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How to select medical journal?

Surat Tanprawate, MD, MSc(Lond.), FRCPT Division of Neurology, Department of Medicine Chaing Mai University

Tuesday, 31 May 2011

The failure of common sense

The failure of common sense Tuesday, 31 May 2011

Tuesday, 31 May 2011

The failure of common sense

The failure of common sense I shake a tree, an apple falls out, now I can

I shake a tree, an apple falls out, now I can eat

Tuesday, 31 May 2011

The failure of common sense

The failure of common sense I shake a tree, an apple falls out, now I can

I shake a tree, an apple falls out, now I can eat

I give antibiotics for sinusitis, the patient gets better, I’m doing a good job as a doctor

Tuesday, 31 May 2011

The failure of common sense

The failure of common sense I shake a tree, an apple falls out, now I can

I shake a tree, an apple falls out, now I can eat

I give antibiotics for sinusitis, the patient gets better, I’m doing a good job as a doctor

I just saw a patient with tumor lysis syndrome, I will start looking for it more and maybe I’ll find it more

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“Where is the wisdom we have lost in knowledge,

“Where is the wisdom we have lost in knowledge, and the knowledge we have lost in

and the knowledge we have lost in information?”

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Three levels of reading

1. Browsing, in which we flick through books and journals looking for anything that might interest us.

2. Reading for information, in which we approach the literature looking for answers to a specific question, usually related to a problem we have met in real life.

3. Reading for research, in which we seek to gain a comprehensive view of the existing state of knowledge, ignorance, and uncertainty in a defined area.

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WFME Global Standards for PG Medical Education

Basic Standard

The trainee must … … become familiar with EBM and critical clinical decision making

Quality Development

The trainee should have formal teaching about critical appraisal of literature, scientific data and EBM …

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Evidence based medicine requires you not only to read papers but to read the “right papersat the “right time

Then to alter ... your behaviour (and, what is often more difficult, the behaviour of other people) in the light of what you have found

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Essential step

1. Patient problem 2. Clinical question 3. Search for evidence 4. Critical appraisal of the evidence 5. Apply the results

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Sackett DL, Haynes B. Evidence based Medicine 1995; 1: 4–5.

Before we start:

“formulate the problem”

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The Answerable Question

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The Answerable Question Tuesday, 31 May 2011

Forming a searchable public health question

The PICO framework used in evidence- based medicine can also be used to create a searchable question in public health

P Patient, population, problem

I

Intervention (program or treatment

or screening test) C Comparison (if any)

O Outcome

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Search of evidence Tuesday, 31 May 2011

Search of evidence

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Every day …

the results of ~ 46 randomised clinical trials are published

~ 1000 new Medline articles

~ 6,000 new articles in biomedical journals

Every year …

~ 3 million articles published in ~ 30,000 journals

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Not all of this information is valid or useful for patient care

a little more than 1% is both rigorous and clinically relevant

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Source of information

Primary: searches of journal databases:

Medline, Psychinfo Secondary: Cochrane, Bandolier, Clinical Evidence National Electronic Library for Health

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Source of information Primary: searches of journal databases: Medline, Psychinfo Secondary: Cochrane, Bandolier, Clinical Evidence National

Primary Journal Database

Primary Journal Database Tuesday, 31 May 2011

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Secondary Journal Database

Secondary Journal Database Tuesday, 31 May 2011

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EBM Databases

Evidence Based Medicine Reviews (EBMR)

-Commercially available thru OVID -Searches a variety of databases

Cochrane Database of Systematic Reviews ACP Journal Club Medline

-Links databases together

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PubMed Search Consolidation

Search Strategy

Selection of search terms

Keywords

Phrases

Synonyms

Combination of search terms

Boolean logic

Application of limits

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Occurrence of search terms Title, Title/Abstract, All fields Types of articles Age groups Etc.

Boolean logic

AND: Combines terms to limit your search as both concepts must be present in all retrieved articles

Example: osteoarthritis AND knee*

OR: Widens your search as either term can be present in all retrieved articles

Example: osteoarthritis OR arthritis

NOT: Limits your search by excluding a concept as one term must be present and the second term must not be present

Example: osteoarthritis NOT hip

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Three preliminary questions to get your bearings

Question 1:Why was the study done and what hypothesis were the authors testing?

