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OBJECTIVE: The aim of this study was to explore applying the method of evidence-based medicine (EBM) to resolve common questions in the field of disability evaluation. METHODS: We used three clinical questions corresponding to problems encountered by insurance physicians in daily practice to explore opportunities for and barriers to the application of EBM. The questions fell under two topics: the prognosis of work ability and the effectiveness of interventions to enhance work participation. We used the four-step EBM strategy: (i) formulation of a clinical question, (ii) searching the literature, (iii) appraisal of the evidence, and (iv) implementation of the findings into clinical practice. We restricted the searches to PubMed (Medline). RESULTS: For rheumatoid arthritis, we found evidence on the prognosis of work disability over a long-term period. For remaining sciatica after lumbar discectomy, we found evidence for the stability of the limitations at this stage. For depression with co-morbid alcoholism, we found evidence that treatment of both conditions would enhance work participation. The searches were effective and efficient. The interpretation of the findings was hampered by a lack of consensus in the literature about outcomes such as the concept of a poor prognosis of work ability. CONCLUSIONS: The EBM strategy and methods can be used by social insurance physicians to find and apply evidence for common questions in disability evaluation. The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) model is instrumental in this, although more consensus on central outcome measures is needed. Further research is needed on the translation of evidence into practice. Development of valid specific search strategies for physicians in disability evaluation would improve the implementation of EBM.

Introduction: One of the most important changes in medical education programs in Iran has been designing and implementing course of Introduction to Clinical Medicine (ICM) in Isfahan University of Medical Sciences. This study determines the methods and results of process evaluation (from CIPP evaluation) used for ICM revision and evaluation program. This study aimed to provide evidences about its efficiency and extract its executive disadvantages and limitation. Method: This is an evaluation study conducted in Isfahan University of Medical Sciences. Data were collected through descriptive studies and in most cases, self-administrated questionnaire was used. In some cases, comparing the final MCQ scores was used. This evaluation was done during conducting new ICM program. Separate evaluation tools were prepared in several steps and used for each course at the end of that. These Steps are literature review, preparing draft questionnaire, getting feedback from, and consulting with main stakeholders of evaluation and preparing the final questionnaires. The content and face validity of the questionnaires were confirmed by experts of education after conducting a pilot study and the reliability were checked by Cronbach's Alpha coefficient. Results: The results showed that the students have more positive attitude toward EBM course. Students believed that ICM was an appropriate section for learning medical records. They were not satisfied with management of medical records course by nursing department, identifying learning objectives and the extent of accessing to them, time devoted to this lesson, teaching method, sources and evaluation method. Evaluation of communication skills course showed students’ positive attitude toward this course and their learning of this course. Overall students' satisfaction in most items of ICM course (volume of ICM course, resources, evaluation methods, exams intervals, content of tests, arrangement of packages, volume of lessons, arrangement of practical courses, giving information) was more in old ICM program than the new one. Clinical students agreed with all changes. Mean score of sign and symptom and pathophysiology of disease showed a slight increase in new ICM program (insignificant statistically). Frequency of the failed student decreased from 18 student-units in old ICM program to 10 student-units in new one. Conclusion: The results showed a relatively successful experience in reviewing and evaluating a medical education program. Regarding complexity of reviewing and evaluating medical education programs, this study can be used as a guide for designing other similar researches that are effective in future planning and decision-makings.

Medicina basada en la evidencia (MBE) es actualmente sinónimo de práctica médica moderna e innovadora. Sin embargo, poco se sabe de su real dimensión y principios. Su relación con la investigación y la "evidencia" es entendida como la interpretación de la literatura medica, la realización de mega ensayos clínicos o meta-análisis. MBE implica el uso juicioso de la mejor evidencia disponible, gracias a la evaluación rigurosa de la calidad metodológica de la información científica, así como de su aplicabilidad. La MBE rescata la experiencia y pericia clínica del médico. Adicionalmente, incorpora como tercer elemento fundamental las preferencias y valores de los pacientes acerca del cuidado de su salud. La intersección de estos tres aspectos constituye la esencia de la MBE. La práctica así entendida de la MBE ubica al paciente y sus circunstancias en el centro mismo del acto médico y lo revaloriza como "ciencia y arte". En esta revisión buscamos destacar como la práctica de la MBE guía hacia una toma de decisiones correcta y democrática. Así mismo, se revisa los diversos aportes en la práctica medica actual, las distorsiones creadas alrededor de ella y las limitaciones para su aplicación en nuestra realidad.(Rev Med Hered 2009;20:191-197).

