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Priority Updates from the Research Literature

Priority Updates from the Research Literature. Bernard Ewigman, MD, MSPH Director, Knowledge Transfer Unit Institute for Translational Medicine The University of Chicago September, 2008. Published PURL. Outline. 1. Description of the PURLs Surveillance System

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Priority Updates from the Research Literature

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  1. Priority Updates from the Research Literature Bernard Ewigman, MD, MSPH Director, Knowledge Transfer Unit Institute for Translational Medicine The University of Chicago September, 2008

  2. Published PURL

  3. Outline 1. Description of the PURLs Surveillance System 2. Experience & Outcomes to Date 3. Opportunities for Engaging in PURLs

  4. Objectives of the PURLs Surveillance System • Identify all new research that leads to a recommendation to change primary care practice. • Publish the practice change recommendation and a summary of the rationale for the change. • Engage communities of physicians in the identification, evaluation, dissemination and implementation of PURLs.

  5. Criteria for a PURL • Relevant to family medicine & primary care • Scientifically valid research, including consideration of prior research & patient oriented outcomes • Leads to a change in practice • Feasible to apply in practice • Practice change can be implemented in a medical care setting

  6. A Priority Update from the Research Literature is: “A recommendation for a feasible change in clinical practice expected to lead to improved outcomes for patients based newly published research.” Criteria for a PURL

  7. PURLs Vs. Other Surveillance • McMaster Online Rating of Evidence (MORE) • BMJOnline Updates • DynaMed Weekly UpdateMedscape • InfoPOEMs Daily Dose of Knowledge • Bottom line: • Each of these systems identify and summarize individual studies to identify relevant and scientifically valid research; • PURLs also performs a rigorous critical appraisal, reviews the literature, conducts polls and applies 3 additional selection criteria beyond relevance and scientific validity

  8. PURLs Versus POEMs (Patient Oriented Evidence that Matters) Like PURLs, POEMs meet criteria for relevance and scientific validity, including patient oriented outcomes. Unlike PURLs, POEMs do not formally review prior research or the status of current practice to determine if the recommendation would constitute a change in practice. POEMs do not formally apply the practice change criterion, the feasibility criterion, or limit selections to those that can be applied in a medical care setting.

  9. PURLs Vs. POEMS • 20 to 30 POEMs per month vs. 1 to 3 PURLs per month • Average of 1.5 new PURLs per month from 7/08 to 6/09

  10. POEMs: > Summarize & critiques single research studies > Includes guideline summaries PURLs: > Summarize & critiques single research studies > Review of prior related research > Review of current guidelines and practice recommendations > Empirical data from practicing physicians and secondary data bases to establish current practice > Identification of barriers to implementation in practice POEMs Versus PURLs

  11. Five Stages of the PURLs Process • 1. Literature surveillance (identification) • 2. Critical review (selection) • 3. Writing for publication • 4. Dissemination • 5. Implementation

  12. Literature Surveillance 1. British Medical Journal Online Updates • Based on the McMaster Online Rating of Evidence System • 130 journals daily updates 2. Current Contents of the Top 16 Journals • NEJM, JAMA, BMJ, Lancet, Ann Int Med, Pediatrics, etc. 3. DynaMed Weekly Update • 170 journals and other sources reviewed daily • InfoPOEMs • 110 journals monthly updates 5. Other sources • e.g. Medscape, other media

  13. Literature Surveillance

  14. Potential PURL Nomination Nomination Email Subject: Potential PURL Nomination: Caffeine in Pregnancy ---------- Forwarded message ----------From: sschumann@uchicago.edu <sschumann@uchicago.edu>Date: Mar 19, 2008 5:31 PMSubject: Abstracts from Elsevier Health SciencesTo: bewigman@uchicago.edu; jhickner@uchicago.edu; m-mendoza@uchicago.edu You have received this Elsevier Health Periodicals email from:Sarah-Annesschumann@uchicago.eduPotential PURL nomination: I would counsel differently based on this with women with a history of miscarriage Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study by Xiaoping Weng, Roxana Odouli, De-Kun LiAmerican Journal of Obstetrics & Gynecology (Vol.198, Issue 3)http://www.ajog.org/article/S0002-9378%2807%2902025-X/abstract?source=aemf

  15. PURLs Terminology Potential PURL—based on abstract only • Looks like it could be a practice changer to a PURL nominator • Approved by PURLs editor Pending PURL—based on critical appraisal • Preliminary review of the literature and • Assessment of current practice • Presented at a PURL Jam, • Approved by the PURLs Editor as Pending PURL PURL—accepted for publication as a practice changer • Assessment of immediate applicability • Approved as a PURL by the JFP Editor

  16. Nomination Process No- Drop PURLS Nominator receives/reviews BMJ, Journals, Dynamed, InfoPOEMs, Other Nominate abstract or summary Yes- Send email to PURLs Editor, nominators & Asst Proj Mgr (Nomination Team) Nomination Team engages in email discussion about nominated potential PURL PURLs Editor decides to approve or drop nominated potential PURL PURLs editor sends email to Project Manager & Nomination team to approve or drop

