Annals Journal Club: Diagnosis of Deep Venous Thrombosis
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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

## HOW IT WORKS

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](http://www.AnnFamMed.org/AJC).

## CURRENT SELECTION

### 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.[Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NjoiNS8xLzYzIjtzOjQ6ImF0b20iO3M6MjI6Ii9hbm5hbHNmbS81LzEvaWlpLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

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.[Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NjoiNS8xLzU3IjtzOjQ6ImF0b20iO3M6MjI6Ii9hbm5hbHNmbS81LzEvaWlpLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

### 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?

*   © 2007 Annals of Family Medicine, Inc.

## 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. Available at: [http://annfammed.org/cgi/content/full/4/3/196](http://annfammed.org/cgi/content/full/4/3/196).
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vNS8xL2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  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.
    
    [CrossRef](http://www.annfammed.org/lookup/external-ref?access_num=10.1001/jama.1995.03530070068032&link_type=DOI) 
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=7629987&link_type=MED&atom=%2Fannalsfm%2F5%2F1%2Fiii.atom) 
    
    [Web of Science](http://www.annfammed.org/lookup/external-ref?access_num=A1995RN46600029&link_type=ISI) 

3.  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.
    
    [CrossRef](http://www.annfammed.org/lookup/external-ref?access_num=10.1001/jama.1995.03530200066040&link_type=DOI) 
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=7474251&link_type=MED&atom=%2Fannalsfm%2F5%2F1%2Fiii.atom) 
    
    [Web of Science](http://www.annfammed.org/lookup/external-ref?access_num=A1995TE73800031&link_type=ISI)