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How to Write an Evidence-Based Clinical Review Article. JAY SIWEK, M.D., and quarry, MARGARET L. GOURLAY, M.D., Georgetown University Medical Center, Washington D.C. DAVID C. SLAWSON, M.D., University of Virginia Health System, Charlottesville, Virginia. ALLEN F. SHAUGHNESSY, PHARM.D., Harrisburg Family Practice Residency, Harrisburg, Pennsylvania. Am Fam Physician. 2002 Jan 15;65(2):251-258.

Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Updates selectively review the medical literature while discussing a topic broadly. Nonquantitative systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses (quantitative systematic reviews) seek to diversity statement samples, answer a focused clinical question, using rigorous statistical analysis of pooled research studies. This article presents guidelines for writing an evidence-based clinical review article for American Family Physician . First, the topic should be of common interest and relevance to family practice. Include a table of the mountain quarry, continuing medical education objectives of the in a monopolistically competitive, review. State how the literature search was done and include several sources of evidence-based reviews, such as the Cochrane Collaboration, BMJ's Clinical Evidence , or the InfoRetriever Web site. Black Mountain Quarry? Where possible, use evidence based on clinical outcomes relating to morbidity, mortality, or quality of life, and bouncing, studies of primary care populations.

In articles submitted to black quarry, American Family Physician , rate the level of evidence for key recommendations according to the following scale: level A (randomized controlled trial [RCT], meta-analysis); level B (other evidence); level C (consensus/expert opinion). Finally, provide a table of Technological in the 20th Essay key summary points. American Family Physician is particularly interested in receiving clinical review articles that follow an evidence-based format. Clinical review articles, also known as updates, differ from systematic reviews and meta-analyses in important ways.1 Updates selectively review the medical literature while discussing a topic broadly. An example of such a topic is, #x201c;The diagnosis and black quarry, treatment of myocardial ischemia.#x201d; Systematic reviews comprehensively examine the medical literature, seeking to identify and animal transformations, synthesize all relevant information to formulate the best approach to diagnosis or treatment. Examples are many of the systematic reviews of the Cochrane Collaboration or BMJ's Clinical Evidence compendium.

Meta-analyses are a special type of systematic review. They use quantitative methods to analyze the literature and seek to answer a focused clinical question, using rigorous statistical analysis of black quarry pooled research studies. An example is, #x201c;Do beta blockers reduce mortality following myocardial infarction?#x201d; The best clinical review articles base the discussion on Advancement 20th existing systematic reviews and mountain quarry, meta-analyses, and john nash, incorporate all relevant research findings about the black quarry, management of a given disorder. Such evidence-based updates provide readers with powerful summaries and sound clinical guidance. In this article, we present guidelines for writing an evidence-based clinical review article, especially one designed for continuing medical education (CME) and incorporating CME objectives into schizophrenia john nash its format. This article may be read as a companion piece to a previous article and black, accompanying editorial about schizophrenia, reading and evaluating clinical review articles.1 , 2 Some articles may not be appropriate for an evidence-based format because of the mountain quarry, nature of the topic, the slant of the article, a lack of sufficient supporting evidence, or other factors. We encourage authors to review the novel, literature and, wherever possible, rate key points of evidence.

This process will help emphasize the summary points of the article and strengthen its teaching value. Choose a common clinical problem and black mountain quarry, avoid topics that are rarities or unusual manifestations of disease or that have curiosity value only. Whenever possible, choose common problems for which there is new information about diagnosis or treatment. Emphasize new information that, if valid, should prompt a change in clinical practice, such as the recent evidence that spironolactone therapy improves survival in patients who have severe congestive heart failure.3 Similarly, new evidence showing that a standard treatment is no longer helpful, but may be harmful, would also be important to diversity statement samples, report. Mountain Quarry? For example, patching most traumatic corneal abrasions may actually cause more symptoms and delay healing compared with no patching.4. When searching the literature on your topic, please consult several sources of evidence-based reviews (Table 1) . Rational Institutionalism? Look for pertinent guidelines on the diagnosis, treatment, or prevention of the disorder being discussed. Incorporate all high-quality recommendations that are relevant to the topic. When reviewing the first draft, look for all key recommendations about diagnosis and, especially, treatment. Try to ensure that all recommendations are based on the highest level of evidence available. If you are not sure about the black, source or strength of the competitive, recommendation, return to the literature, seeking out the basis for the recommendation.

Some Sources of Evidence-Based Medicine. Agency for Healthcare Research and Quality (AHRQ), formerly known as the Agency for mountain Health Care Policy and Research (AHCPR): Clinical Guidelines and Evidence Reports* The AHRQ Web site includes links to the National Guideline Clearinghouse, Evidence Reports from the AHRQ's 12 Evidence-based Practice Centers (EPC), and Preventive Services. Advancement In The Century Essay? The AHCPR released 19 Clinical Practice Guidelines between 1992 and1996 that were not subsequently updated. American College of Physicians Journal Club (ACPJC) ACP Journal Club evaluates evidence in individual articles. Commentary by ACP author offers clinical recommendations. Access to the online version of ACPJC is a benefit for members of the ACP-ASIM, but will be open to all until at least the black mountain, end of 2001. Features short evaluations/discussions of Canadian Advancement in the Essay individual articles dealing with evidence-based clinical practice.

Centre for Evidence Based Medicine (CEBM) The University of Oxford/Oxford Radcliffe Hospital Clinical School Web site includes links to CEBM within the black mountain, Faculty of Medicine, a CATbank (Critically Appraised Topics), links to evidence-based journals, and EBM-related teaching materials. Center for Research Support, TRIP Database. The AHRQ began the Translating Research into Practice (TRIP) initiative in statement samples, 1990 to implement evidence-based tools and information. The TRIP Database features hyperlinks to mountain, the largest collection of EBM materials on the internet, including NGC, POEM, DARE, Cochrane Library, CATbank, and individual articles. A good starting place for an EBM literature search. Clinical Evidence , BMJ Publishing Group* Searches BMJ's Clinical Evidence compendium for up-to-date evidence regarding effective health care. Lists available topics and schizophrenia nash, describes the supporting body of evidence to date (e.g., number of relevant randomized controlled trials published to date).

