1. Finding the GEMS In clinical research Paul Glasziou & Chris Del Mar

2. Overview Background to EBM journal Your selection from 8 articles from 2002 Read, discuss, questions

3. JASPA* (Journal Associated Score of Personal Angst) J: Are you ambivalent about renewing your JOURNAL subscriptions? A: Do you feel ANGER towards prolific authors? S: Do you ever use journals to help you SLEEP? P: Are you surrounded by PILES of PERIODICALS? A: Do you feel ANXIOUS when journals arrive? * Modified from: BMJ 1995;311:1666-1668 0 - liar? 1-3 - normal range >3 - sick; at risk for polythenia gravis and related conditions

4. Rule 31 – Review the World Literature Fortnightly* *"Kill as Few Patients as Possible" - Oscar London 5,000 per day 1,000 per day 50 per day

5. Does CME help? Most CME does not improve clinical behaviour* Lectures worst; interactive, case-based better* Cost of CME in Oz 40,000 doctors x 150 hours/year @ $100/hour = $600 Million * Davis, JAMA 1999

6. Managing Information “Pull” and “Push” methods “Pull” – access information when needed “Just in Time” learning Use whenever questions arise EBM Steps: Question; search; appraise; apply “Push” - alerts us to new information “Just in Case” learning Use ONLY for important, new, valid research

7. Which Information to Push? Shaugnessy’s information rule Value = Validity x Relevance Effort Corollaries If it is not valid, it is of no value If it is not relevant, it is of no value

8. Validity Criteria 1.How can we alleviate the problem? (INTERVENTION/THERAPY) Randomised trial with > 80% followup 2.What is the risk of the problem? (PROGNOSIS) Inception cohort with > 80% followup 3.How accurate are the tests? (DIAGNOSIS) Appropriate spectrum with blinded Gold Standard 4.Systematic Reviews (of any question) Clear question; adequate search & inclusion criteria

9. Which Information to Push? Shaugnessy’s information rule Value = Validity x Relevance Effort Corollaries If it is not valid, it is of no value If it is not relevant, it is of no value

10. Assessing Relevance Valid articles from > 80 journals “voted” on Several GPs Appropriate specialist groups Two questions (Y/N & 0-10 ratings) Will this change your practice? Will it change the way you think about this? Responses compiled Selected articles sent for abstraction

11. Anatomy of a summary Declarative title Recalculated main results Structured abstract Expert Commentary

12. Bimonthly “just in case” journal Valid, Relevant & (almost) No Effort! www.evidence-basedmedicine.com