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Annals Journal Club: Symbiosis Instead of Competing Demands: A Tale of Two Preventive Services

	HOW IT WORKS

TOP HOW IT WORKS CURRENT SELECTION DISCUSSION TIPS DISCUSSION QUESTIONS REFERENCES

 
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/AJC/.

	CURRENT SELECTION

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Article for Discussion
Potter MP, Phengrasamy L, Hudes ES, McPhee SJ, Walsh JME. Offering home fecal occult blood tests at 3 u shot clinics increases colorectal cancer screening rates. Ann Fam Med. 2009;7(1):17–23.[Abstract/Free Full Text]

	DISCUSSION TIPS

TOP HOW IT WORKS CURRENT SELECTION DISCUSSION TIPS DISCUSSION QUESTIONS REFERENCES

 
This clinical trial shows a dramatic effect of adding fecal occult blood testing to fl u shot clinics. In addition to critiquing the article, it may be worthwhile to consider how the findings might be reinvented in your practice setting.

	DISCUSSION QUESTIONS

TOP HOW IT WORKS CURRENT SELECTION DISCUSSION TIPS DISCUSSION QUESTIONS REFERENCES

 

• What question is addressed by the article? How does the question fit with what already is known on this topic?
  
• How does theory inform the intervention design?
  
• How strong is the study design for answering the question?
  
• How do the study methods compare with the CONSORT criteria for clinical trials?² What adjustments in the criteria are necessitated by the randomization of clinic days rather than individuals?
  
• What is the degree to which can the findings be accounted for by:
  1. How participants were selected? The exclusion criteria and drop outs? Are any biases likely to be important?
     
  2. How outcomes were measured?
     
  3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
     
  4. How information was interpreted?
     
  5. Chance?
     
  
  
• What are the main findings? How large is the effect?
  
• What do we learn from the secondary analyses of factors associated with variations in screening completion, and from the description of attempts to follow up patients with positive fecal occult blood tests? What factors affect interpretation of these findings that are less an issue with interpreting the main effects of the clinical trial?
  
• How transportable are the findings to your clinical setting? What factors might affect this transportability?
  
• What are some next steps for applying the findings or answering other questions that this study raises?
  

	REFERENCES

TOP HOW IT WORKS CURRENT SELECTION DISCUSSION TIPS DISCUSSION QUESTIONS REFERENCES

 

1. Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196–197. http://annfammed.org/cgi/content/full/4/3/196.[Free Full Text]
2. CONSORT Group. CONSORT: Consolidated Standards of Reporting Trials. http://www.consort-statement.org/. Accessed Oct 26, 2008.

This article has been cited by other articles:

				K. C. Stange Organizing Health Care for Value Ann. Fam. Med, November 1, 2009; 7(6): 559 - 561. [Full Text] [PDF]

TRACK Comments:

This Article Full Text (PDF) TRACK Discussion: Submit a Comment TRACK Discussion: View Comments Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Search for Related Content