Professor Marlene Freeman of Massachusset General Hospital's answer to the question "How should I prescribe valproic acid (for psychiatric disorders) to women of childbearing age?" is "Don't do it at all.", (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Additive manufacturing ('3D printing') techniques provide engineers with unprecedented design freedoms, opening up the possibility for stronger and lighter component designs. In this paper 'layout optimization' is used to provide a reference volume and to identify potential design topologies for a given component, providing a useful alternative to continuum based topology optimization approaches (which normally require labour intensive post-processing in order to realise a practical component). Here simple rules are used to automatically transform a line structure layout into a 3D continuum. Two examples are considered: (i) a simple beam component subject to three-point bending; (ii) a more complex air-brake hinge component, designed for the Bloodhound supersonic car. These components were successfully additively manufactured using titanium Ti-6Al-4V, using the Electron Beam Melting (EBM) process. Also, to verify the efficacy of the process and the mechanical performance of the fabricated specimens, a total of 12 beam samples were load tested to failure, demonstrating that the target design load could successfully be met. [ABSTRACT FROM AUTHOR]

Recent shifts towards ecosystem-based management and other holistic and participatory forms of oceans governance and management have come with demands for ways to better incorporate social data into decision-making processes such as integrated ecosystem assessments. This includes information related to a wide range of values associated with different aspects of marine social-ecological systems. This paper addresses that demand by first discussing various notions of value in the literature, and then presenting two case studies from British Columbia, Canada that illuminate some of the opportunities and complexities of using a mix of quantitative and qualitative approaches to bear on the challenge. Findings suggest that values are diverse and are contextually dependent, varying at small scales. Findings further suggest that values are hierarchically arranged and grouped differently by individuals into what might be called perspectives. Finally, the findings highlight that mixed-methods approaches featuring qualitative and quantitative elements may provide a step towards resolving tensions between, on one the one hand, a need to distil complex systems into observable, measurable indicators where the inevitable tradeoffs involved in resource management can be articulated, weighed, and on the other hand, a sense that characterizing the broad range of values that are relevant in shaping attitudes and conceptions of “what should be” in marine systems requires holistic thinking and attention to scale, context, relationality, subjectivity and rich detail. [ABSTRACT FROM AUTHOR]

Background. Hypertension is a civilization disease which currently affects about 10.5 m people in Poland. The number of patients with diagnosed, untreated hypertension amounts to 18%, and as many as 45% of patients are treated ineffectively, whereas only 26% are treated effectively. Impedance cardiography (IC) is an important tool both in diagnostics and the treatment of hypertensive patients, particularly in the case of antihypertensive treatment resistance. This method allows for the individualized treatment of each patient on the basis of hemodynamic parameters, monitoring of hypertensive patients in the outpatient care setting, and the assessment of cardiovascular risk factors. Objectives. The aim of the study was to evaluate the efficacy of hypotensive medications in patients with hypertension using impedance cardiography. Material and methods. The study involved 60 hypertensive patients, treated with antihypertensives, who failed to achieve the required blood pressure values. The modification of hypertension therapy was based on EBM (evidence-based medicine) and on hemodynamic parameters obtained using impedance cardiography. Results. It was found that high blood pressure therapy based on impedance cardiography parameters has a significant influence on blood pressure reduction compared to EM B-based therapy: below 140/90: 66.8 vs. 55.1% and below 130/80: 23.5 vs. 18.9%. Conclusions. On the basis of this study it was confirmed that impedance cardiography allows for a significant reduction of hypertension and the selection of the most effective therapeutic strategy, providing for the optimization and efficacy of hypertension treatment. [ABSTRACT FROM AUTHOR]

Introduction Modern medicine employs various approaches to analyzing data collected through clinical observation. The results of such analyses demonstrate general tendencies of the observations, yet they do not point to the dynamics of the therapeutic process. Aim The authors of the present study propose introducing the T 1 scale, thanks to which one can analyse the results and course of each patient's treatment in relation to normal distribution. The aim of this study is to prove that T 1 scale is functional in evaluating the effects of long-term therapy. Material and methods The study shows that T 1 scale, which is realized through the formula y = 10 z i + 50, is a universal scale. It has been concluded that the interval of T 1 scale determines effective dynamics of therapeutic procedures. The study encompasses 234 term infants born with normal weights who were diagnosed with neurodevelopmental disorders. The subjects were observed every 6 weeks. T 1 scale was applied in order to evaluate the dynamics of clinical change of the analysed features. Results and discussion The scale precisely differentiates the population, that is the number of patients for whom beneficial therapeutic effects were observed, the closer the values in T 1 scale are to the mean value of T 1 scale. T 1 scale makes it possible to evaluate clinical observations in the treatment process in a precise manner in line with evidence-based medicine (EBM). Conclusions T 1 scale makes it possible to evaluate clinical observations in the course of treatment in a precise manner in line with EBM. [ABSTRACT FROM AUTHOR]

