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What are PURLs?
PURLs generate new evidence-based recommendations for practice for family physicians and other primary care clinicians. PURLs, or Priority Updates, are stimulated by the publication of new research that meets criteria for a new recommendation to change practice. The completed PURLs are published exclusively in the Journal of Family Practice. To read the PURLs published to date go to http://www.jfponline.com/purls.asp
What are the criteria for PURLs?
Each PURL must meet five criteria:
- Relevant: Relevance to family medicine and primary care
- Valid: Scientific validity, including integration of prior research
- Change in Practice: Leads to a change from the current prevailing practice
- Applicable to Medical Care: The new practice approach is applicable in a medical care setting
- Immediately Applicable: The new practice is immediately applicable.
- Clinically Meaningful: Expected benefits outweigh expected harms.
To see a full description of the PURLs methodology, go to http://www.jfponline.com/purls.asp
What is the purpose of the PURLs Surveillance System?
The purpose of the PURLs Surveillance System is to engage communities of clinicians and methodologists in the identification, evaluation, and dissemination of PURLs; and to accelerate the translation of new research findings into clinical practice.
What is the process for identifying and evaluating PURLs?
There are five steps in the identification and evaluation of a PURL:
1) Nomination of a Potential PURL. Five designated family physicians perform literature surveillance of multiple sources for new research and nominate studies via e-mail that seem like they might change practice as judged by reading the abstract. If the PURLs Editor agrees, then the study is assigned for formal review as a Potential PURL.
2) Review of a Potential PURL. This includes a formal critical appraisal and literature review which is recorded on standardized form (the Potential PURL Review Form), submitted to the PURLs Editor and presented to a peer group at a PURL Jam, similar to a journal club format. If the study still seems as though it will meet criteria for a PURL and is approved by the PURLs Editor, it goes to the next step, Pending PURL for Review.
3) Review of Pending PURL. In this step, we conduct surveys of practicing physicians and analyses of secondary databases to empirically establish current practice and barriers to immediately applicability. In addition, validity issues raised at the initial review are further investigated. These findings are presented by the reviewer at a second PURL Jam. If the study continues to meet criteria for a PURL and is approved by PURLs Editor it is designated as a Pending PURL and sent for review by the Editor of the Journal of Family Practice (JFP Editor). The study and a written summary of the findings from the first three steps of the review are evaluated by JFP Editor, who either accepts it as a topic for a PURLs manuscript for publication or not.
4) PURL Manuscript Preparation. If the JFP Editor accepts the study as a PURL, then a manuscript summarizing the practice change, the summary of the study, and our analysis is written for publication in JFP as a PURL.
5) PURLs Instant Polls. Online “instant” polls are conducted to engage practicing physicians in dialogue and feedback about the new practice recommendation in the PURL as a part of evaluating and disseminating the research. We believe that the publication of a PURL is only one step in the process of evaluating research that changes practice.
What sources are used to nominate Potential PURLs?
Four sources are regularly monitored on daily basis by two family physicians at the University of Chicago:
1) BMJ Online based on McMaster Online Rating of Evidence System, 130 journals updated daily, must score at least “5” for relevance and at least “5” for newsworthiness, all studies pre-screened by methodologists.
2) Electronic table of contents for the top 16 journals publish practice changing research (NEJM, Lancet, BMJ, JAMA, etc)
3) DynaMed Weekly Update; 170 journals reviewed daily; studies most likely to change practice,
4) InfoPOEMs Daily Dose of Knowledge, 110 journals reviewed monthly.
Three family physicians at the University of Missouri-Columbia also do a second review of the studies selected by the InfoPOEMs group for the purpose of nominating Potential PURLs.
These five family physicians nominate Potential PURLs via an e-mail message to the PURLs Editor and other PURLs nominators. The nominations are discussed via a listserv of the nominators including the PURLs Editor and each nomination is either approved for review as a Potential PURL or dropped.
In addition, nominations are accepted from any source. Our goal is to identify every research study that should lead to a change in practice for family physicians and other primary care clinicians so if we have missed any studies through our formal surveillance systems, we want to hear about them. If we have missed a study we will review it and seriously consider it as a PURL or Priority Update.
What have been your experience and outcomes to date?
We began nominating Potential PURLs in July 2007. An analysis was done for publication with NIH to review our outcomes between July 07- August 09. The results are:
• Entered in Medline: 1,636,215
• Seen by nominators: 44,114
• Nominated: 283
• Reviewed: 81
• Submitted: 34
• Rejected: 3
• Published: 31
To review the entire analysis, visit: NIH PURL Poster
How can I get involved in PURLs?
There are currently four roles for individuals in FPIN member departments and residency programs (current or prospective) wishing to get involved in PURLs.
PURL Nominator. Choose three or more journals to monitor upon publication, or a surveillance system (e.g., BMJ, InfoPOEMs, or DynaMed) to regularly monitor for Potential PURLs. Nominations are based on reading the abstract only (you can read the entire study if you wish, but the idea is to nominate the study as soon as possible after publication). To make the nomination send an email with the abstract included to purlnomination@fpin.org along with a brief explanation of why you think it may be a PURL. Actively participate in nomination discussion online. Time commitment: estimate 3 hours or less per month.
PURL Reviewer. Become a part of the Potential PURL Schedule. Accept assignments to review a PURL with a due date approximately 6 to 13 days after assignment. Conduct standardized critical appraisal and brief review of secondary literature. Complete Potential PURL Review Form (PPRF). Present at PURL Jam. Time commitment: Requirement 4-6 reviews annually, 2-3 hours per review
Lead a PURLs Journal Club PURLs Journal Clubs are conducted to teach critical appraisal and assessment of new research for translation into practice, and for groups of physicians to keep abreast of research that has the potential to change practice. They are similar to PURL Jams, except that they can be held with whatever frequency desired by the participants, and the studies chosen for a PURL Journal Club can be flexible. The sources of studies for PURLs Journal Clubs include approved Potential PURLs, Pending PURLs for Review, Pending PURLs or PURLs. FPIN makes the Potential PURL Review Forms as well as the list of studies, the PDFs of the studies available for this purpose.
PURL Co-Author Mentor. Write PURLs for publication in JFP until the PURLs Editor approves you as a co-author mentor. Must demonstrate writing skills, critical appraisal skills, literature review skills, ability to meet deadlines consistently, ability to mentor other authors. Must also either do surveillance (to nominate potential PURLs), do PURL Jams (review potential PURLs), or lead a PURLs Journal Club. Agree to co-author mentor a minimum of 3-4 PURLs per year.
Who should I contact for more information?
Contact Bernard Ewigman, MD, MSPH, PURLs Editor (bewigman@northshore.org) or Cortni Cross, PURLs Project Manager, (cortni@fpin.org) for more information.
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