Welcome

This Web site comprises the cumulative electronic contents of ACP Journal Club's bimonthly print edition since its inception in 1991, with recurrent weeding of out-of-date articles. The content is carefully selected from over 100 clinical journals through reliable application of explicit criteria for scientific merit, followed by assessment of relevance to medical practice by clinical specialists.

Purpose and Procedure

ACP Journal Club's general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts. The specific purposes of ACP Journal Club are

1. To detect, using prestated criteria, the best original and review articles on the cause, course, diagnosis, clinical prediction, prevention, treatment, or economics of medical disorders managed by internists and related subspecialists, and on quality improvement and continuing medical education intervention trials in internal medicine

2. To summarize this literature in the form of "structured abstracts" that describe the objectives, methods, results, and evidence-based conclusions of studies in a reproducible, accurate, and applicable fashion

3. To provide brief commentaries on the context, methods, and clinical applications of the findings of each article by clinicians with a high degree of expertise in the topic of the article who have declared no conflict of interest

4. To disseminate the summaries in a timely fashion to internists and internists-in-training to the extent that resources permit.

The American College of Physicians publishes ACP Journal Club bimonthly under the editorship of R. Brian Haynes, MD, PhD, at McMaster University. The Health Information Research Unit of the Department of Clinical Epidemiology and Biostatistics at McMaster University hosts the editorial office for the service. An international editorial board oversees and reviews policy.

More than 100 journals are reviewed (see Journals reviewed for ACP Journal Club) to identify articles that meet ACP Journal Club criteria. An abridged list of the major journals is included in the Table of Contents of each issue, and a complete list is available from the editorial office. The list is subject to modification based on relative performance of each journal according to the criteria set out below; we also assess journals nominated by readers and editors. Access to foreign-language journals is provided through the systematic reviews we abstract, especially those in the Cochrane Database of Systematic Reviews, which summarizes articles taken from over 800 journals in many languages.

Basic Criteria

To meet the basic criteria, all original research and review articles must

• be in English
• be about adult humans
• be about topics, other than descriptive studies of prevalence, that are important to the clinical practice of general internal medicine and its subspecialties
• analyze the data consistently with the study question.

Category-Specific Criteria

Studies of prevention or treatment must also include

• random allocation of participants to comparison groups
• follow-up (endpoint assessment) of at least 80% of those entering the investigation
• outcome measure of known or probable clinical importance.

Studies of diagnosis must also include

• interpretation of a spectrum of participants, some but not all of whom have the disorder or derangement of interest
• interpretation of a diagnostic ("gold") standard without knowledge of the test result
• each participant must receive both the new test and some form of the diagnostic standard
• interpretation of the test without knowledge of diagnostic standard result
• an objective diagnostic standard (e.g., laboratory test not requiring interpretation) or current clinical standard for diagnosis (e.g., venography for deep venous thrombosis), prefereably with documentation of reproducible criteria for subjectively interpreted diagnostic standard (i.e., report of statistically signficant measure of agreement beyond chance among observers).

Studies of prognosis must also include

• inception cohort of individuals, all initially free of the outcome of interest
• follow-up of at least 80% of patients until a major study endpoint occurs or the study ends.

Studies of etiology must also include

• exploration of the relation between exposures and putative clinical outcomes
• clearly identified comparison groups for those at risk for, or having, the outcome of interest (i.e., randomized controlled trial, quasirandomized controlled trial, nonrandomized controlled trial, cohort analytic study with matching or statistical adjustment to create comparable groups, or nested case-control studies
• blinding of observers of outcomes to exposure (criterion assumed to be met if outcome is objective, i.e., all-cause mortality, objective test).

Studies of quality improvement or continuing education must also include

• random allocation of participants or units to comparison groups
• follow-up of at least 80% of participants
• an outcome measure of known or probable clinical or educational importance.

Studies of the economics of health care programs or interventions must also include

• an economic question based on comparison of alternatives
• alternate diagnostic or therapeutic services or quality improvement activities compared on the basis of both the outcomes produced (effectiveness) and resources consumed (costs)
• evidence of effectiveness must be from a study (or studies) that meets the above-noted criteria for treatment, diagnosis, and quality improvement or a systematic review article that also meets the criteria
• results presented in terms of the incremental or additional costs and outcomes of one intervention over another
• a sensitivity analysis if uncertainty exists about the estimates or precision of the measurements.