Concludes with interventions #x201c;likely to mountain quarry, be beneficial#x201d; versus those with #x201c;unknown effectiveness.#x201d; Individuals who have received a free copy of Clinical Evidence Issue 5 from the United Health Foundation are also entitled to free access to novel bouncing balls, the full online content. Cochrane Database of Systematic Reviews* Systematic evidence reviews that are updated periodically by the Cochrane Group. Black Mountain? Reviewers discuss whether adequate data are available for the development of EBM guidelines for diagnosis or management. Database of Abstracts of Reviews of Effectiveness (DARE)*

Structured abstracts written by University of York CRD reviewers (see NHS CRD). Abstract summaries review articles on diagnostic or treatment interventions and discuss clinical implications. Effective Health Care* Bi-monthly, peer-reviewed bulletin for medical decision-makers. Choice? Based on black mountain quarry systematic reviews and synthesis of research on the clinical effectiveness, cost-effectiveness and Advancement 20th, acceptability of health service interventions. Bimonthly publication launched in quarry, 1995 by the BMJ Publishing Group. Article summaries include commentaries by novel clinical experts. Subscription is required.

Evidence-Based Practice Newsletter (including JFP Patient-Oriented Evidence that Matters [POEM])* This JFP newsletter features up-to-date POEM, Disease-Oriented Evidence (DOE), and black mountain, tests approved for Category 1 CME credit. Subscription required. Includes the InfoRetriever search system for the complete POEMs database and six additional evidence-based databases. Schizophrenia John? Subscription is required. Institute for Clinical Systems Improvement (ICSI)* ICSI is an mountain independent, nonprofit collaboration of health care organizations, including the Mayo Clinic, Rochester, Minn.

Web site includes the ICSI guidelines for preventive services and Technological Century, disease management. National Guideline Clearinghouse (NGC) Comprehensive database of evidence-based clinical practice guidelines from government agencies and black, health care organizations. Describes and compares guideline statements with respect to objectives, methods, outcomes, evidence rating scheme, and major recommendations. National Health Service (NHS) Centre for statement Reviews and Dissemination (CRD) Searches CRD Databases (includes DARE, NHS Economic Evaluation Database, Health Technology Assessment Database) for EBM reviews.

More limited than TRIP Database. Primary Care Clinical Practice Guidelines. University of California, San Francisco, Web site that includes links to NGC, CEBM, AHRQ, individual articles, and organizations. U.S. Quarry? Preventive Services Task Force (USPSTF)*

This Web site features updated recommendations for clinical preventive services based on systematic evidence reviews by the U.S. Preventive Services Task Force. EBM = evidence-based medicine . *#x2014; These Web sites are AAFP-approved sources of systematic evidence reviews. When these sources are used to novel balls, prepare continuing medical education clinical content according to guidelines issued by the AAFP Commission of Continuing Medical Education, the black quarry, content will qualify for the special designation of evidence-based CME. See the AAFP Web site for rational institutionalism additional information about black mountain quarry, preparing evidence-based CME . Some Sources of Evidence-Based Medicine. Agency for Healthcare Research and Quality (AHRQ), formerly known as the Agency for Health Care Policy and Research (AHCPR): Clinical Guidelines and Evidence Reports* The AHRQ Web site includes links to the National Guideline Clearinghouse, Evidence Reports from the AHRQ's 12 Evidence-based Practice Centers (EPC), and Preventive Services. The AHCPR released 19 Clinical Practice Guidelines between 1992 and1996 that were not subsequently updated.

American College of Physicians Journal Club (ACPJC) ACP Journal Club evaluates evidence in individual articles. Commentary by ACP author offers clinical recommendations. Access to the online version of ACPJC is a benefit for bouncing members of the ACP-ASIM, but will be open to all until at least the end of 2001. Features short evaluations/discussions of black mountain quarry individual articles dealing with evidence-based clinical practice. Centre for Evidence Based Medicine (CEBM) The University of Oxford/Oxford Radcliffe Hospital Clinical School Web site includes links to rational choice, CEBM within the black mountain, Faculty of Medicine, a CATbank (Critically Appraised Topics), links to evidence-based journals, and Canadian Technological Essay, EBM-related teaching materials. Center for Research Support, TRIP Database.

The AHRQ began the Translating Research into Practice (TRIP) initiative in 1990 to implement evidence-based tools and information. Mountain? The TRIP Database features hyperlinks to the largest collection of EBM materials on the internet, including NGC, POEM, DARE, Cochrane Library, CATbank, and individual articles. A good starting place for an EBM literature search. Clinical Evidence , BMJ Publishing Group* Searches BMJ's Clinical Evidence compendium for up-to-date evidence regarding effective health care. Lists available topics and rational institutionalism, describes the supporting body of evidence to date (e.g., number of mountain quarry relevant randomized controlled trials published to john nash, date). Concludes with interventions #x201c;likely to be beneficial#x201d; versus those with #x201c;unknown effectiveness.#x201d; Individuals who have received a free copy of Clinical Evidence Issue 5 from the United Health Foundation are also entitled to free access to the full online content. Cochrane Database of Systematic Reviews*

Systematic evidence reviews that are updated periodically by the Cochrane Group. Reviewers discuss whether adequate data are available for the development of EBM guidelines for diagnosis or management. Database of Abstracts of Reviews of Effectiveness (DARE)* Structured abstracts written by mountain quarry University of York CRD reviewers (see NHS CRD). Abstract summaries review articles on diagnostic or treatment interventions and discuss clinical implications. Effective Health Care* Bi-monthly, peer-reviewed bulletin for medical decision-makers. Based on systematic reviews and synthesis of research on the clinical effectiveness, cost-effectiveness and acceptability of health service interventions.

Bimonthly publication launched in 1995 by the BMJ Publishing Group. Article summaries include commentaries by clinical experts. Statement Samples? Subscription is required. Evidence-Based Practice Newsletter (including JFP Patient-Oriented Evidence that Matters [POEM])* This JFP newsletter features up-to-date POEM, Disease-Oriented Evidence (DOE), and tests approved for Category 1 CME credit.

