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Diving For PURLs
The PURL Team decided in November of 2010 to begin publishing the PURL Discovery process through Evidence-Based Practice series called Diving for PURLs.
So why this new series?
Diving for PURLs will provide you with a synopsis of important studies that may not meet all of our PURL criteria. They may still change your individual practice, or they may be research studies that you hear about from your patients or the media. We find that about 1 in 5 studies that we select for intensive review meet all criteria for a PURL.
Our Diving for PURLs group scours sources that cover 500 journals daily for useful research evidence, and we meet weekly to critically appraise and discuss studies that may meet our criteria to become a PURL. During these weekly meetings, we learn a lot about the articles we review. Some of the articles that do not quite meet all of the PURL criteria are still useful to our individual practices or helpful to support dialogue with our patients. Diving for PURLs is our attempt to share with you what we learn through this rigorous, continuous process.
How do we pick PURLs? Here are our criteria:
Relevant: Is the topic relevant to the practice of family medicine and primary care practice, including outpatient, inpatient, obstetrics, emergency, and long-term care? In addition, are the patients being studied sufficiently similar to patients cared for in family medicine and primary care in the United States such that the results can be generalized?
Valid: Are the findings scientifically valid? We apply explicit evidence-based medicine criteria to critically appraise every study that we review.
Change in practice: What are the current recommendations for practice regarding this topic? What is the current standard of care? Would the conclusions of the study necessitate a change in recommended practice?
Medical care setting: Could the change in recommended practice be implemented in a medical care setting? Most clinicians cannot implement school-based interventions or community-based interventions or policy changes; we can change our diagnostic approach, treatments we recommend, referrals we make, and how we educate our patients.
Implementable: Can the new practice recommendation be implemented immediately by the clinician? We assess issues such as the availability of a drug or treatment; the status of a drug with the US Food and Drug Administration; potential financial or practice organization barriers; special training required; and patient preference.
Clinically meaningful: Do the expected benefits outweigh the expected harms? Are the outcomes patient oriented (as opposed to disease oriented)? Are the measured outcomes, if true, clinically meaningful from a patient perspective?
We want to provide you with the best evidence-based information that leads to more benefit for your individual patients, with their unique values and circumstances.
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