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Chapter 6

Keeping Up with the Literature with Dr. Alan Ehrlich

Alan Ehrlich, MD and Paul Simmons, MD
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On average, 5,000 new medical articles are published every day. In this segment, Dr. Alan Ehrlich, Executive Editor of DynaMed, and Paul Simmons discuss some practical tips in staying current with the literature and applying it to our everyday practice.

Pearls:

  • Have some sort of system for learning that may include multiple different resources.
  • Think critically about the data and focus on the clinical outcomes that matter to your patients.

 

  • Keeping up with the latest medical literature is hard!
    • A new article is published every 26 seconds = 5,000 articles a day
  • Online resources:
    • Journal Watch
    • ACP Journal Club
    • DynaMed
    • UpToDate
    • BMJ Best Practice
  • Textbooks:
    • While they may be dated, it can help you have a physical reference for pictures that is supplemented with an online version like The Five Minute Clinical Consult
  • Conferences:
    • Good place to hear the latest during protected time, potentially practice in-person and network with other colleagues
  • Journals:
    • New information, large clinical trial journals (ie: Annals, NEJM, Lancet) → try to read the table of contents and choose an article or two to read more in depth
    • Review article journals (ie: American Family Physician) → the curriculum is more planned out but there is also a lag between writing and publishing leading to them becoming quickly dated
  • A potential program:
    • Have some kind of system:
      • Breaking news source - daily email, podcast
      • Point of care tools - textbooks or something updated on a regular basis
      • Regular time set aside to stay updated - journals, regular conferences
  • Tips for evaluating the literature:
    • Start with the conclusion → is this something that is clinically relevant?
    • How are the methods this study?
      • Blinding
      • Allocation concealment
      • Evidence of baseline disparities
      • Selective reporting of outcomes
      • Focus on surrogate outcomes instead of big clinical outcomes
    • Rarely should you change your practice based on one article
    • Systematic reviews of high quality are important to review, often used by experts (specialists, primary care, research) to create guidelines

 

References:

  1. Shaughnessy AF, et al Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489-499. PMID: 7964548
  2. Smith R. What clinical information do doctors need?. BMJ. 1996;313(7064):1062-1068. PMID: 8898602
  3. Slawson DC, Shaughnessy AF. Becoming an information master: using POEMs to change practice with confidence. J Fam Pract. 2000;49(1):63–67. PMID: 10678341
  4. Xue, H, Liu, Y, Luo, P, et al. Hydroxychloroquine treatment in COVID‐19: A descriptive observational analysis of 30 cases from a single center in Wuhan, China. J Med Virol. 2020; 92: 2523– 2527. PMID: 32779755
  5. Boulware DR, et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med. 2020;383(6):517-525. PMID: 32492293
  6. Cohen MS. Hydroxychloroquine for the Prevention of Covid-19 - Searching for Evidence. N Engl J Med. 2020;383(6):585-586. PMID: 32492298
  7. Bloomgarden ZT. Glycemic control in diabetes: a tale of three studies. Diabetes Care. 2008;31(9):1913-1919. PMID: 18753670
  8. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020;383(19):1813-1826. PMID: 32445440
  9. RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report [published online ahead of print, 2020 Jul 17]. N Engl J Med. 2020;NEJMoa2021436. PMID: 32678530
  10. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, et al. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Kwag KH, González-Lorenzo M, Banzi R, Bonovas S, Moja L. Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries. J Med Internet Res. 2016;18(1):e15. Published 2016 Jan 19. PMID: 26786976
  11. Ketchum AM, Saleh AA, Jeong K. Type of evidence behind point-of-care clinical information products: a bibliometric analysis. J Med Internet Res. 2011 Feb 18;13(1):e21. PMID: 21335319
  12. Electronic Preventive Services Selector (ePSS). Ahrq.gov. Published 2019. Link

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