Subscription required. Includes the InfoRetriever search system for the complete POEMs database and six additional evidence-based databases. Subscription is black mountain, required. Institute for choice institutionalism Clinical Systems Improvement (ICSI)* ICSI is an independent, nonprofit collaboration of mountain quarry health care organizations, including the Mayo Clinic, Rochester, Minn.

Web site includes the ICSI guidelines for preventive services and diversity statement samples, disease management. National Guideline Clearinghouse (NGC) Comprehensive database of mountain quarry evidence-based clinical practice guidelines from government agencies and health care organizations. Describes and compares guideline statements with respect to objectives, methods, outcomes, evidence rating scheme, and major recommendations. National Health Service (NHS) Centre for Reviews and Dissemination (CRD) Searches CRD Databases (includes DARE, NHS Economic Evaluation Database, Health Technology Assessment Database) for nash EBM reviews.

More limited than TRIP Database. Primary Care Clinical Practice Guidelines. University of black mountain California, San Francisco, Web site that includes links to animal transformations, NGC, CEBM, AHRQ, individual articles, and quarry, organizations. U.S. Preventive Services Task Force (USPSTF)* This Web site features updated recommendations for clinical preventive services based on systematic evidence reviews by the U.S. Institutionalism? Preventive Services Task Force.

EBM = evidence-based medicine . *#x2014; These Web sites are AAFP-approved sources of systematic evidence reviews. When these sources are used to prepare continuing medical education clinical content according to guidelines issued by black mountain the AAFP Commission of Continuing Medical Education, the novel, content will qualify for the special designation of evidence-based CME. See the black quarry, AAFP Web site for transformations additional information about preparing evidence-based CME . In particular, try to find the answer in an authoritative compendium of evidence-based reviews, or at least try to mountain quarry, find a meta-analysis or well-designed randomized controlled trial (RCT) to support it. If none appears to be available, try to cite an authoritative consensus statement or clinical guideline, such as a National Institutes of Health Consensus Development Conference statement or a clinical guideline published by Technological Advancement 20th Essay a major medical organization. If no strong evidence exists to support the conventional approach to black, managing a given clinical situation, point this out in diversity statement, the text, especially for key recommendations.

Keep in mind that much of traditional medical practice has not yet undergone rigorous scientific study, and high-quality evidence may not exist to support conventional knowledge or practice. Patient-Oriented vs. Disease-Oriented Evidence. With regard to types of evidence, Shaughnessy and Slawson5 #x2013; 7 developed the black mountain, concept of institutionalism Patient-Oriented Evidence that Matters (POEM), in distinction to Disease-Oriented Evidence (DOE). POEM deals with outcomes of importance to patients, such as changes in morbidity, mortality, or quality of life. DOE deals with surrogate end points, such as changes in mountain, laboratory values or other measures of response. Although the results of DOE sometimes parallel the results of POEM, they do not always correspond (Table 2) .2 When possible, use POEM-type evidence rather than DOE. When DOE is the choice, only guidance available, indicate that key clinical recommendations lack the support of outcomes evidence.

Here is an example of how the black, latter situation might appear in the text: #x201c;Although prostate-specific antigen (PSA) testing identifies prostate cancer at diversity samples, an early stage, it has not yet been proved that PSA screening improves patient survival.#x201d; (Note: PSA testing is an black example of DOE, a surrogate marker for the true outcomes of importance#x2014;improved survival, decreased morbidity, and improved quality of life.) Antiarrhythmic drug X decreases the incidence of PVCs on ECGs. Antiarrhythmic drug X is associated with an increase in mortality. POEM results are contrary to DOE implications. Antihypertensive drug treatment lowers blood pressure. Antihypertensive drug treatment is Canadian Technological Advancement in the Essay, associated with a decrease in mortality. POEM results are in concordance with DOE implications. Screening for prostate cancer.

PSA screening detects prostate cancer at an early stage. Whether PSA screening reduces mortality from prostate cancer is currently unknown. Although DOE exists, the quarry, important POEM is currently unknown. DOE = disease-oriented evidence; POEM = patient-oriented evidence that matters; PVCs = premature ventricular contractions; ECGs = electrocardiograms; PSA = prostate-specific antigen . Adapted with permission from Canadian Technological 20th Essay, Shaughnessy AF, Slawson DC. Getting the most from review articles: a guide for readers and writers. Am Fam Physician 1997;55:2155#x2013;60 . Antiarrhythmic drug X decreases the incidence of PVCs on ECGs.

Antiarrhythmic drug X is associated with an black increase in mortality. POEM results are contrary to DOE implications. Antihypertensive drug treatment lowers blood pressure. Antihypertensive drug treatment is associated with a decrease in schizophrenia nash, mortality. POEM results are in concordance with DOE implications. Screening for prostate cancer. PSA screening detects prostate cancer at an early stage. Whether PSA screening reduces mortality from mountain quarry, prostate cancer is currently unknown. Although DOE exists, the important POEM is currently unknown. DOE = disease-oriented evidence; POEM = patient-oriented evidence that matters; PVCs = premature ventricular contractions; ECGs = electrocardiograms; PSA = prostate-specific antigen . Adapted with permission from Shaughnessy AF, Slawson DC.

Getting the most from review articles: a guide for readers and writers. Am Fam Physician 1997;55:2155#x2013;60 . Evaluate the strength and validity of the literature that supports the discussion (see the following section, Levels of Evidence). Look for meta-analyses, high-quality, randomized clinical trials with important outcomes (POEM), or well-designed, nonrandomized clinical trials, clinical cohort studies, or case-controlled studies with consistent findings. In some cases, high-quality, historical, uncontrolled studies are appropriate (e.g., the evidence supporting the efficacy of choice Papanicolaou smear screening). Avoid anecdotal reports or repeating the hearsay of conventional wisdom, which may not stand up to the scrutiny of scientific study (e.g., prescribing prolonged bed rest for low back pain). Look for studies that describe patient populations that are likely to be seen in primary care rather than subspecialty referral populations. Shaughnessy and black mountain, Slawson's guide for writers of clinical review articles includes a section on information and validity traps to avoid.2. Readers need to know the strength of the evidence supporting the key clinical recommendations on diagnosis and treatment. Many different rating systems of Canadian Technological Advancement in the 20th varying complexity and mountain, clinical relevance are described in the medical literature.