Question 2:What type of study was done?

Question 3:Was this design appropriate to the broad field of research addressed?

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Types of “paper” research evidence

Primary studies

Case studies Experiments Surveys

Clinical Trials

Secondary studies

Non‐systema6c reviews

Systema0c reviews

Meta‐analyses

Guidelines

Decision analyses Economic analyses

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Topics of Primary Study and Types of Study Design

Phenomena Observation / qualitative studies

Etiology Cohort studies (or Case-control studies)

Diagnosis and screening Cross-sectional analytical studies

Prognosis Cohort studies

Intervention

Randomised Controlled Trials

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Choosing a paper

Relevance for the purpose Purpose may be clinical problem-solving; informing about new treatment or diagnostic test Search efficiently Recent and best available paper Avoid case reports

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Where do i find the information?

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Where do i find the information?

Title, Abstract or final paragraph of the Introduction should clearly state the question

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Where do i find the information?

Title, Abstract or final paragraph of the Introduction should clearly state the question

If you still cannot ascertain what the focused question is after reading these sections, search for another paper

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ABSTRACT

Should I Spend My Time Reading This Paper ?

States the Purpose of Article, Major Procedures and Methods, Main Findings, and Conclusions

More and More Journals are using Structured Abstracts

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Avoid !

The study did not examine an important scientific issue

The study was not original – that is, someone else has already done the same or a similar study

The study did not actually test the authors’ hypothesis A different study design should have been used Practical difficulties (for example, in recruiting subjects) led the authors to compromise on the original study protocol The sample size was too small

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Avoid !

The study was uncontrolled or inadequately controlled The statistical analysis was incorrect or inappropriate The authors have drawn unjustified conclusions from their data

There is a considerable conflict of interest (for example, one of the authors or a sponsor might benefit financially from the publication of the paper and insufficient safeguards were seen to be in place to guard against bias)

The paper is so badly written that it is incomprehensible

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Essential step

1. Patient problem 2. Clinical question 3. Search for evidence 4. Critical appraisal of the evidence 5. Apply the results

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Sackett DL, Haynes B. Evidence based Medicine 1995; 1: 4–5.

Case scenario

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A case scenario

A 60-year old patient, known hypertensive, presents with sudden onset headache, vomiting, left hemiplegia and altered consciousness starting 3 hours ago

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CT Scan

CT Scan Tuesday, 31 May 2011

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Patient problem

Intracerebral hemorrhage with cerebral edema

Clinical question

Surgical role

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Surgery of ICH

Cerebellar: >3 cm in diameter and altered sensorium

Hydrocephalus: External drainage Supratentorial

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Supratentorial ICH

Supratentorial ICH Tuesday, 31 May 2011

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Prasad K et al.Surgery for primary supratentorial intracerebral haemorrhage.

Prasad K et al.Surgery for primary supratentorial intracerebral haemorrhage.

Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.:

Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.:

CD000200. DOI: 10.1002/14651858.CD000200.pub2.

CD000200. DOI: 10.1002/14651858.CD000200.pub2.

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Prasad K et al.Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.:

CD000200. DOI: 10.1002/14651858.CD000200.pub2.

Tuesday, 31 May 2011

Medicine

Tuesday, 31 May 2011 Neurology

Tuesday, 31 May 2011

Neurology

Tuesday, 31 May 2011 Neurology
Tuesday, 31 May 2011 Greenhalgh T. How to Read a Paper: The Basics of Evidence-based Medicine.
Tuesday, 31 May 2011 Greenhalgh T. How to Read a Paper: The Basics of Evidence-based Medicine.

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Greenhalgh T. How to Read a Paper:

The Basics of Evidence-based Medicine. London; BMJ; 2006.

Clear and concise. Book based on a series of papers published in the British Medical Journal (see course web page for PDFs)

Elwood MJ. Critical Appraisal of Epidemiological Studies and Clinical Trials. London; Oxford University Press; 2007.

Thorough coverage of epidemiological principles as well as providing a nice approach for critical appraisal. One of the best epi books ever written.

Thank you for your attention

My Deepest Gratitude to Dr. Siwaporn Chankrachang

Tuesday, 31 May 2011