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Digital Bullet Journal template.

Free PowerPoint template and Google Slides theme.

Free digital bullet journal template..

It comes with a month view and 3 different week views, you can choose the one you like best or even create a week view yourself. It also has a layout for a list of books you want to read (you can color them once you have read them) and a list of movies or series to watch, once you have, you can rate them by coloring the stars.

You will also find some blank pages for you to decorate. I’ve made one as an example (the one titled “These are my PD notes” and I even linked to it on the agenda view).

I’ve used theme colors, so you can change the accents by going to the former master, now called theme. Click on Slide > Edit theme and change the theme colors.

Once you have chosen the week view you like, remember to duplicate it first (right click > duplicate) so you will always have a blank one.

I’ll be updating it monthly (as I do with all the templates that include calendars) so if you don’t want to add more months yourself, you can come back again and “grab” new copies as I update them, and then simply copy and paste the new slides on your bullet journal.

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Journal — a presentation template for google slides, google slides have never looked so good.

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How to Prepare an Outstanding Journal Club Presentation

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Rishi Sawhney; How to Prepare an Outstanding Journal Club Presentation. The Hematologist 2006; 3 (1): No Pagination Specified. doi: https://doi.org/10.1182/hem.V3.1.1308

Download citation file:

• Ris (Zotero)
• Reference Manager

Dr. Sawhney is a member of the ASH Trainee Council and a Fellow at the Medical University of South Carolina.

Journal club presentations provide a forum through which hematology trainees keep abreast of new developments in hematology and engage in informal discussion and interaction. Furthermore, honing presentation skills and mastering the ability to critically appraise the evidence add to our armamentarium as clinicians. Outlined here is a systematic approach to preparing a journal club presentation, with emphasis on key elements of the talk and references for electronic resources. Use of these tools and techniques will contribute to the success of your presentation.

I. ARTICLE SELECTION:

The foundation of an outstanding journal club presentation rests on the choice of an interesting and well-written paper for discussion. Several resources are available to help you select important and timely research, including the American College of Physicians (ACP) Journal Club and the Diffusion section of The Hematologist . McMaster University has created the McMaster Online Rating of Evidence (MORE) system to identify the highest-quality published research. In fact, the ACP Journal Club uses the MORE system to select their articles 1 . Specific inclusion criteria have been delineated in order to distinguish papers with the highest scientific merit 2 . Articles that have passed this screening are then rated by clinicians on their clinical relevance and newsworthiness, using a graded scale 3 . With the help of your mentors and colleagues, you can use these criteria and the rating scale as informal guidelines to ensure that your chosen article merits presentation.

II. ARTICLE PRESENTATION:

Study Background: This section provides your audience with the necessary information and context for a thoughtful and critical evaluation of the article's significance. The goals are 1) to describe the rationale for and clinical relevance of the study question, and 2) to highlight the preclinical and clinical research that led to the current trial. Review the papers referenced in the study's "Background" section as well as previous work by the study's authors. It also may be helpful to discuss data supporting the current standard of care against which the study intervention is being measured.

Study Methodology and Results: Clearly describe the study population, including inclusion/exclusion criteria. A diagrammatic schema is easy to construct using PowerPoint software and will help to clearly illustrate treatment arms in complex trials. Explain the statistical methods, obtaining assistance from a statistician if needed. Take this opportunity to verbally and graphically highlight key results from the study, with plans to expand on their significance later in your presentation.

Author's Discussion: Present the authors' conclusions and their perspective on the study results, including explanations of inconsistent or unexpected results. Consider whether the conclusions drawn are supported by the data presented.

III. ARTICLE CRITIQUE:

This component of your presentation will define the success of your journal club. A useful and widely accepted approach to this analysis has been published in JAMA's series "User's guide to the medical literature." The Centre for Health Evidence in Canada has made the complete full-text set of these user's guides available online 4 . This site offers review guidelines for a menu of article types, and it is an excellent, comprehensive resource to focus your study critique. A practical, user-friendly approach to literature evaluation that includes a worksheet is also available on the ASH Web site for your use 5 .

While a comprehensive discussion of scientific literature appraisal is beyond the scope of this discussion, several helpful tips warrant mention here. In assessing the validity of the study, it is important to assess for potential sources of bias, including the funding sources and authors' affiliations. It is also helpful to look for accompanying editorial commentary, which can provide a unique perspective on the article and highlight controversial issues. You should plan to discuss the trade-offs between potential benefits of the study intervention versus potential risks and the cost. By utilizing the concept of number needed to treat (NNT), one can assess the true impact of the study intervention on clinical practice. Furthermore, by incorporating the incidence rates of clinically significant toxicities with the financial costs into the NNT, you can generate a rather sophisticated analysis of the study's impact on practice.

IV. CONCLUSIONS, IMPLICATIONS, AND FUTURE DIRECTIONS:

Restate the authors' take-home message followed by your own interpretation of the study. Provide a personal perspective, detailing why you find this paper interesting or important. Then, look forward and use this opportunity to "think outside the box." Do you envision these study results changing the landscape of clinical practice or redirecting research in this field? If so, how? In articles about therapy, future directions may include moving the therapy up to first-line setting, assessing the drug in combination regimens or other disease states, or developing same-class novel compounds in the pipeline. Searching for related clinical trials on the NIH Web site 6  can prove helpful, as can consultation with an expert in this field.

Good journal club discussions are integral to the educational experience of hematology trainees. Following the above approach, while utilizing the resources available, will lay the groundwork for an outstanding presentation.

WEB BASED REFERENCES

www.acpjc.org

hiru.mcmaster.ca/more/InclusionCriteria.htm

hiru.mcmaster.ca/more/RatingFormSample.htm

www.cche.net/main.asp

www.hematology.org/Trainees

www.cancer.gov/clinicaltrials

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Open Access

Ten simple rules for effective presentation slides

* E-mail: [email protected]

Affiliation Biomedical Engineering and the Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, United States of America

• Kristen M. Naegle

Published: December 2, 2021

• https://doi.org/10.1371/journal.pcbi.1009554
• Reader Comments

Citation: Naegle KM (2021) Ten simple rules for effective presentation slides. PLoS Comput Biol 17(12): e1009554. https://doi.org/10.1371/journal.pcbi.1009554

Copyright: © 2021 Kristen M. Naegle. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The author received no specific funding for this work.

Competing interests: The author has declared no competing interests exist.

Introduction

The “presentation slide” is the building block of all academic presentations, whether they are journal clubs, thesis committee meetings, short conference talks, or hour-long seminars. A slide is a single page projected on a screen, usually built on the premise of a title, body, and figures or tables and includes both what is shown and what is spoken about that slide. Multiple slides are strung together to tell the larger story of the presentation. While there have been excellent 10 simple rules on giving entire presentations [ 1 , 2 ], there was an absence in the fine details of how to design a slide for optimal effect—such as the design elements that allow slides to convey meaningful information, to keep the audience engaged and informed, and to deliver the information intended and in the time frame allowed. As all research presentations seek to teach, effective slide design borrows from the same principles as effective teaching, including the consideration of cognitive processing your audience is relying on to organize, process, and retain information. This is written for anyone who needs to prepare slides from any length scale and for most purposes of conveying research to broad audiences. The rules are broken into 3 primary areas. Rules 1 to 5 are about optimizing the scope of each slide. Rules 6 to 8 are about principles around designing elements of the slide. Rules 9 to 10 are about preparing for your presentation, with the slides as the central focus of that preparation.

