Karen 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

 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.

 Asking questions  Searching for evidence  Critical appraisal  Integration into decisions  Self-evaluation Part of becoming competent in “Practice-Based Learning and Improvement”

 Four parts to every journal club:  Selection of an answerable clinical question  Presentation of abstracts and selection of full article to review  Presentation and discussion of full article  CAT based on article discussed distributed for peer review * See schedule:

 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 findings/manifestations  Etiology  Differential diagnosis  Diagnostic tests  Prognosis  Therapy  Prevention  Experience and meaning  Improvement

Your Turn:  Think about patients you saw yesterday or during your last call.  What questions did you have?

 Nakia, ETSU Medical Librarian ( ) can assist with literature searches.  Dr. Schetzina can assist with interpreting data, critically appraising article, and developing an outline for your presentation  Resources are posted on EPIC at ( )  Integration with hospital rounds  In August Nakia will present with Dr. Wallace on evidence searches/resources

 Show and discuss 3-5 abstracts that you think may answer your clinical question, focusing on the methods used in the study.  Research question/hypothesis  Population / setting / sample size  Design  Potential conflict of interest  Select (generally by majority consensus) what article to review in-depth.

 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:

 How does the evidence inform your clinical practice?  Do you plan to change anything that you do based on this review?

 CAT distributed and feedback discussed following the article presentation  Finalized CATs published to EPIC website archive; you may cite on your CV   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: Updated April 8, Accessed February 4, 2011.

July: 1. Aboaziza 2. Presley/Jafri 3. Jaynes/Kearns August: Librarians only Sept: 1. Presley/Jafri 2. Jaynes/Kearns 3. Hudson/Burns Oct: 1. Jaynes/Kearns 2. Hudson/Burns 3. Bidot/Agarwal Nov: 1. Hudson/Burns 2. Bidot/Agarwal 3. Aboaziza/Farmer Dec: 1. Bidot/Agarwal 2. Aboaziza/Farmer 3. Lauhan/Herrmann 1=Discuss article 2=Present abstracts 3=Assigned a question