Triaging Journals Triaging Journals

Tony Myers MDTony Myers MD

9/26/009/26/00

Bottom LineBottom Line

We need to learn not only We need to learn not only howhow to read the to read the medical literaturemedical literature,,

but but what what to read.to read.

Medical JournalsMedical Journals

““Knowledge creation” vs. “translation” Knowledge creation” vs. “translation” journalsjournals

Knowledge creation journalsKnowledge creation journals Good for keeping up: temptation to bypassGood for keeping up: temptation to bypass Fountain from which all knowledge flows Fountain from which all knowledge flows

Academic translation journals vs Throw-Academic translation journals vs Throw-awaysaways

Academic Translation JournalsAcademic Translation Journals

Evidence-based PracticeEvidence-based Practice jfp.msu.edu/ebp.htmjfp.msu.edu/ebp.htm

JFP POEMSJFP POEMS jfp.msu.edujfp.msu.edu

Why Am I Reading?Why Am I Reading?

Goal of readingGoal of reading Keeping upKeeping up Disease specific knowledgeDisease specific knowledge Patient specific knowledgePatient specific knowledge

Goal of ReadingGoal of Reading

Disease and Patient specific knowledge.Disease and Patient specific knowledge. Memory limitationsMemory limitations Review articles and textbooksReview articles and textbooks Point of care searchingPoint of care searching

Keeping UpKeeping Up

Concentrate on “high yield” journals with Concentrate on “high yield” journals with favorable POEM:DOE ratiofavorable POEM:DOE ratio

Scan table of contents for titles of interestScan table of contents for titles of interest Consider three questions to determine Consider three questions to determine

relevancerelevance

Determining RelevanceDetermining Relevance

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

Determining RelevanceDetermining Relevance

POEM=POEM=Patient Oriented Evidence that MattersPatient Oriented Evidence that Matters Study looked at outcomes that matter to patientsStudy looked at outcomes that matter to patients ..

Live longer?Live longer? Feel better?Feel better? Less need for dialysis?Less need for dialysis?

Determining RelevanceDetermining Relevance

POEMs?POEMs? Intensive insulin tx lowers Hgb A1CIntensive insulin tx lowers Hgb A1C CHF patients live longer on ACE inhibitorsCHF patients live longer on ACE inhibitors Calcium channel blockers lower BPCalcium channel blockers lower BP HCTZ decreases the incidence of stroke in hypertensive HCTZ decreases the incidence of stroke in hypertensive

patientspatients

Determining RelevanceDetermining Relevance

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

Is the problem common to my practice?Is the problem common to my practice? If true, will it require me to change my If true, will it require me to change my

current practice?current practice?

High Yield JournalsHigh Yield Journals

Four editors reviewing 85 journals each Four editors reviewing 85 journals each monthmonth

Original research articles, including meta-Original research articles, including meta-analyses and brief reportsanalyses and brief reports

Gold standard: Group consensusGold standard: Group consensus

Finding POEMsFinding POEMs

Six month review: identified 8085 articles Six month review: identified 8085 articles (1350 per month)(1350 per month)

Only 211 (2.6%) POEMsOnly 211 (2.6%) POEMs

Finding POEMsFinding POEMs

Positive Predictive Value: 49%Positive Predictive Value: 49% Negative Predictive Value: 99%Negative Predictive Value: 99%

Reason for disagreement: “Change” factorReason for disagreement: “Change” factor

Finding POEMsFinding POEMs

> 10% POEMs> 10% POEMs: JAMA, Ann Int Med, : JAMA, Ann Int Med, NEJM, JABFP, JFP, Arch Int Med, Am J NEJM, JABFP, JFP, Arch Int Med, Am J Em MedEm Med

10 or more POEMs10 or more POEMs: JAMA, Ann Int Med, : JAMA, Ann Int Med, NEJM, Arch Int Med, BMJ, Ob/GynNEJM, Arch Int Med, BMJ, Ob/Gyn

Feeling Good About Not Knowing Everything:Information MasteryFeeling Good About Not Knowing Everything:Information Mastery

Responsibility: Responsibility: less to read, but more less to read, but more important to find and evaluateimportant to find and evaluate

ConclusionsConclusions

Read few, only if forced by screen for Read few, only if forced by screen for relevancerelevance

Get rid of “bedside” stackGet rid of “bedside” stack Use time for other things (e.g.., letters to the Use time for other things (e.g.., letters to the

editor, JFP POEMs/ACP Journal clubs, editor, JFP POEMs/ACP Journal clubs, EBM, monthly searches “POEM bulletin EBM, monthly searches “POEM bulletin boards”- boards”- Evidence-Based PracticeEvidence-Based Practice

ExercisesExercises

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

Is the problem common to my practice?Is the problem common to my practice? If true, will it require me to change my If true, will it require me to change my

current practice?current practice?