finding the gems in clinical research paul glasziou & chris del mar
TRANSCRIPT
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Finding the GEMS
In clinical research
Paul Glasziou &
Chris Del Mar
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Overview
Background to EBM journalYour selection from 8 articles from 2002Read, discuss, questions
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JASPA*(Journal Associated Score of Personal Angst)
J: Are you ambivalent about renewing your JOURNAL subscriptions?
A: Do you feel ANGER towards prolific authors?
S: Do you ever use journals to help you SLEEP?
P: Are you surrounded by PILES of PERIODICALS?
A: Do you feel ANXIOUS when journals arrive?
* Modified from: BMJ 1995;311:1666-1668
0 - liar?1-3 - normal range>3 - sick; at risk for polythenia gravis and related conditions
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Rule 31 – Review the World Literature Fortnightly*
*"Kill as Few Patients as Possible" - Oscar London
0
5000
10000
15000
20000
25000
'50 '55 '60 '65 '70 '75 '80 '85 '90 '95
Num
ber
of R
ando
mis
ed T
rial
s
0
200000
400000
600000
800000
1000000
1200000
1400000
1600000
1800000
2000000
Med
ical
Art
icle
s p
er Y
ear
Trials MEDLINE BioMedical
5,000 per day
1,000 per day
50 per day
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Does CME help?
Most CME does not improve clinical behaviour*Lectures worst; interactive, case-based better*
Cost of CME in Oz
40,000 doctors x 150 hours/year
@ $100/hour = $600 Million
* Davis, JAMA 1999
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Managing Information“Pull” and “Push” methods
“Pull” – access information when needed“Just in Time” learning
Use whenever questions ariseEBM Steps: Question; search; appraise; apply
“Push” - alerts us to new information“Just in Case” learning
Use ONLY for important, new, valid research
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Which Information to Push?Shaugnessy’s information rule
Value = Validity x Relevance Effort
CorollariesIf it is not valid, it is of no valueIf it is not relevant, it is of no value
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Validity Criteria
1. How can we alleviate the problem? (INTERVENTION/THERAPY) Randomised trial with > 80% followup
2. What is the risk of the problem? (PROGNOSIS) Inception cohort with > 80% followup
3. How accurate are the tests? (DIAGNOSIS) Appropriate spectrum with blinded Gold Standard
4. Systematic Reviews (of any question) Clear question; adequate search & inclusion criteria
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Which Information to Push?Shaugnessy’s information rule
Value = Validity x Relevance Effort
CorollariesIf it is not valid, it is of no valueIf it is not relevant, it is of no value
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Assessing Relevance
Valid articles from > 80 journals “voted” onSeveral GPsAppropriate specialist groups
Two questions (Y/N & 0-10 ratings)Will this change your practice?Will it change the way you think about this?
Responses compiledSelected articles sent for abstraction
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Anatomy of a summary
Declarative title
Recalculated main results
Structured abstract
Expert Commentary
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Bimonthly “just in case” journalValid, Relevant & (almost) No Effort!
www.evidence-basedmedicine.com