Pediatrics Journal Club Guide

Goals of Journal Club

• Develop skills in designing studies
• Practice analyzing an abstract in a structured way
• Exposure to landmark papers, historical articles, and new literature
• Participation in discussion!

Expectations for Journal Club

Participants

• Show up!
• Participate in small groups
• Share ideas

Presenters

• Select article
• Prepare 6-7 slides to present
• Research question
• Causal hypothesis
• Findings
• Clinical implications
• Next study

Structure

• Presenters work in pairs
• Each pair of presenters presents 1 paper
• Ideally 2 groups of participants discuss each research question and develop a proposed study design

Causal Hypothesis

• “study purpose” or “causal hypothesis” = the causal relationship that the authors originally intended to study and how they actually studied it

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• Identify key aspects of the study design just by reading the abstract
• Quickly understand the purpose and design of the study
• Read the rest of the article with focus
• Critically assess the results within the context of the study design
• Did the authors adequately study what they intended to?

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Content adapted from CTS601A, Dr. William Jesdale

Vocabulary

Exposure → Outcome, in Context

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• Study design: type of study
• Exposure: independent variable; the “cause” of what you are studying
• Exposure Contrast: reference group; compared to what alternative
• Etiologic Period: when does exposure have an influence on disease, when exposure matters
• Causal Direction: the impact/effect
• Outcome: what you are measuring/studying
• Outcome Contrast: compared to what alternative; “null hypothesis”
• Population Context: In what population(s) is this relationship expected to be causal?; when, where, and in whom

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Components of a Causal Hypothesis

Exposure → Outcome, in Context

Conceptual definition: What is the idea? (intention)

Operational realization: How does a given person get assigned an exposure status? An outcome status? Included in study population? (actual)

• What are the gaps between the conceptual definition and operational definition 🡪 leads to better understanding of the context for interpreting the results of the study
• Can the results and clinical implications be expanded beyond the context of the study?

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Content adapted from CTS601A, Dr. William Jesdale

Types of Study Designs

• Meta-Analysis: combining data from many different research studies
• Systematic Review: A summary of the clinical literature
• Randomized Controlled Trial: A controlled clinical trial that randomly (by chance) assigns participants to two or more groups
• Cohort Study (Prospective Observational Study): A clinical research study in which people who presently have a certain condition or receive a particular treatment are followed over time and compared with another group of people who are not affected by the condition
• Case-control Study: Case-control studies begin with the outcomes and do not follow people over time. Researchers choose people with a particular result (the cases) and interview the groups or check their records to ascertain what different experiences they had
• Cross-sectional study: Observation of a defined population at a single point in time or time interval. Exposure and outcome are determined simultaneously
• Case Reports and Series: A report on a series of patients with an outcome of interest. No control group is involved

Cheat Sheet

Example of Journal Club Presentation

Background and Research Question

Background: Asthma is a common chronic condition among pediatric patients and is a common cause for presentation to the ED. Short-acting beta(2)-agonists are used to treat asthma symptoms. There are multiple modes of delivery for the medication.

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Research Question: Is breath-enhanced nebulizer effective for treating asthma in pediatrics patients?

Cheat Sheet

Abstract

Exposure

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Etiologic Period

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Causal Direction

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Outcome

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Context

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Identify components of the causal hypothesis

Causal Hypothesis

Exposure → Outcome, in Context

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Breath-enhanced delivery of albuterol compared to conventional jet delivery administered during acute asthma exacerbation causes a greater increase in FEV1 among pediatric patients 6-18 years old with a history of moderate to severe asthma while in the Emergency Department

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Results

• Sample = 107 pediatric patients between 6-18 years old
• Improvement in FEV₁ was significantly greater with conventional jet nebulizer (mean ΔFEV₁ +13.8% vs +9.1%, P = .04).
• Spirometry is effort dependent and challenging to obtain accurate measurements
• Is a change in FEV1 of 9.1% vs 13.8% CLINICALLY significant?
• This is an objective outcome, but FEV1 is not used for clinical decision making in the ED
• There were no significant differences in clinical asthma scores, ED length of stay, disposition, or side effects.
• These were outcomes of clinical importance for providers in the ED
• These were secondary outcomes in this study, so they may not have been powered to detect changes, but there was no trend observed either

Clinical Implications

• Children who received conventional jet nebulizer treatments had statistically significantly more change in FEV1 than those who received breath-enhanced nebulizer treatments.
• Despite greater change in FEV1, there were not differences in clinical symptoms or length of stay or disposition.

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• Based on this study, conventional jet nebulizers deliver albuterol “more effectively” than breath-enhanced nebulizers in pediatric patients
• Not worth the investment of buying new machines for the pediatric ED to replace conventional jet nebulizers

Next Steps

• Perform a similar RCT with larger sample size and multiple primary outcomes of clinical importance.

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• Perform a similar RCT with DuoNebs instead of albuterol

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• Perform a similar RCT, but measure outcome at 20 minutes after neb was completed rather than 10 minutes