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Triaging Journals

Triaging Journals. Tony Myers MD 9/26/00. Bottom Line. We need to learn not only how to read the medical literature , but what to read. Medical Journals. “Knowledge creation” vs. “translation” journals Knowledge creation journals Good for keeping up: temptation to bypass

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Triaging Journals

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  1. Triaging Journals Tony Myers MD 9/26/00

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

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

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

  5. Why Am I Reading? • Goal of reading • Keeping up • Disease specific knowledge • Patient specific knowledge

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

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

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

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

  10. Determining Relevance • POEMs? • Intensive insulin tx lowers Hgb A1C • CHF patients live longer on ACE inhibitors • Calcium channel blockers lower BP • HCTZ decreases the incidence of stroke in hypertensive patients

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

  12. High Yield Journals • Four editors reviewing 85 journals each month • Original research articles, including meta-analyses and brief reports • Gold standard: Group consensus

  13. Finding POEMs • Six month review: identified 8085 articles (1350 per month) • Only 211 (2.6%) POEMs

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

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

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

  17. Conclusions • Read few, only if forced by screen for relevance • Get rid of “bedside” stack • 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

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

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