1. Evidence into Practice: how to read a paper Rob Sneyd (with help from...Andrew F. Smith, Lancaster, UK)

2. Outline Evidence-based medicine Appraisal of published trials The anatomy of a journal

3. Four steps to evidence-based practice 1.Ask a clinical question 2.Search for evidence 3.Critically appraise the evidence 4.Integrate the evidence into practice

4. Levels of evidence ISystematic review of RCTs IISingle RCT III Cohort studies IVCase series VSingle case report

5. Appraisal of published studies

6. Is this paper any good? 1.Validity 2.Applicability 3.Logical flow

7. Validity: bias and distortion

8. Bias in clinical trials Recruitment Selection Allocation Performance Observer Inference Reviewer

9. Bias in clinical trials Recruitment Selection Allocation Randomisation PerformanceBlinding ObserverBlinding Inference Reviewer

10. Introduction

11. Method Introduction

12. Method Meaningful outcomes Inclusion and exclusion Detail - replicability Measurement tools Allocation concealment Blinding and control groups Follow-up and dropouts Power calculation and significance

13. Method Results Introduction

14. Method Discussion Results Introduction

15. Discussion Summary of main findings Comment on strengths and weaknesses Comparison with other studies – similarities and differences Mechanisms and implications Unanswered questions and future work

16. Method Conclusion Discussion Results Introduction

17. Method Conclusion Discussion Results Abstract Introduction

18. Anatomy of the anaesthesia journal

21. Editorials Rarely contain primary data Help interpret research and promote its use in practice Promote discussion Offer authoritative opinion

23. What are review articles for? Answering clinical questions Keeping up to date Starting-point for future research Assimilating primary research

24. Systematic review A review in which evidence on a topic has been systematically identified, appraised and summarised according to predetermined criteria

25. Systematic review 1.Decide scope and purpose 2.Exhaustive search for material 3.Inclusion on pre-defined criteria 4.Quality assessment of relevant studies 5.Data extraction 6.Synthesis and integration 7.Interpretation

27. Case reports Focus on individuals rather than populations Narrative power Archive of collective experience Sensitive to novelty: new benefits, complications, the unknown and unrecognised

29. Correspondence The proper dialogue of science Extend journals peer review by readers comments, corrections and interpretation Not usually peer reviewed Under-rated and poorly indexed

30. Conclusion Simple non-statistical principles can help make sense of research Evidence and opinion both have their place but should not be confused Bias is everywhere and must be taken into account Critical appraisal helps us identify good evidence