Studies of clinical prediction guides must also include

• generation of the guide in one or more sets of patients (training set)
• validation in another set of real patients (test set)
• the above-noted criteria for treatment, diagnosis, prognosis, or etiology.

Studies of differential diagnosis must also include

• a cohort of patients who present with a similar, initially undiagnosed but reproducibly defined clinical problem
• an explicitly described clinical setting, including the referral filter
• ascertainment of diagnosis for 80% of patients using a reproducible diagnostic workup strategy for all patients and follow-up until patients are diagnosed or follow-up of 1 month for acute disorders or 1 year for chronic or relapsing disorders.

Systematic review articles must also include

• an identifiable description of the methods indicating the sources and methods for searching for articles
• a statement of the clinical topic and the inclusion and exclusion criteria for selecting articles for detailed review
• at least one article that meets the above-noted criteria for treatment, diagnosis, prognosis, clinical prediction, etiology, quality improvement, economics of health care, or differential diagnosis.

These criteria are subject to modification if, for example, it is found feasible to apply higher standards that increase the validity and applicability of studies for clinical practice. The objective of ACP Journal Club is to abstract only the very best literature, consistent with a reasonable number of articles "making it through the filter."

Articles meeting the criteria set out above are abstracted according to the procedure for more informative abstracts (1), with the following modifications: Abstracts can be up to 425 words in length. Abstracts are reviewed by an expert in the content area covered by the article. A commentary is added to provide the context of the article in the research that has preceded it, any important methodological problems that affect interpretation, and recommendations for clinical application. The author of the article is given an opportunity to review the abstract and commentary before publication. Because there is not enough space to accommodate abstracts for all articles that meet the criteria set forth in Purpose and Procedure, citations for the extra articles will be captured during an online search and prefaced with the acronym OAN at www.acpjc.org.

Star Ratings

The stars found immediately adjacent to the citation of each abstracted article are averaged scores for clinical relevance and newsworthiness from the McMaster Online Rating of Evidence (MORE) system. This Internet-based system gathers ratings of new articles, already assessed for scientific merit, from sentinel readers, a panel of over 2000 physicians from around the world. Each sentinel reader assigns ratings to new articles for both relevance and newsworthiness on a scale from 1 to 7). These ratings are then averaged for at least 3 raters for each pertinent discipline. For example, an article about diabetes would be sent to raters in primary care and raters in endocrinology; the ratings from at least 3 raters are averaged for each discipline. Ratings that average 6 or higher help to keep your knowledge up-to-date for essential new evidence. The areas in which the articles are rated are shown as follows: General Internal medicine/Family Practice/General Pracyice (GIM/FP/GP), Hospitalists, Emergency Medicine (Emergency Med), Allergy & Immunology (Allerg & Immunol), Cardiology, Dermatology, Endocrinology, Gastroenterology, Genetics, Geriatrics, Hematology/Thrombosis (Hematol/Thrombo), Infectious Disease, Tropical & Travel Medicine (Trop & Travel Med), Critical Care, Nephrology, Neurology, Oncology, Physical Medicine & Rehabilitation (Phys Med & Rehab), Pulmonology, Rheumatology, Occupational/Environmental Health (Occup/Envir Health), Public Health, and Mental Health.

Refurbishing of acpjc.org

Each year the content of the online version of ACP Journal Club (acpjc.org) is updated. Abstracts and their accompanying commentaries are reviewed at 5-year intervals (e.g., content from 1994 and 1999 is updated in 2004). The reviews are done by the editor and associate editors of the journal, the author of the original article, the commentator, and a research associate familiar with study design and biostatistics. Outdated studies are archived, and the remaining reports are updated, if necessary. Updates could include revisions to the title of the abstract, additions to the commentary, addition of a table to the abstract and possibly calculation of more clinically useful statistics (e.g., number needed to treat), and links to other relevant studies in the database.

ACP Journal Club is also included in Evidence-Based Medicine Reviews from Ovid Technologies; telephone 800-950-2035.

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