This book is based on a seven-session course for clinicians with an interest in evidence-based geriatric medicine.
Five of the sessions focus on clinical problems posed by individual patients and are linked with workshops on more general themes of evidence-based medicine (for example, how to use the Cochrane Collaboration library or the Internet).
For all sessions there are tutor notes plus extensive extracts from another book by David Sackett et al on EBM.
The topics chosen for critical appraisal are in areas where there are clear-cut answers from the primary literature. For example, a 75-year-old patient with systolic hypertension asked if diuretics reduce the risk of stroke or death.
The critical appraisal discussed is of the well-known study in this area, The Systolic Hypertension Elderly Programme study.
A 70-year-old man asked about the evidence of benefit of a stroke unit, and the critical appraisal is the paper on the meta-analysis of the effectiveness of such units.
The analysis and accompanying notes give a useful appraisal of these articles and also provide a background to a more general approach to EBM.
The book's title, Practising Evidence-based Geriatrics, is somewhat misleading as it mostly poses questions that are either not specific to geriatrics or have clear-cut answers from the primary literature.
The problem with evidence based geriatrics is integration into clinical practice when the answers are not directly available from the primary literature and where elderly or frail subjects may behave differently from younger groups.
Examples include treatment of hypertension in subjects over 80 years, and warfarin treatment in atrial fibrillation where co-morbidity such as falls or confusion may increase the risks of treatment.
There are similar problems when it comes to the effectiveness of clinical programmes in which it is unclear how easy it is to generalise interventions in other settings.
While this book provides a very helpful summary on the practice of EBM when data is clear, it does not help with the more difficult question of how to integrate the evidence to the common situations within geriatric medicine.
Adrian Hopper Consultant physician Elderly care unit St Thomas' Hospital, London.