1. Fineout-Overholt, Ellen RN, PhD

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USERS' GUIDES TO THE MEDICAL LITERATURE. ESSENTIALS OF EVIDENCE-BASED CLINICAL PRACTICE Gordon Guyatt, Drummond Rennie, and The Evidence-Based Medicine Working Group, 2002 AMA Press 515 North State St Chicago, IL 60610 Telephone: 312-464-5000 ISBN: 1-57947-174-9 Cost: $55.00


The Journal of the American Medical Association (JAMA) series on how to use the medical literature has been expanded and put into book and CD-ROM format. The Evidence-Based Medicine Working Group, along with editors Gordon Guyatt and Drummond Rennie, have provided practitioners with a valuable resource for evaluating evidence relevant to their practice. The authors of this "how-to" book have made certain that it includes challenges to all levels of users of evidence, from beginners to experts. The material is presented in 3 formats: a 700-page manual for evidence-based practice (EBP) (Manual) that is thorough and comprehensive, a 440-page pocket version of the essentials of EBP (Essentials) that provides an in-depth discussion of the basics, and a hyperlinked CD-ROM that contains the 700-page manual and is included with both hardcopy versions. The Essentials book is small enough to keep in a large pocket, although the print is small and may be difficult for tired eyes to read. The Manual is readable and not too cumbersome in size. Both hard copy versions have quick-reference cards. My favorite format was the CD-ROM. The print size is changeable to match the reader's preference and maneuvering within the text is a breeze. For example, when the reader is referred to a section that is relevant to the current one being read, with one click the reader is sent to that section instead of thumbing through pages and pages looking for the relevant sections. As expected, the CD-ROM version includes features such as highlighted keywords that can be clicked on to review a definition or concept. In addition, the color format is attractive and easy on the eyes when reading for extended periods.


Guyatt and Rennie provide a thorough discussion of EBP content. Part I covers the basics, providing information to prepare users of evidence to form and readily answer clinical questions and to interpret the evidence relevant to making a clinical decision. Part II goes beyond the scope of average users and provides expanded information on each section in Part I. Part II is directed at teachers of EBP and advanced evidence users. Most of the book is devoted to interpretation of scientific evidence, such as that generated from randomized controlled trials. However, other types of evidence, such as qualitative, are also discussed.


In Part I, the authors clearly define EBP. Lengthy discussions address how to evaluate the strongest scientific evidence and then use it, along with clinical expertise and patient values, to make a clinical decision. As with other EBP texts, the authors discuss the basics, including forming the right question, finding the evidence, and evaluating evidence related to therapy, differential diagnosis, diagnostic tests, prognostics, and harm. Clinical examples are used to take the reader through application of the principles introduced and discussed. A well-described clinical scenario is provided at the beginning of the section. Throughout each section, colored boxes called "Using the Guide" provide explanations of the principles as they relate to the scenario. The clinical scenarios, used to illustrate points and apply principles, were the features that I particularly liked. These scenarios helped to make the content more meaningful and clear for me. Alternatively, I occasionally got bogged down in the nonscenario-related explanations provided.


Another nice feature in Part I is the section on online resources. The text contains a summary table and in-depth descriptions of several online sources of evidence, including Best Evidence, the Cochrane Library, UptoDate (an online textbook that is updated every 4 months), and Clinical Evidence. Links are provided on the CD-ROM as well. In each scenario, the authors explain how to answer the question by finding the evidence in some of these databases. The accompanying explanations helped to clarify the appropriateness of the chosen database for that particular question.


The two hardcopy versions diverge in Part II. In the short version, the Essentials, Part II covers only two portions of sections in Part II of the Manual. All sections are fully covered on the CD-ROM. In Part II of the Manual, the authors discuss more advanced issues relevant to EBP, including N of 1 randomized controlled trials, publication bias, measuring agreement beyond chance, intention to treat analysis, and confidence intervals. Some sections of Part II are intense reading and may be intimidating to beginning users of evidence; however, advanced users will relish the completeness of the authors' chosen topics and discussions.


From the perspective of an advanced practice nurse, the one drawback to the book is the physician-oriented focus and absence of nurse contributors. Nevertheless, the usefulness of the information to advanced nursing practice is unquestionable. The authors thoroughly explain EBP and provide tools for use by all practitioners who wish to promote best practice. I liked the two mediums of written text and CD-ROM and found myself moving between these formats. I have read other books on EBP, but this text intrigued me with the use of in-depth clinical examples for the application of the principles discussed. I would recommend this text for graduate-level courses in advanced nursing practice and for all practitioners who are determined to provide the best care they can for their patients.