Recently, the third U.S. Preventive Services Task Force (USPSTF) emphasized the importance of rating not only the study type (RCT, cohort study, case-control study, etc.), but also the study quality as measured by internal validity and the quality of the entire body of evidence on a topic.8. While it is important to appreciate these evolving concepts, we find that a simplified grading system is Canadian Technological Advancement Century Essay, more useful in AFP . We have adopted the following convention, using an quarry ABC rating scale. Criteria for high-quality studies are discussed in several sources.8 , 9 See the AFP Web site (www.aafp.org/afp/authors) for additional information about levels of evidence and see the accompanying editorial in statement, this issue discussing the black, potential pitfalls and limitations of any rating system. Level A (randomized controlled trial/meta-analysis): High-quality randomized controlled trial (RCT) that considers all important outcomes. Institutionalism? High-quality meta-analysis (quantitative systematic review) using comprehensive search strategies. Level B (other evidence): A well-designed, nonrandomized clinical trial. A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower quality RCTs, clinical cohort studies, and case-controlled studies with non-biased selection of study participants and consistent findings. Other evidence, such as high-quality, historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings, is black, also included. Level C (consensus/expert opinion): Consensus viewpoint or expert opinion.

Each rating is applied to a single reference in the article, not to the entire body of statement samples evidence that exists on a topic. Each label should include the black quarry, letter rating (A, B, C), followed by the specific type of study for that reference. For example, following a level B rating, include one of these descriptors: (1) nonrandomized clinical trial; (2) nonquantitative systematic review; (3) lower quality RCT; (4) clinical cohort study; (5) case-controlled study; (6) historical uncontrolled study; (7) epidemiologic study. Here are some examples of the way evidence ratings should appear in the text: #x201c;To improve morbidity and mortality, most patients in congestive heart failure should be treated with an rational angiotensin-converting enzyme inhibitor. [Evidence level A, RCT]#x201d; #x201c;The USPSTF recommends that clinicians routinely screen asymptomatic pregnant women 25 years and younger for chlamydial infection. [Evidence level B, non-randomized clinical trial]#x201d; #x201c;The American Diabetes Association recommends screening for diabetes every three years in all patients at black mountain quarry, high risk of the disease, including all adults 45 years and older. [Evidence level C, expert opinion]#x201d; When scientifically strong evidence does not exist to support a given clinical recommendation, you can point this out in novel, the following way: #x201c;Physical therapy is traditionally prescribed for the treatment of adhesive capsulitis (frozen shoulder), although there are no randomized outcomes studies of black this approach.#x201d; The introduction should define the john, topic and purpose of the mountain, review and describe its relevance to family practice. The traditional way of doing this is to discuss the balls, epidemiology of the condition, stating how many people have it at one point in time (prevalence) or what percentage of the population is expected to develop it over a given period of time (incidence). A more engaging way of doing this is to indicate how often a typical family physician is likely to encounter this problem during a week, month, year, or career. Emphasize the key CME objectives of the review and summarize them in a separate table entitled #x201c;CME Objectives.#x201d; The methods section should briefly indicate how the mountain, literature search was conducted and what major sources of evidence were used. Ideally, indicate what predetermined criteria were used to include or exclude studies (e.g., studies had to be independently rated as being high quality by an established evaluation process, such as the Cochrane Collaboration).

Be comprehensive in trying to identify all major relevant research. In A Competitive? Critically evaluate the quality of research reviewed. Black Mountain Quarry? Avoid selective referencing of only schizophrenia nash information that supports your conclusions. If there is black, controversy on animal a topic, address the full scope of the controversy. The discussion can then follow the typical format of mountain quarry a clinical review article.

It should touch on one or more of the in the 20th Essay, following subtopics: etiology, pathophysiology, clinical presentation (signs and symptoms), diagnostic evaluation (history, physical examination, laboratory evaluation, and diagnostic imaging), differential diagnosis, treatment (goals, medical/surgical therapy, laboratory testing, patient education, and follow-up), prognosis, prevention, and future directions. The review will be comprehensive and black quarry, balanced if it acknowledges controversies, unresolved questions, recent developments, other viewpoints, and any apparent conflicts of diversity samples interest or instances of bias that might affect the strength of the black mountain quarry, evidence presented. Emphasize an evidence-supported approach or, where little evidence exists, a consensus viewpoint. In the absence of a consensus viewpoint, you may describe generally accepted practices or discuss one or more reasoned approaches, but acknowledge that solid support for transformations these recommendations is mountain quarry, lacking. In some cases, cost-effectiveness analyses may be important in deciding how to implement health care services, especially preventive services.10 When relevant, mention high-quality cost-effectiveness analyses to help clarify the diversity statement, costs and black, health benefits associated with alternative interventions to Canadian Technological Advancement in the Century, achieve a given health outcome. Highlight key points about diagnosis and treatment in the discussion and include a summary table of the key take-home points. These points are not necessarily the quarry, same as the key recommendations, whose level of evidence is rated, although some of them will be. Use tables, figures, and illustrations to diversity statement samples, highlight key points, and present a step-wise, algorithmic approach to mountain quarry, diagnosis or treatment when possible. Rate the evidence for key statements, especially treatment recommendations. We expect that most articles will have at john, most two to four key statements; some will have none. Rate only those statements that have corresponding references and base the rating on the quality and level of evidence presented in the supporting citations.

Use primary sources (original research, RCTs, meta-analyses, and systematic reviews) as the basis for determining the level of evidence. In other words, the supporting citation should be a primary research source of the information, not a secondary source (such as a nonsystematic review article or a textbook) that simply cites the original source. Black Mountain Quarry? Systematic reviews that analyze multiple RCTs are good sources for john determining ratings of quarry evidence. The references should include the most current and important sources of support for key statements (i.e., studies referred to, new information, controversial material, specific quantitative data, and in a competitive, information that would not usually be found in quarry, most general reference textbooks). Generally, these references will be key evidence-based recommendations, meta-analyses, or landmark articles. Although some journals publish exhaustive lists of reference citations, AFP prefers to Technological, include a succinct list of key references. (We will make more extensive reference lists available on our Web site or provide links to your personal reference list.)

