Finding the GEMS

In clinical research

Paul Glasziou &

Chris Del Mar

Overview

Background to EBM journalYour selection from 8 articles from 2002Read, discuss, questions

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

Rule 31 – Review the World Literature Fortnightly*

*"Kill as Few Patients as Possible" - Oscar London

0

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'50 '55 '60 '65 '70 '75 '80 '85 '90 '95

Num

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Med

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Trials MEDLINE BioMedical

5,000 per day

1,000 per day

50 per day

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

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

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

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

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

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

Anatomy of a summary

Declarative title

Recalculated main results

Structured abstract

Expert Commentary

Bimonthly “just in case” journalValid, Relevant & (almost) No Effort!

www.evidence-basedmedicine.com