Abstract
The authors set themselves an ambitious task from the outset: to improve the reader's performance in the health-care team by structuring the way in which we deal with problems, from answering telephone inquiries to preparing business cases for new tests. The authors previously edited the 2007 book Evidence-Based Laboratory Medicine: Principles, Practice and Outcomes (Washington: AACC Press), which was reviewed in the Annals in 2008 (
The book consists of three main parts, as well as a clear summary of what the reader should expect from it. The text is thoroughly referenced throughout, with literature sources for the clinical examples as well as for the main text. There is space for notes, and for the reader to note down examples from their own clinical practice. There are ‘Key Concept’ boxes at regular intervals in the main body of the text, as well as grey boxes to the side of the text containing additional useful information and examples, not necessarily medical ones. These in particular are useful in concentrating the mind, as some of the concepts can be a little dry. I did not find that these boxes interrupt the flow of the text, as such additions sometimes can.
Part 1 consists of an introduction to evidence-based laboratory medicine (EBLM). It also introduces the methods used in the book – the ‘PICO’ system for formulating questions (patient/population, intervention, control and outcome), the steps in the EBLM cycle and six clinical scenarios. I found this section to be the least satisfying in the book on a first read-through, as many concepts and abbreviations are introduced but not always explained fully at this stage (all are explained thoroughly later in the book, but this is not always made clear at the time). It was also not apparent when the scenarios would be discussed further. However, on a second read-through after completing the rest of the book, this section does provide a clear overview of the contents overall.
Part 2 covers the five steps in the EBLM cycle – ask, acquire, appraise, apply and assess. It is the major section of the book, with a section for each ‘A’. The Ask section goes through formulating questions using the PICO principle, giving many clinical examples and encouraging the reader to formulate questions from their own experience, and giving room for these to be written into the book. Questions from different perspectives are introduced – clinical cases involving screening, diagnosis, prognosis and treatment, as well as analytical, operational and economic scenarios. The Acquire section is the section which I found to be the most useful – it includes a section on how to use the PubMed database, something which I have been doing for years, but I now see that I have not been using it to its full capacity. This is an extremely useful section, whether for experienced users wishing to hone their skills, or relative novices. As with the other sections, examples are given and a search is walked through with screen shots. The Appraise section is a readable overview of critical appraisal, with several checklists explained and examples given. The Apply section is full of examples relevant to daily practice. The Assess section assesses the reader's assimilation of the principles of EBLM.
Part 3 consists of a comprehensive list of acronyms, other abbreviations and definitions of terms, studies and other relevant items that is particularly useful when appraising the papers found in Part 2. There is also a full list of recommended resources, both online and books, and lists of useful websites. This section will be valuable for revising EBLM, reading papers or constructing studies. The Appendices include various critical appraisal tools described earlier in the book, and a section on study design.
In general, this book gives an excellent overview of evidence-based laboratory medicine, and does not require any prior knowledge of the subject. It performs a dual function of informing good clinical practice and giving a structural framework for formulating answers, whether to questions asked in the laboratory or in the FRCPath examination. I would recommend it, both as a workbook for those wanting to work through the book either to learn or revise the subject, and as a useful reference for the duty biochemist room or the departmental library. I feel that the book lives up to its ambitious aim.