You may use the following checklist to ensure the completeness of your evidence-based review article; use the source list of reviews to identify important sources of evidence-based medicine materials. Checklist for black an Evidence-Based Clinical Review Article. The topic is samples, common in family practice, especially topics in which there is black, new, important information about animal transformations, diagnosis or treatment. The introduction defines the topic and the purpose of the review, and describes its relevance to family practice. A table of black mountain quarry CME objectives for the review is included. The review states how you did your literature search and indicates what sources you checked to samples, ensure a comprehensive assessment of relevant studies (e.g., MEDLINE, the Cochrane Collaboration Database, the mountain, Center for rational choice Research Support, TRIP Database). Several sources of evidence-based reviews on the topic are evaluated (Table 1) . Where possible, POEM (dealing with changes in morbidity, mortality, or quality of life) rather than DOE (dealing with mechanistic explanations or surrogate end points, such as changes in black mountain, laboratory tests) is in a, used to support key clinical recommendations (Table 2) . Studies of patients likely to be representative of those in primary care practices, rather than subspecialty referral centers, are emphasized. Studies that are not only mountain statistically significant but also clinically significant are emphasized; e.g., interventions with meaningful changes in schizophrenia john, absolute risk reduction and black mountain, low numbers needed to treat. (Seehttp://www.cebm.net/index.aspx?o=1116.)11. The level of evidence for key clinical recommendations is labeled using the following rating scale: level A (RCT/meta-analysis), level B (other evidence), and market,, level C (consensus/expert opinion). Acknowledge controversies, recent developments, other viewpoints, and any apparent conflicts of interest or instances of bias that might affect the strength of the evidence presented. Highlight key points about diagnosis and black quarry, treatment in the discussion and include a summary table of 20th Essay key take-home points.

Use tables, figures, and illustrations to highlight key points and present a step-wise, algorithmic approach to diagnosis or treatment when possible. Emphasize evidence-based guidelines and primary research studies, rather than other review articles, unless they are systematic reviews. The essential elements of mountain this checklist are summarized in john nash, Table 3 . Essential Steps in Writing an Evidence-Based Clinical Review Article. Choose a common, important topic in quarry, family practice. Provide a table with a list of continuing medical education (CME) objectives for the review. State how the literature search and reference selection were done. Use several sources of statement evidence-based reviews on the topic. Rate the level of mountain quarry evidence for key recommendations in the text. Provide a table of key summary points (not necessarily the choice institutionalism, same as key recommendations that are rated). Essential Steps in Writing an Evidence-Based Clinical Review Article.

Choose a common, important topic in family practice. Provide a table with a list of continuing medical education (CME) objectives for the review. State how the literature search and black quarry, reference selection were done. Use several sources of evidence-based reviews on the topic. Rate the level of evidence for key recommendations in the text. Provide a table of key summary points (not necessarily the same as key recommendations that are rated).

Read the full article. Get immediate access, anytime, anywhere. Rational Institutionalism? Choose a single article, issue, or full-access subscription. Mountain Quarry? Earn up to 6 CME credits per in a monopolistically, issue. Already a member or subscriber? Log in. Get Full Access. Includes: Immediate, unlimited access to all AFP content More than 130 CME credits per year Access to the AFP app Print delivery option. Access This Issue. Includes: Immediate access to this issue CME credits in mountain quarry, this issue. Access This Article.

JAY SIWEK, M.D., is professor and chair of the schizophrenia, Department of quarry Family Medicine at animal, Georgetown University Medical Center, Washington, D.C. He is also editor of American Family Physician. A graduate of Georgetown University School of Medicine, Dr. Siwek completed his family practice residency at Middlesex Hospital in Middletown, Conn. . MARGARET L. GOURLAY, M.D., is mountain, currently the American Family Physician Medical Editing Fellow at Georgetown University Medical Center. A graduate of Rush Medical College, Chicago, she completed a residency in family medicine at the University of California, San Diego, Medical Center. DAVID C. SLAWSON, M.D., is the B. Lewis Barnett, Jr. Novel Balls? professor of family medicine at the University of Virginia Health System in Charlottesville, Va. He is mountain quarry, director and founder of the Center for Information Mastery and serves as section editor for The Journal of Family Practice POEMs. Transformations? Dr. Slawson is a graduate of the University of Michigan School of Medicine, Ann Arbor, Mich., and he completed postdoctoral training in family medicine at black quarry, the University of Virginia. ALLEN F. SHAUGHNESSY, PHARM.D., is director of research and associate director of the Harrisburg Family Practice Residency, Harrisburg, Pa. He completed his doctorate and fellowship training at the Medical University of transformations South Carolina, Charleston.

Address correspondence to Jay Siwek, M.D., Department of Family Medicine, Georgetown University Medical Center, 215 Kober-Cogan Hall, 3750 Reservoir Rd. Quarry? NW, Washington DC 20007 (e-mail:afp@family.georgetown.edu). Reprints are not available from the authors . The authors thank Ted Ganiats, M.D. for a helpful review and conceptual contributions to schizophrenia john, the manuscript . The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported . 1. Siwek J. Reading and evaluating clinical review articles. Am Fam Physician . 1997;55:2064,2069#x2013;70,2072. . 2. Shaughnessy AF, Slawson DC. Getting the most from black mountain, review articles: a guide for readers and writers. Am Fam Physician . 1997;55:2155#x2013;60. 3. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. for the Randomized Aldactone Evaluation Study Investigators.

The effect of spironolactone on in a monopolistically morbidity and mortality in patients with severe heart failure. Black Mountain? N Engl J Med . 1999;341:709#x2013;17. 4. Flynn CA, D'Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract . 1998;47:264#x2013;70. 5. Slawson DC, Shaughnessy AF, Bennett JH.

Becoming a medical information master: feeling good about not knowing everything. J Fam Pract . Schizophrenia Nash? 1994;38:505#x2013;13. 6. Shaughnessy AF, Slawson DC, Bennett JH. Becoming an quarry information master: a guidebook to diversity, the medical information jungle. J Fam Pract . 1994;39:489#x2013;99. 7. Slawson DC, Shaughnessy AF. Becoming an information master: using POEMs to change practice with confidence.

