Transcript How to Prepare for Journal Club

Geriatric Research Seminar
September 1, 2009
Geriatric Research Seminar




Learn to interpret findings presented in
the medical literature
Become familiar with common statistical
methods used in medical research
Learn about research activities in geriatrics
occurring on the UNMC campus
Present preliminary findings of their
scholarly activity.
Geriatric Research Seminar

Monthly research presentations first
Tuesday of the month.
How to Prepare for Journal
Club
Brenda K. Keller, MD
Adapted from
“Suggestions for leading a Journal Club”
Tom Newman, UCSF May 2000
http://itsa.ucsf.edu/~newman/JOCLUB.htm
And
A Recommended Journal Club Format
Deb Grady, MD UCSF
Select a Provocative Article





Choose an article you pulled as a result of
an encounter with a patient.
Article should report original research
No reviews (they don’t have the methods
sections)
Meta-analyses only if you have a
compelling reason for presenting
Don’t choose industry sponsored articles.
Prepare Yourself


Read the article critically
Think about the decisions the authors
made regarding the design

what possible problems could result from that
decision and how would they affect the
results and conclusions
Choose key concepts to emphasize
Outline the content of the Article
Make one page handout for participants








Authors and funding source
Research question
Study design
Study subjects
Predictor variables
Outcome variables
Results
Conclusions
Authors and funding source



This is analogous to the “identifying
information and source of history” on H&P
Who are the authors? Do you know any of
their previous work? Has it been reliable?
Who paid for the study? This gives you a
head start on knowing what sort of biases
to look for.
Background

What is the context and motivation for
doing the study?
Research question
What is the question this study was
designed to answer?
 What clinical situation will I be better able
to handle if the study is valid?
Often the last line of the abstract gives the
authors answer to the research question.

Study design







What type of study is this?
Randomized blinded controlled?
Cohort study?
Case-Control?
Cross-sectional?
Case series?
Each study type has its strengths and
weaknesses
Study Types



1. Observational
2. Experimental
3. Meta-analysis
I. Observational studies
A. Descriptive or case–series
 B. Case–control studies (retrospective)

 1.
Causes and incidence of disease
 2. Identification of risk factors
Observational Studies con’t



C. Cross-sectional studies, surveys
(prevalence)
 1. Disease description
 2. Diagnosis and staging
 3. Disease processes, mechanisms
D. Cohort studies (prospective)
 1. Causes and incidence of disease
 2. Natural history, prognosis
 3. Identification of risk factors
E. Historical cohort studies
II. Experimental Studies

A. Controlled trials

1. Parallel or concurrent controls
a. Randomized
 b. Not randomized


2. Sequential controls
a. Self-controlled
 b. Crossover



3. External controls (including historical)
B. Studies with no controls.
III. Meta-analyses
Study Subjects





Who was in the study?
How were they selected? Sampling process
Who was excluded?
How many subjects were there?
These questions help you to identify if the study
is valid (internal validity) and whether the results
are generalizable to the sort of patients you are
likely to see. (external validity)
Predictor variables

What are the “independent variables”?


ie: The variables the authors think might cause or
predict changes in the outcome variable.
May be one or many.


For example if you want to assess the impact of illness
burden (predictor variable) on functional decline (outcome
variable), you may need to include other factors known to
affect functional status such as age, and mental status.
How are the variables measured?


Subjective or objective measurements.
Large or small increments of change.
Outcome variables

What they are: the clinically significant
phenomena the investigators are trying to
predict, prevent or treat.




How are they measured?




Presence or absence of disease
Measures of symptom burden
Survival time
If it is a disease, what are criteria for dx.
If it determines clinical improvement- are those
making that determination blinded to the tx group
Is the change clinically relevant?
How often and how long are they followed?
Results



What did they find?
Generally summarized in tables/graphs
Consider both the statistical significance
and the effect size-the magnitude of
difference between the groups.
Conclusions

What do the authors think the results
mean?
Discussion



What are the possible biases or flaws of
the study?
Is the study design appropriate to answer
the question?
Estimate the likelihood that each of biases
has affected the validity of the study, and
what direction would affect results.
Summary


Preparation is the key to meaningful
exchange of information at journal club.
Enjoy the search!
Resources



Oxman AD et al. Users’ guides to the medical literature I.
How to get started. JAMA 1993;270(17):2093-2095
Guyatt GH et al. Users’ guides to the medical literature.
II: How to use an article about therapy or prevention. A.
Are the results valid? JAMA 1993:270(21):2598-2601
Guyatt GH et al. Users’ guides to the medical literature.
II: How to use an article about therapy or prevention. B:
What were the results and will they help me in caring for
my patients? JAMA 1994:271(1):59-63.
Resources




Jaeschke R et al. Users’ guides to the medical literature.
III: How to use an article about a diagnostic test: A. Are
the results of the test valid? JAMA 1994: 271(5):389-391
Jaeschke R et al. Users’ guides to the medical literature.
III: How to use an article about a diagnostic test. B.
What are the results and will they help me in caring for
my patients? JAMA 1994:271(9):703-707
Levine M et al. Users’ Guides to the medical literature:
IV: How to use an article about harm. JAMA 1994:
271(20):1615-1619
Laupacic A et al. Users’ guides to the medical literature:
V: How to use an article about prognosis. JAMA
1994:272(3)234-237.