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

doi:10.1370/afm.1097

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.

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.OpenUrl Abstract/FREE Full Text

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/?
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.)
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?

REFERENCES

↵
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.
OpenUrl FREE Full Text
↵
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.
OpenUrl CrossRef PubMed