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 1849-1920

WHAT ARE THE GOALS? 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.

5 SKILLS FOR PRACTICING EVIDENCE-BASED MEDICINE Asking questions Searching for evidence Critical appraisal Integration into decisions Self-evaluation

Part of becoming competent in “Practice-Based Learning and Improvement”

INTEGRATION OF EBM SKILLS INTO JOURNAL CLUB Four parts to every journal club:

Selection of an answerable clinical questionPresentation of abstracts and selection of

full article to reviewPresentation and discussion of full articleCAT based on article discussed distributed

for peer review

* See schedule: www.etsu.edu\com\epic

FOREGROUND VS. BACKGROUND QUESTIONS

ANSWERABLE CLINICAL QUESTIONS Background 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

CLINICAL QUESTIONS THAT ARISE Clinical findings/manifestations Etiology Differential diagnosis Diagnostic tests Prognosis Therapy Prevention Experience and meaning Improvement

SKILL 1: ASKING ANSWERABLE CLINICAL QUESTIONS

Your Turn: Think about patients you saw yesterday

or during your last call. What questions did you have?

WHO/WHAT CAN HELP WITH THIS PROCESS? Nakia, ETSU Medical Librarian (439-

6246) can assist with literature searches.

Dr. Schetzina can assist with interpreting data, critically appraising article, and developing an outline for your presentation (schetzin@etsu.edu).

Resources are posted on EPIC at www.etsu.edu (www.etsu.edu\com\epic )

Integration with hospital rounds In August Nakia will present with Dr.

Wallace on evidence searches/resources

ABSTRACTS PRESENTATION Show and discuss 3-5 abstracts that you

think may answer your clinical question, focusing on the methods used in the study.Research question/hypothesisPopulation / setting / sample sizeDesignPotential conflict of interest

Select (generally by majority consensus) what article to review in-depth.

QUALITY OF EVIDENCE

ARTICLE PRESENTATION Review your clinical question Summarize your evidence search Summarize the study Discuss:

Are the results valid?Are they important?Are they relevant to our patient(s)?

Download/use worksheets from the EPIC site to guide your critical appraisal: http://www.etsu.edu/com/epic/evidencebased.aspx

CLINICAL BOTTOM LINE How does the evidence inform your

clinical practice? Do you plan to change anything that

you do based on this review?

CAT: CRITICALLY-APPRAISED TOPIC CAT distributed and feedback discussed

following the article presentation Finalized CATs published to EPIC website

archive; you may cite on your CV www.etsu.edu\com\epic 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:

http://www.etsu.edu/com/epic/PediatricCATs.aspx Updated April 8, 2009. Accessed February 4, 2011.

CALENDAR ON EPICJuly:

1. Aboaziza2. Presley/Jafri3. Jaynes/Kearns

August: Librarians only

Sept:

1. Presley/Jafri2. Jaynes/Kearns3. Hudson/Burns

Oct:

1. Jaynes/Kearns2. Hudson/Burns3. Bidot/Agarwal

Nov:

1. Hudson/Burns2. Bidot/Agarwal3. Aboaziza/Farmer

Dec:

1. Bidot/Agarwal2. Aboaziza/Farmer3. Lauhan/Herrmann

1=Discuss article2=Present abstracts3=Assigned a question

ANY QUESTIONS?