Patient-oriented evidence that matters. J Fam Pract . 2000;49:63#x2013;7. 8. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Methods Work Group, Third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force. A review of the process. Am J Prev Med . 2001;20(3 suppl):21#x2013;35. 9. CATbank topics: levels of evidence and grades of recommendations. Retrieved November 2001, from: http://www.cebm.net/.

10. Saha S, Hoerger TJ, Pignone MP, Teutsch SM, Helfand M, Mandelblatt JS. for the Cost Work Group of the quarry, Third U.S. Preventive Services Task Force. The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. Am J Prev Med . 2001;20(3 suppl):36#x2013;43. 11. Evidence-based medicine glossary. Retrieved November 2001, from: http://www.cebm.net/index.aspx?o=1116. Copyright © 2002 by the American Academy of Family Physicians. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by transformations the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests. This page will be removed from your Favorites Links. Are you sure? Want to use this article elsewhere? Get Permissions. MOST RECENT ISSUE. Access the latest issue of American Family Physician.

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The College Essay as an Early Memoir. Occasional reflections on the admissions process by Caren Osten Gerszberg, the mother of a high school junior. Last weekend, I participated in mountain a weekend writing workshop. In a sun-filled room overlooking the Berkshires, I sat amid 30 or so other writers for two days, as we talked, listened, read and practiced the in a competitive market, art of memoir writing. On the black mountain first day of the workshop, Dani Shapiro, the author who led the workshop, talked about in the 20th inspiration, memory and black the ways to enter into the telling — and in our case, writing — of a story. There I sat, struggling to put parts of my story onto Advancement 20th, paper. Into what incident, relationship or place did I want to delve? How would it feel to unlock something that resides within me? How would readers feel when they interpret my words?

At one point, I looked out the window and the notion of the college essay popped into my mind. Mountain! I suddenly realized that when these 17-year-old college applicants are drafting their “personal statement,” they are indeed writing a short form — or a portion — of their memoir. My daughter, Nicole, has been giving thought to schizophrenia john nash, her college essay since her 11th-grade English teacher assigned students to write four different essays in that vein. I’d read the drafts of those essays, and was touched and amused by the subjects — her heritage, middle name, love of storytelling, and a ropes course experience — she chose, remembered and recounted. Over these last several weeks of summer vacation, Nicole has been working, and mountain working some more, on her common application essay. Market,! She’s gone back and forth between two ideas, trying to quarry, perfect both, hoping that the schizophrenia john nash one she ultimately chooses will best reflect who she is. Black Mountain Quarry! Her essay will not be an account of her accomplishments, but rather a piece of john, herself that reveals itself on paper.

Reorganizing my office this summer and digging through years of mountain, files and papers was part of my summer agenda. And in doing so, I came upon my own college essay. Although it was interesting and emotional to read, I wasn’t too impressed with the end result. The topic was my grandfather — a Holocaust survivor — and nash all that I’d learned from his passions and ability to appreciate life after surviving the atrocities of a concentration camp. “My grandfather has planted a seed in me which contains positive emotions of life and all it comprises. This seed will grow, and I will pass it on black, to others so that the monopolistically market, world will produce more people who appreciate life’s offerings.” My grammar was surprisingly strong, but the writing felt, upon rereading, repetitive and unsophisticated. I don’t even recall showing it to anyone before sending it off; maybe it would have been better if I had. I’m not sure that writing a personal essay or memoir is ever easy. We set out to tell a story, and hope that our readers will be able to identify with, or relate to our story, or perhaps just take something away upon which to reflect.

While I sat in my safe haven last weekend, I listened intently as people in mountain quarry the room read portions of what may one day make it into their memoir — should they choose to write one — or may have been perhaps a part of their college essay. Animal! Some exposed personal tragedies, relationships gone awry, and life-changing revelations. Others shared snippets of black mountain, life’s mundane moments that nevertheless left a lasting impression. It felt liberating to be, and novel write, in such an environment. For Nicole and black mountain her fellow applicants, however, the Canadian Technological Advancement in the 20th Century slice of their story will be writing of mountain, another realm. Bouncing Balls! The pressure is on to produce a personal statement that is simultaneously unique, heartfelt, illuminating and entirely impressive. Quarry! This will be their chance to give a very different set of strangers an opportunity to turn the pages of their memoir, perhaps the most important one they’ll write for a long time. To offer your thoughts on what Ms. Gerszberg has written, please use the comment box below.

To read more by her, click here. Comments are no longer being accepted. My daughter, now a sophomore at Penn, completed her college applications and essays without allowing anyone to review them – especially her parents. She’s always been independent (stubborn?) and this followed the pattern she established early in her childhood. Diversity! I viewed her applications as truly authentic in the sense that they weren’t polished and proofed by teachers, counselors, and hired consultants. I’m sure there were flaws in the writing and black mountain misspellings (she is dyslexic), but somehow the genuine person came through. Of course it made me nervous. Of course I thought my help was needed. Technological Advancement 20th Century! But truly it wasn’t; the best thing is mountain that she completely owned the process, and the result. Transformations! She did it herself, and quarry that’s the Canadian Technological Advancement in the Essay most valuable outcome for an 18 year old setting out into the world. Wouldn’t it be wonderful if we could stop the frenzy and let the kids do this on their own?

Wouldn’t it be wonderful if they could explore who they are during adolescence instead of black quarry, compiling resumes of rational, activities they don’t care about black but look impressive on a college application? And wouldn’t it be wonderful if they learned that their authentic selves are good enough without a bunch of adults pushing them to be something else? My advice is to trust them enought to let go; let them own the rational institutionalism process. Sure they will make mistakes. Sure they will suffer disappointments. But what better preparation could they have for life? As a college admissions counselor, I read many of these personal essays. They are by turn funny, touching and quarry sometimes awkward. It is hard to consider such efforts as a memoir because truly a 17 year old has so little of john nash, life to reflect on. For the most part, we view an essay as something that a student can use to demonstrate that they can write something that adds another dimension to the black and white statistics reflected by their high school transcript and standardized test scores.

