Worksheets

What is the CLINICAL QUESTION addressed in the study? P-I-C-O

• Patients/Population (P)

• Intervention (I)

• Comparison (C)

• Outcome (O)

What was the DESIGN of the study?

Comment on each VALIDITY item for this study:

• Primary Items:

  • Randomization

  • Blinding/Masking (intervention and outcome)

  • Allocation Concealment

  • Withdrawals/Followup

• Additional Validity Items:

  • Sample size/Power

  • Equal treatment of groups aside from intervention

  • Intention to Treat analysis

  • Comparability of groups and statistical adjustment

  • Funding for study

Comment on the RESULTS of the study (both statistical and clinical significance):

• Descriptive Statistics (consider comparability of groups, total sample size randomized and analyzed)

• Results for the Primary Outcome

• Important Results for any Secondary Outcomes

• Magnitude of results (number needed to treat, effect size, etc.)

• Harms/Adverse Effects (with number needed to harm if possible)

Comment on the GENERALIZABILITY, EXTERNAL VALIDITY or APPLICABILITY of the study:

• What patient oriented outcomes were reported?

• Similarity of study subjects to local or target population?

• Cost and feasibility issues

• Balance between benefits and harms

Comment on the usefulness of the Figures and Tables in explaining the results

What is the BOTTOM LINE? How can we use this study in practice?

What is the CLINICAL QUESTION addressed in the study? P-I-C-O

• Patients/Population (P)

• Intervention (I)

• Comparison (C)

• Outcome (O)

What was the DESIGN of the study?

Comment on each VALIDITY item for this study:

• Primary Items:

  • Comprehensive search for evidence

  • Inclusion and exclusion criteria (PICO, study design)

  • Validity assessment of included studies

  • Assessment of heterogeneity

• Additional Validity Items:

  • Is combining the results of the included studies reasonable?

  • Funding for review

Comment on the RESULTS of the study (both statistical and clinical significance):

• Table of Included Studies (similarity of studies, major flaws)

• Results for the Primary Outcome

• Important Results for any Secondary Outcomes

• Magnitude of results (number needed to treat, effect size, etc.)

• Harms/Adverse Effects (with number needed to harm if possible)

Comment on the GENERALIZABILITY, EXTERNAL VALIDITY or APPLICABILITY of the study:

• What patient oriented outcomes were reported?

• Similarity of study subjects to local or target population?

• Cost and feasibility issues

• Balance between benefits and harms

Comment on the usefulness of the Figures and Tables in explaining the results

What is the BOTTOM LINE? How can we use this study in practice?

What is the CLINICAL QUESTION addressed in the study? P-I-C-O

• Patients/Population (P)

• Intervention (I) [for these studies, this is the new test of interest]

• Comparison (C) [for these studies, this is the reference standard test for the condition]

• Outcome (O) [for these studies, the outcome is the diagnosis of the disease you're interested in]

What was the DESIGN of the study?

Comment on each VALIDITY item for this study:

• Primary Items:

  • Was there an independent comparison of test and reference standard?

  • Was there a blind comparison of test and reference standard?

  • Did the study include subjects with appropriate spectrum of disease?

• Additional Validity Items:

  • Sampling and enrollment

  • Funding for study

• Comment on the RESULTS of the study (both statistical and clinical significance):

• Descriptive Statistics (consider comparability of groups, total sample size randomized and analyzed)

• Likelihood Ratios - positive and negative (calculated from sensitivity and specificity)

• Harms/Adverse Effects (with number needed to harm if possible)

Comment on the GENERALIZABILITY, EXTERNAL VALIDITY or APPLICABILITY of the study:

• Cost and feasibility of the test

• Can pre-test probability be estimated?

• Can the results of this test change management?

• Is the population studied similar enough to your patients to be useful?

Comment on the usefulness of the Figures and Tables in explaining the results

What is the BOTTOM LINE? How can we use this study in practice?

Use these guidelines to help your prepare your presentation for Journal Club.

Keep your presentation brief – 5-10 minutes and include ALL the following sections:

1. Overview

   • Brief background about the condition

   • The “point” of the article (review the overall diagnosis and management, discuss new therapies, discuss a particular set of patients, etc.)

   • Major conclusions of the review (SORT recommendations go in the next section)

2. SORT Recommendations

   • Discuss the specific recommendations

   • Briefly discuss the strength of evidence behind each recommendation (e.g. why was the recommendation graded “C”?)

3. Describe one thing you will START doing as a result of this article

4. Describe one thing you will STOP doing or do differently as a result of this article