1. METHODOLOGY AND FIRST TWO YEARS OF EXPERIENCE WITH PURLS: A NEW TERTIARY LITERATURE REVIEW SYSTEM Kate Rowland, MD Umang Sharma, MD University of Chicago Department of Family Medicine

2. Keeping up with the literature Challenges: volume, variable quality, feasibility Incorporation of new research into practice notoriously slow Need an efficient system to stay up to date Existing secondary systems still high volume – EvidenceUpdates (BMJ) – DynaMed weekly updates – InfoPoems

3. Origins of primary care research Where is research impacting primary care physicians done? Who funds such research? Who are the researchers completing such studies? Where is such research published?

4. Introducing PURLs Priority Updates from the Research Literature Tertiary system designed for efficiency and completeness Planned, developed, and tested between 2005-2007 First PURLs published in 2007

5. PURLs criteria 1.Scientifically valid 2.Relevant to Family Medicine 3.Applicable in a Medical Care Setting 4.Immediately implementable 5.Clinically meaningful 6.Change in practice

6. PURLs processes Nomination Decision to review Critical appraisal Discussion; criteria checklist Decision to submit

7. PURLs process: potential PURL review Standardized critical appraisal forms Review of secondary literature sources PURL criteria checklist 1-3 potential PURLs per week 1-3 hours for reviewer per article

8. Medical literature: July 07-August 09 Entered in Medline: 1,636,215 Seen by nominators: 44,114 Nominated: 283 Reviewed: 81 Submitted: 34 Rejected: 3 Published: 31

9. Journal Source Journal of the American Medical Association6 New England Journal of Medicine5 British Medical Journal3 Lancet3 Archives of Pediatric & Adolescent Medicine2 Obstetrics & Gynecology2 Annals of Internal Medicine1 American Journal of Psychiatry1 Archives of Otolaryngology1 Allergy1 Archives of Disease in Childhood1 Archives of Internal Medicine1 Academic Emergency Medicine1 Annals of Emergency Medicine1 Explore1 Journal of Bone and Joint Surgery: American volume1

10. PURL characteristics Study typeRCT22 Meta-analysis/ systematic review 7 Cohort study2 PopulationAdults25 Pediatrics4 Both2 SettingOutpatient26 Both in- and outpatient 4 Inpatient1

11. PURL timing (days) Time from article release to nomination 33 (0-281) Time from nomination to review 21 (7-65) Time from review to PURL publication 123 (72-348) Time from article release to PURL publication 178 (72-440)

12. Characteristics of original articles Site of original research International16 United States10 Both5 Affiliation of primary researcher Specialist14 Primary care7 Health services3 Unsure3 Primary care/specialty 1 Physical therapy1 Psychology1

13. Characteristics of original articles Funding sourceInternational government 10 Pharmaceutical company 5 Not reported5 US government4 International foundation/ university 4 US government and pharmaceutical company 1

14. Conclusions Most research that changes primary care practice is done outside of the US, mostly by specialists, and with funding from international governments and industry.

15. Future directions PURLs project continues – 24 PURLs published in 2009 and 2010 Similar descriptive analyses as data pool grows Development of nationwide physician panel – What is current practice? – How do PURLs affect practice? Policy implications

16. Acknowledgments Bernard Ewigman, MD, MSPH, PURLs editor Cortni Cross, PURLs project manager Joan Nashelsky, MLS, FPIN librarian Family Physicians Inquiries Network The PURLs nomination team The PURLs working group