LETTER
Information for Readers
David A. Blandino, MD
1 October 1995 | Volume 123 Issue 7 | Pages 553-554
TO THE EDITOR:
The interest in improving the Instructions for Authors section of Annals [1] should be matched by the same interest in developing an Instructions for Readers section. Compared with authors and editors, practicing physicians and other consumers of the medical literature have an even greater need for clarity and efficient guidance [2].
The Instructions for Readers section would not only contain the list of criteria for a quality clinical trial [1] but would also contain a description of a clinical trial grading system analogous to those used by organizations that make evidence-based recommendations. These existing grading systems assess the quality of evidence from various sources and convert it into a grade using explicit conventions [3]. For the evaluation of individual clinical trials, the system would grade the specific criteria that are essential in determining a study's internal and external validity [4]. Although many have proposed such grading systems to assist editors, reviewers, and authors, I have seen no such system used by a journal to assist its readers.
The abstract for each clinical trial would then contain the grades for the important criteria to indicate how well the study answered the following question [4]: What are the results and how valid are they? In addition, the abstract could contain a summary grade with commentary to determine whether these results should change clinical practice behavior and, if so, in what situations. I believe that until all physicians have the skills and time to do this for themselves, such a system is necessary to ensure better patient outcomes. Even if qualified editors or reviewers do not make such recommendations, someone else will [5]; too often, those that do are less qualified and much less objective.
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Author and Article Information
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Shadyside Hospital; Pittsburgh, PA 15232
1. Working Group on Recommendations for Reporting of Clinical Trials in the Biomedical Literature. Calls for comments on a proposal to improve reporting of clinical trials in the biomedical literature. Ann Intern Med. 1994; 121:894-5.
2. Haynes RB, McKibbon KA, Fitzgerald D, Guyatt GH, Wuller CJ, Sackett DL. How to keep up with the medical literature: I. Why try to keep up and how to get started. Ann Intern Med. 1986; 105:149-53.
3. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore: Williams & Wilkins; 1989.
4. Guyatt GH, Sackett DL, Cook DJ, for the Evidence-Based Working Group. Users' guide to the medical literature, II: How to use an article about therapy or prevention, A: Are the results of the study valid? JAMA. 1993; 270:2598-601.
5. Moser M, Blaufox MD, Freis E, Gifford RW, Kirkendall W, Langford H, et al. Who really determines your patients' prescriptions? JAMA. 1991; 265:498-500.
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