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

If readers have not read the JAMA series Users' Guides to the Medical Literature and find the prospect of tracking down all twenty-five of the articles daunting, this publication offers the complete series between two covers. Guyatt and Rennie have amassed all articles in the series, which began in 1993. The information from the articles has been updated and woven together, without redundancies.

Divided into two parts, the Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice aims to make medical research literature accessible to clinicians. Part one is designed to teach clinicians ways of using research literature in their daily practice. To do so, it covers the philosophy of evidence-based medicine (EBM) as well as the ways to find, analyze, and apply the research to patient care for therapy; diagnosis; prognosis; and possible harmful applications. Case scenarios and clinical examples are liberally used to illustrate the concepts. References to part two are included for those who desire to dig deeper into a particular topic.

Part two is designed to instruct clinicians on how to teach model use of medical literature in daily practice. Correspondingly, the discussions are deeper, while additional topics, such as using statistical regression covered in “Part Two: Prognosis,” have been added. Sections from part one are reproduced here, though worded slightly differently. Although some might be tempted to read only part two, those wishing to teach EBM should gird themselves to study and read both parts, as each contains a significant amount of unique material.

The users' guides come with a set of pocket cards for figuring likelihood ratios and interpreting diagnostic tests and quick notes on evaluating articles for patient therapy. A CD-ROM version is also included for those who prefer to scroll or jump using hypertext their way through the guides. Hypertext has been used to link topics from part one to part two as well as to link references and illustrations.

A second Users' Guides to the Medical Literature by Guyatt and Rennie [1] is available. This one carries the subtitle Essentials of Evidence-Based Clinical Practice and is in essence a pocket guide version of the manual. Unfortunately, this is not indicated anywhere on the text. The similarities in titles can result in some confusion as to the difference between the two. The purpose of the Essentials of Evidence-Based Clinical Practice is to assist clinicians in learning the basics of EBM and applying it in practice. It includes all of part one and four subchapters from part two of the Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. The Essentials of Evidence-Based Clinical Practice also includes the same pocket cards and a CD-ROM of the full text of A Manual for Evidence-Based Clinical Practice. For those wishing to learn EBM principles for their own practice but not to teach, buying the smaller, cheaper Essentials of Evidence-Based Clinical Practice is more economical.

Competing with Guyatt and Rennie's Users' Guides to the Medical Literature texts is Sackett et al.'s Evidence-Based Medicine: How to Practice and Teach EBM [2]. At 265 pages (compared to A Manual for Evidence-Based Clinical Practice at 712 pages), Sackett's book is the easier and quicker read. It covers the basics of EBM—definition of what it is, ways of finding the research, diagnosis and screening, prognosis, therapy, harm, guidelines, and teaching methods—and includes a CD-ROM version of the text with pocket cards corresponding to the chapters. Written more like a workbook than a lecture, Sackett's Evidence-Based Medicine will probably be the favorite of those who need to get up to speed on EBM quickly. In comparison, the Manual for Evidence-Based Clinical Practice is denser and more in depth in its treatment of how to practice EBM.

Those who want instruction on how to systematically and rigorously search the literature for research articles are better off with McKibbon's PDQ Evidence-based Principles and Practice [3]. The Users' Guides to the Medical Literature do provide basic pointers on how to search for evidence, however, these pointers are indeed basic, very brief, and intended for busy clinicians who need to retrieve only one or two sound articles.

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice will be useful for physicians as well as nurse practitioners and others desiring an in-depth coverage of EBM. It is highly recommended for purchase by medical libraries. For cost savings, hospital or smaller academic libraries may consider buying Guyatt and Rennie's Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice, as it contains the full text of A Manual for Evidence-Based Clinical Practice on CD-ROM.