Rule 1: Include only one idea per slide

Each slide should have one central objective to deliver—the main idea or question [ 3 – 5 ]. Often, this means breaking complex ideas down into manageable pieces (see Fig 1 , where “background” information has been split into 2 key concepts). In another example, if you are presenting a complex computational approach in a large flow diagram, introduce it in smaller units, building it up until you finish with the entire diagram. The progressive buildup of complex information means that audiences are prepared to understand the whole picture, once you have dedicated time to each of the parts. You can accomplish the buildup of components in several ways—for example, using presentation software to cover/uncover information. Personally, I choose to create separate slides for each piece of information content I introduce—where the final slide has the entire diagram, and I use cropping or a cover on duplicated slides that come before to hide what I’m not yet ready to include. I use this method in order to ensure that each slide in my deck truly presents one specific idea (the new content) and the amount of the new information on that slide can be described in 1 minute (Rule 2), but it comes with the trade-off—a change to the format of one of the slides in the series often means changes to all slides.

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

Top left: A background slide that describes the background material on a project from my lab. The slide was created using a PowerPoint Design Template, which had to be modified to increase default text sizes for this figure (i.e., the default text sizes are even worse than shown here). Bottom row: The 2 new slides that break up the content into 2 explicit ideas about the background, using a central graphic. In the first slide, the graphic is an explicit example of the SH2 domain of PI3-kinase interacting with a phosphorylation site (Y754) on the PDGFR to describe the important details of what an SH2 domain and phosphotyrosine ligand are and how they interact. I use that same graphic in the second slide to generalize all binding events and include redundant text to drive home the central message (a lot of possible interactions might occur in the human proteome, more than we can currently measure). Top right highlights which rules were used to move from the original slide to the new slide. Specific changes as highlighted by Rule 7 include increasing contrast by changing the background color, increasing font size, changing to sans serif fonts, and removing all capital text and underlining (using bold to draw attention). PDGFR, platelet-derived growth factor receptor.

https://doi.org/10.1371/journal.pcbi.1009554.g001

Rule 2: Spend only 1 minute per slide

When you present your slide in the talk, it should take 1 minute or less to discuss. This rule is really helpful for planning purposes—a 20-minute presentation should have somewhere around 20 slides. Also, frequently giving your audience new information to feast on helps keep them engaged. During practice, if you find yourself spending more than a minute on a slide, there’s too much for that one slide—it’s time to break up the content into multiple slides or even remove information that is not wholly central to the story you are trying to tell. Reduce, reduce, reduce, until you get to a single message, clearly described, which takes less than 1 minute to present.

Rule 3: Make use of your heading

When each slide conveys only one message, use the heading of that slide to write exactly the message you are trying to deliver. Instead of titling the slide “Results,” try “CTNND1 is central to metastasis” or “False-positive rates are highly sample specific.” Use this landmark signpost to ensure that all the content on that slide is related exactly to the heading and only the heading. Think of the slide heading as the introductory or concluding sentence of a paragraph and the slide content the rest of the paragraph that supports the main point of the paragraph. An audience member should be able to follow along with you in the “paragraph” and come to the same conclusion sentence as your header at the end of the slide.

Rule 4: Include only essential points

While you are speaking, audience members’ eyes and minds will be wandering over your slide. If you have a comment, detail, or figure on a slide, have a plan to explicitly identify and talk about it. If you don’t think it’s important enough to spend time on, then don’t have it on your slide. This is especially important when faculty are present. I often tell students that thesis committee members are like cats: If you put a shiny bauble in front of them, they’ll go after it. Be sure to only put the shiny baubles on slides that you want them to focus on. Putting together a thesis meeting for only faculty is really an exercise in herding cats (if you have cats, you know this is no easy feat). Clear and concise slide design will go a long way in helping you corral those easily distracted faculty members.

Rule 5: Give credit, where credit is due

An exception to Rule 4 is to include proper citations or references to work on your slide. When adding citations, names of other researchers, or other types of credit, use a consistent style and method for adding this information to your slides. Your audience will then be able to easily partition this information from the other content. A common mistake people make is to think “I’ll add that reference later,” but I highly recommend you put the proper reference on the slide at the time you make it, before you forget where it came from. Finally, in certain kinds of presentations, credits can make it clear who did the work. For the faculty members heading labs, it is an effective way to connect your audience with the personnel in the lab who did the work, which is a great career booster for that person. For graduate students, it is an effective way to delineate your contribution to the work, especially in meetings where the goal is to establish your credentials for meeting the rigors of a PhD checkpoint.

Rule 6: Use graphics effectively

As a rule, you should almost never have slides that only contain text. Build your slides around good visualizations. It is a visual presentation after all, and as they say, a picture is worth a thousand words. However, on the flip side, don’t muddy the point of the slide by putting too many complex graphics on a single slide. A multipanel figure that you might include in a manuscript should often be broken into 1 panel per slide (see Rule 1 ). One way to ensure that you use the graphics effectively is to make a point to introduce the figure and its elements to the audience verbally, especially for data figures. For example, you might say the following: “This graph here shows the measured false-positive rate for an experiment and each point is a replicate of the experiment, the graph demonstrates …” If you have put too much on one slide to present in 1 minute (see Rule 2 ), then the complexity or number of the visualizations is too much for just one slide.

Rule 7: Design to avoid cognitive overload

The type of slide elements, the number of them, and how you present them all impact the ability for the audience to intake, organize, and remember the content. For example, a frequent mistake in slide design is to include full sentences, but reading and verbal processing use the same cognitive channels—therefore, an audience member can either read the slide, listen to you, or do some part of both (each poorly), as a result of cognitive overload [ 4 ]. The visual channel is separate, allowing images/videos to be processed with auditory information without cognitive overload [ 6 ] (Rule 6). As presentations are an exercise in listening, and not reading, do what you can to optimize the ability of the audience to listen. Use words sparingly as “guide posts” to you and the audience about major points of the slide. In fact, you can add short text fragments, redundant with the verbal component of the presentation, which has been shown to improve retention [ 7 ] (see Fig 1 for an example of redundant text that avoids cognitive overload). Be careful in the selection of a slide template to minimize accidentally adding elements that the audience must process, but are unimportant. David JP Phillips argues (and effectively demonstrates in his TEDx talk [ 5 ]) that the human brain can easily interpret 6 elements and more than that requires a 500% increase in human cognition load—so keep the total number of elements on the slide to 6 or less. Finally, in addition to the use of short text, white space, and the effective use of graphics/images, you can improve ease of cognitive processing further by considering color choices and font type and size. Here are a few suggestions for improving the experience for your audience, highlighting the importance of these elements for some specific groups:

• Use high contrast colors and simple backgrounds with low to no color—for persons with dyslexia or visual impairment.
• Use sans serif fonts and large font sizes (including figure legends), avoid italics, underlining (use bold font instead for emphasis), and all capital letters—for persons with dyslexia or visual impairment [ 8 ].
• Use color combinations and palettes that can be understood by those with different forms of color blindness [ 9 ]. There are excellent tools available to identify colors to use and ways to simulate your presentation or figures as they might be seen by a person with color blindness (easily found by a web search).
• In this increasing world of virtual presentation tools, consider practicing your talk with a closed captioning system capture your words. Use this to identify how to improve your speaking pace, volume, and annunciation to improve understanding by all members of your audience, but especially those with a hearing impairment.

Rule 8: Design the slide so that a distracted person gets the main takeaway

It is very difficult to stay focused on a presentation, especially if it is long or if it is part of a longer series of talks at a conference. Audience members may get distracted by an important email, or they may start dreaming of lunch. So, it’s important to look at your slide and ask “If they heard nothing I said, will they understand the key concept of this slide?” The other rules are set up to help with this, including clarity of the single point of the slide (Rule 1), titling it with a major conclusion (Rule 3), and the use of figures (Rule 6) and short text redundant to your verbal description (Rule 7). However, with each slide, step back and ask whether its main conclusion is conveyed, even if someone didn’t hear your accompanying dialog. Importantly, ask if the information on the slide is at the right level of abstraction. For example, do you have too many details about the experiment, which hides the conclusion of the experiment (i.e., breaking Rule 1)? If you are worried about not having enough details, keep a slide at the end of your slide deck (after your conclusions and acknowledgments) with the more detailed information that you can refer to during a question and answer period.

Rule 9: Iteratively improve slide design through practice

Well-designed slides that follow the first 8 rules are intended to help you deliver the message you intend and in the amount of time you intend to deliver it in. The best way to ensure that you nailed slide design for your presentation is to practice, typically a lot. The most important aspects of practicing a new presentation, with an eye toward slide design, are the following 2 key points: (1) practice to ensure that you hit, each time through, the most important points (for example, the text guide posts you left yourself and the title of the slide); and (2) practice to ensure that as you conclude the end of one slide, it leads directly to the next slide. Slide transitions, what you say as you end one slide and begin the next, are important to keeping the flow of the “story.” Practice is when I discover that the order of my presentation is poor or that I left myself too few guideposts to remember what was coming next. Additionally, during practice, the most frequent things I have to improve relate to Rule 2 (the slide takes too long to present, usually because I broke Rule 1, and I’m delivering too much information for one slide), Rule 4 (I have a nonessential detail on the slide), and Rule 5 (I forgot to give a key reference). The very best type of practice is in front of an audience (for example, your lab or peers), where, with fresh perspectives, they can help you identify places for improving slide content, design, and connections across the entirety of your talk.

Rule 10: Design to mitigate the impact of technical disasters

The real presentation almost never goes as we planned in our heads or during our practice. Maybe the speaker before you went over time and now you need to adjust. Maybe the computer the organizer is having you use won’t show your video. Maybe your internet is poor on the day you are giving a virtual presentation at a conference. Technical problems are routinely part of the practice of sharing your work through presentations. Hence, you can design your slides to limit the impact certain kinds of technical disasters create and also prepare alternate approaches. Here are just a few examples of the preparation you can do that will take you a long way toward avoiding a complete fiasco:

• Save your presentation as a PDF—if the version of Keynote or PowerPoint on a host computer cause issues, you still have a functional copy that has a higher guarantee of compatibility.
• In using videos, create a backup slide with screen shots of key results. For example, if I have a video of cell migration, I’ll be sure to have a copy of the start and end of the video, in case the video doesn’t play. Even if the video worked, you can pause on this backup slide and take the time to highlight the key results in words if someone could not see or understand the video.
• Avoid animations, such as figures or text that flash/fly-in/etc. Surveys suggest that no one likes movement in presentations [ 3 , 4 ]. There is likely a cognitive underpinning to the almost universal distaste of pointless animations that relates to the idea proposed by Kosslyn and colleagues that animations are salient perceptual units that captures direct attention [ 4 ]. Although perceptual salience can be used to draw attention to and improve retention of specific points, if you use this approach for unnecessary/unimportant things (like animation of your bullet point text, fly-ins of figures, etc.), then you will distract your audience from the important content. Finally, animations cause additional processing burdens for people with visual impairments [ 10 ] and create opportunities for technical disasters if the software on the host system is not compatible with your planned animation.

Conclusions

These rules are just a start in creating more engaging presentations that increase audience retention of your material. However, there are wonderful resources on continuing on the journey of becoming an amazing public speaker, which includes understanding the psychology and neuroscience behind human perception and learning. For example, as highlighted in Rule 7, David JP Phillips has a wonderful TEDx talk on the subject [ 5 ], and “PowerPoint presentation flaws and failures: A psychological analysis,” by Kosslyn and colleagues is deeply detailed about a number of aspects of human cognition and presentation style [ 4 ]. There are many books on the topic, including the popular “Presentation Zen” by Garr Reynolds [ 11 ]. Finally, although briefly touched on here, the visualization of data is an entire topic of its own that is worth perfecting for both written and oral presentations of work, with fantastic resources like Edward Tufte’s “The Visual Display of Quantitative Information” [ 12 ] or the article “Visualization of Biomedical Data” by O’Donoghue and colleagues [ 13 ].

Acknowledgments

I would like to thank the countless presenters, colleagues, students, and mentors from which I have learned a great deal from on effective presentations. Also, a thank you to the wonderful resources published by organizations on how to increase inclusivity. A special thanks to Dr. Jason Papin and Dr. Michael Guertin on early feedback of this editorial.

• View Article
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• 3. Teaching VUC for Making Better PowerPoint Presentations. n.d. Available from: https://cft.vanderbilt.edu/guides-sub-pages/making-better-powerpoint-presentations/#baddeley .
• 8. Creating a dyslexia friendly workplace. Dyslexia friendly style guide. nd. Available from: https://www.bdadyslexia.org.uk/advice/employers/creating-a-dyslexia-friendly-workplace/dyslexia-friendly-style-guide .
• 9. Cravit R. How to Use Color Blind Friendly Palettes to Make Your Charts Accessible. 2019. Available from: https://venngage.com/blog/color-blind-friendly-palette/ .
• 10. Making your conference presentation more accessible to blind and partially sighted people. n.d. Available from: https://vocaleyes.co.uk/services/resources/guidelines-for-making-your-conference-presentation-more-accessible-to-blind-and-partially-sighted-people/ .
• 11. Reynolds G. Presentation Zen: Simple Ideas on Presentation Design and Delivery. 2nd ed. New Riders Pub; 2011.
• 12. Tufte ER. The Visual Display of Quantitative Information. 2nd ed. Graphics Press; 2001.

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Journal Club: How to Prepare Effectively and Smash Your Presentation

Journal club. It’s so much more than orally dictating a paper to your peers.

It’s an opportunity to get a bunch of intelligent people in one place to share ideas. It’s a means to expand the scientific vocabulary of you and the audience. It’s a way to stimulate inventive research design.

But there are so many ways it can go wrong.

Poorly explained papers dictated blandly to an unengaged audience. Confusing heaps of data shoehorned into long presentations. Everybody stood awkwardly outside a meeting room you thought would be free.

Whether you are unsure what journal club is, are thinking of starting one, or simply want to up your presentation game—you’ve landed on the ultimate journal club guide.

The whats, the whys, and the hows, all in one place.

What Is a Journal Club in Science?

A journal club is a series of meetings in which somebody is elected to present a research paper, its methods, and findings to a group of colleagues.

The broad goal is to stimulate discussion and ideas that the attendees may apply to their own work. Alternatively, someone may choose a paper because it’s particularly impactful or ingenious.

Usually, the presenter alternates per a rota, and attendance may be optional or compulsory.

The presenter is expected to choose, analyze, and present the paper to the attendees with accompanying slides.

The presentation is then followed by a discussion of the paper by the attendees. This is usually in the form of a series of questions and answers directed toward the presenter. Ergo , the presenter is expected to know and understand the paper and subject area to a moderate extent.

Why Have a Journal Club?

I get it. You’re a busy person. There’s a difficult research problem standing between you and your next tenure.

Why bother spending the time and energy participating in a series of meetings that don’t get you closer to achieving your scientific goals?

The answer: journal club does get you closer to achieving your scientific goals!

But it does this in indirect ways that subtly make you a better scientist. For example:

• It probably takes you out of your comfort zone.
• It makes you a better communicator.
• It makes you better at analyzing data.
• It improves your ability to critique research.
• It makes you survey relevant literature.
• It exposes you and your audience to new concepts.
• It exposes your audience to relevant literature.
• It improves the reading habits of you and your audience.
• It gets clever people talking to each other.
• It gives people a break from practical science.

It also provides a platform for people to share ideas based on their collective scientific experience. And every participant has a unique set of skills. So every participant has the potential to provide valuable insight.

This is what a good journal club should illicit.

Think of journal club as reading a book. It’s going to enrich you and add beneficially to the sum of your mental furniture, but you won’t know how until you’ve read it.

Need empirical evidence to convince you? Okay!

In 1988 a group of medical interns was split into two groups. One received journal club teaching and the other received a series of seminars. Approximately 86% of the journal club group reported improved reading habits. This compares to 0% in the group who received seminar-based teaching. [1]

Journal Club Template Structure

So now you know what journal club is, you might wonder, “how is it organized and structured?”

That’s what the rest of this article delves into. If you’re in a rush and need to head back to the lab, here’s a graphical summary (Figure 1).

Nobody likes meetings that flounder around and run over time. And while I have no data to prove it, I reckon people take less away from such meetings. Here’s a basic journal club template that assumes you are the presenter.

Introduce the Paper, Topic, Journal, and Authors

Let your audience know what you will be talking about before diving right in. Remember that repetition (of the important bits) can be a good thing.

Introducing the journal in which the paper is published will give your audience a rough idea of the prestige of the work.

And introducing the authors and their respective institutes gives your audience the option of stowing this information away and following it up with further reading in their own time.

Provide a Reason Why You Chose the Paper

Have the authors managed to circumvent sacrificing animals to achieve a goal that traditionally necessitated animal harm? Have the authors repurposed a method and applied it to a problem it’s not traditionally associated with? Is it simply a monumental feat of work and success?

People are probably more likely to listen and engage with you if they know why, in all politeness, you have chosen to use their time to talk about a given paper.

It also helps them focus on the relevant bits of your presentation and form cogent questions.

Orally Present Key Findings and Methods of the Paper

Simple. Read the paper. Understand it. Make some slides. Present.

Okay, there are a lot of ways you can get this wrong and make a hash of it. We’ll tell you how to avoid these pitfalls later on.

But for now, acknowledge that a journal club meeting starts with a presentation that sets up the main bit of it—the discussion.

Invite Your Audience to Participate in a Discussion

The discussion is the primary and arguably most beneficial component of journal club since it gives the audience a platform to share ideas. Ideas formulated by their previous experience.

And I’ve said already that these contributions are unique and have the potential to be valuable to your work.

That’s why the discussion element is important.

Their questions might concur and elaborate on the contents of the paper and your presentation of it.

Alternatively, they might disagree with the methods and/or conclusions. They might even disagree with your presentation of technical topics.

Try not to be daunted, however, as all of this ultimately adds to your knowledge, and it should all be conducted in a constructive spirit.

Summarize the Meeting and Thank Your Audience for Attending

There’s no particularly enlightening reason as to why to do these things. Summarizing helps people come away from the meeting feeling like it was a positive and rewarding thing to attend.

And thanking people for their time is a simple courtesy.

How Do You Organize It?

Basic steps if you are the organizer.

Okay, we’ve just learned what goes into speaking at the journal club. But presenter or not, the responsibility of organizing it might fall to you.

So, logistically , how do you prepare a journal club? Simply follow these 5 steps:

• Distribute copies of the research article to potential participants.
• Arrange a meeting time and location.
• Organize a speaker.
• Hold the journal club.
• Seek feedback on the quality of the meeting.

Apart from point 5, these are fairly self-explanatory. Regarding point 5, feedback is essential to growing as a scientist and presenter. The easiest way to seek feedback is simply to ask.

Alternatively, you could create a form for all the meetings in the series and ask the audience to complete and return it to you.

Basic Steps If You Are the Speaker

If somebody has done all the logistics for you, great! Don’t get complacent, however.

Why not use the time to elevate your presentation to make your journal club contribution memorable and beneficial?

Don’t worry about the “hows” because we’re going to elaborate on these points, but here are 5 things you can do to ace your presentation:

• Don’t leave it to the last minute.
• Know your audience.
• Keep your presentation slides simple.
• Keep your audience engaged.
• Be open to questions and critiques.

Regarding point 1, giving yourself sufficient time to thoroughly read the article you have chosen to present ensures you are familiar with the material in it. This is essential because you will be asked questions about it. A confident reply is the foundation of an enlightening discussion.

Regarding point 3, we’re going to tell you exactly how to prepare effective slides in its own section later. But if you are in a rush, minimize the use of excessive text. And if you provide background information, stick to diagrams that give an overview of results from previous work. Remember: a picture speaks louder than a thousand words.

Regarding point 4, engagement is critical. So carry out a practice run to make sure you are happy with the flow of your presentation and to give you an idea of your timing. It is important to stick to the time that is allotted for you.

This provides good practice for more formal conference settings where you will be stopped if you run over time. It’s also good manners and shows consideration for the attendees.

And regarding point 5, as the presenter, questions are likely to be directed toward you. So anticipate questions from the outset and prepare for the obvious ones to the best of your ability.

There’s a limit to everyone’s knowledge, but being unable to provide any sort of response will be embarrassing and make you seem unprepared.

Anticipate that people might also disagree with any definitions you make and even with your presentation of other people’s data. Whether or not you agree is a different matter, but present your reasons in a calm and professional manner.

If someone is rude, don’t rise to it and respond calmly and courteously. This shouldn’t happen too often, but we all have “those people” around us.

How Do You Choose a Journal Club Paper?

Consider the quality of the journal.

Just to be clear, I don’t mean the paper itself but the journal it’s published in.

An obscure journal is more likely to contain science that’s either boring, sloppy, wrong, or all three.

And people are giving up their time and hope to be stimulated. So oblige them!

Journal impact factor and rejection rate (the ratio of accepted to rejected articles) can help you decide whether a paper is worth discussing.

Consider the Impact and Scope of the Paper

Similar to the above, but remember, dross gets published in high-impact journals too. Hopefully, you’ve read the paper you want to present. But ask yourself what makes this particular paper stand out from the millions of others to be worth presenting.

Keep It Relevant and Keep It Interesting

When choosing a paper to present, keep your audience in mind. Choose something that is relevant to the particular group you are presenting to. If only you and a few other people understand the topic, it can come off as elitist.

How Do You Break Down and Present the Paper?

Know and provide the background material.

Before you dive into the data, spend a few minutes talking about the context of the paper. What did the authors know before they started this work? How did they formulate their hypothesis? Why did they choose to address it in this way?

You may want to reference an earlier paper from the same group if the paper represents a continuation of it, but keep it brief.

Try to explain how this paper tackles an unanswered question in the field.

Understand the Hypothesis and Methods of the Paper

Make a point of stating the  hypothesis  or  main question  of the paper, so everyone understands the goal of the study and has a foundation for the presentation and discussion.

Everyone needs to start on the same foot and remain on the same page as the meeting progresses.

Turn the Paper into a Progression of Scientific Questions

Present the data as a logical series of questions and answers. A well-written paper will already have done the hard work for you. It will be organized carefully so that each figure answers a specific question, and each new question builds on the answer from the previous figure.

If you’re having trouble grasping the flow of the paper, try writing up a brief outline of the main points. Try putting the experiments and conclusions in your own words, too.

Feel free to leave out parts of the figures that you think are unnecessary, or pull extra data from the supplemental figures if it will help you explain the paper better.

Ask Yourself Questions about the Paper Before You Present

We’ve touched on this already. This is to prepare you for any questions that are likely to be asked of you. When you read the paper, what bits didn’t you understand?

Simplify Unfamiliar and Difficult Concepts

Not everyone will be familiar with the same concepts. For example, most biologists will not have a rigorous definition of entropy committed to memory or know its units. The concept of entropy might crop up in a biophysics paper, however.

Put yourself in the audience’s shoes and anticipate what they might not fully understand given their respective backgrounds.

If you are unsure, ask them if they need a definition or include a short definition in your slides.

Sum Up Important Conclusions

After you’ve finished explaining the nitty-gritty details of the paper, conclude your presentation of the data with a list of significant findings.

Every conclusion will tie in directly to proving the major conclusion of the paper. It should be clear at this point how the data answers the main question.

How Do You Present a Journal Club Powerpoint?

Okay, so we’ve just gone through the steps required to break down a paper to present it effectively at journal club. But this needs to be paired with a PowerPoint presentation, and the two bridged orally by your talk. How do you ace this?

Provide Broad Context to the Research

We are all bogged down by minutia and reagents out of necessity.

Being bogged down is research. But it helps to come up for air. Ultimately, how will the research you are about to discuss benefit the Earth and its inhabitants when said research is translated into actual products?

Science can be for its own sake, but funded science rarely is. Reminding the journal club audience of the widest aims of the nominated field provides a clear starting point for the discussion and shows that you understand the efficacy of the research at its most basic level.

The Golden Rule: A Slide per Minute

Remember during lectures when the lecturer would open PowerPoint, and you would see, with dismay, that their slides went up to 90 or something daft? Then the last 20 get rushed through, but that’s what the exam question ends up being based on.

Don’t be that person!

A 10-15 minute talk should be accompanied by? 10-15 slides! Less is more.

Be Judicious about the Information You Choose to Present

If you are present everything in the paper, people might as well just read it in their own time, and we can call journal club off.

Try to abstract only the key findings. Sometimes technical data is necessary for what you are speaking about because their value affects the efficacy of the data and validity of the conclusions.

Most of the time, however, the exact experimental conditions can be left out and given on request. It’s good practice to put all the technical data that you anticipate being asked for in a few slides at the end of your talk.

Use your judgment.

Keep the Amount of Information per Slide Low for Clarity

Your audience is already listening to you and looking at the slides, so they have a limited capacity for what they can absorb. Overwhelming them with visual queues and talking to them will disengage them.

Have only a few clearly related images that apply directly to what you speaking about at the time. Annotate them with the only key facts from your talk and develop the bigger picture verbally.

This will be hard at first because you must be on the ball and confident with your subject area and speaking to an audience.

And definitely use circles, boxes, and arrows to highlight important parts of figures, and add a flowchart or diagram to explain an unfamiliar method.

Keep It Short Overall

The exact length of your meeting is up to you or the organizer. A 15-minute talk followed by a 30-minute discussion is about the right length, Add in tea and coffee and hellos, and you get to an hour.

We tend to speak at 125-150 words per minute. All these words should not be on your slides, however. So, commit a rough script to memory and rehearse it.

You’ll find that the main points you need to mention start to stand out and fall into place naturally. Plus, your slides will serve as visual queue cards.

How Do You Ask a Question in Journal Club?

A well-organized journal club will have clear expectations of whether or not questions should be asked only during the discussion, or whether interruptions during the presentation are allowed.

And I don’t mean literally how do you soliloquize, but rather how do you get an effective discussion going.

Presenters: Ask Questions to the Audience

We all know how it goes. “Any questions?” Silence.

Scientists, by their very nature, are usually introverted. Any ideas they might want to contribute to a discussion are typically outweighed by the fear of looking silly in front of their peers. Or they think everyone already knows the item they wish to contribute. Or don’t want to be publicly disproven. And so on.

Prepare some questions to ask the audience in advance. As soon as a few people speak, everyone tends to loosen up. Take advantage of this.

Audience: Think About Topics to Praise or Critique

Aside from seeking clarification on any unclear topics, you could ask questions on:

• Does the data support the conclusions?
• Are the conclusions relevant?
• Are the methods valid?
• What are the drawbacks and limitations of the conclusions?
• Are there better methods to test the hypothesis?
• How will the research be translated into real-world benefits?
• Are there obvious follow-up experiments?
• How well is the burden of proof met?
• Is the data physiologically relevant?
• Do you agree with the conclusions?

How to Keep It Fun

Make it interactive.

Quizzes and polls are a great way to do this! And QR codes make it really easy to do on-the-fly. Remember, scientists, are shy. So why not seek their participation in an anonymized form?

You could poll your audience on the quality of the work. You could make a fun quiz based on the material you’ve covered. You could do a live “what happened next?” You could even get your feedback this way. Here’s what to do:

• Create your quiz or poll using Google forms .
• Make a shareable link.
• Paste the link into a free QR code generator .
• Put the QR code in the appropriate bit of your talk.

Use Multimedia

Talking to your audience without anything to break it up is a guaranteed way of sending them all to sleep.

Consider embedding demonstration videos and animations in your talk. Or even just pausing to interject with your own anecdotes will keep everyone concentrated on you.

Keep It Informal

At the end of the day, we’re all scientists. Perhaps at different stages of our careers, but we’ve all had similar-ish trajectories. So there’s no need for haughtiness.

And research institutes are usually aggressively casual in terms of dress code, coffee breaks, and impromptu chats. Asking everyone to don a suit won’t add any value to a journal club.

Your Journal Club Toolkit in Summary

Anyone can read a paper, but the value lies in understanding it and applying it to your own research and thought process.

Remember, journal club is about extracting wisdom from your colleagues in the form of a discussion while disseminating wisdom to them in a digestible format.

Need some inspiration for your journal club? Check out the online repositories hosted by PNAS and NASPAG to get your juices flowing.

We’ve covered a lot of information, from parsing papers to organizational logistics, and effective presentation. So why not bookmark this page so you can come back to it all when it’s your turn to present?

While you’re here, why not ensure you’re always prepared for your next journal club and download bitesize bio’s free journal club checklist ?

And if you present at journal club and realize we’ve left something obvious out. Get in touch and let us know. We’ll add it to the article!

• Linzer M et al . (1988) Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills . JAMA 260 :2537–41

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205 Best Journal-Themed Templates for PowerPoint & Google Slides

With over 6 million presentation templates available for you to choose from, crystalgraphics is the award-winning provider of the world’s largest collection of templates for powerpoint and google slides. so, take your time and look around. you’ll like what you see whether you want 1 great template or an ongoing subscription, we've got affordable purchasing options and 24/7 download access to fit your needs. thanks to our unbeatable combination of quality, selection and unique customization options, crystalgraphics is the company you can count on for your presentation enhancement needs. just ask any of our thousands of satisfied customers from virtually every leading company around the world. they love our products. we think you will, too" id="category_description">crystalgraphics creates templates designed to make even average presentations look incredible. below you’ll see thumbnail sized previews of the title slides of a few of our 205 best journal templates for powerpoint and google slides. the text you’ll see in in those slides is just example text. the journal-related image or video you’ll see in the background of each title slide is designed to help you set the stage for your journal-related topics and it is included with that template. in addition to the title slides, each of our templates comes with 17 additional slide layouts that you can use to create an unlimited number of presentation slides with your own added text and images. and every template is available in both widescreen and standard formats. with over 6 million presentation templates available for you to choose from, crystalgraphics is the award-winning provider of the world’s largest collection of templates for powerpoint and google slides. so, take your time and look around. you’ll like what you see whether you want 1 great template or an ongoing subscription, we've got affordable purchasing options and 24/7 download access to fit your needs. thanks to our unbeatable combination of quality, selection and unique customization options, crystalgraphics is the company you can count on for your presentation enhancement needs. just ask any of our thousands of satisfied customers from virtually every leading company around the world. they love our products. we think you will, too.

Widescreen (16:9) Presentation Templates. Change size...

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Knox Lincoln County Beekeepers to offer summer presentations

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The Knox Lincoln County Beekeepers is planning four presentations at Lincoln Academy in the ATEC building this summer at 81 Academy Hill Road in Newcastle.

This an opportunity to meet local beekeepers and learn more about the art and science of keeping bees healthy and productive.

Saturday, May 18 marks the first presentation, which runs from 9:30-11:30 a.m. Carolyn Nichols’s workshop “Beekeepers CSI: Inspecting for Disease” offers a hands-on experience delving into the intricate world of forensic beekeeping. This workshop is tailored to provide a unique opportunity to sharpen skills in order to identify pests and diseases that may plague honey bee colonies.

As participants rotate through various learning stations, they will practice using diagnostic tools, observe subtle signs, and develop disease recognition skills. They will explore sustainable practices, hygiene routines, and integrated pest management strategies related to varroa mite management.

Nichols is the Morse High School apiarist and a nationally certified science teacher. She was named Maine State Beekeeper of Year 2023.

Visit klcbee.com to register.

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A 44-year-old man with recurrent ST-segment elevation: a case report of two presentations of Granulomatosis with Polyangiitis

Conflict of interest: None declared.

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Kevin Cheng, Ranil de Silva, A 44-year-old man with recurrent ST-segment elevation: a case report of two presentations of Granulomatosis with Polyangiitis, European Heart Journal - Case Reports , Volume 8, Issue 5, May 2024, ytae228, https://doi.org/10.1093/ehjcr/ytae228

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Granulomatosis with Polyangiitis (GPA) is a rare multi-system autoimmune disorder that may present with cardiac manifestations that are often under-recognized. In this report, we discuss a usual case of a patient who presented as a cardiac emergency with recurrent ST elevation and discuss the approach and management.

A 44-year-old man presented with two episodes of chest pain associated with ST-segment elevation on 12-lead ECG. Under investigation over the past several weeks for fatigue, nasal congestion, and red eyes, his first presentation was associated with widespread ST-segment elevation and an echogenic myocardium suggestive of myocarditis that was confirmed on cardiac MRI. A week later, the development of chest pain, antero-lateral ST elevation, and regional wall motion abnormalities suggested an acute coronary syndrome and he proceeded to primary percutaneous intervention that treated a lesion in the distal left anterior descending artery secondary to coronary arteritis. Diagnosed with GPA, he was started on immunosuppression and has had a resolution of his cardiac involvement at follow-up.

This case report describes an unusual case of myocarditis and coronary arteritis presenting acutely in the same patient and emphasizes the importance of considering systemic autoimmune conditions when encountering primarily cardiac presentations. Early recognition and diagnosis of cardiac involvement will improve the long-term outcomes in these patients.

Cardiac manifestations of Granulomatosis with Polyangiitis (GPA) are rare but associated with severe disease.

The spectrum of cardiac involvement may include pericarditis, myocarditis, coronary arteritis, valvulitis, and arrhythmias.

While there are no pathognomonic features of GPA on cardiac MRI, this modality was helpful to differentiate between acute myocarditis, myocardial infarction, and other differential diagnoses.

Granulomatosis with Polyangiitis (GPA) is a systemic necrotizing vasculitis characterized by pulmonary and renal manifestations. Cardiac manifestations of GPA are important to recognize because they indicate the presence of severe inflammatory disease and the potential to develop cardiac complications. In this case report, we present an unusual case of a patient with recurrent chest pain associated with ST-segment elevation in a new presentation of GPA. Initially presenting with an acute myocarditis, he subsequently developed an acute coronary syndrome (ACS) secondary to coronary arteritis. We highlight the differences in presentation and treatment between the two episodes and emphasize the need to consider systemic autoimmune conditions when encountering acute cardiac presentations.

A 44-year-old man developed sudden onset atypical chest and jaw pain with widespread ST elevation on 12-lead ECG ( Figure 1 ). Otherwise fit and well, he was a non-smoker and had a normal CT coronary angiogram two years prior. Over the preceding several weeks, he had been investigated for fatigue, nasal congestion, and red eyes and CT imaging of his chest, abdomen, and pelvis had found pancreatic and pulmonary masses. A pulmonary biopsy had shown granulomata with acid fast bacilli for which anti-tuberculous therapy had been started. On examination, he was pyrexial but had a normal cardiac examination. Transthoracic echocardiography (TTE) showed normal left ventricular (LV) systolic function, no regional wall motion abnormalities but an echogenic myocardium ( Figure 2 ). High sensitivity-troponin T at 12 h was 1089 ng/L (0–14). Given the strong initial suspicion of acute myocarditis, an urgent cardiac magnetic resonance (CMR) imaging scan was performed that demonstrated multiple focal areas of high signal intensity consistent with acute inflammation and confirming the diagnosis of acute myocarditis ( Figure 3A and B ). Focal round infiltrative lesions were also found in the basal antero-septum and mid/apical septum associated with oedema, fibrosis, and central necrosis ( Figure 3C ).

First episode of ST-segment elevation due to acute myocarditis. Twelve-lead ECG demonstrating widespread ST elevation with involvement of antero-lateral and inferior territories and preservation of R wave progression.

Transthoracic echocardiogram showing echogenic myocardium in the antero-septal wall (arrow).

( A ) Cardiac MRI (T2-STIR) demonstrating multiple focal areas of high signal consistent with acute inflammation and myocarditis (white arrow). ( B ) Late gadolinium enhancement (LGE) image confirming extracellular expansion in keeping with inflammation and oedema with ( C ) round lesions in the basal antero-septum and mid/apical septum associated with oedema, fibrosis, and central necrosis suspicious for necrotizing granulomata.

One week later, he developed recurrent left-sided chest pain with dynamic antero-lateral ST elevation ( Figure 4 ) with runs of non-sustained ventricular tachycardia. High sensitivity-troponin T was 24 786 ng/L and C-reactive protein 186 mg/L. Transthoracic echocardiography revealed hypokinetic apical segments and the patient proceeded to emergent coronary angiography that revealed a severe (75% stenotic) lesion in the distal left anterior descending (LAD) artery ( Figure 5A ) and an occluded small calibre posterior left ventricular branch of the right coronary artery (RCA, Figure 5B ). A drug-eluting stent was deployed in the distal LAD. A post-procedural TTE showed a mildly impaired LV systolic function [left ventricular ejection fraction (LVEF) 45%], apical akinesia, and left and right ventricular mural thrombi ( see Supplementary material online , Figure S1 ). A repeat CMR showed an additional infarcted appearance of the apical septum ( see Supplementary material online , Figure S1 ).

Second episode of ST-segment elevation due to ST elevation myocardial infarction. Twelve-lead ECG showing antero-lateral ST elevation with loss of R wave progression.

( A ) Coronary angiography demonstrating severe stenosis in the distal LAD artery (white arrow) and ( B ) an occluded posterior left ventricular (PLV) branch (white arrow).

Given the constellation of systemic symptoms, granulomata, and myocarditis, an autoimmune vasculitis was considered as a unifying diagnosis as well as the cause of his ACS. A positive ANCA with a raised Proteinase-3 (PR3) autoantibody titre confirmed the diagnosis of GPA with acute myocarditis and coronary arteritis. Mycobacterium tuberculosis PCR was negative, and anti-tuberculous therapy was discontinued.

The patient was commenced on rituximab and azathioprine that resolved his symptoms, inflammatory markers, and renal function. Triple therapy with warfarin, aspirin, and clopidogrel for 3 months was started (mural thrombi and recent stent), and he remained on warfarin and clopidogrel until complete resolution of thrombi was demonstrated on follow-up TTE. This also showed residual apical akinesia but a normal LVEF (66%). Thereafter, his warfarin was stopped and he continued on long-term clopidogrel. Annual CMR surveillance has shown normal LV volume and systolic function (LVEF 63%), no oedema but transmural apical fibrosis representing established infarction in the LAD territory. At 5-year follow-up, he remains well with no further major adverse cardiovascular events.

Granulomatosis with Polyangiitis is an ANCA-associated necrotizing granulomatous vasculitis affecting small- to medium-sized vessels. Rates of cardiac involvement vary but reports suggest that up to ∼40% of cases of GPA may involve the heart. 1 , 2 The advent of increasingly sensitive imaging modalities such as CMR has increased the detection of sub-clinical disease (estimated at 61–73% of cases). 3–5 However, clinical cardiac disease is much lower estimated at 3–13% of cases. 6–8

The spectrum of cardiac manifestations includes pericarditis (most commonly), myocarditis, coronary arteritis, valvulitis, and cardiac arrhythmias. Cardiac involvement is indicative of a severe pattern of systemic disease and is associated with a worse prognosis, even when asymptomatic. 9 , 10 Small studies have shown cardiac involvement to be associated with an increased mortality, poor response to immunosuppression, and increased risk of disease relapse. 4 , 11

The importance of considering underlying systemic conditions when encountering primarily cardiac presentations should be emphasized. Analysis of the ECG was critical in differentiating between the two clinical syndromes. In the initial presentation of myocarditis, widespread ST elevation occurred in a non-coronary distribution with preserved R wave progression in the precordial leads. In the subsequent presentation with vasculitis, ST elevation was confined to the antero-lateral territories with loss of R wave progression. While there are no clear pathognomonic features of GPA on CMR, it was helpful to discriminate between the two pathophysiological mechanisms. T2-STIR imaging initially demonstrated multiple areas of high signal consistent with acute inflammation suggestive of myocarditis. Subsequently, the presence of late gadolinium enhancement (LGE) demonstrated apical scar representative of the subsequent ischaemic event. Cardiac magnetic resonance is also helpful in being able to distinguish from other differential diagnoses such as TB myopericarditis, which normally exhibits greater pericardial involvement, and cardiac sarcoidosis, where LGE is usually subepicardial or within the mid-wall and typically involves the basal septum or inferolateral walls. Other cardiac imaging modalities for the detection of GPA and surveillance of disease activity include 18 F-fluoro-2-deoxyglucose positron emission tomography/computed tomography although evidence is currently limited to a handful of case reports. 12

The management of myocarditis and coronary arteritis in this setting is not well defined but involves treating both the cardiac complications and the underlying systemic autoimmune disease. Our patient was treated in a conventional manner with ACE-inhibition and beta-blockade and had a good outcome from early percutaneous coronary intervention. Of note, an additional consideration of percutaneous revascularization in this situation is that the metallic stent may act as a focus for thrombosis or that in-stent restenosis may occur from aggressive neo-intimal proliferation and arterial inflammation. 13 , 14 Whether a stent-free approach may be appropriate in these situations remains to be determined. There are currently no specific recommendations for treating cardiac involvement in GPA but aggressive systemic immunosuppression is often given. 15 Remission is usually achieved with intravenous corticosteroids, cyclophosphamide, or methotrexate but plasma exchange or rituximab may be used in refractory cases. Long-term maintenance therapy is achieved with corticosteroids and azathioprine or methotrexate for a course of 24 months and monitoring of PR-3 titres. Repeat surveillance imaging, as in this case, may also be considered to monitor for resolution of cardiac manifestations.

We present an unusual case of recurrent ST elevation due to acute myocarditis and ACS from coronary arteritis in the same patient with a new diagnosis of GPA. Differences in ECG and echocardiography helped differentiate the immediate management, and CMR enabled distinction between the initial inflammatory process and subsequent infarct. A necrotizing granulomatous vasculitis of the small- to medium-vessels, GPA typically presents with pulmonary and renal manifestations. However, increasing evidence suggests that cardiac involvement is not uncommon and associated with a worse prognosis. Advances in cardiac imaging and a greater awareness of cardiac complications in systemic autoimmune disease will aid earlier diagnosis and improve the management and outcomes of these patients.

Dr Kevin Cheng is a cardiology registrar at the Royal Brompton Hospital, London, and a BHF clinical research fellow at the National Heart and Lung Institute, Imperial College London. His research focuses on coronary artery disease, epicardial coronary and microvascular physiology assessment, and clinical trials investigating novel therapies for angina.

Supplementary material is available at European Heart Journal – Case Reports online.

Consent: The authors confirm that written consent for submission and publication of this case report including the images and associated text has been obtained from the patient in line with COPE guidance.

Funding: None declared.

All data are incorporated into this article and its online Supplementary material .

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Author notes

• acute coronary syndromes
• myocarditis
• wegener granulomatosis
• st segment elevation
• coronary arteritis
• cardiac mri
• cardiovascular findings

Supplementary data

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• Case report
• Open access
• Published: 14 May 2024

Unveiling a foreign body masquerading as periarticular calcification: a case report

• Amirhossein Kamalinia 1 ,
• Asal Seifaei 2 ,
• Seyed Arman Moein 1 , 3 &
• Hamid Namazi 1  

Journal of Medical Case Reports volume  18 , Article number:  251 ( 2024 ) Cite this article

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Introduction

Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic.

Case presentation

We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms.

This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient’s subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms.

Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.

Peer Review reports

Acute calcific periarthritis is an inflammatory condition characterized by calcium hydroxyapatite deposition within periarticular soft tissues, precipitating an intense localized inflammatory response [ 1 ]. Notably, even with advanced imaging, differentiating acute calcium deposition diseases from mimickers poses a diagnostic challenge in atypical presentations involving the hands and fingers [ 2 ].

Evaluating isolated extremity pain can be challenging when initial exams and imaging provide limited information. Categorizing nonspecific symptoms as idiopathic is often used as a catch-all diagnosis. However, subtle hints in remote patient histories often reveal pain causes [ 3 , 4 ]. Although, patients may not recall causative trauma, remote injuries can cause foreign body retention, leading to delayed inflammation and discomfort. Thus, a common mistake in assessing chronic limb pain is solely focusing on the site of pain, rather than considering the patient’s complete medical history and any underlying causes [ 5 , 6 ]. Seemingly minor details buried in a patient’s account may shed light on occult pathologies underlying their complaints. In cases of nonspecific limb discomfort, benign-appearing symptoms may signal retained foreign bodies or other occult disease processes [ 7 , 8 , 9 ].

We present a case of retained foreign glass as an unexpected finding in the workup of chronic finger pain despite intact skin and unrevealing initial studies. Sharp hand injuries with foreign bodies are commonly seen in daily orthopedic practice. This case spotlights the imperativeness of re-examining even obscure historical subtleties when evaluating diagnostically evasive extremity pain to illuminate the underlying drivers of patients’ symptoms. This experience serves as a reminder for meticulous history-taking and pre-operative evaluation in orthopedic surgeries.

A 48-year-old White male presented to our clinic with a chief complaint of vague and intermittent pain at the ulnar aspect of the fifth metacarpophalangeal (MCP) joint of the right hand. With a blood pressure of 130/80 mmHg, heart rate of 86 beats per minute, respiratory rate of 21 breaths per minute, and temperature of 37.2 °C, vital signs were normal. His past medical history was not remarkable, and he had no familial history of related diseases such as rheumatoid arthritis. He had no recollection of trauma to his hand. The patient’s physical examination revealed mild tenderness to palpation over the ulnar collateral ligament, without appreciable swelling, erythema, ecchymosis, wound, or scar. Range of motion and strength testing were within normal limits. Besides a borderline first-hour erythrocyte sedimentation rate (ESR) 22 mm/hour (normal range 0–20 mm/hour), his lab data was not remarkable. Complete blood count (CBC), C-reactive protein (CRP), urine analysis, and rheumatologic work-ups showed no abnormality. Radiographic evaluation showed a calcified lesion adjoining the ulnar collateral ligament at the fifth MCP joint, indicating possible chronic inflammation (Fig.  1 ). Initially, with a possible diagnosis of chronic calcified peroarthritis and inflammation of the ulnar collateral ligament of the fifth MCP joint, medical management was chosen. Acetaminophen tablet 500 mg three times per day and indometacin tablet 75 mg two times per day were prescribed. Yet, the patient’s symptoms did not diminish with medical therapy.

Radiographic imaging showing a calcified lesion concerning for inflammation. A Posterior-anterior view of right hand demonstrating calcification (arrow) adjoining ulnar collateral ligament of fifth metacarpophalangeal joint. B Oblique view providing additional visualization of periarticular calcification (arrow)

Given the uncertainty regarding overall diagnostic accuracy, the patient was recommended for surgical intervention for further management of the underlying pathology. During the surgical exploration, a glass foreign body encapsulated in fibrotic tissue was identified, eroding into the underlying bone of the fifth MCP joint (Fig.  2 ). Upon further history-taking postoperatively, the patient recalled sustaining an unreported glass laceration to the volar right hand nearly 10 years prior, for which he did not seek medical attention given the lack of symptoms at the time. Apparently, the injury had left no visible scar. He was discharged the same day with no problem regarding the surgery.

Discovery of glass foreign body. A Intraoperative exposure revealing an unexpected finding (not shown). B Retrieved encapsulated glass fragment eroding into bone (not pictured)

The patient had an uncomplicated postoperative course with complete symptom resolution at 6-week follow-up (Fig.  3 ). Furthermore, the patient had no complaint regarding his surgery and had no complication in his finger function at 6-month follow-up.

Postoperative imaging after glass removal. A Posterior-anterior hand radiograph showing interval removal of the calcified lesion. B Oblique perspective demonstrating postsurgical changes at the fifth metacarpophalangeal joint space after glass foreign body removal

In this article, we present a case of chronic fifth metacarpophalangeal joint pain. Though radiographs showed a calcific lesion, surgical exploration revealed an encapsulated glass foreign body, an unexpected decade-old relic the patient had forgotten until the postoperative history re-taking highlighted the vital value of comprehensively probing even obscure historical clues when evaluating vague limb pain.

A complete medical history is a vital component of patient evaluation, and yet subtleties may be overlooked without iteratively revisiting with directed questioning. Patients frequently fail to associate remote or seemingly insignificant injuries with current symptoms, diminishing perceived relevance [ 4 , 6 , 10 ].

In a similar case, a 21-year-old female with progressive foot pain had a lesion resembling a vascular malformation. Finally, during the surgery, it turned out that it was a wood splinter in her foot, and she did not recall an event of stepping on a broken broomstick [ 11 ].

However, obscurities uncovered on careful historical re-examination frequently illuminate explanatory pathology. In cases of nonspecific extremity discomfort such as this one, exhaustive recounting of past trauma, even minor lacerations healed without intervention, is imperative [ 7 , 8 ]. Focused history-taking is equally essential at postoperative follow-ups when new symptom context guides identification of relevance in previous events [ 12 ]. As this case reveals, a forgotten glass cut causing no initial issues precipitated future complications necessitating eventual surgery. The dramatic symptom resolution post-extraction demonstrates how remote subtleties direct diagnostic accuracy in perplexing presentations. This requires thorough interviewing and analysis of all potential triggering factors to achieve a comprehensive diagnosis.

Also, several inflammatory arthropathies can present similarly to foreign body retention on preliminary imaging. Foreign material may mimic hydroxyapatite deposition disease, though less common in the hand, and will demonstrate calcific focus with surrounding inflammation [ 13 , 14 ]. Meanwhile, embedded fragments can observationally overlap with gout and pseudogout frequently which manifests as erosions with sclerotic margins and soft tissue swelling [ 15 ]. Even synovial osteochondromatosis, though distinguishable by loose intra-articular bodies, causes bony projections potentially confused with external debris [ 16 ]. These considerations showcase how advanced imaging lacks the specificity to accurately diagnose intra-articular pathology in atypical presentations [ 17 ]. While sensitive for joint disease, areas of calcification or ossification cannot delineate if they result from endogenous pathophysiology versus exogenous introduction. This limitation underscores the vital value of history-taking in diagnostically clarifying ambiguous scans [ 18 , 19 ].

In conclusion, our case report enhances overall comprehension of such cases and reinforces the importance of a comprehensive approach in diagnosing and managing similar conditions. Our findings underscore the critical significance of thorough history-taking in uncovering latent musculoskeletal etiologies, emphasizing the pivotal role this aspect plays in clinical practice.

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Data of the patient can be requested from authors. Please write to the corresponding author if you are interested in such data.

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Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Amirhossein Kamalinia, Seyed Arman Moein & Hamid Namazi

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

Asal Seifaei

Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran

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Contributions

AK and AS drafted the manuscript. HN collected the data and revised the manuscript. SAM collected and reported the imaging data. HN proofread the manuscript and did the English language editing of the manuscript. HN revised the final version of the manuscript and supervised the study. All authors read and approved the final version of the manuscript.

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Correspondence to Seyed Arman Moein or Hamid Namazi .

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The present study was approved by the Medical Ethics Committee of Shiraz University of Medical Sciences. The purpose of this report was completely explained to the patient, and written inform consent was obtained from the patient.

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Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

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Kamalinia, A., Seifaei, A., Moein, S.A. et al. Unveiling a foreign body masquerading as periarticular calcification: a case report. J Med Case Reports 18 , 251 (2024). https://doi.org/10.1186/s13256-024-04475-6

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Published : 14 May 2024

DOI : https://doi.org/10.1186/s13256-024-04475-6

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