Critical Appraisal of Bio-medical Literature, on-line tutorial from the Wisdom Centre:

A very readable and practical series, originally published in the British Medical Journal and edited by Trisha Greenhalgh. Also now available as a book from BMJ Publishing Group:

The Medline database, BMJ 1997;315:180-183 (19 July)

Getting your bearings (deciding what the paper is about) BMJ 1997;315:243-246 (26 July) http://www.bmj.com/cgi/content/full/315/7102/243

Assessing the methodological quality of published papers BMJ 1997;315 (2 August)

Statistics for the non-statistician. I: Different types of data need different statistical tests BMJ 1997;315:364-366 (9 August) http://www.bmj.com/cgi/content/full/315/7104/364

Statistics for the non-statistician. II: "Significant" relations and their pitfalls BMJ 1997;315:422-425 (16 Aug) http://www.bmj.com/cgi/content/full/315/7105/422

Papers that report drug trials BMJ 1997;315:480-483 (23 August) http://www.bmj.com/cgi/content/full/315/7106/480

Papers that report diagnostic or screening tests BMJ 1997;315:540-543 (30 August) http://www.bmj.com/cgi/content/full/315/7107/540

Papers that tell you what things cost (economic analyses) BMJ 1997;315:596-599 (6 Sept) http://www.bmj.com/cgi/content/full/315/7108/596

Papers that summarise other papers (systematic reviews and meta-analyses) BMJ 1997;315:672-675 (13 Sept) http://www.bmj.com/cgi/content/full/315/7109/672

Papers that go beyond numbers (qualitative research) BMJ 1997;315:740-743 (20 September) http://www.bmj.com/cgi/content/full/315/7110/740

A very good set of guides to using the literature were published in the Journal of the American Medical Association (JAMA) a few years ago and are now available on the Web with clinical scenarios and worked examples of question answering at: http://www.cche.net/principles/content_all.asp

Each includes a check list of questions to use in critical appraisal, and some also include advice about the best Medline search strategy. In detail they cover:

Therapy and prevention http://www.cche.net/principles/content_therapy.asp

Diagnosis http://www.cche.net/principles/content_diagnosis.asp

Harm http://www.cche.net/principles/content_harm.asp

Prognosis http://www.cche.net/principles/content_prognosis.asp

Overview articles http://www.cche.net/principles/content_overview.asp

Clinical decision analyses http://www.cche.net/principles/content_d_analysis.asp

Clinical practice guidelines http://www.cche.net/principles/content_p_guideline.asp

Clinical utilization reviews* http://www.cche.net/principles/content_u_review.asp

Outcomes of health service research: http://www.cche.net/principles/content_v_outcome.asp

Quality of life measures http://www.cche.net/principles/content_qol.asp

Economic analyses http://www.cche.net/principles/content_e_analysis.asp

Grading Healthcare Recommendations http://www.cche.net/principles/content_grading.asp

Applicability of clinical trials results http://www.cche.net/principles/content_results.asp

Probability for different diagnoses http://www.cche.net/principles/content_d_probability.asp

(*basically write ups of clinical audit projects)

The hard copy references for the JAMA series are:

• Oxman AD. Sackett DL. Guyatt GH (1993) Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA. 270(17):2093-5,
• Guyatt GH. Sackett DL. Cook DJ (1993) Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 270(21):2598-601
• Guyatt GH. Sackett DL. Cook DJ (1994) Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA. 271(1):59-63
• Jaeschke R. Guyatt G. Sackett DL (1994) Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 271(5):389-91
• Jaeschke R. Guyatt GH. Sackett DL (1994) Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 271(9):703-7
• Levine M. Walter S. Lee H. Haines T. Holbrook A. Moyer V (1994) Users' guides to the medical literature. IV. How to use an article about harm. Evidence-Based Medicine Working Group. JAMA. 271(20):1615-9
• Laupacis A. Wells G. Richardson WS. Tugwell P. (1994) Users' guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group. JAMA. 272(3):234-7
• Oxman AD. Cook DJ. Guyatt GH (1994) Users' guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group JAMA. 272(17):1367-71
• Richardson WS , Detsky AS. VII. How to use a Clinical Decision Analysis. A. Are the results of the study valid? JAMA1995; 273 (16) : 1292-1295.
• Richardson WS, Detsky AS. VII. How to use a Clinical Decision Analysis. B. What are the results and will they help me in caring for my patients? JAMA 1995; 273 (20) : 1610-1613.
• Hayward RS. Wilson MC. Tunis SR. Bass EB. Guyatt G. (1995) Users' guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? The Evidence-Based Medicine Working Group. JAMA. 274(7):570-4
• Wilson MC. Hayward RS. Tunis SR. Bass EB. Guyatt G. (1995)Users' guides to the Medical Literature. VIII. How to use clinical practice guidelines. B. what are the recommendations and will they help you in caring for your patients? The Evidence-Based Medicine Working Group. JAMA. 274(20):1630-2
• Guyatt GH. Sackett DL. Sinclair JC. Hayward R. Cook DJ. Cook RJ (1996) Users' guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group JAMA. 274(22):1800-4 [published erratum appears in JAMA 1996 275(16):1232].
• Naylor CD. Guyatt GH. (1996)Users' guides to the medical literature. X. How to use an article reporting variations in the outcomes of health services. The Evidence-Based Medicine Working Group. JAMA. 275(7):554-8
• Naylor CD. Guyatt GH. (1996) Users' guides to the medical literature. XI. How to use an article about a clinical utilization review. Evidence-Based Medicine Working Group. JAMA. 275(18):1435-9
• Guyatt GH. Naylor CD. Juniper E. Heyland DK. Jaeschke R. Cook DJ(1997)Users' guides to the medical literature. XII. How to use articles about health-related quality of life. Evidence-Based Medicine Working Group. JAMA. 277(15):1232-7
• Drummond MF, Richardson WS, O'Brien BJ, Levine M and Heyland D XIII. How to use an article on economic analysis of clinical practice: A. Are the results of the study valid? JAMA 1997;277:1552-1557.
• O'Brien BJ, Heyland D, Richardson WS, Levine M , Drummond MF . XIII How to use an article on economic analysis of clinical practice: B. What are the results and will they help me in caring for my patients? JAMA 1997;277:1802-1806
• Dans AL. Dans LF. Guyatt GH. Richardson S (1998) Users' guides to the medical literature: XIV. How to decide on the applicability of clinical trial results to your patient. Evidence-Based Medicine Working Group JAMA. 279(7):545-9
• Richardson WS. Wilson MC. Guyatt GH. Cook DJ. Nishikawa J.(1999) Users' guides to the medical literature: XV. How to use an article about disease probability for differential diagnosis. Evidence-Based Medicine Working Group. JAMA. 281(13):1214-9
• Guyatt GH. Sinclair J. Cook DJ. Glasziou P (1999) Users' guides to the medical literature: XVI. How to use a treatment recommendation. Evidence-Based Medicine Working Group and the Cochrane Applicability Methods Working Group. JAMA. 281(19):1836-43
• Barratt A. Irwig L. Glasziou P. Cumming RG. Raffle A. Hicks N. Gray JA. Guyatt GH. (1999) Users' guides to the medical literature: XVII. How to use guidelines and recommendations about screening. Evidence-Based Medicine Working Group. JAMA. 281(21):2029-34
• Randolph AG, Haynes RB, Wyatt JC, Cook DJ, Guyatt GH. Users guide to medical literature. XVIII How to use an article evaluating the clinical impact of a computer-based clinical decision support system. JAMA 1999;282: 67-74:
• Bucher HC, Guyatt GH, Cook DJ, Holbrook A, McAlister FA. Users' guides to the medical literature: XIX. Applying clinical trial results. A. How to use an article measuring the effect of an intervention on surrogate end points. JAMA 1999 Aug 25;282(8):771-8
• McAlister FA, Laupacis A, Wells GA, Sackett DL. Users' Guides to the Medical Literature: XIX. Applying clinical trial results. B. Guidelines for determining whether a drug is exerting (more than) a class effect. JAMA. 1999 Oct 13;282(14):1371-7.
• McAlister FA, Straus SE, Guyatt GH, Haynes RB. Users' guides to the medical literature: XX. Integrating research evidence with the care of the individual patient. JAMA 2000 June 7;283(21):2829-2836
• Hunt DL, Jaeschke R, McKibbon KA. Users' guides to the medical literature: XXI. Using electronic health information resources in evidence-based practice. Evidence-Based Medicine Working Group. JAMA. 2000 Apr 12;283(14):1875-9.
• McGinn TG, Guyatt GH, Wyer PC, Naylor CD, Stiell IG, Richardson WS. Users' guides to the medical literature: XXII: How to use articles about clinical decision rules. JAMA 2000 Jul 5;284(1):79-84
• Giacomini MK, Cook DJ. Users' guides to the medical literature XXIII. Qualitative research in health care A. Are the Results of the Study Valid? JAMA. 2000 Jul 19;284(3):357-362

The Evidence Based Medicine Tool Kit, basically a simpler version of the Users’ Guides

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