Geriatrics

Journal Club

Journal club takes place monthly at the home of a faculty member in geriatric medicine or psychiatry, and is designed to provide a fun, informal way both to keep up on the literature in our field and to learn strategies for critical appraisal of research papers. We typically review two papers in an evening, after everyone has had a chance to sample some snacks and drinks. It is not expected that participants have read the papers in advance. Clinicians and scholars at any stage (students, residents, fellows, post-docs, faculty) are welcome to come and join the discussion.

If you are going to lead the discussion of a paper, we’d ask that you abstract the article’s design and findings using the format below. This makes for more stimulating discussion (relative to wading paragraph-by-paragraph through the original article), and often makes the strengths and weaknesses of the research design more apparent.

Please email Pat Schott at pschott@unmc.edu if you would like to be sent our journal club schedule.

How to prepare for Journal Club? Instructions in ppt format 

A Recommended Journal Club Format
(From Dr. Deb Grady, UCSF)

Printable version. (pdf format)

  1. Background, Context, & Motivation
  2. Research Question
  3. Design(E.g., prospective, double-blind, randomized, parallel, captopril-controlled clinical trial)
  4. Subjects
    1. Inclusion criteria
    2. Exclusion criteria
    3. Sampling (number of centers, etc.)
  5. Measurements
    1. Predictor variables
    2. Outcomes (including primary, secondary, others)
  6. Follow-up
      How often and how long
  7. Analysis
      (e.g., survival analysis with log rank test;  intent-to-treat)
  8. Findings
      Tables, graphs
      Highlight key results

The following guidelines are from the JAMA series on Users' Guides to the Medical Literature.  References:
Oxman AD et al.  Users' guides to the medical literature:  I:  How to get started.  JAMA 1993;270(17):2093-2095.

Guyatt GH et al.  Users' guides to the medical literature:  II:  How to use an article about therapy or prevention.  A:  Are the results of the study valid?  JAMA 1993;270(21):2598-2601.

Guyatt GH et al.  Users' guides to the medical literature:  II:  How to use an article about therapy or prevention.  B:  What were the results and will they help me in caring for my patients?  JAMA 1994;271(1):59-63.

Jaeschke R et al.  Users' guides to the medical literature:  III:  How to use an article about a diagnostic test:  A:  Are the results of the test valid?  JAMA 1994;271(5):389-391.

Jaeschke R et al.  Users' guides to the medical literature:  III:  How to use an article about a diagnostic test:  B:  What are the results and will they help me in caring for my patients?  JAMA 1994;271(9):703-707.

Levine M et al.  Users' guides to the medical literature:  IV:  How to use an article about harm.  JAMA 1994;271(20):1615-1619.

Laupacis A et al.  Users' guides to the medical literature:  V:  How to use an article about prognosis.  JAMA 1994;272(3):234-237.

Readers' Guides for an Article About Therapy

  • Are the results of the study valid?
    • Was the assignment of patients to treatments randomized?
    • Were all pts who entered the trial properly accounted for and attributed at its conclusion?  Was follow-up complete?  Were pts analyzed in the groups to which they were randomized?
    • Were patients, health workers, and study personnel blind to treatment?
    • Were the groups similar at the start of the trial?
    • Aside from the experimental intervention, were the groups treated equally?
  • What were the results?
    • How large was the treatment effect?
    • How precise was the estimate of the treatment effect?
  • Will the results help me in caring for my patients?
    • Can the results be applied to my patient care?
    • Were all clinically important outcomes considered?
    • Are the likely treatment benefits worth the potential harms and costs?

Evaluating and Applying the Results of Studies of Diagnostic Tests

  • Are the results of the study valid?
    • Was there an independent, blind comparison with a reference standard?
    • Did the patient sample include an appropriate spectrum of patients to whom the diagnostic test will be applied in clinical practice?
    • Did the results of the test being evaluated influence the decision to perform the reference standard?
    • Were the methods for performing the test described in sufficient detail to permit replication?
  • What were the results?
    • Are likelihood ratios for the test presented or data necessary for their calculation provided?
  • Will the results help me in caring for my patients?
    • Will the reproducibility of the test result and its interpretation be satisfactory in my setting?
    • Are the results applicable to my patient?
    • Will the results change my management?
    • Will patients be better off as a result of the test?

Users' Guides to an Article About Harm

  • Are the results of the study valid?
    • Were there clearly identified comparison groups that were similar with respect to important determinants of outcome, other than the one of interest?
    • Were the outcomes and exposures measured in the same way in the groups being compared?
    • Was follow-up sufficiently long and complete?
    • Is the temporal relationship correct?
    • Is there a dose-response gradient?
  • What are the results?
    • How strong is the association between exposure and outcome?
    • How precise is the estimate of risk?
  • Will the results help me in caring for my patients?
    • Are the results applicable to my practice?
    • What is the magnitude of the risk?
    • Should I attempt to stop the exposure?

Users' Guides to an Article About Prognosis

  • Are the results of the study valid?
    • Was there a representative and well-defined sample of patients at a similar point in the course of the disease?
    • Was follow-up sufficiently long and complete?
    • Were objective and unbiased outcome criteria used?
    • Was there adjustment for important prognostic factors?
  • What are the results?
    • How large is the likelihood of the outcome event(s) in a specified period of time?
    • How precise are the estimates of the likelihood?
  • Will the results help me in caring for my patients?
    • Were the study patients similar to my own?
    • Will the results lead directly to selecting or avoiding therapy?
    • Are the results useful for reassuring or counseling patients?

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