Annals Journal Club Selection:

Jan/Feb 2007

The Annals Journal Club is designed to encourage a learning community of those seeking to improve health care and health through enhanced primary care. Additional information is available on the Journal Club home page.

The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1

Articles for Discussion

Segal JB, Eng J, Tamariz LJ, Bass EB. Review of the evidence on diagnosis of deep venous thrombosis and pulmonary embolism. Ann Fam Med. 2007;5(1):63-73.
Qaseem A, Snow V, Barry P, et al. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Fam Med. 2007;5(1):57-62.

Discussion Tips

These articles portray a clinical policy guideline developed by two collaborating professional organizations and the evidence review that was used to develop the guideline. We recommend beginning with the clinical practice guideline for an overview of the scientific evidence, and then reading and discussing the evidence review with an emphasis on how often narrowly configured evidence is framed, retrieved, evaluated, synthesized, and translated into recommendations for practice.2,3 (You also may wish to look at the companion management guideline published in this issue, and the accompanying evidence review published in the Annals of Internal Medicine.)

Discussion Questions

What are the recommendations?
How strong is the evidence for each recommendation?
What questions were used to frame the evidence review and the guideline development? How well do these questions reflect your questions when faced with a patient in whom you suspect a venous thrombus or a thromboembolism?
How well does the study selection approach capture all relevant data?
Were all relevant outcomes considered?
How were different outcomes and trade-offs considered in making overall recommendations?
How do you interpret the variability in some of the studies that went into the evidence review? What effect does this variability have on your application of the findings?
What biases are apparent in how the evidence was evaluated and synthesized?
How well did the organizations specify their process for developing the guideline from the scientific evidence?
How practical are the recommendations for use in practice? How applicable are they to your patients and setting?
What needs for primary care�relevant information does this evidence review and recommendation identify?

References

Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4:196-197. Available at: http://annfammed.org/cgi/content/full/4/3/196.
Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt GH. Users� guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? JAMA. 1995;274(7):570-574.
Wilson MC, Hayward RS, Tunis SR, Bass EB, Guyatt G. Users� guides to the medical literature. VIII. How to use clinical practice guidelines. B. What are the recommendations, and will they help you in caring for your patients? JAMA. 1995;274(20):1630-1632.

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