The fellowship didactics include monthly Journal Clubs. The Journal Clubs are usually at 710hrs on the second and fourth tuesdays of the month. The topics are decided in advance and the articles are usually emailed to the residents and attending faculty members about one week in advance. The topics are from current critical care literature and the articles are archived for future references. The Journal Club is in a short powerpoint format highlighting the essential facts and inferences. All fellows are encouraged to present at Journal Club on a regular basis. Arrangements to attend relevent Journal Clubs with the Pulmonary Critical Care Group, Trauma Surgery, or other sub-speciality departments can be arranged and is encouraged. To maximize the benefit of presenting an article at the SICU journal club, the following points should be considered and accounted for in the presentation. Below is an example of a study that was presented at a SICU journal club some time in the recent past. Name of Article: Kim, DH. INCREASES IN CARDIAC OUTPUT CAN REVERSE FLOW DEFICITS FROM VASOSPASM INDEPENDENT OF BLOOD PRESSURE: A STUDY USING XENON COMPUTED TOMOGRAPHIC MEASUREMENT OF CEREBRAL BLOOD FLOW. Neurosurgery 2003:53:1044
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Grading Considerations
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Comments
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A. Description of evidence
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Concise, clear, accurate
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1 Exposure
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1. Hypervolemia
2. Increase MAP
3. Increase CI
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2 Outcome
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Cerebral blood flow measured in terms of ml/100 gm/min.
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3 Design
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Prospective, observational trial
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4 Study population
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16 patients with non-traumatic SAH on mechanical ventilation
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5 Main result
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Induced hypertension with alpha agonist increases CBP
Increased CO without increase MAP increases CBF
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B. Non-causal explanations
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Each sub-topic is addressed
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6 Information/misclassification bias
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All patients had cerebral vasospasm by arteriography after TCD screen.
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7 Confounding
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Define confounding
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CO2 levels
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8 Chance
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Significant p values
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CVP without Power
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C. Positive features of causation
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Relevant sub-topics are addressed
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20
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9 Time relationship
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Yes: 30 to 60 minutes
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10 Strength
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Signficant strength of association
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11 Dose-response
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No dose response curve
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12 Consistency
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Other studies (lLevey)
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13 Specificity
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Cause leads to a specific effect
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Summary of internal validity:
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Except for CO2
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D. External validity
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Applicable to Iowa patients
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14 To the eligible population
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Yes
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15 To the source population
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Yes, but temporal consistency unknown
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16 To other populations
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Unknown
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E. Other evidence
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10
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17 Consistency
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Yes
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19 Plausibility
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This study is biologically plausible.
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What happens over time?
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20 Coherence
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Yes
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Conclusion about the study:
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This is an important addition to the medical literature.
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Clinical outcomes
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Writing:
Clarity of purpose (rich use of examples, quotes and explanations)
Organization and structure (topic sentences, relation to appraisal outline topics clear)
Writing conventions (word usage, grammar, sentence structure, precision of language)
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- Use the Lecture Handout as a guide
Excellent reference: Rothman, KJ & Greenland, S. Modern Epidemiology, 2nd edition. 1998. Chapter 2: Causation…. |