1. An activity-based journal club to help staff & students improve confidence at reading scientific papers
Cornwall Health Library:
Katy Oak
Catriona Organ

2. Workshop:
Background
Activity
More ideas

3. Knegt, N.C. et al Behavioral pain indicators in people with intellectual disabilities: a systematic review. Journal of Pain 14 (9) p

4. West, R. Placebo-controlled trial of Cytisine for smoking cessation
West, R. Placebo-controlled trial of Cytisine for smoking cessation. NEJM (13) p

5. Journal Club objectives:
Increase understanding & confidence reading articles
Improve writing assignments
Better analysis of academic articles

6. Journal Club format: Activity Checklist Paper
Breaking complex principles in to more basic elements and then using these to build their knowledge

7. Strongly
Agree
Agree

8. "A journey of a thousand miles begins with a single step“ Lao Tzu
Reading RCT papers
Going to look at an activity for understanding RCT methodology.
Activity starts
Assessment questions:
Rate yourself, stand in line and divide in to groups.

9. Does caffeine increase the heart rate of people attending the HLG Conference in Keele?
Design and run an RCT as best you can. If you can’t practically do something that you think should be included then write this in to your presentation.

10. Sample Randomisation placebo caffeine Control group Experimental group
Measure heart rate
Measure heart rate
placebo
caffeine
Remember that an RCT is really trying to find out if whatever is being tested in the experimental arm has made a difference to the outcome being measured. We need to try to eliminate anything else that may effect the results.

11. Other micro-teaches

12. From here: Slides for explanation if needed

13. Power Calculation Before trial Sample size
Ability to detect smallest clinically relevant difference
0.8 or 80% probability of finding a difference if it exists
Statistical power is how likely a study is to detect a difference if it truly exists.
Should be 80-90%
So, 10-20% chance of not showing a difference.
Power is used to set the sample size needed before the study begins.

14. West, R. Placebo-controlled trial of Cytisine for smoking cessation
West, R. Placebo-controlled trial of Cytisine for smoking cessation. NEJM (13) p

15. Randomisation
01, 10, 02, 34, 75, 36, 09, 24, 98
O, E, E, E, O, E, O, E, E
Block, stratified
Odd = placebo
Even = experimental

16. CONSORT statement aims to improve reporting of RCTs ITT – preserves randomisation - include all randomised participants in the analysis, all retained in the group to which they were allocated.
Missing data to achieve ITT : imputation = worst-case, similar subject’s data, last obs – but you need to know
Less than 20%
What to look for in a paper:
ITT analysis or Pragmatic approach – most likely to give more conservative results
On-Treatment Analysis or Per-protocol = ignore data from dropouts – can give ‘true effect’ view but can introduce bias.
Flow diagram

17. Randomisation
01, 10, 02, 34, 75, 36, 09, 24, 98
O, E, E, E, O, E, O, E, E
Block, stratified
Odd = placebo
Even = experimental

18. P - values
The probability that the result would have occurred by chance.
The lower the p – value, the less likely that the result is due to chance.
P < statistically significant.
P < = 1 / 100
P < = 1/ 1000

19. Confidence Intervals
We are 95% confident that the true population result lies within the given range

20. Confidence Intervals Difference between MEANS
If the range crosses zero then the result is not significant
Difference between RISK & ODDs
If the range crosses 1 then the result is not significant

21. How good is the methodology?
How far can the results be …...generalised to a wider population?