David O. Warner, M.D.

or many attendees, one of the highlights of the ASA Annual Meeting is the opportunity to learn about the latest research in our specialty. There are literally thousands of abstract presentations available for your enjoyment and edification, abstracts that have undergone peer review by experts in the area. Given the diversity of topics, you can almost certainly find presentations that are of interest and relevance. On the other hand, such an embarrassment of riches can seem overwhelming. The adoption of the “track” system at the Annual Meeting, which aims to organize thematically similar materials such as refresher courses, workshops and scientific presentations, among others, should help attendees to find events that are in their area of interest. Even so there may be dozens of posters and presentations to digest within a relatively short period of time. How can you best use the limited time available to evaluate the clinical research that can make a difference in your practice?

First, take advantage of the electronic searching tools now available for the abstracts. If you have a very specific topic in mind, these tools can help you find the most relevant abstracts. These tools also can generate extensive lists of more broadly defined topics. For the technology-challenged, the printed program contains the titles of each abstract with a short summary describing each one, and simply spending a few minutes perusing this material is a good way of using a few spare minutes in the airport as you travel to the meeting. A little preparation saves time and keeps one from wandering around the meeting later. Having said this, wandering around the poster session floor is not a bad way to spend an afternoon. Hidden gems can often be found, and the poster sessions also provide a good overview of the current “hot topics” in clinical investigation.

Once you have found a poster describing a clinical research study of potential interest, first read two sections: the purpose (or hypothesis) and the conclusions. Is the purpose clearly stated? Are the conclusions interesting to you? If not, move on; it is unlikely that a further investment of time will be useful. If so spend some time getting acquainted with the particulars. If the author is available, let him or her guide you through the poster — this can save time and prevent confusion. Authors love to talk about their work, and it is a good opportunity to form relationships with others who have similar interests.

The standard guideline to evaluating clinical trials, the CONSORT statement,¹ contains more than 20 criteria, and you certainly cannot scrutinize each abstract to this extent. There are, however, a few tips that you may find helpful in this setting.

• Pay particular attention to the number of patients studied. Often abstracts will present preliminary results, or a subset of a larger study, and studies may not be sufficiently powered to make definitive conclusions. This is not to say that smaller studies are not of value, but do not change your practice based on experience with 20 patients.

• A certain amount of statistical hand-waving is socially acceptable in a preliminary abstract, but the statistical conclusions should at least be believable based on the inspection of the data; and if the only way statistical significance is apparent is by appeal to an esoteric statistical test with a name that you have never heard of (and cannot pronounce) — beware.

• For studies of new drugs or devices, you also should always check the sources of funding and the stated conflicts of interest (stock ownership, etc.) of the authors. If the results of the study have the potential to further the financial interests of the sponsor or the authors, it does not necessarily invalidate the results. Indeed all authors have an interest in publishing interesting results, regardless of who funds the study. It would be naïve, however, to ignore potential conflicts of interest, a fact widely recognized by disclosure policies designed to identify such conflicts. It is particularly important to identify these conflicts because conclusions favorable to industry are more likely both when industry sponsors the study and when authors have financial conflicts of interest.^2,3 Disclosure information is provided in the back of the program book.

Finally, remember that because abstracts are by definition brief, the peer review they undergo is limited, and all results must be regarded as preliminary, not gospel (yet). Thus take every abstract with a healthy grain of salt. Popular anesthesiology magazines and others often trumpet “breakthroughs” based on meeting abstracts, but the results of even the best studies need to be confirmed before changes in practice based on these studies should be implemented. Rather, meeting presentations serve to introduce study results to the public and to begin the process of critique and debate that leads to genuine advances. This process depends, though, upon an active and engaged audience for these presentations.

So when you attend the ASA Annual Meeting, spend some time wandering through the poster area and attending other presentations — you will not only gain information that will help your patients but also help to improve our specialty by providing valuable feedback to our clinical investigators.


References:
1. Moher D, Schulz K, Altman D. The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA. 2001; 285:1987-1991.
2. Friedman LS, Richter ED. Relationship between conflicts of interest and research results. J Gen Intern Med. 2004; 19:51-56.
3. Bekelman JE, Li Y, Gross CP. Scope and impact of financial conflicts of interest in biomedical research: A systematic review. JAMA. 2003; 289:454-465.

David O. Warner, M.D., is Professor of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota.