Foreword to the first edition by Professor Sir David Weatherall xii Preface to the seventh edition xiv Preface to the first edition xvii Acknowledgements xix Chapter 1 Why read papers at all? 1 Does ‘evidence- based medicine’ simply mean ‘reading papers in medical journals’? 1 Why do people sometimes groan when you mention evidence- based healthcare? 4 Before you start: formulate the problem 11 Exercises based on this chapter 13 References 14 Chapter 2 Searching the literature 15 The information jungle 15 What are you looking for? 16 Levels upon levels of evidence 17 Synthesised sources: systems, summaries and syntheses 18 Pre-appraised sources: synopses of systematic reviews and primary studies 21 Specialised resources 22 Primary studies: tackling the jungle 23 One-stop shopping: federated search engines 25 Using artificial intelligence to search the literature 25 Asking for help and asking around 26 Online tutorials for effective searching 26 Exercises based on this chapter 27 References 28 Chapter 3 Getting your bearings: what is this paper about? 30 The science of ‘trashing’ papers 30 Three preliminary questions to get your bearings 32 What are randomised controlled trials and why do they matter? 34 What are cohort studies? 38 What are case–control studies? 40 What are cross-sectional surveys? 40 What are case reports? 41 The traditional hierarchy of evidence 42 Exercises based on this chapter 43 References 43 Chapter 4 Assessing methodological quality 45 Was the study original? 45 Who is the study about? 46 Was the design of the study sensible? 47 Was bias avoided or minimised? 49 Was assessment ‘blind’? 54 Were preliminary statistical questions addressed? 55 A note on ethical considerations 58 Summing up 59 Exercises based on this chapter 60 References 60 Chapter 5 Statistics for the non-statistician 63 How can non-statisticians evaluate statistical tests? 63 Have the authors set the scene correctly? 65 Paired data, tails and outliers 71 Correlation, regression and causation 72 Probability and confidence 74 The bottom line (quantifying the chance of benefit and harm) 77 Summary 79 Exercises based on this chapter 79 References 80 Chapter 6 Papers that report clinical trials of simple interventions 82 What is a clinical trial? 82 Drug trials: ‘evidence’ and marketing 83 Making decisions about therapy 86 Surrogate endpoints 87 What information to expect in a paper describing a randomised controlled trial: the CONSORT statement 91 Getting worthwhile evidence from pharmaceutical representatives 91 A note on vaccine trials 94 Exercises based on this chapter 95 References 95 Chapter 7 Papers that report trials of complex interventions 99 Complex interventions 99 Ten questions to ask about a paper describing a complex intervention 101 Exercises based on this chapter 106 References 107 Chapter 8 Papers that report diagnostic or screening tests 109 Ten suspects in the dock 109 Validating diagnostic tests against a gold standard 110 Ten questions to ask about a paper that claims to validate a diagnostic or screening test 115 Likelihood ratios 119 Clinical prediction models 122 Exercises based on this chapter 124 References 125 Chapter 9 Papers that summarise other papers (systematic reviews and meta-analyses) 128 When is a review systematic? 128 Evaluating systematic reviews: five questions to ask 131 Meta-analysis for the non-statistician 137 Explaining heterogeneity 142 New approaches to systematic review 145 Exercises based on this chapter 146 References 146 Chapter 10 Papers that advise you what to do (guidelines) 151 The great guidelines debate 151 Ten questions to ask about a clinical guideline 155 Exercises based on this chapter 162 References 162 Chapter 11 Papers that estimate what things cost (health economic evaluations) 164 What is an economic evaluation? 164 Health economics studies: two key approaches 166 Costs and benefits of health interventions 167 Measuring the value of health states 168 Quality-adjusted life-years 169 Low-value health: choosing wisely 171 Twelve questions to ask about a health economic evaluation 172 Conclusion 176 Exercises based on this chapter 176 References 177 Chapter 12 Papers that go beyond numbers (qualitative research) 179 What is qualitative research? 179 Summarising and synthesising qualitative research 183 Nine questions to ask about a qualitative research paper 184 Conclusion 191 Exercises based on this chapter 192 References 192 Chapter 13 Papers that report questionnaire research 195 The rise and rise of questionnaire research 195 Ten questions to ask about a paper describing a questionnaire study 196 Exercises based on this chapter 205 References 206 Chapter 14 Papers that report quality improvement case studies 208 What are quality improvement studies and how should we research them? 208 Ten questions to ask about a paper describing a quality improvement initiative 210 Conclusion 217 Exercises based on this chapter 217 References 218 Chapter 15 Papers that describe genetic association studies 220 The three eras of human genetic studies (so far) 220 What is a genome-wide association study? 222 Clinical applications of genome-wide association studies 225 Direct- to- consumer genetic testing 226 Mendelian randomisation studies 227 Epigenetics: a space to watch 228 Ten questions to ask about a genetic association study 230 Exercises based on this chapter 234 References 234 Chapter 16 Applying evidence with patients 237 The patient perspective 237 Patient- reported outcome measures 239 Shared decision- making 240 Option grids 243 n-of-1 trials and other individualised approaches 244 Exercises based on this chapter 246 References 247 Contents xi Chapter 17 Papers on artificial intelligence in healthcare 249 Introduction 249 Artificial intelligence 251 Big data 253 Machine learning 254 Generative artificial intelligence: large language and multimodal models 254 Ethical principles for the use of artificial intelligence for health 255 Appraising artificial intelligence papers: a plethora of checklists 256 Ten questions to ask about a paper that reports AI studies in healthcare 260 Summary 264 Exercises based on this chapter 264 References 265 Chapter 18 EBM+: the importance of mechanistic evidence 268 What is mechanistic evidence? An example 268 The many types of mechanistic evidence and a preliminary hierarchy 269 EBM+ means ‘both and’, not ‘either or’ 270 Mechanistic evidence in the COVID-19 pandemic 272 Exercises based on this chapter 275 References 276 Chapter 19 Papers that report consensus exercises 278 Why are consensus method papers important? 279 How do experts choose and reach consensus on a specific topic? 279 Consensus methods 281 Ten questions to ask about a paper that reports a consensus statement 285 Exercises based on this chapter 290 References 291 Chapter 20 Criticisms of evidence-based healthcare 293 What’s wrong with evidence-based healthcare when it’s done badly? 293 What’s wrong with evidence-based healthcare when it’s done well? 296 Why is ‘evidence-based policymaking’ so hard to achieve? 299 Exercises based on this chapter 301 References 301 Appendix 1 Checklists for finding, appraising and implementing evidence 304 Appendix 2 Assessing the effects of an intervention 316 Index 317  

Learn to assess published research in this best-selling introduction to evidence-based healthcare Evidence-based practices have revolutionized medical care. Clinical and scientific papers have something to offer practitioners at every level of the profession, from students to established clinicians in medicine, nursing and allied professions. Novices are often intimidated by the idea of reading and appraising the research literature. How to Read a Paper demystifies this process with a thorough, engaging introduction to how clinical research papers are constructed and how to evaluate them. Now fully updated to incorporate new areas of research, readers of the seventh edition of How to Read a Paper will also find: A careful balance between the principles of evidence-based healthcare and clinical practiceNew chapters covering consensus methods, mechanistic evidence, big data and artificial intelligenceDetailed coverage of subjects like assessing methodological quality, systemic reviews and meta-analyses, qualitative research, and more. How to Read a Paper is ideal for all healthcare students and professionals seeking an accessible introduction to evidence-based healthcare – particularly those sitting undergraduate and postgraduate exams and preparing for interviews.