Triaging Journals Tony Myers MD 92600 Bottom Line

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Triaging Journals Tony Myers MD 9/26/00

Triaging Journals Tony Myers MD 9/26/00

Bottom Line We need to learn not only how to read the medical literature,

Bottom Line We need to learn not only how to read the medical literature, but what to read.

Medical Journals ä “Knowledge creation” vs. “translation” journals ä Knowledge creation journals ä Good

Medical Journals ä “Knowledge creation” vs. “translation” journals ä Knowledge creation journals ä Good for keeping up: temptation to bypass ä Fountain from which all knowledge flows ä Academic translation journals vs Throw- aways

Academic Translation Journals ä Evidence-based Practice ä jfp. msu. edu/ebp. htm ä JFP POEMS

Academic Translation Journals ä Evidence-based Practice ä jfp. msu. edu/ebp. htm ä JFP POEMS ä jfp. msu. edu

Why Am I Reading? ä Goal of reading ä Keeping up ä Disease specific

Why Am I Reading? ä Goal of reading ä Keeping up ä Disease specific knowledge ä Patient specific knowledge

Goal of Reading ä Disease and Patient specific knowledge. ä Memory limitations ä Review

Goal of Reading ä Disease and Patient specific knowledge. ä Memory limitations ä Review articles and textbooks ä Point of care searching

Keeping Up ä Concentrate on “high yield” journals with favorable POEM: DOE ratio ä

Keeping Up ä Concentrate on “high yield” journals with favorable POEM: DOE ratio ä Scan table of contents for titles of interest ä Consider three questions to determine relevance

Determining Relevance ä Will this information have a direct bearing on the health of

Determining Relevance ä Will this information have a direct bearing on the health of my patients (is it something they care about)?

Determining Relevance ä POEM=Patient Oriented Evidence that Matters ä Study looked at outcomes that

Determining Relevance ä POEM=Patient Oriented Evidence that Matters ä Study looked at outcomes that matter to patients. ä Live longer? ä Feel better? ä Less need for dialysis?

Determining Relevance ä POEMs? ä Intensive insulin tx lowers Hgb A 1 C ä

Determining Relevance ä POEMs? ä Intensive insulin tx lowers Hgb A 1 C ä CHF patients live longer on ACE inhibitors ä Calcium channel blockers lower BP ä HCTZ decreases the incidence of stroke in hypertensive patients

Determining Relevance ä Will this information have a direct bearing on the health of

Determining Relevance ä Will this information have a direct bearing on the health of my patients (is it something they care about)? ä Is the problem common to my practice? ä If true, will it require me to change my current practice?

High Yield Journals ä Four editors reviewing 85 journals each month ä Original research

High Yield Journals ä Four editors reviewing 85 journals each month ä Original research articles, including metaanalyses and brief reports ä Gold standard: Group consensus

Finding POEMs ä Six month review: identified 8085 articles (1350 per month) ä Only

Finding POEMs ä Six month review: identified 8085 articles (1350 per month) ä Only 211 (2. 6%) POEMs

Finding POEMs ä Positive Predictive Value: 49% ä Negative Predictive Value: 99% ä Reason

Finding POEMs ä Positive Predictive Value: 49% ä Negative Predictive Value: 99% ä Reason for disagreement: “Change” factor

Finding POEMs ä > 10% POEMs: JAMA, Ann Int Med, NEJM, JABFP, JFP, Arch

Finding POEMs ä > 10% POEMs: JAMA, Ann Int Med, NEJM, JABFP, JFP, Arch Int Med, Am J Em Med ä 10 or more POEMs: JAMA, Ann Int Med, NEJM, Arch Int Med, BMJ, Ob/Gyn

Feeling Good About Not Knowing Everything: Information Mastery ä Responsibility: less to read, but

Feeling Good About Not Knowing Everything: Information Mastery ä Responsibility: less to read, but more important to find and evaluate

Conclusions ä Read few, only if forced by screen for relevance ä Get rid

Conclusions ä Read few, only if forced by screen for relevance ä Get rid of “bedside” stack ä Use time for other things (e. g. . , letters to the editor, JFP POEMs/ACP Journal clubs, EBM, monthly searches “POEM bulletin boards”- Evidence-Based Practice

Exercises ä Will this information have a direct bearing on the health of my

Exercises ä Will this information have a direct bearing on the health of my patients (is it something they care about)? ä Is the problem common to my practice? ä If true, will it require me to change my current practice?