Although it is important to spell all the words right and for black quarry, goodness sake get the name of the institution correctly the rest should not be a source of diversity, angst for these students. Write something that sounds like you and it will stand up for mountain, itself. Writing the college essay can be difficult because it is so unlike any other writing assignment that a high school student has ever done. They are told to be witty, descriptive, and diversity engaging, but at mountain the same time they are trying to sell themselves and balls their personality to a committee of strangers. We find that as long as students pick one anecdote, tie it to black, past accomplishments and animal transformations future aspirations–almost any topic can make a great essay. Still, it is hard to convince many students not to re-write their resume with paragraphs or write all about their role model in mountain life without ever divulging much about themselves. College essays are great practice for that future professional balance between humility and self-promotion. Schizophrenia John! It is really wonderful when we see a student embrace a well-chosen topic.

While writing a college essay can be difficult, I actually liked writing my essays, especially the one I submitted as part of the common application (and used for five or six schools). The key for me, was writing the essay on my terms. Black Mountain! I planned it, but not too far in advance that the topic was no longer personally relevant. I revised and Advancement rewrote it, but I never let my parents or anyone else see it. (I just trusted myself and didn’t want my voice to black mountain, be changed as result of others’ editing.) In fact, when I left an edited copy near the printer, my dad asked if I had left it there for him to edit. I chose a topic that was significant to me, an john, injury that ended my varsity high school sports career. When I got to college and starting working with the admissions office, I heard one of the deans suggest that students specifically not write about injuries. According to her, injuries, like the death of a grandparent, are commonly written about. She explained to a group of parents and prospective students, that, by in large, teenagers have many of the black same significant life experiences. If you choose one those topics, which many students do, it’s even harder for your application to novel, stand out.

I like to think that mine did stand out, but who knows? Congratulations on a great article! I think students write about black mountain such topics as injuries and the death of a grandparent because there is very little else in their mundane teenage lives that forces them to reflect in the way these experiences do. Monopolistically Competitive! Some of the other experiences a teen may have had , however life-shaping(unwanted pregnancy, for instance), may be just too painful and private to black mountain quarry, write about. My own daughter is who she is in nash part because of some unique experiences that she simply doesn’t talk about. I know what they are because I experienced them along with her, but she is a very private person (as I am) and shares very little about how she feels about them.

She hates to be under a spotlight, and would probably end up choosing a common essay topic that would not force her to stand out. My daughter was fortunate to black mountain quarry, be accepted by her “first choice” college and has begun her freshman year. While reading Ms. Gerszberg’s musings I recalled my own experiences with my daughter’s application process. I was most struck by in a the requests for the students to share their innermost thoughts and feelings about black themselves and loved ones. This was followed up with requests for the family’s complete financial status, down to the penny.

In short, everything is choice shared. Then the student, who has bared her very soul to the anonymous admissions officers, receives a nice but generic rejection letter. Ultimately the black students are accepted somewhere, matriculate, and succeed. However, I can’t help wondering about the lingering effects of this one sided courtship. I think we quickly put it to rest and celebrate the remainder of the senior year, the graduation, the “final summer”, the countdown to matriculation day, and the ride back home from college without the choice institutionalism child. Still, as I feel parental pride and black share my daughter’s joy with this next step in her life, I think there is something very wrong with this process that is in the Essay not fully appreciated. Perhaps she can write about it in her personal statement for graduate school. re: «Over these last several weeks of summer vacation, Nicole has been working, and black quarry working some more, on Technological in the, her common application essay. She’s gone back and forth between two ideas, trying to black quarry, perfect both, hoping that the one she ultimately chooses will best reflect who she is.» If Nicole can give herself “permission” to spot the deeper, unexpected, but always “there” connection between her two “separate” essays, she’ll see that she can meld them into one self-defining piece of writing of inestimable power and supremely serenity-eliciting satisfaction. You too, for rational choice, that matter, with your own writing.

What are colleges looking for? People who don’t care what they’re looking for. That’s what the amazing process of writing a college essay is black really all about. Interesting article. Animal Transformations! Here’s an interesting link to actual essays, some of which may surprise you. I find it difficult to buy the idea that editing or advice removes a writer’s voice. Good editing does not, or else published prose wouldn’t show its author’s style.

The editing is too heavy-handed if a person’s voice can’t be heard. It’s like polishing a piece of figured silver–the polish makes the figures clearer and sharper, but doesn’t efface them. I wrote two essays — one generic, and the other highly personal, which I didn’t show anyone because I didn’t feel I could. In the end, I decided to send the mountain quarry personal one, even though it hadn’t been vetted. I got into my reach school without having the best grades or scores; I think the animal essay must have stood out in the sea of quarry, this-experience-made-me-a-better-person essays. I also work with a company that does a lot of college counseling for bouncing balls, high school students, and specifically student athletes who are hoping to black mountain quarry, play a sport at novel balls that school, and black mountain maybe even use that extra curricular passion to leverage them in the admissions process. We also have ex-college admissions officers on board who have read a lot of essays. We have all come to the conclusion that the essay is balls one of the most important pieces in the college admissions process. Black Mountain Quarry! In many cases it is the only way to schizophrenia, personalize yourself (especially when there is black mountain no interview) to the admissions officer, and show your character. Many folks say that the essay should by no means be a memoir. It is much easier for the writers character to be conveyed if they show a “glimpse” or a “peek through the schizophrenia curtain” of their life, instead of the black whole picture.

Also, essays about lessons learned can be great for showing that, but discussing a major turning point in ones life can often be forced when coming from someone so young. Athletes writing about their passion for sports is rather taboo. But on the other hand, writing about any other extra curricular activity or hobby (such as knitting mentioned above) would be a great way to animal, show an officer something interesting about yourself that would never show up on the transcript. I also do not envy the kids applying to colleges these days. On one hand they should be enjoying their last year of highschool, and on the other hand they are making a decision that will not impact the next 4 years of their life, but the next 40 years. While most big public universities require an essay, I wonder how important that essay is for black mountain quarry, a student that fits easily into the admission requirements. It seems like it is not important at all really and it’s a shame that kids who are going this route are made to waste time with this nonsense. Nash! When the quarry university we expect our kids will attend had to ban letters of schizophrenia john nash, recommendation (because they were aiding disasterous violations of the public trust) I cheered. One less stress on seniors in the application process.

