To: All Anesthesiology Faculty, Residents & Crnas

To: All Anesthesiology Faculty, Residents & CRNAs

From: Ranita Donald, MD Director, Departmental Journal Club

Date: August 27, 2013

Subject: Journal Club 2013-2014 Academic Year

Please find attached Journal Club schedule for the AY 2013-2014. Journal Club schedule will run from September 2013 until May 2014. Journal Club will be held once a month on Mondays (with occasional exceptions), at 6:00 AM in the CMC conference room and continental breakfast will be provided. Whenever possible, Journal Club dinner will be arranged and everyone will be notified.

There are two faculty members assigned for each journal club session. Each faculty member will select one journal article, therefore two articles for each session. Faculty members will also be responsible for completion of the CME paper work in timely manner, which will be provided to them several days prior to the conference. During journal club after resident’s presentation of the article, faculty will lead the discussion of the article which they selected. Faculty member is expected to provide guidance to the resident assigned with them regarding the contents and the way article should be presented at the conference. Residents need to learn how to critique and present the journal articles, for which suggestions are attached. Resident, who will be selected as “Best Presenter” of the journal article by journal club attendees, along with best attendance for journal clubs, will be awarded at the end of the year.

Chief resident (Dr. John Blackburn) has made the resident’s schedule for the Journal Club participation. Residents assigned for a particular Journal Club are responsible for initial brief presentation of the articles during conference. Resident should get in touch with the faculty who selected the article, for guidance. If any resident is unable to do the journal club (due to vacation or interview etc.) then she/he should find a replacement or exchange with someone and inform the chief resident or me as soon as possible.

Since conference time is limited, two journal articles in total are sufficient for in-depth discussion of the material. Articles can be selected from any medical journal as long as they are relevant to the field of anesthesiology and its subspecialties. Investigational research articles are preferred but review articles can be used, as long as only one review article will be presented in any one session. Clinical investigational articles are preferred by attendees as compared to laboratory investigations. Faculty assigned should send the article electronically, well in advance (3-4 weeks) to Susan Dawkins or me. There should be enough time for distribution and to review the articles. Attendees should complete the web evaluation on ONE45 system and CME/CE credits will be provided to all the attendees.

Your presence and contribution is important for each session of this educational activity. Every faculty member (not involved with clinical duties during that time) is expected to attend this once a month educational event, to contribute to resident education and to provide an exchange of views. Everyone’s efforts are valuable and very much appreciated.

Thank you. cc: M. R. Castresana, M.D., F.C.C.M., Aubre Keenan, Susan Dawkins

Journal Club Schedule 2013-2014

DATE TOPIC FACULTY RESIDENTS

Ambulatory/ Office Based Sept 16th Chaknis/Patel Ashford/Banks Anesthesia

Oct 21st Pediatric Anesthesia Florentino/Chhatbar Neil/Adeleye

Nov 18th Obstetrical Anesthesia Redd/Dalela Graham/Alvi

Patient Safety, Economics & Dec 16th Johnston/Hua Barry/Crane Ethics in Anesthesiology General Anesthesia Jan 22nd Donald/Cancel Evans/Mills & Periop. Medicine

February Board Review Month Faculty No Journal Club

Chronic & Acute March 17th Heyman/Ranganath Shah/Thomas Pain Management

st April 21 Neuro-Anesthesia Mayfield/Francis Richburg/Karkar

May 19th CT Anesthesia/Critical Care Castresana/Kumar Blackburn/Puri Suggested Checklist for Critical Appraisal of Scientific Articles Ranita Donald, M.D.

Critical appraisal skills are believed to play a key role in evidence-based medicine practice. Learning of critical appraisal skills will result in significant improvement in knowledge and efficiency, as well as increased use of the literature in clinical decision making. Therefore the goals & objectives for our journal club are:

1. To learn evidence-based medicine practice. 2. To develop life-long learning skills 3. To develop skills to critically appraise scientific articles 4. To develop scientific journal presentation skills 5. To improve knowledge & thereby improve clinical practice 6. To provide stimulus for research ideas

Following is the check list for critical appraisal of an article, which also provides guidance or points to remember during presentation and discussion of a scientific article during journal club:

Introduction

Purpose:  What was the purpose of the authors in writing the article or doing the research?  What scientific hypotheses are the authors attempting to address?  Was the study really needed in this field?  Was the background information adequate to understand the objectives of the study?  Was the study reviewed and approved by the Institutional Review Board?

Authors:  Who is the author? What are his or her academic credentials?  Is he/she a well-known expert in this topic of research?  With what organization or institution is the author affiliated?

Sponsorship or Funding Source:  Who sponsored the study?  Is there any possibility of bias or unfounded assumptions?  Is there a financial conflict of interest?

