The December Journal Club was held last week with excellent attendance. The winner of the best presentation prize was Dr. Francisco Vargas who critiqued the CaVent trial. Many thanks to Leo Godlewski of Hanger Orthotics for sponsoring the club’s evening.
The score sheets had a misprint in the scaling factor. The scaling factor is highest for the substance of the critique (x3) and the next highest is the presentation substance (x2). Scoring was corrected for this.
To emphasize the importance of an in-depth understanding of the paper being presented and to keep the journal articles topical, the rules are being modified. First, the selected journal has to come from the past two years. The second modification is that every presentation has to end with a table of related or similar papers and their conclusions or results. These should be a listing of landmark papers or first of its kind papers, and the discussant should be prepared to comment on them. If there are too many papers, the discussant should be prepared to discuss a few landmark papers on the topic or discuss a meta-analysis or Cochrane review article on the topic.
The presented paper should be graded on the following scale:
- Level 1 – High Quality – Randomized controlled trials with high power. Meta-analyses of multiple RCT’s.
- Level 2 – Moderate Quality – Evidence from one well designed experiment. RCT’s with low power. Prospective cohort study.
- Level 3 – Low Quality – Evidence obtained from well-designed, quasi-experimental studies such as non-randomized, controlled, single-group, pre-post, cohort, time, or matched case-control series.
- Level 4 – Very Low Quality – Evidence from well-designed, non-experimental studies such as comparative and correlational descriptive and case studies. Evidence from case reports and clinical examples. Expert opinion.
Also, in the critique, a recommendation should be made and this recommendation also graded with the following scale:
|A||The USPSTF recommends the service. There is high certainty that the net benefit is substantial.||Offer or provide this service.|
|B||The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.||Offer or provide this service.|
|C||The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.||Offer or provide this service for selected patients depending on individual circumstances.|
|D||The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.||Discourage the use of this service.|
|I||The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.||Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.|