Do you use AFP to teach evidence-based medicine?

For the past few days, I participated in the annual Northeast Region meeting of the Family Medicine Education Consortium in Hershey, Pennsylvania. In addition to presenting a well-received session on social media tools in family medicine (including the AFP Community Blog), I attended a thought-provoking seminar on "Reinventing Journal Club: Innovations in the Internet Age" led by faculty and residents from the University of Rochester. This seminar demonstrated their program's successful experience with increasing residents' use of AAFP-recommended evidence-based medicine resources such as reports from the Agency for Healthcare Research and Quality, the Cochrane Database of Systematic Reviews, and Essential Evidence Plus to answer clinical questions.

At the end of the seminar, I asked the presenters if they encouraged their residents to read American Family Physician, and what role the journal plays in their evidence-based medicine curriculum, if any. (After all, we require AFP's clinical review authors to consult the same types of EBM resources as part of their literature searches and to label key clinical recommendations using the rigorous Strength-of-Recommendation Taxonomy.) Their response was that everyone reads AFP, so they didn't necessarily see a need to promote the journal as a resource.

In a previous editorial, AFP Deputy Editor Mark Ebell, MD, MS argued that rather than focusing on the skills needed to analyze original research studies, the typical family physician should instead aim to be an "informed consumer of the secondary literature" and "an expert at assessing the quality of an information source." Since medical school and residency are the best times for family physicians to develop skills in answering clinical questions, we would like to know how teachers of family medicine are using the journal for this purpose. Are there any particular AFP features that you find especially useful for teaching EBM, or areas where you feel we could improve? We welcome your feedback and suggestions.

Complementary and alternative medicine: what should FPs and patients know?

Since 2003, AFP has published an occasional series of articles evaluating the evidence for complementary and alternative medicine (CAM) therapies, ranging from ecinachea to probiotics to yoga and meditation for anxiety and depression. In an editorial introducing the series, associate medical editor Sumi Sexton, MD wrote:

The intent of this new AFP series is to summarize and label the evidence behind various alternative therapies, starting with the most frequently prescribed and well-researched herbal remedies and supplements. ... Currently, an abundance of information on CAM exists in textbooks, journals, newsletters, and Web sites. The purpose of the series is not to replace the existing information or to encourage physicians to prescribe CAM therapies, but rather to extract the most important data in the literature and present it as concisely as possible.

However, as an exchange of letters in the October 15th issue of AFP about an article on acupuncture for pain demonstrates, drawing conclusions about the effectiveness of CAM therapies can be challenging. Dr. Paul Delaney asserts that "in a desire to present information regarding treatments designated as complementary and alternative medicine (CAM), the editors of American Family Physician seem willing to suspend the usual criteria for evidence-based medicine." In rebuttal, Dr. Robert Kelly cites a Cochrane review that supports the effectiveness of acupuncture in relieving chronic low back pain, and Dr. Sexton notes that the article's supporting references "included several RCTs, systematic reviews, and a meta-analysis, which would warrant an evidence level A for any review article."

A recent report from the National Center for Health Statistics found that U.S. adults spent nearly $34 billion in out-of-pocket costs for CAM practitioners and purchases of CAM therapies, classes, and educational materials in 2007. What do you think family physicians and patients should know about CAM, and how would you rate AFP's CAM series at meeting these needs?

Putting depression guidelines into practice

It's difficult to find time to ask about depressive symptoms in practice, and family physicians who want to make screening a priority must also ensure access to follow-up resources that improve patient outcomes. Recently, the U.S. Preventive Services Task Force and the AAFP both updated their clinical recommendations on screening adults for depression. Both organizations now recommend screening only "when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up." The October 15th issue of AFP contains several valuable depression care resources, including a clinical review of postpartum major depression, an abridged version of the USPSTF statement, a case study and quiz questions on applying the USPSTF and AAFP recommendations in practice, and an editorial about the experience of the integrated delivery system MaineHealth in improving depression screening and care for its members.

Readers seeking to remodel their care management processes to be consistent with the latest depression guidelines will find the editorial to be a good start. In addition, AFP and its sister publication, Family Practice Management, offer helpful online content on proven staff-assisted depression care supports, including validated screening tools, patient registries, and communication strategies to encourage self-management. Finally, you can find links to these resources and more in the AFP By Topic collection on depression and bipolar disorder.

ACL injury and musculoskeletal care resources

The cover article of the October 15th issue of AFP reviews the diagnosis, management, and prevention of anterior cruciate ligament (ACL) injuries. Although we have always recognized the importance of including high-quality illustrations of relevant anatomy and physical examination maneuvers in articles like these, this article also includes short videos of diagnostic and prognostic tests that you can watch on the AFP web page or on the AFPJournal YouTube channel. Click on the image below to see a demonstration of the Lachman test, which the authors note is the most accurate test for detecting an ACL injury. Eventually, we hope to build a library of online videos of common examination skills and procedures in family medicine. In the meantime, don't miss the AFP By Topic collection on Musculoskeletal Care, which contains links to online content on joint injections, fracture management, and approaches to musculoskeletal problems organized by region of the body.

Feedback from the AAFP Scientific Assembly

We were delighted to meet many of you at the AAFP Publications Booth during the Scientific Assembly in Denver last week and listen to your thoughtful comments and suggestions about how to improve AFP's online experience. We received some valuable feedback on the new AFP By Topic feature, and are working to make it available as a mobile app within the next several months.

Our 40th topic collection on Menopause includes an updated review from the October 1st issue on how to counsel menopausal patients about hormone therapy and alternatives for vasomotor symptoms. Future topic collections will organize current AFP content on thyroid disorders, sleep disorders, and gastrointestinal conditions. Please let us know if you have suggestions for other topics that you commonly encounter in your practice, by posting a comment on this blog, AFP's Facebook page, or sending a tweet to @AFPJournal.