Type of Journal:  Is the article from a scholarly journal or a throw-away journal?  Is this article published in a ‘peer-reviewed’, refereed journal?  What is the quality of the periodical journal in which article is published ( criteria to to apply: peer-reviewed status, citation rates, impact factors, circulation, manuscript acceptance rate, indexing on Medline, the Cochrane or Brandon/Hill library list etc.)? Methodology

Study Design:  How was this research designed? ( Cohort, Case control, Meta analysis, Pilot study, Cross-sectional study or Case series, etc.)?

Subjects:  Is the target population clearly defined?  Was the assignment of the subjects randomized and blinded in this study?  What were the criteria used in the selection process of the subjects?  Are the subjects adequate in number to provide power for this study?  Was there a control group? Were the study group and control group characteristics appropriately matched?  Did investigators obtain informed consent from participating patients?

Method:  Was the study method clear with a chronological description of what was done and how it was done?  Were the methods described in sufficient detail for others to repeat or extend the study?  Were the design and methods used by the authors, were sufficient to address the study hypothesis?  Have the authors indicated why a particular method was used, any potential problems with the methods used and the limitations of their methods?  Does the study method make sense? Would you have used the same approach?  Were the study group and the control group exposed /treated equally (random allocation)?  Were the patients/researcher/data collector blinded about the group assignments?  Was there a follow-up? Was the follow-up long enough and satisfactory?  What are the strengths and weaknesses of the chosen study design?

Data collection:  How were data collected and analyzed?  Were the outcome data measured and analyzed similarly in both groups?  What is the quality of the interpretation of the data?  Have the authors specified the statistical methods used for the study? (such as t-test, Analysis of Variance, Multiple regression, Hypothesis testing, P-value, Linear Regression, Chi-square test, Confidence Interval, Wilcoxon test, Fisher’s exact test or Power analysis, etc.)?  Were the statistical methods used to analyze the data appropriate?

Results

 What did the results show?  Are the results of the study convincing? Researchers can sometimes draw the wrong conclusions from statistical data. Do results really support the hypothesis?  Is there possible reproducibility of the study result in your practice?  Are the results applicable to your patient population/ clinical practice?  Will this study cause you to change/modify your clinical management of patients? Discussion

 What are the potential explanations for the results?  Were the objectives of the study met?  Are there other studies on this topic showing similar/different conclusions?  How do you account for those differences?  Do authors indulge in needless speculations?  Do we require another study to clarify some of the unsolved issues?  What other studies are required to address the original hypothesis?  Do authors discuss the limitations of their study compared to the other studies?

References

 Do authors cite appropriate papers for the comments made?  Do authors cite their own publications needlessly?  Are the references recent so that analysis is up to date?

References:

1. Dexter Franklin. Checklist for Statistical Topics in Anesthesia & Analgesia Reviews. Anesthesia & Analgesia 2011;113:216-219 2. Lee KP, Schotland M, et al. Association of Journal Quality Indicators with Methodological quality of clinical research articles. JAMA 2002;287:2805-2808 3. Barash PG, Cullen BF, Stoelting RK, Clinical Anesthesia, 6th edition 4. Rosner R, Fundamentals of Biostatistics, 6th edition 5. Pua HL, Lerman J, et al. An evaluation of the quality of clinical trials in Anesthesia. Anesthesiology 2001;95:1068-1073 6. Todd MM, editorial: Clinical research manuscripts in Anesthesiology. Anesthesiology 2001;95: 1051-1053 7. Critical Appraisal of Research Evidence 101, Created by Ontario Public Health Libraries Association 2008 8. Meiler SE. Guidelines for a critical review of Scientific Papers: 2006, email-document http://www.ghsu.edu/som/anes/journalclubguidelines.htm 9. Clarke M, Anderson P, et al. Discussion sections in reports of controlled trial published in general Medical Journals. JAMA 2002;287: 2799-2801 10. Centre for Evidence Based Medicine: Web source- www.cebm.net 11. The Cochrane Library: Web source- www.thecochranelibrary.com 12. Jefferson T, Demicheli V, et al. Quality of systematic reviews of economic evaluations in health care. JAMA 2002;287:21, 2809-2812 13. Dwarakanath LS, Khan KS. Modernizing the journal Club. Hosp Med: 2000;61:425-7 14. Fu CHY, Hodge B, et al. Is Journal Club effective for teaching Critical Appraisal Skills? Academic Psychiatry 1999; 23:205-209 15. Norman JR, Shannon SI. Effectiveness of instruction in critical appraisal (Evidence-based medicine) skills. Can Med Assoc J. 1998; 158: 177-181