  17. Potential PURL Assignment

  18. Potential PURL Process Proj Mgr assigns Potential PURL to reviewer, sends PDF & PPRF to reviewer Reviewer completes critical appraisal and secondary literature review- completes PPRF Mike sends current practice question to SERMO, purlreviewers, JFP poll, etc (Highwire Poll) Potential PURL is reviewed, reviewer presents to Editors & group; dissemination of potential PURL PURLs Editor reviews PPRF & PDF and prepares for PURL Jam Reviewer sends completed PPRF to Asst Proj Mgr Asst Proj Mgr sends PPRF & PDF to PURLs Editor PURLs Editor decides whether Potential PURL is Pending or Drop * PPRF= Potential PURL Review Form

  19. Potential PURL Review Form

  20. Pending PURL

  21. PURL Authorship Process PURLs Author receives PPRF, PDF, instructions, examples, co-author mentor, editor information and immediate applicability poll results PURLs Author writes first draft of manuscript- reviewed/revised PURLs Author sends first draft to co-author mentor- draft revised and returned Proj Mgr sends PPRF, PDF and applicability poll to JFP editorial team PURLs Editor sends to JFP editor, cc to Proj Mgr and authors PURLs co-author mentor sends draft to PURLs editor, reviews and provides feedback to authors JFP Editor reviews and makes editorial recommendations, requests questions. Communicates with PURLs editor JFP Editor reviews and makes editorial recommendations, requests questions. Communicates with PURLs editor Accepted PURLs manuscript- approved by JFP Editor

  22. Experience and Outcomes to Date • Journals & other sources monitored daily by Chicago faculty since July 2007 • 20-30 POEMs reviewed monthly for Potential PURLs by Missouri group since Jan 2008 • 145 Potential PURLs nominated between July 2007 and June 2008

  23. Experience & Outcomes in the First 12 Months • Of the 145 Potential PURLs nominated between July 2007 and June 2008: • 91 (63%) were approved for formal review as a Potential PURL at PURL Jam, of these 91: • 15 (17%) were approved as PURLs and published (or accepted for publication) between November 2007 and October 2008

  24. Experience & Outcomes in the First 12 Months • Of the 145 Potential PURLs nominated between July 2007 and June 2008: • 91 (63%) were approved for formal review as a Potential PURL at PURL Jam, of these 91: • 15 (17%) were approved as PURLs and published (or accepted for publication) between November 2007 and October 2008

  25. Current Crew Editor in Chief (Bernard Ewigman) Deputy Editor (John Hickner) Project Manager (Cortni Cross) Active Nominators Mike Mendoza, MD MPH-Univ of Chicago Sarah Anne Schumann, MD-Univ of Chicago Jim Stevermer, MD MSPH-Univ of Missouri Erik Lindbloom, MD MSPH-Univ of Missouri Active Potential PURL Reviewers Univ of Chicago faculty (7)

  26. Current Crew Active PURL Authors Univ of Chicago faculty (7) Univ of Missouri faculty (1) Univ of Minnesota faculty (1) PURL Co-Author MentorsBernard Ewigman, MD MSPH- Univ of Chicago John Hickner, MD MSc -Univ of Chicago Sarah Anne Schumann, MD- Univ of Chicago Jim Stevermer, MD MSPH- Univ of Missouri

  27. Getting Involved PURL Nominator/Co-Author Mentor PURL Reviewer/Co-Author Mentor

  28. PURL Nominator • Choose three or more journals to monitor upon publication, or a surveillance system (BMJ, InfoPOEMs, DynaMed) • Identify a Potential PURL article/summary within 24 hours of publication • Send an email to purlnomination@fpin.org: • Send each nomination separately • Subject Line: PURL Nomination and a short title • Include copy or link to abstract/summary • Actively participate in nomination discussion Time Commitment: 3 hours per month

  29. PURL Reviewer • Become a part of the Potential PURL Schedule • Assignments will be made with a due date approx. 7-14 days out • Complete the Potential PURL Review Form (PPRF) according to the instructions • Present at a PURL Jam Requirements: 4-6 reviews annually Time Commitments: 2-3 hours per review

  30. PURL Requirements • Every PURL must have a co-author mentor • Estimate total of 18 PURLs per year • Ideally, 6 co-author mentors • Co-author mentors can offer authorship for others • Bottom line: to have PURLs authorship, you must have a PURLs co-author mentor Requirements: 3-4 PURLs annually Time Commitments: 10-15 hours per PURL

  31. How do you become a PURLs co-author mentor? • Write PURLs until you are approved by the PURLs Editor as a co-author mentor • Demonstrate writing skills, critical appraisal skills, literature review skills, ability to meet deadlines consistently, ability to mentor other authors • EITHER do surveillance (to nominate PURLs) OR do PURL Jams (to review Potential PURLs) • Agree to co-author mentor a minimum of 3-4 PURLs per year

  32. PURL Jam: An Opportunity for Teaching Critical Appraisal & the Scholarship of Integration • PURL Jam • Structured “journal club” • Review only studies that have been selected for their potential to change practice • Standard review forms to guide critical appraisal and preliminary literature review

  33. PURL Jam: An Opportunity for Teaching Critical Appraisal & the Scholarship of Integration • Choose from past Potential PURLs or current Potential PURLs • Compare your conclusions with primary reviewer • Suitable for residents & faculty

  34. Contact Information Bernard Ewigman, MD, MSPH Editor in Chief be.editor@gmail.com Cortni Cross Project Manager cortni@fpin.org

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