Field of medicine: Evidence-based medicine and clinical epidemiology.

Format: Softcover book.

Audience: Health care professionals, medical educators, and medical trainees interested in developing proficiency in evidence-based medicine.

Purpose: To serve as a resource and teaching text for persons who wish to acquire the searching, analytical, and statistical skills needed for evidence-based decision making.

Content: The book is divided into three sections. The first addresses medical decision-making techniques and includes chapters on refinement of probability, decision analysis, treatment and testing thresholds, and cost-effectiveness analysis. The second section guides the reader through techniques for accessing the medical literature through MEDLINE and the Internet and offers recommendations for keeping up with the literature. The last section concerns the validity of medical information in relation to the study of diagnostic tests, interventions, and prognosis and the evaluation of integrative literature (overviews, meta-analyses, practice guidelines, decision analyses, and cost-effectiveness analyses).

Highlights: The chapters on decision analysis and testing and treatment thresholds are ambitious and are aimed at highly motivated learners. They use appropriate clinical examples; are interactive and clear; and have extensive, readable tables and figures to help guide the learner through clinically relevant exercises.

Limitations: This book exacts more effort than many internists may be prepared to give. Readers are expected to commit to technical aspects of clinical epidemiology to a degree that raises some question about the audience for this book. MEDLINE searches are well illustrated but primarily use a search engine unique to the University of California, San Francisco, system (and, to lesser degree, the National Library of Medicine's Grateful Med). Most readers will be using other search systems, which may differ greatly. Almost no attention is given to the use of "secondary" sources, such as the Cochrane Library or Best Evidence, whose summaries of validated sources make evidence-based medicine considerably more user-friendly.

Related reading: Two recent books have set the standards for guiding practicing physicians and teachers into implementing evidence-based medicine. Both Sackett's Evidence-based Medicine (Churchill Livingstone, 1997) and Greenhalgh's How to Read a Paper (BMJ, 1997) present material from the point of view of the practicing physician and make implementation in practice seem more accessible than this text does.

Reviewer: Eleanor Z. Wallace, MD, SUNY Health Sciences Center, Brooklyn, New York.