
verifytherecommendeddoseorformula,themethodanddurationofadministration,andcontraindications.Itis
theresponsibilityofpractitioners,relyingontheirownexperienceandknowledgeoftheirpatients,tomake
diagnoses,todeterminedosagesandthebesttreatmentforeachindividualpatient,andtotakeallappropriate
safetyprecautions.
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Series editor foreword
TheCrashCourseseriesfirstpublishedin1997andnow,16yearson,wearestill
goingstrong.Medicineneverstandsstill,andtheworkofkeepingthisseriesrele-
vantfortoday’sstudentsisanongoingprocess.Alongwithrevisingexistingtitles,
nowintheirfourtheditions,wearedelightedtoaddthisnewtitletotheseries.
Amongthechangestoourprofessionoverthe years,theriseofevidence-based
medicine has dramatically improved the quality and consistency of medical care
forpatientsandbringsnewchallengestodoctorsandstudentsalike.Itisincreas-
inglyimportantforstudentstobeskilledinthecriticalappraisalofpublishedmed-
icalresearchandtheapplicationofevidencetotheirclinicalpractice,andtohave
theabilitytouseaudittomonitorandimprovethatpracticeovertheyears.These
skills are now an important and explicit part of the medical curriculum and the
examinationsyouneedtopass.Thisexcellentnewtitlepresentsthefoundations
oftheseskillswithaclearandpracticalapproachperfectlysuitedtothoseembark-
ingontheirmedicalcareers.
Withthisnewbook,weholdfasttotheprinciplesonwhichwefirstdevelopedthe
series.CrashCoursewillalwaysbringyoualltheinformationyouneedtorevisein
compact, manageable volumes that integrate basic medical science and clinical
practice. The books still maintain the balance between clarity and conciseness,
andprovidesufficientdepthforthoseaimingatdistinction.Theauthorsaremedical
studentsandjuniordoctorswhohaverecentexperienceoftheexamsyouarenow
facing,andtheaccuracyofthematerialischeckedbyateamoffacultyadvisors
fromacrosstheUK.
Iwishyouallthebestforyourfuturecareers!
DrDanHorton-Szar
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Prefaces
Author
CrashCourseEvidence-BasedMedicine:ReadingandWritingMedicalPapersis
directedatmedicalstudentsandhealthcareprofessionalsatallstagesoftheirtrain-
ing.Duetotheever-increasingrateatwhichmedicalknowledgeisadvancing,itis
crucialthat all professionalsare ableto practice evidence-based medicine,which
includes being able to critically appraise the medical literature. Over the course
ofthisbook,allstudytypeswillbediscussedusingasystematicapproach,therefore
allowing for easy comparison. In addition to equipping readers with the skills
required to critically appraise research evidence, this book covers the key points
onhowtoconductresearchandreportthefindings.Thisrequiresanunderstanding
ofstatistics,whichareusedthroughoutallstagesoftheresearchprocess–from
designing a study to data collection and analysis. All commonly used statistical
methodsareexploredinaconcisemanner,usingexamplesfromreal-lifesituations
toaidunderstanding.AswiththeotherbooksintheCrashCourseseries,themate-
rialisdesignedtoarmthereaderwiththeessentialfactsonthesesubjects,while
maintaining a balance between conciseness and clarity. References for further
readingareprovidedwherereaderswishtoexploreatopicingreaterdetail.
TheGeneralMedicalCouncil’sTomorrow’sDoctors–guidanceforundergraduate
medicalstudentsstatesthatstudent-selectedcomponents(SSCs)shouldaccount
for10-30%ofthestandardcurriculum.SSCscommonlyincludeclinicalaudit,lit-
eraturereview,andquantitativeorqualitativeresearch.Notonlywillthisbookbe
aninvaluableassetforpassingtheSSCassessments,itwillenablestudentstopre-
parehigh-qualityreportsandthereforeimprovetheirchancesofpublishingpapers
inpeer-reviewedjournals.Theimportanceofthisextendsbeyondundergraduate
study,assucheducationalachievementscarryweightwhenapplyingforFounda-
tionProgrammepositionsandspecialisttraining.
Evidence-basedmedicineisaverticalthemethatrunsthroughallyearsofundergrad-
uateandpostgraduatestudyandcommonlyappearsinexams.Theself-assessment
questions, which follow the modern exam format, will help the reader pass that
dreadedevidence-basedmedicineandstatisticsexamwithflyingcolours!
Amit Kaura
Faculty advisor
Fordecadesthreedisciplineshavebeenconvergingslowlytocreateanewwayof
practising medicine. Statisticians provide the expertise to ensure that research
resultsarevalid;clinicianshavedevelopedthescienceofevidence-basedmedicine
tobringtheresultsofthatresearchintopractice;andeducatorsandmanagershave
developedclinicalaudittocheckthatpractitionersaredoingwhattheythinkthey
aredoing.Yetthe seams still show.Fewarticles present thestatistics in theway
most useful to clinicians. If this surprises you, look to see how few articles on
vii
therapygivetheNumberNeededtoTreat.Haveyoueverseenanarticleondiag-
nosisgivetheNumberNeededtoTest?Itisevenmorerareforanarticlethatpro-
posesanewtreatmenttosuggestatopicforaudit.
Thisbookis,tomyknowledge,thefirstthatseesthesethreestrandsasasingleway
ofpractisingmedicine.Itisnocoincidencethatittookadoctorwhoqualifiedinthe
seconddecadeofthe21stcenturytobringthesestrandstogether.Manydoctors
who teach have still not mastered the evidence-based approach and some still
see audit as something you do to satisfy your managers. Armed with this book,
thestudentcanlayafoundationforhisorherclinicalpracticethatwillinformevery
consultationoveralifetimeinmedicine.
Andrew Polmear
viii
Acknowledgements
Iwouldliketoexpressmydeepgratitudeto:
(cid:129) Dan Horton-Szar, Jeremy Bowes, Sheila Black and the rest of the team at
Elsevier,whograntedmethisamazingopportunitytoteachandinspirethenext
generationofclinicalacademics;
(cid:129) Andrew Polmear, the Faculty Advisor for this project, for his valuable and
constructivesuggestionsduringthedevelopmentofthisbook;
(cid:129) AndySalmon,SeniorLecturerandHonoraryConsultantinRenalMedicineand
Physiology,arolemodelprovidinginspirationthathasbeenashininglight;
(cid:129) Tanya Smith for interviewing me for Chapter 21 on ‘Careers in academic
medicine’.
(cid:129) allthosewhohavesupportedmeinmyacademiccareertodate,includingJamie
Jeremy,EmeritusProfessorattheBristolHeartInstituteandMarkCheesman,
CareoftheElderlyConsultantatSouthmeadHospital;
(cid:129) myclosefriends,SimranSinhaandHajebKamali,foralltheirencouragement
duringthepreparationofthisbook.
AmitKaura
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