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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

17. Conclusions ä Read few, only if forced by screen for relevance ä Get rid of “bedside” stack ä 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 ä Will this information have a direct bearing on the health of my patients (is it something they care about)? ä Is the problem common to my practice? ä If true, will it require me to change my current practice?