Writing for the Secondary Literature Mark H. Ebell, M.D., M.S. Deputy Editor, American Family Physician Former Editor, Journal of Family Practice Professor, Office of the Provost University of Georgia, Athens, GA

Secondary literature FPIN’s Clinical Inquiries AFP’s STEPs, Clinical Pharmacology, Point of Care Guides Review articles

FPIN Clinical Inquiries Written by members of Family Practice Inquiries Network consortium Goal: Concisely answer a focused clinical question with the best available evidence Published in JFP, AFP and online Work with librarian who does literature search and FPIN editor

FPIN Clinical Inquiries Good initial authoring experience  Lots of help with lit search  Mentoring by FPIN editor  Mentoring by JFP or AFP editor as well Drawbacks  Lit search done for you, so you don’t have to learn those skills  Sometimes topics are not well defined or questions are too broad.

STEPs STEPS stands for  Safety  Tolerability  Efficacy  Price  Simplicity Gives family physicians an objective review of a single new drug

Good initial authoring experience Highly structured format (“fill in the blanks”) Good option for pharmacologists Mentoring from Associate Editor Allen Shaughnessy, Pharm D

Point of Care Guides New option for authors Review a clinical decision rule and put it in form usable by clinicians Often include encounter form or printable table Appear once per month – to date all have been written by Mark Ebell MD, MS

Previous topics DVT diagnosis Sore throat management PE diagnosis and management Pre-op evaluation Pneumonia prognosis Atrial fibrillation anticoagulation decision- making Warfarin dosing

Review articles Still widely used educational medium Tremendous impact  200,000 AFP readers x 40% read most articles = 80,000 physicians  Each physicians has about 2000 patients…you do the math! Good for less experienced authors, but good option is to recruit more experienced co- author (or have dedicated, experienced proofreader)

Old approach to review articles 1. Begin with what you want to say  How you’ve always managed a problem  What textbooks say  What other review articles say  What local experts say and do 2. Write your article 3. Find references to support what you wrote

New approach to review articles 1. Identify key questions for clinicians 2. Perform a careful search of the literature  Look first for: Systematic reviews (Cochrane), meta-analyses, evidence-based guidelines, clinical decision rules  Then look for: Individual research articles, especially POEMs; use InfoRetriever and PubMed Clinical Queries. 3. Write the article

Other tips Talk to the editor and get a good idea of the scope of topic.  Diagnosis, treatment, or both?  How much pathophysiology?  Number of tables and/or figures (usually < 6-8)?  Beware overly broad topics (i.e. “Care of the nursing home patient”) RTFAI!!!

Identify key questions Write a list of 5 to 10 questions, ask colleagues Examples  How common or important is this problem?  What is the differential diagnosis?  How should I use the clinical exam?  What is the role of diagnostic testing?  What is the treatment of choice?  What are alternative treatments?  What are complications of treatment and of the disease?  What is the prognosis, and what kind of follow-up is appropriate?  Any controversies in the literature?

Use focused Medline Searching Use a medical librarian Go to PubMed Use “Clinical Queries” feature in the left hand menu Use “Related articles” once you find a good article

No no’s… Don’t use other review articles as references (gossip…) Don’t use textbook chapters as references (out of date…) Don’t accept conventional wisdom and local experts at face value

AFP: How do we select topics? Extensive list of topics Most articles solicited  Contact made  Topic assigned  Target submission date Benefits  Less duplication of effort  Ability to guide authorship from beginning

AFP: What are we NOT looking for… Overly specialized topics: “Hepatic abscess” Overly narrow topics: “CBT for ADHD” Case reports Overly broad or long topics: “Cardiovascular disease for the family physician” Information that is not relevant to the daily practice of the family physician

AFP: What we ARE looking for Concise, evidence-based summaries of the diagnosis and treatment of common or important conditions in the practice of family physicians

Let’s discuss some of your topics

Question authority! Remember… begin with the question, not the answer!