Background: Evidence-based medicine (EBM) has been included in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) milestones project as a required component during emergency medicine (EM) residency training. Milestone Level One states that graduating medical students must be able to "describe basic principles of EBM."Objective: We sought to identify the EBM skills of third- and fourth-year medical students.Methods: Our institution, a network with 17 different residencies, hosts U.S. osteopathic and allopathic medical students. As a part of orientation, students are required to complete an entry Fresno Test of EBM (FTEBM). Retrospectively, medical student FTEBM scores from 2011 were assessed using descriptive statistics.Results: Four hundred seventeen FTEBM scores were analyzed. Participants represented 40 medical schools, including 17 allopathic (MD) and 23 osteopathic (DO) schools. Fifty percent of participants (n = 210) were female, and 51.6% (n = 215) were from a DO medical school. Overall mean performance for the FTEBM was 47.2%. Exploring the results by individual question were (individual EBM question topics are in parentheses): 1A (study question), 62.0%; 1B (study question), 64.4%: 2 (sources of evidence), 67.6%; 3 (study design), 57.1%; 4 (search strategies), 53.2%; 5 (relevance), 41.2%; 6 (internal validity), 43.6%; 7 (magnitude), 37.8%; 8 (two-by-two grids), 30.0%; 9 (number needed to treat), 16.9%; 10 (confidence intervals), 34.3%; 11 (diagnosis), 5.0%; and 12 (prognosis), 43.4%.Conclusions: As measured by the FTEBM, senior medical students demonstrate understanding of about half of EBM. EM residencies can anticipate the need to instruct their residents in EBM concepts in order to meet ACGME/ABEM milestone requirements. [ABSTRACT FROM AUTHOR]

Additive manufacturing is increasingly considered for production of high quality, metallic, aerospace parts. Despite the high potential of this manufacturing process to reduce weight and lead time, the fundamental understanding of additive manufactured Ti–6Al–4V material is still at an early stage, especially in the area of fatigue and damage tolerance. This paper covers the effects of inherent surface roughness on the fatigue life. In the as built condition, metallic parts have a poor surface texture, which is generally removed in fatigue critical areas. It is shown that the fatigue properties of Ti–6Al–4V samples, produced by direct metal laser sintering and electron beam melting, are dominated by surface roughness effects. A simple model based on an equivalent initial flaw size is formulated. [ABSTRACT FROM AUTHOR]

This article presents economic models for a new hybrid method where additive manufacturing (AM) and subtractive methods (SMs) are integrated through composite process planning. Although AM and SM offer several unique advantages, there are technological limitations such as tolerance and surface finish requirements; tooling and fixturing, etc. that cannot be met by a single type of manufacturing. The intent of this article is not to show a new manufacturing method, but rather to provide economic context to additive and subtractive methods as the best practice provides, and look at the corresponding economics of each of those methods as a function of production batch size, machinability, cost of the material, part geometry and tolerance requirements. Basic models of fixed and variable costs associated with additive, subtractive and hybrid methods to produce parts are also presented. An experimental design is used to study the influence of production volume, material and operating cost, batch size, machinability of the material and impact of reducing AM processing time. A composite response model for the unit cost is computed for the various levels associated with such engineering requirements. The developed models provide insight into how these variables affect the costs associated with engineering a mechanical product that will be produced using AM and SM methods. From the results, it appears that batch size, AM processing time and AM processing cost were the major cost factors. It was shown that the cost of producing ‘near-net’ shape through SM and AM was the decision criteria; which will be critical for tough-to-machine alloys and at multi-batch size. [ABSTRACT FROM AUTHOR]

