METHODOLOGY AND FIRST TWO YEARS OF EXPERIENCE WITH PURLS: A NEW TERTIARY LITERATURE REVIEW SYSTEM...
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Transcript of METHODOLOGY AND FIRST TWO YEARS OF EXPERIENCE WITH PURLS: A NEW TERTIARY LITERATURE REVIEW SYSTEM...
METHODOLOGY AND FIRST TWO YEARS OF EXPERIENCE WITH PURLS: A NEW
TERTIARY LITERATURE REVIEW SYSTEM
Kate Rowland, MDUmang Sharma, MD
University of Chicago Department of Family Medicine
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
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?
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
PURLs criteria
1. Scientifically valid2. Relevant to Family Medicine3. Applicable in a Medical Care Setting4. Immediately implementable5. Clinically meaningful6. Change in practice
PURLs processes
Nomination Decision to review
Critical appraisal
Discussion; criteria
checklist
Decision to submit
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
Medical literature: July 07-August 09Entered in Medline: 1,636,215
Seen by nominators: 44,114
Nominated: 283
Reviewed: 81
Submitted: 34
Rejected: 3
Published: 31
Journal SourceJournal of the American Medical Association 6New England Journal of Medicine 5British Medical Journal 3Lancet 3Archives of Pediatric & Adolescent Medicine 2Obstetrics & Gynecology 2Annals of Internal Medicine 1American Journal of Psychiatry 1Archives of Otolaryngology 1Allergy 1Archives of Disease in Childhood 1Archives of Internal Medicine 1Academic Emergency Medicine 1Annals of Emergency Medicine 1Explore 1Journal of Bone and Joint Surgery: American volume 1
PURL characteristicsStudy type RCT 22
Meta-analysis/ systematic review
7
Cohort study 2Population Adults 25
Pediatrics 4Both 2
Setting Outpatient 26Both in- and outpatient
4
Inpatient 1
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)
Characteristics of original articlesSite of original research
International 16United States 10Both 5
Affiliation of primary researcher
Specialist 14Primary care 7Health services 3Unsure 3Primary care/specialty
1
Physical therapy 1Psychology 1
Characteristics of original articlesFunding source International
government10
Pharmaceutical company
5
Not reported 5
US government 4
International foundation/university
4
US government and pharmaceutical company
1
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.
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
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