Annals Journal Club: Point-of-Care C-Reactive Protein to Assist Antibiotic Prescribing for Respiratory Tract Infections
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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

### Article for Discussion

Cals JWL, Schot MJC, de Jong SAM, Dinant GJ, Hopstaken RM. Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial. Ann Fam Med. 2010;8(2):124–133.[Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC8yLzEyNCI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC8yL2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

### Discussion Tips

In the last issue *Annals* journal club assessed a systematic review of an uncommon treatment for a particular kind of respiratory infection. This issue’s journal club provides an opportunity to consider a new adjunctive aid to decisions about antibiotic prescribing for a wider range of respiratory tract infections.

### Discussion Questions

*   What questions are addressed by this article? How do the questions fit with what already is known about diagnostic tests and delayed prescriptions for respiratory infections?

*   How does the way the questions were framed affect the utility of the findings?

*   How strong is the study design for answering the questions?

*   To what degree can the findings be accounted for by:
    
    1.  How study participants were selected or excluded?
    
    2.  How the main variables were measured?
    
    3.  Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
    
    4.  Chance?

*   How do the methods match up against the CONSORT Guidelines for clinical trials: [http://www.consort-statement.org/consort-statement/?](http://www.consort-statement.org/consort-statement/?)

*   What are the main study findings across the different outcome measures?

*   What can we learn from the subgroup analyses?

*   Does the study funding affect your confidence in the findings? Does the registration of the trial increase your confidence?2 (See: [http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1112](http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1112).)

*   How comparable are the study populations to your practice? What is your judgment about the transportability of the findings?

*   How (if at all) could this study change your practice?

*   What important researchable questions remain?

*   © 2010 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. [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/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC8yL2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  De Angelis C, Drazen JM, Frizelle, JM, et al. Clinical trial registration: a statement from the International Committee of Medical Journal Editors. N Engl J Med. 2004; 351:1250–1251.
    
    [CrossRef](http://www.annfammed.org/lookup/external-ref?access_num=10.1056/NEJMe048225&link_type=DOI) 
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=15356289&link_type=MED&atom=%2Fannalsfm%2F8%2F2%2Fiii.atom) 
    
    [Web of Science](http://www.annfammed.org/lookup/external-ref?access_num=000223861300015&link_type=ISI)