The microstructure and mechanical properties of SLM and EBM Ti–6Al–4V samples have been compared. The effect of part size and orientation on the defects, microstructure and their contribution to the tensile and fatigue properties were elucidated. As-fabricated SLM and EBM samples mainly consisted of α′ and α + β phases, respectively. Pores were the main defects in SLM and EBM samples, and closely related to scanning strategies and energy input. The porosity of SLM samples was higher compared to EBM samples. The part size had an obvious influence on the microstructure and mechanical properties of EBM samples but less so for SLM samples. Both SLM and EBM samples possessed higher strength and better ductility in the vertical orientation than those in the horizontal orientation. The tensile strength of SLM samples was significantly greater than that of EBM samples whereas the ductility was much lower. Due to the pores contained in samples, fatigue strength of both EBM and SLM samples was lower than those of cast and annealed alloys. However, hot isostatic pressing (HIP) significantly increased the fatigue limits of both SLM and EBM samples to above 550 MPa by closing of the pores. [ABSTRACT FROM AUTHOR]

Electron beam melting additive manufacturing (AM) process has been developed for the manufacture of Ti6Al4V parts for the aerospace industry. In the AM research team from Airbus Group, this technology is being evaluated with a view to production of flight hardware. During the evaluation of the process, the microstructure variation as a function of geometry was studied. A distinctive microstructure was observed up to 0.5 mm from of part surface (the skin layer) and the thickness of the α-plate spacing varied depending on the thickness of the parts being produced. With the purpose of quantifying the influence of the grain thickness and the mechanical performance of the material, cylinders with nine different diameters (6 up to 40 mm diameter) were manufactured with 80 mm height. The microstructure characterisation showed how the α-plate spacing changed from thin to thick structures and the influence of grain size on tensile strength was quantified. [ABSTRACT FROM PUBLISHER]

Objectives: The role of routine C4d staining in endomyocardial biopsy specimens is uncertain. The implications of a diagnosis of acute cellular rejection (ACR) with a positive C4d with or without any evidence of antibody-mediated rejection (AMR) are unclear. This study sought to evaluate a distinct phenotype of ACR+/C4d+ in AMR- patients.Methods: Data on C4d, ACR, and AMR were collected. Donor-specific antibody (DSA), panel-reactive antibody (PRA), flow crossmatch, and data on ACR and AMR episodes were also reviewed.Results: Thirty-five patients were followed. Group I with C4d+ biopsy specimens was compared with group II with C4d- biopsy specimens. ACR greater than 1R was higher in group I compared with group II (50% vs 7.4%; P = .01). Clinical suspicion of AMR, positive retrospective crossmatches, and detection of de novo DSA were also higher in group I.Conclusions: Our result indicate that C4d and ACR positivity in posttransplant patients may be a harbinger of a subclinical form of asymptomatic AMR. [ABSTRACT FROM AUTHOR]

Applying evidence based medicine (EBM) in our daily practice and health settings is a great challenge for residents due to the lack of time and experience. The following case scenario is an example of real life application of EBM.

Additive Manufacturing (AM) methods are generally used to produce an early sample or near net-shape elements based on three-dimensional geometrical modules. To date, publications on AM of metal implants have mainly focused on knee and hip replacements or bone scaffolds for tissue engineering. The direct fabrication of metallic implants can be achieved by methods, such as Selective Laser Melting (SLM) or Electron Beam Melting (EBM). This work compares the SLM and EBM methods used in the fabrication of titanium bone implants by analyzing the microstructure, mechanical properties and cytotoxicity. The SLM process was conducted in an environmental chamber using 0.4–0.6 vol % of oxygen to enhance the mechanical properties of a Ti-6Al-4V alloy. SLM processed material had high anisotropy of mechanical properties and superior UTS (1246–1421 MPa) when compared to the EBM (972–976 MPa) and the wrought material (933–942 MPa). The microstructure and phase composition depended on the used fabrication method. The AM methods caused the formation of long epitaxial grains of the prior β phase. The equilibrium phases (α + β) and non-equilibrium α’ martensite was obtained after EBM and SLM, respectively. Although it was found that the heat transfer that occurs during the layer by layer generation of the component caused aluminum content deviations, neither methods generated any cytotoxic effects. Furthermore, in contrast to SLM, the EBM fabricated material met the ASTMF136 standard for surgical implant applications.

