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Geriatric Research Seminar

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Geriatric Research Seminar

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  1. Geriatric Research Seminar September 1, 2009

  2. Geriatric Research Seminar • Learn to interpret findings presented in the medical literature • Become familiar with common statistical methods used in medical research • Learn about research activities in geriatrics occurring on the UNMC campus • Present preliminary findings of their scholarly activity.

  3. Geriatric Research Seminar • Monthly research presentations first Tuesday of the month.

  4. How to Prepare for Journal Club Brenda K. Keller, MD Adapted from “Suggestions for leading a Journal Club” Tom Newman, UCSF May 2000 And A Recommended Journal Club Format Deb Grady, MD UCSF

  5. Select a Provocative Article • Choose an article you pulled as a result of an encounter with a patient. • Article should report original research • No reviews (they don’t have the methods sections) • Meta-analyses only if you have a compelling reason for presenting • Don’t choose industry sponsored articles.

  6. Prepare Yourself • Read the article critically • Think about the decisions the authors made regarding the design- • what possible problems could result from that decision and how would they affect the results and conclusions • Choose key concepts to emphasize

  7. Outline the content of the ArticleMake one page handout for participants • Authors and funding source • Research question • Study design • Study subjects • Predictor variables • Outcome variables • Results • Conclusions

  8. Authors and funding source • This is analogous to the “identifying information and source of history” on H&P • Who are the authors? Do you know any of their previous work? Has it been reliable? • Who paid for the study? This gives you a head start on knowing what sort of biases to look for.

  9. Background • What is the context and motivation for doing the study?

  10. Research question • What is the question this study was designed to answer? • What clinical situation will I be better able to handle if the study is valid? Often the last line of the abstract gives the authors answer to the research question.

  11. Study design • What type of study is this? • Randomized blinded controlled? • Cohort study? • Case-Control? • Cross-sectional? • Case series? • Each study type has its strengths and weaknesses

  12. Study Types • 1. Observational • 2. Experimental • 3. Meta-analysis

  13. I. Observational studies  • A. Descriptive or case–series   • B. Case–control studies (retrospective)     • 1. Causes and incidence of disease     • 2. Identification of risk factors 

  14. Observational Studies con’t • C. Cross-sectional studies, surveys (prevalence)     • 1. Disease description     • 2. Diagnosis and staging     • 3. Disease processes, mechanisms  • D. Cohort studies (prospective)     • 1. Causes and incidence of disease     • 2. Natural history, prognosis     • 3. Identification of risk factors   • E. Historical cohort studies

  15. II. Experimental Studies • A. Controlled trials     • 1. Parallel or concurrent controls    • a. Randomized     • b. Not randomized     • 2. Sequential controls    • a. Self-controlled   • b. Crossover    • 3. External controls (including historical)   • B. Studies with no controls.

  16. III. Meta-analyses

  17. Study Subjects • Who was in the study? • How were they selected? Sampling process • Who was excluded? • How many subjects were there? • These questions help you to identify if the study is valid (internal validity) and whether the results are generalizable to the sort of patients you are likely to see. (external validity)

  18. Predictor variables • What are the “independent variables”? • ie: The variables the authors think might cause or predict changes in the outcome variable. • May be one or many. • For example if you want to assess the impact of illness burden (predictor variable) on functional decline (outcome variable), you may need to include other factors known to affect functional status such as age, and mental status. • How are the variables measured? • Subjective or objective measurements. • Large or small increments of change.

  19. Outcome variables • What they are: the clinically significant phenomena the investigators are trying to predict, prevent or treat. • Presence or absence of disease • Measures of symptom burden • Survival time • How are they measured? • If it is a disease, what are criteria for dx. • If it determines clinical improvement- are those making that determination blinded to the tx group • Is the change clinically relevant? • How often and how long are they followed?

  20. Results • What did they find? • Generally summarized in tables/graphs • Consider both the statistical significance and the effect size-the magnitude of difference between the groups.

  21. Conclusions • What do the authors think the results mean?

  22. Discussion • What are the possible biases or flaws of the study? • Is the study design appropriate to answer the question? • Estimate the likelihood that each of biases has affected the validity of the study, and what direction would affect results.

  23. Summary • Preparation is the key to meaningful exchange of information at journal club. • Enjoy the search!

  24. Resources • 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 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.

  25. Resources • 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 • Laupacic A et al. Users’ guides to the medical literature: V: How to use an article about prognosis. JAMA 1994:272(3)234-237.