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Critical Appraisal for Psychiatry
  1. Patrick G O'Malley, MD, MPH
  1. Walter Reed Army Medical Center Washington, DC, USA

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    The aim of Critical Appraisal for Psychiatry is to provide a brief, but comprehensive, introduction to the underlying concepts and practice of evidence-based mental health. It is targeted to psychiatric trainees preparing for the MRCPsych part II exam, but it should also appeal to more senior and junior psychiatrists, and other mental health professionals who need more than superficial understanding of evidence-based medicine concepts. I believe this book will also be a useful resource for anyone interested in practising or teaching evidence based medicine.

    This resource is a collaborative effort by 3 authors from the Department of Psychiatry at the Royal Edinburgh Hospital, Edinburgh. It is a concise yet extraordinarily comprehensive discussion of the basic concepts of evidence-based medicine. It is well written, and difficult concepts are expertly explained. Examples are given by using clinical questions, selecting a research paper to answer each question, and explaining the process of critical appraisal for the various kinds of research articles applicable to clinical care.

    The text is divided into 5 sections, beginning with an introductory chapter on “Putting it all in context”, followed by the main sections of the book including “Research methods”, “Statistics”, “Critical appraisal”, and “Mock exam papers and model answers”. Each chapter ends with a selection of multiple choice questions with answers, and the book ends with a nice glossary of keyterms.

    The introductory section discusses the history and future of the science of psychiatry, principles of quality improvement and accountability (termed “clinical governance”), basic information on the need for critical appraisal, and the evolution and definition of evidence-based medicine. It also discusses the uncertainty surrounding clinical decision making and the clinician's enormous information needs, and provides a comprehensive list of information resources such as the Cochrane Library and other internet-based resources that will enable one to practice evidence-based mental health.

    The section on “Research methods” includes a discussion of the anatomy of the hierarchy of research methods from case reports to systematic reviews and meta-analyses. The “Statistics” section addresses the basic concepts of descriptive statistics, confidence intervals, and probability and statistical significance, and contains a clear and insightful explanation of basic analytical concepts and statistics, from the t-statistic for differences in means, to survival analysis and meta-analysis statistics. The “Critical appraisal” section includes the principles of critical appraisal for diagnosis, treatment, harm, prognosis, systematic reviews (including meta-analysis), economic evaluations, clinical practice guidelines, and clinical audit.

    The authors of Critical Appraisal for Psychiatry are clearly clinicians explaining complex material to clinicians, and their work is quite easy to read. Without question this book will be clinically useful because it quickly and accurately assists with the appraisal of information as one uses the medical literature to answer patient related questions. I am a teacher of evidence-based medicine, and I will surely use this resource as a quick reference for explaining epidemiological and statistical concepts, identifying sources of information, and as a quick guide to doing and teaching critical appraisal.

    In an age of scientific accountability, psychiatry can no longer lag behind in applying the principles of evidence-based medicine to clinical psychiatric practice. The Royal College of Psychiatry has recognised the importance of this and has made a basic knowledge base of evidence-based mental health a requirement of training psychiatrists. Anyone who has ever tried to teach evidence-based medicine to trainees knows that this not an easy task. Lawrie et al have written a book designed for psychiatric trainees that will make this task substantially easier for both teachers and learners of clinical psychiatry.


    Quality of information: ★★★★★

    Clinical usefulness: ★★★★★

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