The coastal zone is an area where a multitude of physical-natural, social and economic issues converge. The interactions among these elements are accentuated by the demographic concentration that characterises coastal areas all over the world. Coastal areas have the unique characteristic of being located in the connecting space between land and marine areas. The economic activities that take place on the coast require the services provided by terrestrial, intertidal and marine ecosystems for their proper functioning. In consequence, the main objective of this research is to identify and map ecosystem services provided by coastal ecosystems in the region of Andalusia (Spain) in order to move towards an Ecosystem-Based Management of this area. Ecosystem services are obtained from a literature review supported by a participatory process through expert consultation. The results obtained from the participatory process, together with the analysis and mapping of the ecosystems, make it possible to obtain those areas where the diversity of potential ecosystem services is greatest. The results of the research highlight certain ecosystems, such as the intertidal ecosystems, which, although they occupy the smallest surface area, are the ones that offer the greatest services to the population. Therefore, studying ecosystem services in coastal areas in order to move towards an Ecosystem-Based Management must be done from a broad perspective, considering the coastal zone as a complete socio-ecological system. [ABSTRACT FROM AUTHOR]

• Examined studies that used the explainable artificial intelligence (XAI) technique for AI model in healthcare applications. • As a result, three major healthcare datasets were identified: clinical features, text, and high-dimensional data. • This review also included optimal model performance of Machine Learning (ML) and Deep Learning (DL) models for XAI. • Areas that require more attention, like XAI for biosignal abnormalities and clinical note interpretation, were identified. • A reliable AI model for healthcare applications should ideally be both high performing and produce interpretable results. Artificial intelligence (AI) has branched out to various applications in healthcare, such as health services management, predictive medicine, clinical decision-making, and patient data and diagnostics. Although AI models have achieved human-like performance, their use is still limited because they are seen as a black box. This lack of trust remains the main reason for their low use in practice, especially in healthcare. Hence, explainable artificial intelligence (XAI) has been introduced as a technique that can provide confidence in the model's prediction by explaining how the prediction is derived, thereby encouraging the use of AI systems in healthcare. The primary goal of this review is to provide areas of healthcare that require more attention from the XAI research community. Multiple journal databases were thoroughly searched using PRISMA guidelines 2020. Studies that do not appear in Q1 journals, which are highly credible, were excluded. In this review, we surveyed 99 Q1 articles covering the following XAI techniques: SHAP, LIME, GradCAM, LRP, Fuzzy classifier, EBM, CBR, rule-based systems, and others. We discovered that detecting abnormalities in 1D biosignals and identifying key text in clinical notes are areas that require more attention from the XAI research community. We hope this is review will encourage the development of a holistic cloud system for a smart city. [ABSTRACT FROM AUTHOR]

Abstract Introduction Numerous studies have demonstrated that many physicians lack fundamental skills in interpreting and using clinical care evidence. We hypothesized that building a foundation for evidence-based medicine (EBM) prior to the clinical years would provide an initial scaffold that could be integrated during clinical training. Many schools have interpreted LCME standard ED-17 as synonymous with instruction in EBM. Methods This was one of nine modules in EBM skills for first-year and second-year medical students, who were novices in EBM knowledge. The two-part module began with a 2-hour, in-class didactic covering the fundamental features of risk and harm studies, including internal study validity, and study results. Between 1 and 14 days later, students then participated in a 2-hour interactive large-group EBM exercise during which they applied their knowledge and practiced forming judgments for overall study validity. The large-group exercise is based on principles of team-based learning (TBL), but does not follow them exactly. Results We performed a pre-post assessment of alternative items (10 pre, 12 post) covering the same objectives. The preassessment scores were 175 correct and 215 incorrect (difficulty 44.87%). Postassessment scores were 421 correct and 47 incorrect (difficulty 89.96%). Discussion The mode of instruction is highly adaptable. In previous years, the module followed strict TBL pedagogy for the application exercise, and this EBM exercise can easily be converted back to a traditional TBL by having teams simultaneously report answers using whiteboards or flipcharts and then debating their choices. In addition, the initial didactic session can be prerecorded for students to review before class.