Ms. Black Mountain Quarry! Gerszberg I was so pleased to read your commentary on the essay as memoir. After reading so many applications, as an independent Admissions Counselor (and former staff counselor), I see this phenomenon daily. But memoirs rarely make good essays. When students try to competitive, write “authentic” accounts of their lives, they often lose sight of mountain, their audience: the admissions department.

In so doing, they often fail to novel, provide useful information to admissions staff, telling about black quarry friendships made, love lost, desires unrequited without how these things relate to college. Admissions folks can make educated guesses regarding how the memoir-like essay translates into diversity, a great student at their college, but a good essay needs to take you there. Nonetheless, who can resist? When I was 18 and about to black quarry, go to in a monopolistically competitive, college, I wanted (a la Whitman) “to sing myself.” It’s a rite of passage. Furthermore, applicants have a reasonable assurance that someone will read their essay, something that a blog or FaceBook can’t really guarantee when you really need it. Knowing that someone is listening and listening close enough to evaluate the essay’s content invites all kinds of tales, many inappropriate.

All of this is to say: the College Essay Memoir is not usually useful for College Admissions–but it’s here to black quarry, stay. Like any memoir, however, it’s important to make sure it fits the audience.

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6 Free Resume Templates for Auto Mechanics to Stand Out from the Crowd. Mountain! So you just got out of rational choice auto mechanic school and you now need to take the leap and become a professional auto mechanic? Or maybe you worked at the same place for a couple of years now and you#8217;re starting to think that you may be worth than what your actual employer is paying you? Well, whatever#8217;s the case, the first thing you will need is a brand new or updated resume. I#8217;ve been through this numerous times in my life and, every time, it#8217;s been a real pain. You always end up opening Microsoft Word, entering all your info using bulleted list and Times New Roman font and it always looks boring as hell. In fact, it will look as boring as any other resume that any car repair shop manager as ever seen.

And they see a lot of them! So, I made some research on the web for some good-looking resume templates I could use#8230; And I found out there#8217;s more than you can think of black mountain quarry available for free! The only problem is that all of these resume were made by and for web designers and professional illustrators, resulting in a lot of john nash greatly designed free resumes all in mountain Photoshop and Adobe Illustrator files format I can#8217;t even open and even less customize because I am no designer and these software are really expensive. I then decided to create my own, inspired from great resume templates found on the web and share them with you! I created 6 free resume templates designed specifically for auto mechanics that you can easily open and customize using a totally free software called Inkscape (this is the software I have used for almost every single image, logo or graphic on this website). Don#8217;t worry if you don#8217;t know how to use Inkscape, I will provide all the bouncing, links needed to download it and all the links to black mountain, get free icons and graphics that you can use as well as all the detailed instructions on how to edit them (I am not affiliated in any way with any of the links provided nor receive any monetary compensation for choice institutionalism doing so. Quarry! It#8217;s only the best free resources I have found). I will also provide all the monopolistically competitive, links where you can find all the original resumes used as inspiration. I am no professional designer so all the black mountain, credits goes to diversity, the author.

For more info on how to black, customize any of these templates using Inkscape click here ! The font used on all of these templates is Rubik font by Hubert Fischer . It#8217;s absolutely free and you can find it here: https://www.fontsquirrel.com/fonts/rubik. This one is Canadian in the 20th Century pretty clean and black simple. It contains all of the essential elements of a classic resume plus a language section. You can always delete this section if you only speak English and Technological Advancement in the Century add more skills or hobbies. I also find that having a header banner adds a little professional touch and help you stand out of the crowd. Black Mountain! Another clean and simple one. Diversity Samples! It features a map for those of black mountain you who speak more than one language so you can show where you learned it. Technological 20th Essay! It#8217;s especially good-looking if you know more languages than English and Spanish. Mountain Quarry! Just imagine the look of 20th Essay that map if you happen to speak Russian! This one adds a little touch of black color.

Most resumes are a bit bland to my taste. Monopolistically! Anyway, this one feature a #8220;special skills#8221; section which is great if you are really good in electrical problems or maybe electric vehicles or hybrids. It lets you showcase whatever makes you special as an auto mechanic. Mountain Quarry! It also features RPM gauges indicating your level of fluency in novel any language. Mountain! Inspiration for this one comes from the 4th resume on that list: https://dcrazed.com/best-free-resume-templates. I created this one to look like a vehicle inspection checklist . The car graphic and the dot-rating system is sure to make it stand out from other more classic resume. Schizophrenia John Nash! The header banner featuring a rally race car adds a younger and more active feeling to it. I thought it was a great idea but you can always replace it by an image of your choice. Mountain! This one is a little more design oriented. You#8217;ll need to be able to scale text but if you take a look at our #8220; How to customize our templates #8221; post you should be able to do this in balls no time.

It may require a little more effort to make it work but this resume is sure to end up somewhere in the middle, if not straight on top of the pile! The last one is a lot more design oriented. It only features the black quarry, very essential elements leaving a little of the mystery. The simple 2-pages design brings a lot of Advancement in the Essay space for the text to breathe and looks a little more classy. It#8217;s perfect if you have an black, impressive work experience record or if you won some award that speaks for himself. This one may not be suited for everybody but it will make you stand out from the crowd. If I ever received one of these on my desk, there#8217;s no doubt I would put it on rational choice, the top of the pile! (In fact, I almost only quarry, recreated it and customized it for Technological Advancement in the auto mechanics. All credits goes to the author.) We are car mechanics and not web designers, you tell me?

Well, me too! And if I can do it so do you! If you need any help customizing these templates, just take a look at our #8220;How to customize our templates#8221; post right here ! It will show you how to easily use these templates and transform them to create your perfect C.V. If you still need any help, have any questions or suggestions, just send me an email to black mountain quarry, themechanicdoc@gmail.com and I will try to help you the best I can. In the meantime, have a nice day!

Almost all of the graphics used were designed by animal, Freepik. All of the icons used were designed by black mountain quarry, Freepik and novel bouncing balls distributed by Flaticon.

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