- Introduction
- Goals and objectives
- The article
- Review the article
- Presentation
- Recent Journal Club articles
Introduction
Each month during their rotation at the RVH site, each CCM fellow will be responsible for presenting an Evidence-Based Medicine Journal Club on a topic related to Critical Care. They will select one published article from the literature to be reviewed using standardized methodology. The purpose is to provide critical appraisals of articles that impact the clinical practice of critical care and are of interest to practicing Intensivists. These sessions are designed to foster the development of skills necessary for the practice ofEvidenced-Based Medicine.
Articles are selected from the broad range of medical literature and are chosen on the basis of their applicability and importance to the practice of critical care, and the interests and experience of the fellows and faculty. As such, this collection is in no way meant to be an exhaustive review of the literature in the fields which impact critical care. Instead, our focus is on careful critique and thoughtful commentary on a limited number of published studies. Each article is critiqued in a standard way using specific guidelines according to the type of article reviewed.
Goals and objectives
- Conduct structured critical appraisal
- Identify whether or not the results of a study are valid
- Interpret the results
- Apply the results to patients
- Understand the limitations of the application of evidence
- Recognize and understand basic study design, distinguishing weak from strong methodology
- Gain familiarity with basic statistical tests
- Gain insight into a specific clinical problem
- Integrate new knowledge into the daily practice of critical care medicine.
- Hone skills related to oral and written presentations
The article
The article must fulfill the following criteria:
1. The results of the study, if valid, must impact clinical practice in some way.
2. The methods of the study must fulfill basic validity criteria:
- Therapy: randomized, all patients accounted for.
- Diagnosis: independent blind comparison with a "gold" standard, patient sample included a reasonable mix of patients with and without disease similar to the population the test will be used on in practice.
- Harm. the comparison group was similar except for the "exposure" of interest, exposure and outcome were measured the same way in both groups.
3. The study contains no other major flaws of methodology
4. The primary article should be recent (last 2 years).
5. The article (or one just like it) should not have been reviewed in the last 2 years.
Review the article
- Critique the article according to the guidelines at Users' Guides to Evidence-Based Practice from the Centres for Health Evidence.
- Use the worksheets provided at Worksheets for Evidence-Based Practice.
Presentation
Your presentation will be done in with overheads. Your presentation should be roughly organized as follows:
- Topic Background (state why this is important) 3 min
Outline a hypothetical (or real) case ( keep it brief) 2 min - Present the paper (its helpful to make overheads of the figures and tables) 10-15 min
Methods
Results - Present the critical appraisal . 10 min
- Sum up. Include your conclusion and how YOU will put these results into practice. 5 min
Aim to finish in 30 minutes or less to save time for discussion. Try not to get too bogged down in one aspect (i.e., was the measurement tool valid?). If this cannot be settled quickly, it's your job to say so and move on.
The above goals, objectives, and formats were adapted from information obtained from the Critical Care Medicine Websites of the University of Pittsburgh and the University of Western Ontario.
Recent Journal Club articles
Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial.
Drakulovic et al; Lancet 1999;354:1851-58.
Reviewed by: Talat Chughtai (Sep. 8, 2000)
A Trial of goal-oriented hemodynamic therapy in critically ill patients.
Gattinoni et al; N Engl J Med 1995;333:1025-32.
Reviewed by: Talat Chughtai (Oct 6, 2000)
Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the ICU (a proposed solution for indiscriminate antibiotictreatment).
Singh et al; Am J Resp Crit Care Med 2000;162:505-511.
Reviewed by: Talat Chughtai (Nov 3, 2000).
Association of noninvasive ventilation with nosocomial infection and survival in critically ill patients.
Girou et al; JAMA 2000;284:2361-2367.
Reviewer: Talat Chughtai ( Dec.1, 2000)