Significant contributions to debates in the philosophy of evidence-based medicine (EBM) have come from a variety of different philosophical quarters, yet mainstream discourse in the field has been largely devoid of contributions from scholars working in the pragmatist tradition. This is a particularly conspicuous omission, given pragmatism's commitment to the melioristic view that philosophy both can, and should, be about the business of concretely bettering the human estate. Two exceptions to this oversight come from Brian Walsh and Maya Goldenberg. Unfortunately, in both cases, the misapplication of pragmatist thinking leads to the mistaken view that EBM is committed to some form of pernicious objectivism. This article aims to revise these pragmatist critiques in order to bring them more consistently in line with pragmatist values and commitments. Doing so shows that EBM is defensible on pragmatist grounds against objectivist attacks., (© The Author(s) 2022. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In this review, we recommend means to enhance the evidence-base for intraoperative neurophysiological monitoring (IONM). We address two preliminary issues: (1) whether IONM should be evaluated as a diagnostic test or an intervention, and (2) the state of the evidence for IONM (as presented in systematic reviews, for example). Three reasons may be suggested to evaluate at least some IONM applications as interventions (or as part of an ''interventional cascade''). First, practical barriers limit our ability to measure IONM diagnostic accuracy. Second, IONM results are designed to be correlated with interventions during surgery. Third, IONM should improve patient outcomes when IONM-directed intervention alters the course of surgery. Observational evidence for IONM is growing yet more is required to understand the conditions under which IONM, in its variety of settings, can benefit patients. A multi-center observational cohort study would represent an important initial compromise between the pragmatic difficulties with conducting controlled trials in IONM and the Evidence-Based Medicine (EBM) view that large scale randomized trials are required. Such a cohort study would improve the evidence base and (if justified) provide the rationale for controlled trials. [ABSTRACT FROM AUTHOR]

The Food and Agriculture Organization of the United Nations (FAO)'s mandate is central to the sustainable use of natural resources and biodiversity on the planet. The Organization's normative role at the global level offers a neutral forum for development of international instruments and agreements relevant to agricultural production (including fisheries), in addition to facilitating their implementation through field activities. FAO's role in the LME Program recently has been increasing, offering the opportunity to link fisheries governance frameworks at the sectoral level (such as the Ecosystem Approach to Fisheries—EAF), to broader ocean governance frameworks (such as ecosystem based management, EBM) as promoted within the LME movement. It is argued that these approaches are both needed and complementary and that links between the two can be fruitfully established as demonstrated by experiences made in FAO-led LME projects, i.e. the Bay of Bengal Large Marine Ecosystem (BOBLME) and the Canary Current Large Marine Ecosystem (CCLME). [ABSTRACT FROM AUTHOR]

Advanced hybrid joints strengthened by surfi-sculpt (manufactured by electron beam surfi-sculpt (EBS)) have been developed to address the challenges in joining fibre reinforced polymer (FRP) composites to metals. In the present work, the effect of composite orientation on the mechanical properties of the joints is experimentally studied. In the study, the thickness of the composite adherend is kept constant and the volume content of ±45° ply is increased from 11.1% to 88.9%. Joints without surfi-sculpts are manufactured as reference joints. The result indicates that surfi-sculpt is able to delay the damage initiation and improve the joints ultimate failure load, failure strain, and absorbed energy. Composite orientation is able to vary joints mechanical properties significantly. With the volume content of ±45° ply increase, joints damage mechanisms change from bare composite matrix crush to the combination of surfi-sculpts bending, surfi-sculpts breakage and composite compression. With optimum composite orientation, the joints damage initiation load is increased by 24.84%, the joints ultimate failure load is increased by 134.5% and the joint energy absorption is increased by 257.39%. Scanning electron microscope (SEM) observation shows that surfi-sculpts experience three damage stages. [ABSTRACT FROM AUTHOR]

Background The Users' Guides to the Medical Literature Manual has been a major influence on the teaching and practice of health care globally. Methods The 3rd edition of the multi-authored Manual was reviewed using the principles outlined in Evidence-based Medicine (EBM) texts. One 'clinical scenario' was selected for critical appraisal, as were several chapters; objectivity was enhanced by citing references to support opinions. Results (summary of the appraisal) (1) Strengths: Clinical pearls, too numerous to list. Examples: (i) evidence is never enough to drive clinical decision making; (ii) do not rush to adopt new interventions; and (iii) question efficacy data based only on surrogate markers. (2) Weaknesses: The Manual shares shortcomings of textbooks discussed by Straus et al.: (i) references may not be current, important ones may be excluded and citations may be selective; (ii) often, opinion-based; and (iii) delays between revisions. (3) Notable omissions: Little or no discussion of: (i) important segments of the population: those <18 years of age, >65 years of age and those with multimorbidity; (ii) surgical disciplines; (iii) Greenhalgh et al.'s essay on EBM; (iv) alternate views on the hierarchy of evidence; and (vi) critical thinking. (4) Additional issues: (i) Omission of important references on dabigatran (clinical scenario: chapter 13.1); (ii) authors' advice (Chapter 13.3) to 'bypass the discussion section of published research'; and (iii) the advocacy of pre-appraised sources of evidence and network meta-analysis without warnings about limitations, are critiqued. Conclusion The Manual has several clinical pearls but readers should also be aware of shortcomings. [ABSTRACT FROM AUTHOR]