how to select medical journal

8/6/2019 How to Select Medical Journal

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How to select

medical journal?Surat Tanprawate, MD, MSc(Lond.), FRCPT

Division of Neurology, Department of MedicineChaing Mai University

Tuesday, 31 May 2011


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The failure of common

sense



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sense I shake a tree, an apple falls out, now I

can eat



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can eat

I give antibiotics for sinusitis, the patientgets better, Im doing a good job as adoctor



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can eat

I give antibiotics for sinusitis, the patientgets better, Im doing a good job as adoctor

I just saw a patient with tumor lysissyndrome, I will start looking for it moreand maybe Ill nd it more



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Where is the wisdom we have lost

in knowledge,

and the knowledge we have lost in

information?Tuesday, 31 May 2011


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Three levels of reading

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

2. Reading for information , in which we approach theliterature looking for answers to a specific question, usuallyrelated to a problem we have met in real life.

3. Reading for research , in which we seek to gain acomprehensive 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 familiarwith EBM and critical clinical decisionmaking

Quality Development The trainee should have formal teachingabout critical appraisal of literature,scientic data and EBM



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Essential step

1. Patient problem

2. Clinical question3. Search for evidence

4. Critical appraisal of the evidence5. Apply the results

Sackett DL, Haynes B. Evidence based Medicine 1995; 1 : 45.



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Before we start:formulate the problem



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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



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Every day

the results of ~ 46 randomised clinical trials arepublished

~ 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 usefulfor patient care

a little more than 1% is both rigorous andclinically relevant



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Source of information

Primary: searches of journal databases:Medline, Psychinfo

Secondary: Cochrane, Bandolier, ClinicalEvidence

National Electronic Library for Health



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Primary Journal Database



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Secondary Journal Database



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EBM DatabasesEvidence Based Medicine Reviews

(EBMR)-Commercially available thru OVID-Searches a variety of databases

Cochrane Database of Systematic ReviewsACP Journal Club

Medline-Links databases together



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PubMed Search ConsolidationSearch Strategy

Selection of search terms Keywords Phrases

Synonyms

Combination of search terms Boolean logic

Application of limits Occurrence of search terms

Title, Title/Abstract, All elds Types of articles Age groups Etc.



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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 presentin all retrieved articles

Example: osteoarthritis OR arthritis

NOT : Limits your search by excluding a concept asone term must be present and the second term mustnot 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 authorstesting?

Question 2:What type of study wasdone?

Question 3:Was this design appropriateto the broad eld of research addressed?



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Primary studiesCase studiesExperimentsSurveysClinical Trials

Secondary studiesNonsystema6c reviewsSystema0c reviews

Metaanalyses Guidelines Decision analyses

Economic analyses

Types of paper research evidence



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Choosing a paper

Relevance for the purpose Purpose may be clinical problem-solving;

informing about new treatment ordiagnostic test

Search efciently Recent and best available paper Avoid case reports



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Where do i nd the

information?



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Where do i nd the

information? Title , Abstract or nal paragraph of

the Introduction should clearly state thequestion



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Where do i nd the

information? Title , Abstract or nal paragraph of

the Introduction should clearly state thequestion

If you still cannot ascertain what thefocused question is after reading thesesections, search for another paper



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ABSTRACTShould I Spend My Time

Reading This Paper ?

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

More and More Journals are usingStructured Abstracts



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Avoid ! The study did not examine an important scientic

issue

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

The study did not actually test the authorshypothesis

A different study design should have been used Practical difculties (for example, in recruiting

subjects) led the authors to compromise on theoriginal study protocol

The sample size was too smallTuesday, 31 May 2011


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Avoid ! The study was uncontrolled or inadequately controlled The statistical analysis was incorrect or inappropriate

The authors have drawn unjustied conclusions fromtheir data

There is a considerable conict of interest (forexample, one of the authors or a sponsor might benetnancially from the publication of the paper andinsufcient safeguards were seen to be in place toguard against bias)

The paper is so badly written that it isincomprehensible



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Essential step

1. Patient problem

2. Clinical question3. Search for evidence

4. Critical appraisal of the evidence5. Apply the results

Sackett DL, Haynes B. Evidence based Medicine 1995; 1 : 45.



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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 alteredconsciousness starting 3 hours ago



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CT Scan



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Patient problem

Intracerebral hemorrhage with cerebraledema

Clinical question

Surgical role



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Surgery of ICH

Cerebellar: >3 cm in diameter andaltered sensorium

Hydrocephalus: External drainage Supratentorial



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Supratentorial ICH



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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.

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.



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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.


Neurology Medicine


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eu o ogy Medicine



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Greenhalgh T. How to Read a Paper:The Basics of Evidence-basedMedicine. London; BMJ; 2006.Clear and concise. Book based on aseries of papers published in theBritish Medical Journal (see courseweb page for PDFs)

Elwood MJ. Critical Appraisal ofEpidemiological Studies andClinical Trials. London; OxfordUniversity Press; 2007.Thorough coverage of epidemiologicalprinciples as well as providing a niceapproach for critical appraisal.One of the best epi books ever written.



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Thank you for your

attention

My Deepest Gratitude to Dr. Siwaporn Chankrachang

how to select medical journal

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