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Keeping up with the Medical Literature
1. Keeping Up With the Medical Literature in the 21 st Century Rachel Chapman, M.D. Clinical Assoc. Professor of Pediatrics University of Michigan School of Medicine Photo from Fraser and Dunstan “On the Impossibility Of being expert,” BMJ 2010
46. PICO Question Patient or Problem Intervention Comparison intervention Outcomes Tips for Building Describe a group of patients similar to your own What intervention are you considering What is the main alternative to the intervention What do you hope to accomplish with the intervention Example “ In patients with anemia of prematurity… … does treatment with erythropoietin… … when compared with standard therapy alone… … lead to a decrease in the number of needed transfusions?”
47. Oxford Centre for EBM Levels of Evidence for Therapy Questions Level Type of Evidence 1 Systematic Review of RCTs with homogeneity Individual RCT with narrow confidence interval 2 Systematic Review of cohort studies with homogeneity Individual Cohort study or low quality RCT Outcomes Research; Ecological studies 3 Systematic Review of case-control studies with homogeneity Individual Case-Control Study 4 Case series and poor quality cohort and case-control studies 5 Expert opinion without critical appraisal, or based solely on physiology or bench research
Photo from BMJ “Reading between the Lines” Fraser and Dunstan BMJ 12/18 “On the impossibility of being expert>” “We now know less and less about more and more, so being expert means knowing publicly acknowledging the limits of your ignorance” I have nothing to disclose other than that I am not a librarian and not an informatics specialist. I fell into the EBM, self-directed learning/life long learning field by being at the right place at the right time—Frohna, Schumacher, Greene, …. Focus for today are really strategies for the busy clinician, not the “EBM expert” NOTHING TO DISCLOSE
So, to set the stage…..To give you a sense of the explosion—I did this same search in 2003 for a resident talk: 9254 pub, 443 clinical trials, 272 RCTs, 58 CPGs EBM Reviews primarily systematic reviews
SO, Fraser and Dunstad’s BMJ paper was accompanied by a witty editorial identifying 5 approaches to coping with info overload Ostrich-ignore torrent of new information—adopted by many as they age Pigeon: Most common-hang around with other doctors, GR, occ CME mtg, follow some guidelines, consult a colleague, occ flick through journals, mostly mass media, from patients (annoying) Owl: Searches of original literature for carefully framed questions, critically appraise, apply to your patients—almost no one has the time and few have the skills Jackdaw Strategy: Pigeon + search for refined/ digested evidence: Cochrane, Clinical Evidence, guidelines, other EBR—full of holes, freq don’t apply to pts with comorbidity Inhuman Strategy: “absurd for doctors to practise without the help of machines”
I hope to introduce/remind you of some strategies that would likely fall along the right side. At the conclusion of this session, the learner should be able to:
How many have heard about the 2 new OM RCT’s published in NEMJ last week? How did you hear about them? And when?? Media/NPR/paper, get journal?, TOC alerts, saved searches, pre-digested (EBM reviews, Dynamed, etc.). How many have read them?? Critically appraised them? Integrated results with current knowledge and Applied results to a patient??
Wed
Thur
Prompt audienc
Advantage to RSS—can all be in one place, rather than multiple e-mails Multi-journal alerts through PubMed (tutorial available), Amadeus (missing some key peds-but has many subspecialty journals)
E-mailed tables of content
E-mailed tables of content
No fee to register for alerts
Directions for both on library Peds website
Similar service available through ovid. Tutorials for both available on library Peds website—will provide info at end
Pub Crawler, performs preset Medline searches every week and e-mails you the results
Better because multiple searches at once You can limit to RCTs and/or systematic reviews
Quality rating based on specific criteria for filtering, focus on patient oriented outcomes, inclusion of specific recommendations for application, validity assessment, LOE assigned, and coordinated hunting tool
Lit surveilance includes cover to cover BMJ, Cochrane, CDC, JAMA, Lancet MMWR, National Guideline Clearance House, NEJM, NIH Consensus Statements, Pediatrics. Also scans syst rev and RCTs from most pedi subspecialty journals, Archives, but NOT J Peds
J-Peds-Clinical Research Abstracts for Pediatricians
Journal Watch: biweekly summaries of articles
E-ammended alerts from AAP Grand Rounds—tells you about the review—still need to pay for Grand Rounds to read it
Auto alerts for new AAP policy statements and CPGs
Free through the medical library Long—but include summaries—careful printing
Most recent and or new info since summary always at top!!
Literature review not same rigor as a systematic review Potential author bias/ opinion versus evidence Improving over time - in many ways a review article that is updated quarterly
Databases and Point of Care Tools also available through Lorelei’s site
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