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Finding the GEMS In clinical research Paul Glasziou & Chris Del Mar

Finding the GEMS In clinical research Paul Glasziou & Chris Del Mar. Overview. Background to EBM journal Your selection from 8 articles from 2002 Read, discuss, questions. JASPA* ( J ournal A ssociated S core of P ersonal A ngst).

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Finding the GEMS In clinical research Paul Glasziou & Chris Del Mar

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  1. Finding the GEMS In clinical research Paul Glasziou & Chris Del Mar

  2. Overview • Background to EBM journal • Your selection from 8 articles from 2002 • Read, discuss, questions

  3. JASPA*(Journal Associated Score of Personal Angst) J: Are you ambivalent about renewing your JOURNALsubscriptions? A: Do you feel ANGER towards prolific authors? S: Do you ever use journals to help you SLEEP? P: Are you surrounded by PILESof PERIODICALS? A: Do you feel ANXIOUS when journals arrive? 0 - liar? 1-3 - normal range >3 - sick; at risk for polythenia gravis and related conditions * Modified from: BMJ 1995;311:1666-1668

  4. Rule 31 – Review the World Literature Fortnightly* *"Kill as Few Patients as Possible" - Oscar London 5,000 per day 1,000 per day 50 per day

  5. Cost of CME in Oz 40,000 doctors x 150 hours/year @ $100/hour = $600 Million Does CME help? • Most CME does not improve clinical behaviour* • Lectures worst; interactive, case-based better* * Davis, JAMA 1999

  6. Managing Information“Pull” and “Push”methods • “Pull” – access information when needed • “Just in Time” learning • Use whenever questions arise • EBM Steps: Question; search; appraise; apply • “Push” - alerts us to new information • “Just in Case” learning • Use ONLY for important, new, valid research

  7. Which Information to Push?Shaugnessy’s information rule • Value = Validity x Relevance Effort • Corollaries • If it is not valid, it is of no value • If it is not relevant, it is of no value

  8. Validity Criteria • How can we alleviate the problem? (INTERVENTION/THERAPY) • Randomised trial with > 80% followup • What is the risk of the problem? (PROGNOSIS) • Inception cohort with > 80% followup • How accurate are the tests? (DIAGNOSIS) • Appropriate spectrum with blinded Gold Standard • Systematic Reviews (of any question) • Clear question; adequate search & inclusion criteria

  9. Which Information to Push?Shaugnessy’s information rule • Value = Validity x Relevance Effort • Corollaries • If it is not valid, it is of no value • If it is not relevant, it is of no value

  10. Assessing Relevance • Valid articles from > 80 journals “voted” on • Several GPs • Appropriate specialist groups • Two questions (Y/N & 0-10 ratings) • Will this change your practice? • Will it change the way you think about this? • Responses compiled • Selected articles sent for abstraction

  11. Anatomy of a summary Declarative title Structured abstract Expert Commentary Recalculated main results

  12. Bimonthly “just in case” journalValid, Relevant & (almost) No Effort! www.evidence-basedmedicine.com

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