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Opinions

Results of medical research are published in a huge number of papers in a large number of journals. Medical practice is constantly changing and the rate of change is accelerating. How can doctors learn about new information, and decide how they should modify their practice? JAMA published some articles that reflect the "evidence-based medicine" approach to medical practice. I think that these articles will help us enhance our ability to access, summarize, evaluate and translate information from literature to day-to-day clinical problems.

• How to use an article about a diagnostic test: what are the results and will they help me in caring for my patients?
  Jaeschke R et al. JAMA 1994; 271: 703-707.
• How to use an article about therapy or prevention: what were the results and will they help me in caring for my patients?
  Guyatt GH et al. JAMA 1994; 271: 59-63.
• How to use an article about a diagnostic test: are the results of the study valid?
  Jaeschke R et al. JAMA 1994;271: 389-391.
• How to use an article about therapy or prevention: are the results of the study valid?
  Guyatt GH et al. JAMA 1993; 270: 2598-2601.

• Multiple risk factors for predicting coronary heart disease: the concept, accuracy, and application.
  Gordon T et al. Am Heart J 1982; 103: 1031-1039.

In this paper the basic methods are described which may be used to develop, to evaluate, and to use models to predict CAD. Moreover, the influence of the classical risk factors of heart disease are discussed and quantified: smoking, blood pressure, blood lipids, glucose intolerance, and enlargement of the heart. Data from the Framingham study are used to illustrate the methods, and how to compute risk tables.

• The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina.
  Liuzzo G et al. N Engl J Med 1994; 331: 417-424.

This study reflects modern thinking on the role of an inflammatory component in unstable angina. C-reactive protein and amyloid A protein, measured at hospital admission, were found to be predictive of outcome. This is an important finding, because patients with unstable angina can be stratified into groups with high or low risk of coronary heart death , with obvious consequences for treatment.