Introduction to the Medical Literature Robert D. Hadley, PhD, PA-C PAS 851 June 23, 2003

Why read the literature? Secret: your faculty don’t know everything! Goal: As students and practicing PAs, you need to be able to: 1. Find information for yourself 2. Critically evaluate information that is found 3. Apply to practice

Requires familiarity with the medical literature. How many students read medical literature? What journals? Do you receive PA journals? What type of journals are the PA journals. Are papers in PA journals research?

What is research?

Where is research published?

What is research good for?

Is research the only thing you should read?

What are the different types of articles you might read? original research research reviews meta-analyses clinical case studies practice guidelines clinical reviews etc.

What is “primary” vs. “secondary” literature?

What is EBM? Has anyone heard of it? What is definition? Evidence-Based Medicine will be further expanded in PAS 610, Research Methods.

Where would you find: Review of clinical presentation of CAP? A large study on the risk reduction associated with aspirin use in CAD? Practice guidelines for lipid therapy? Patient handouts? CME?

The use of the WWW in medical literature How many journals at UK are available as online versions? Are journals equally available at home and at UK/Morehead? What are ways that UK libraries restrict access to online journals? Why does UK library restrict access to online journals?

What is a WWW portal? Which are good? How do you know? Examples:

How do you decide what papers to read? What does the title assert? Abstract: What do they claim? Is this paper worth reading? What kind of paper is it: review, retrospective study, controlled study, “randomized, double ‑ blind, placebo ‑ controlled clinical trial”, etc.? What did they do? What methods did they use?

How do you decide what papers to read? What were their results? Statistical significance vs. size of the effect? Do their results support their conclusions? Are the results significant (i.e. important)? Where was it published? We put more stock in the New England Journal of Medicine, or Science than in the Herald ‑ Leader. Peer ‑ reviewed papers are more reliable, but the peer review process is no guarantee.

How do you decide what papers to read? Who are the authors? Are they employees/ supported by the company that manufactures/ sells the drug in the study? The bottom line: “How can this study influence the way I practice?” Do I need to educate my co-workers (or professors) about a new standard of care based on this work?

How do you find time to read? JUST DO IT! alerting services (e.g. Medscape, etc.) See for a selected listing Use literature to extend your knowledge in clinical courses. Look up clinical practice guidelines or pathophysiology for clinical entity that is discussed. Read the PA journals when they are mailed to you

Assignment: Read a paper and decide how the new information fits into clinical practice. Write a paragraph describing: Citation How you found it Type of paper Summary of results Application to clinical practice paragraph to

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