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Introduction

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The objective of this book is to help you make efficient use of the published literature in guiding your patient care. What does the published literature comprise? Our definition is broad. You may find evidencea in a wide variety of sources, including original journal articles, reviews and synopses of primary studies, clinical practice guidelines, and traditional and innovative medical textbooks. Increasingly, clinicians can most easily access many of these sources through the Internet.

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aThe italicization, here and in every other chapter, represents the first occurrence in the chapter of a word defined in the glossary.

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The Structure of the Users' Guides to the Medical Literature: The Foundations

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This book is not like a novel that you read from beginning to end. Indeed, the Users' Guides are designed so that each part is largely self-contained. Thus, we anticipate that clinicians may be selective in their reading of the core content chapters and will certainly be selective when they move beyond the essentials. On the first reading, you may choose only a few advanced areas that interest you. If, as you use the medical literature, you find the need to expand your understanding of, for instance, studies addressing screening tests or the use of surrogate outcomes, you can consult the relevant chapters to familiarize or reacquaint yourself with the issues. You may also find the glossary a useful reminder of the formal definitions of terms used herein. Finally, we rely heavily on examples to make our points. You will find examples identified by their blue background.

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The book comprises 7 sections: The Foundations, Therapy, Harm, Diagnosis, Prognosis, Summarizing the Evidence, and Moving From Evidence to Action (Box 1-1).

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BOX 1-1

Sections of This Book

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The first section of this book introduces the foundations of evidence-based practice. Two chapters in this section, What Is Evidence-Based Medicine? and Evidence-Based Medicine and the Theory of Knowledge, present the 3 guiding principles of evidence-based medicine (EBM) and place EBM in the context of a humanistic approach to medical practice. The subsequent chapters in this section deal with defining your clinical question, locating the best evidence to address that question, and distinguishing bias from random error (a key principle of critical appraisal).

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Clinicians are primarily interested in making accurate diagnoses and selecting optimal treatments for their patients. They also must avoid exposing patients to harm and offer patients prognostic information. Thus, chapters in 4 sections of this book (Therapy, Harm, Diagnosis, and Prognosis) begin by outlining what every medical student, intern and resident, and practicing physician and other clinicians will need to know to ...

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