1 Introduction to Journal ClubKaren E. Schetzina, MD, MPH "It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it." Sir William Osler
2 WHAT ARE the GOALS? Learning evidence-based medicine (EBM) skills.Learning about the best evidence to inform clinical decisions. Learning about important new evidence that should change practice.
3 5 Skills for Practicing Evidence-Based MedicineAsking questions Searching for evidence Critical appraisal Integration into decisions Self-evaluation Part of becoming competent in “Practice-Based Learning and Improvement”
4 Integration of EBM Skills into Journal ClubFour parts to every journal club: Selection of an answerable clinical question Presentation of abstracts and selection of full article to review Presentation and discussion of full article CAT based on article discussed distributed for peer review * See schedule:
5 Foreground VS. Background QuestionsFigure 1.1 Knowledge needs depend on experience with condition.
6 Answerable Clinical QuestionsBackground questions Ask for general knowledge about a condition or thing Example: How E. coli 0157:H7 trigger hemolytic uremic syndrome? Foreground questions Asks for specific knowledge to inform clinical decisions or actions Have four essential components: Patient and/or problem Intervention or exposure Comparison, if relevant Clinical outcomes
7 Clinical Questions that ariseClinical findings/manifestations Etiology Differential diagnosis Diagnostic tests Prognosis Therapy Prevention Experience and meaning Improvement
8 Quality of Evidence
9 Skill 1: Asking Answerable Clinical QuestionsYour Turn: Think about patients you saw yesterday or during your last call. What questions did you have?
10 Skill 2: Abstracts PresentationShow and discuss 3-5 abstracts that you think may answer your clinical question, focusing on the methods used in the study. Research question/hypothesis Population / setting / sample size Design Potential conflict of interest Select (generally by majority consensus) what article to review in-depth.
11 Who/What Can Help with this Process?Nakia, ETSU Medical Librarian ( ) can assist with literature searches. You must meet with Dr. Kiana Johnson 2 weeks before your full article presentation: Office hours: Mondays from 9am until 2pm, Tuesdays/Friday from 8:15am to 2pm Dr. Schetzina can also assist you Resources are posted In August Nakia will present with Dr. Wallace on evidence searches/resources
12 Skill 3: Full Article Presentation and DiscussionReview your clinical question Summarize your evidence search Summarize the study Discuss (with audience participation): Are the results valid? Are they important? Are they relevant to our patient(s)? Download/use worksheets to guide your critical appraisal:
13 Clinical Bottom Line How does the evidence inform your clinical practice? Do you plan to change anything that you do based on this review?
14 CAT: Critically-Appraised TopicCAT must be distributed so feedback may be provided during your article presentation Finalized CATs published to our website archive; you may cite on your CV Citation example: Schetzina, KE. Critically Appraised Topic: Use of Basal- Bolus Insulin Therapy at Time of Diagnosis of Type 1 Diabetes Mellitus in Pediatric Patients Provides Improved Glycemic Control Compared to Traditional NPH Regimens. ETSU Pediatric CATs. Available at: Updated April 8, Accessed February 4, 2011.
15 Calendar 1=Discuss article 2=Present abstracts 3=Assigned a question August: Evidence Searches (QCOM Librarians, Dr. Richard Wallace & Nakia Woodward) 2. Kalra 3. Reddy/Albracht Sept: 1. Kalra 2. Reddy/Albracht 3. Armentrout/ Payne Julie/Caitlin can assist by ing out your article to the department and printing and bringing copies of your article and CAT to journal club
16 Any QUESTIONS?