journal club presentation ppt template

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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The journal club presentation template is designed to professionally showcase your idea. This template is perfect for researchers, school clubs, meetings, high schools, and colleges, educational presentations, group club sessions, and marketing purposes. This template allows for easy customization of font style, size, and color, as well as rearrangement of slide layout to fit individual needs. You can edit the journal club presentation in PowerPoint and Google Slides. Make your meetings more exciting enlighten your information with our dynamic journal club presentation today.

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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

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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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Landmark research series template.

PowerPoint template for Landmark EBM articles. This is a structured format for reviewing and presenting landmark research articles.

Journal Club Template

PowerPoint template for Journal Club. This is a structured format for reviewing and presenting original research articles.

Poster Presentation Template (36×48)

PowerPoint template for poster presentations. The dimensions of this poster are 36 x 48 inches, which can be printed by the Department of Medicine.

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Journal Club Presentation Resources (Statistics Help): Meta-Analyses & Systematic Reviews

• Introduction
• Level of Evidence / EBM Calculators
• Library Resources
• Types of Research Studies
• ANOVA / Misc. Statistics Resources
• Confidence Intervals/ Type I & II Errors/ Statistical Power
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• PPC II Journal Club Assignment Guide

Evaluation Tools

• AHRQ: Spotting a Bad Meta-Analysis AHRQ YouTube video
• Are Network Meta-Analysis More Prone to Unreliable Conclusions? Improving Medical Statistics and the Interpretation of Clinical Trials
• Development of AMSTAR: A Measurement Tool to Assess the Methodological Quality of Systematic Reviews BMC Medical Research Methodology article
• How to Review a Meta-analysis Article Russo MW. How to review a meta-analysis. Gastroenterol Hepatol (N Y). 2007;3(8):637-42.

• Jadad Score Berger VW, Alperson SY. A general framework for the evaluation of clinical trial quality. Rev Recent Clin Trials. 2009;4(2):79-88. doi:10.2174/157488709788186021
• Limitations of Meta-analysis: Overview Improving Medical Statistics and the Interpretation of Clinical Trials
• Living Systematic Reviews: Towards Real-time Evidence for Health-care Decision-making BMJ Blog By Chris Mavergames and Julian Elliott
• Meta-Analysis: Principles and Procedures article Egger M. Meta-analysis: principles and procedures. BMJ 1997;315:1533.

• The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses GA Wells, B Shea, D O'Connell, J Peterson, V Welch, M Losos, P Tugwell. Department of Epidemiology and Commuunity Medicine, University of Ottawa
• Overview of Meta-Analysis and Methods greatdoctorstv YouTube video of Gordon Guyatt, M.D., M.Sc.

• Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement Annals of Internal Medicine article
• Problems with Meta-Analysis Methods greatdoctorstv YouTube video of Gordon Guyatt, M.D., M.Sc.
• Tips for Learners of Evidence-Based Medicine: 4. Assessing Heterogeneity of Primary Studies in Systematic Reviews and Whether to Combine their Results Hatala R, Keitz S, Wyer P, Guyatt G. Tips for learners of evidence-based medicine: 4. Assessing heterogeneity of primary studies in systematic reviews and whether to combine their results. CMAJ. 2005;172(5):661-5.
• Traditional Reviews vs. Systematic Reviews tutorial Students 4 Best Evidence
• What is a Systematic Review? Bandolier What is...? series
• MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies

Understanding the Statistics

• Exploring Systematic Reviews YourHealthNet
• What is Meta-Analysis? Bandolier What is...? series
• Another 5 Things to Know About Meta-Analysis Bastian H. Absolutely Maybe : Evidence and Uncertainties about Medicine and Life PLOS blog.
• Bandolier: L'Abbé Plot
• Bandolier Cumulative Meta-analysis Definition
• Cochrane Training: Introduction to systematic reviews: online learning module
• Forest Plot at a Glance tutorial Students 4 Best Evidence
• Funnel Plots Cochrane Collaboration
• Heterogeneity: Assessing Heterogeneity in Meta-Analysis: Q Statistic or I2 Index? University of Connecticut - Tania Huedo-Medina, et al.
• How to Read a Forest Plot in a Meta-analysis Sedgwick P. How to read a forest plot in a meta-analysis. BMJ 2015;351:h4028
• Introduction to Sources of Bias in Clinical Trials Cochrane Handbook for Systematic Reviews of Interventions
• Living Systematic Reviews The Cochrane Library
• Measuring Inconsistency in Meta-Analyses Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60.
• Meta-analyses: Heterogeneity and Subgroup Analysis Sedgwick P. Meta-analyses: heterogeneity and subgroup analysis. BMJ. 2013;346:f4040.
• Meta-analyses: How to Read a Funnel Plot Sedgwick P. Meta-analyses: how to read a funnel plot. BMJ. 2013;346:f1342.
• Meta-analyses: Tests of Heterogeneity Sedgwick P. Sample size: how many participants are needed in a trial?. BMJ. 2012;344:e3971.
• Meta-Analysis Handbook of Biological Statistics John H. McDonald
• Meta-Regression Cochrane Handbook
• Sensitivity Analysis Cochrane Handbook
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Journal Club Presentation

Transcript: 10% and 15% of patients experience a major complication within 1 year and 5 years, respectively. injury to abdominal viscera - gastrocolocutaneous fistula rate has been reported to range from 1.7% to 12.5%. bumper of the PEG can damage or tear the esophagus “buried bumper” syndrome Disruption of the tract small bowel obstruction operative tube replacement jejunojejunal intussusception bowel stricture small bowel hematoma Over all complication rates as high as 38% Early complication rates: similar open vs lap Tube dislodgement: 65% of patients within 5 years Excess granulation tissue mild peristomal leakage skin irritation cellulitis Shenoy S, Karunakar BP. Factors influencing the peripheral venous catheter survival in critically ill children in a pediatric intensive care unit. Indian J Pediatr. 2014;81:1293–1296. Optimization: MDT Discussion INR <1.6/platelet count >50,000/mm3 Site: Higher incidence of VTE and infections with femoral lines Case reports of tunnelling into the developing breast bud Pneumothorax is a rare complication of subclavian lines Radiological lines into lumbar, gonadal, mammary, or portal veins. 10% central line-associated sepsis (prophylaxis no use bt 70% ethanol works) Often difficult to clear coagulase- ve staphylococcus Luminal thrombus: removal after 3–5 days of therapeutic anticoagulation, and anticoagulation should be given for 6 weeks to 3 months. In neonates, erosion of a central catheter tip can result in a TPN effusion; (??Chylothorax) 30% of children in the first year of life require more than one insertion attempt to secure IV access 1894 - Stamm Mortality: 30% by the mid-20th Now: as low as 0% The depth of the UVC can be determined by the formula: (1.5 body weight in kilograms) + 5.5 cm pharyngoesophageal perforation: 4% for neonates weighing less than 750 g VeinViewers , AccuVeins , and VascuLumina- tors devices “nasogastric tube syndrome” Cricopharyngeus - higher perfs in neonates Dr. John W. Broviac (b. 1942) Journal Club Presentation Meert KL, Daphtary KM, Metheny NA. Gastric vs small-bowel feeding in critically ill children receiving mechanical ventilation: a randomized controlled trial. Chest. 2004;126:872–878. Gastrostomy Tubes Luck RP, Haines C, Mull CC. Intraosseous access. J Emerg Med. 2010;39:468–475. 24% on neonates Complications PICC Peripheral Access the “push” gastrostomy technique Intraosseous Lines Synopsis Dr Robert O. Hickman (b. 1927) WARNING!! axillary, subclavian, and innominate - thrombosis High thoracic injury perforates into the posterior mediastinum Distal esophageal injury - right- sided pneumothorax Mortality as low as 4% in one series PEG Vascular Access 1973: Lap-Assisted Gastrostomy sudden, life-threatening bilateral vocal cord paralysis, Nasal Complictions Intragastric and Postpyloric feeding Central Venous Access similar risks of aspiration minor differences in feeding capacity BUT NG is often less challenging, allows for physiologically “normal” bolus feeding 1979: The overall complication rate is o1%, No documentation of bone deformity or growth arrest The aspirate can be used Group and Save Doses used through IO lines are the same Typically removed within 24 h of placement. Mean lifespan 39hrs Tunnelled Lines Norfolk and Norwich Paediatric Surgery 17th February 2017 William Gauderer, a pediatric surgeon, first described his experience with percutaneous endoscopic gastrostomy (PEG) in 1980 1–6 months. Misplaced Tubes Maintenance Enteral Access primary inability to swallow severe gastroesophageal reflux chronic aspiration difficult oral medication regimen general failure to thrive PICC should sit in the superior vena cava or just in the atrium Cheaper and avoids PN risks: - liver failure - sepsis - catheter rated Nasojejunal Tubes Open "STAMM" Gastrostomy 2 lumen: Salem Sump vs Replogle "In extremely rare cases with other complicating factors, NG tubes have been misplaced into the brain, pericardial space, liver, spleen, and the urinary bladder." Umbilical Venous Catheter Nasogastric Tubes total parenteral nutrition chemotherapy administration of caustic medications central venous monitoring blood draws cell harvest apheresis dialysis. Enteral feeding support for more than 4 weeks Faster recovery times, and quick advancement to goal enteral feeds. ?? primary button placement In emergencies - can be placed 3–4 cm from the umbilicus below the hepatic circulation No topical antibiotic ointment should be applied low-dose heparin (0.25–1.0 U/mL) should be added to the fluid last 14 days Feeding jejunostomy paresis of the posterior cricoarytenoid muscles due to ulceration and infection over the posterior lamina of the cricoid no true reduction in aspiration events, aspiration pneumonia, or other complications were appreciated BUT possible higher caloric intake overall in ICU and gastric dysmotility Multiple studies since the 1970s: cause perforation of the duodenum or jejunum resulting in small bowel fistulas or peritonitis. NB Easy to miss in

Transcript: GKEITA KAMIJ and RYUJI ABE Aftereffects of Cognitively Demanding Acute Aerobic Exercise on Working Memory Background Background Number of studies have shown chronic regular exercise improves cognitive function across lifespan Cognitive Function - intellectual process where you become aware of, perceive, or comprehend an idea perception, thinking, reasoning, and remembering Executive function - umbrella term for the neurologically-based skills involving mental control and self-regulation Working memory - immediate conscious perceptual and linguistic processing allows people to maintain and update information in their brains about things they’re working on, such as assignments, goals and strategies. Cognitively-demanding exercise - exercise performed while the subject engages in a cognitive activity Research has suggested sustained cognitive effort during exercise may not enhance cognitive function walking in nature vs walking in urban areas studies have shown cognitively demanding exercise to be less effective than simpler exercise in enhancing cognitive function in children and young adults exergaming and classroom settings Cognitively Demanding Exercise Cognitively Demanding Exercise Small number of studies have used a within-participants design to examine the aftereffects of cognitively demanding acute exercise Most studies have used a between-participant design Within-Participant Design Within-Participant Design Majority of acute exercise studies have focused on children, young adults, or older adults little is known about the effects of acute exercise on cognitive function in middle-age individuals Unknown if middle-age individuals experience effects of aerobic exercise on working memory like those found in other age groups If there's an association between aerobic exercise and working memory, it could encourage middle-age individuals to exercise during working hours What's Missing? Study Purpose Subjects Methodology 36 middle-age men were recruited from (40-52 y/o) No neurological disorders No CV disease No medications that influenced CNS Nonsmokers Normal or corrected-to-normal vision 28 subject completed study Two-back task - cognitive demand continuous sequence of single-digit numbers from 0 to 9 press one of two buttons with their index fingers corresponding to whether the currently presented single digit matched (right button) or did not match (left) the digit presented two previously in the sequence Switch task - cognitive function continuous sequence of single-digit numbers from 1 to 9, excluding 5 digits enclosed in solid or dashed square solid square - left button if was lower than 5 and right button if digit higher than five dashed square - left button if odd, right button if even Cognitive Tasks Cognitive Tasks https://www.cogstate.com/clinical-trials/computerized-cognitive-assessment/ Two-back task Two-back task https://www.psytoolkit.org/experiment-library/taskswitching.html Switch task Switch task Duration = 25 min each 5-min warm-up; workload was gradually increased 20 min of cycling at 60%-70% of age-predicted HRmax Participants instructed to maintain a cadence between 60 and 70 rpm RPE assessed every 5 min using the 15-point Borg scale Exercise intensity and duration sufficient to detect cognitive benefits after acute aerobic exercise Exercise Intervention Exercise Interventions 1. Rest-cognition condition sit quietly on a cycle ergometer for 5 min four blocks of a 3-min switch task 2-min breaks after each block to refocus 2. Exercise-cognition condition 5-min warm-up; workload was gradually increased 20 min of cycling exercise at 60%-70% of age-predicted HRmax During exercise, simultaneously performed four blocks of a 3-min switch task 2-min breaks after each block 3. Exercise-only condition identical to the exercise-cognition condition, except no switch task during exercise Experimental Protocol Protocol Protocol Diagram Hypothesis Research Hypothesis Working memory performance, as reflected in response accuracy and reaction times (RT) on two-back task, would improve after the interventions in both exercise conditions, but not in the rest-cognition condition No firm prediction regarding beneficial effects of acute exercise on working memory in the exercise-cognition versus exercise-only conditions Analysis Results Two-back task - response accuracy, RT, and SDRT analyzed using a 3x3 repeated-measures ANOVA Condition: rest-cognition, exercise-cognition, exerciseonly) Time: pretest, post 1, post 2 Switch task - response accuracy, RT, and SDRT analyzed using a 2x2 repeated-measures ANOVA Condition: rest-cognition, exercise-cognition Trial: switch, nonswitch HR and RPE were also analyzed using repeated-measures ANOVAs Working memory performance improved after moderate aerobic exercise, as indicated by greater hit accuracy and shorter correct rejection RT This supports existing evidence that simple aerobic exercise has a beneficial impact on working memory Positive effects of exercise were

Journal Club presentation

Transcript: Comparison of the accumulation and effectiveness of different sizes of long-circulating, drug-loaded (DACHPt) polymeric micelles in both highly and poorly permeable tumours BALB/c nude mice inoculated subcutaneously with C26 or BxPC3 cells to prepare tumour model Mice injected on days 0, 2 and 4 with oxaliplatin (8 mg/kg) or micelles (3 mg/kg on a platinum basis) to evaluate antitumour activity Mice injected with 100 µg micelles on a platinum basis for tumour accumulation experiments Haemotoxylin and eosin staining for histological investigations Fluorescent labelling of micelles to investigate size-dependent extravasation and penetration in tumours Immunofluorescent localization of platelet endothelial cell adhesion molecule-1 (PECAM-1) to show distribution of blood vessels Assessment of drug microdistribution in tumours by detecting element disposition (µ-SR-XRF) Observation of platinum and iron in tumour tissue to evaluate the distribution of haemoproteins and the location of the drug Use of DACHPt/m with diameters of 30 and 70 nm (critical differences in antitumour activity, tumour accumulation and microdistribution in BxPC3 model for diameters below and above 50 nm) Labelling of 30 nm micelles with Alexa 488 and 70 nm micelles with Alexa 594 Injection of fluorescently labelled micelles in mice bearing C26 or BxPC3 tumours (10 mg/kg) Microdistribution of micelles assessed 1h and 24h after injection using in vivo confocal laser scanning microscopy (fluorescent measurements relative to the fluorescence intensity in the vasculature immediately after injection (Vmax)) Low doses of a transforming growth factor ß (TGF-ß) inhibitor transiently decreases the pericyte coverage of the endothelium in the neovasculature of pancreatic tumours, resulting in enhanced accumulation and antitumour activity of 65 nm micelles and 90 nm Doxil What is the effect of TGF-ß inhibitors on the delivery of sub-100 nm DACHPt/m in BxPC3 tumours??? BxPC3-bearing mice received intraperitoneal injections of TGF-ß inhibitor (LY364947) at 1 mg/kg every second day (0, 2, 4, 6 & 8) for the antitumour acitivity experiment and 1h before the micelles injection for tumour accumulation studies 30 and 70 nm fluorescently labelled micelles (3mg/kg) were injected on days 0, 4 & 8 The tumoricidal efficiency of long-circulating polymeric micelles depends on the size of the micelles and the permeability of the tumour Sub-100 nm DACHPt/m show no size-dependent restrictions on extravasation and penetration in hypervascular tumours Only DACHPt/m < 50 nm can penetrate poorly permeable hypovascular tumours Increasing the permeability of hypovascular tumours using TGF-ß inhibitor improves the accumulation and distribution of larger (70 nm) micelles Clarification of tumour accumulation and intratumoural distribution of nanomedicines in the range between 5 and 30 nm Optimizing the size of nanomedicines by looking at the balance between antitumour efficacy and potential toxicity Accumulation of sub-100 nm polymeric micelles in poorly permeable tumours depends on size Method Nature reviews. Drug discovery [1474-1776] Davis, Mark yr:2008 vol:7 iss:9 pg:771 -782 Preliminary data C26 Similar extravasation and penetration of 30 and 70 nm micelles BxPC3 30 nm micelles crossed vascular wall (20% Vmax at 40µm from blood vessel), 70 nm micelles failed to reach interstitial space Extravasation points of 70 nm micelles surrounded the blood vessels Method (1) 70 nm micelles reduced the tumour growth rate as effectively as 30 nm micelles Accumulation of 70 nm micelles was reaching a level comparable to 30 nm micelles Results Prolonged circulation time acquired by size control (ca. 5 - 100 nm), too small = leakage, too big = uptake by macrophages from the reticuloendothelial system (RES) hydrophylic surface (mostly PEG) prevents opsonization by macrophages and uptake by RES Goals of drug delivery systems: Minimize premature drug degradation Prevent undesirable side effects Increase drug bioavailability in pathological area Accumulation of nanomedicines in the pathological area by the enhanced permeability and retention (EPR) effect Results (24h post injection) Results (1) Higher P(Glu) ratio from homopolymer to copolymer results in increased micelle size Micelles of different sizes show similar drug release rates Differently sized DACHPt/m maintained their diameters for over 48h ( in cell culture media + 10% serum at 37 ⁰C) Differently sized DACHPt/m showed similar plasma clearance rates and plasma half lives Microdistribution of fluorescently labelled DACHPt/m of varying sizes in tumours Method (2) Nature reviews. Drug discovery [1474-1776] Duncan, R yr:2003 vol:2 iss:5 pg:347 -360 So far, several nanomedicines have shown significant antitumour activity in highly vascularized tumours (e.g. Doxil (90 nm) and Abraxane (130 nm)) However, most of these nanomedicines with large diameters (> 100 nm) have shown limited penetration and accumulation in hypovascular/hypopermeable

Journal club presentation

Transcript: Identification of Hemopexin as an Anti-Inflammatory Factor That Inhibits Synergy of Hemoglobin with HMGB1 in Sterile and Infectious Inflammation Hemopexin: Heme binding protein HMGB1: cytokine mediator of inflammation inflammation: complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants Introduction Tissue injury/necrosis ruptures red blood cells and releases hemoglobin into the extracellular space Cell-free hemoglobin degradation of protein aggregates mechanisms are only partially understood this paper reveals importance of 'vacuolar' pathway in MHCI presentation illustrates importance of autophagy and lysosomes for this pathway shows how modulations of autophagy effect MHCI presentation of viral antigen gB finds junctions where vacuolar and classical pathway probably intersect Isolation of bone marrow derived macrophages (BMDMs) from mice 1. treatment of BMDMs from C57/BL6 WT mice with HMGB1 alone or in combination with Hb- measure TNF and IL-6 2. treatment of BMDMs from TLR2, TLR4 and RAGE KO mice with HMGB1 alone or in combination with Hb-measure TNF 3. pre-treatment of BMDMs from C57/BL6 WT mice with inhibitors of ROS, Syk kinase-then stimulate with HMGB1 alone or HMGB1+Hb- measure TNF 4. treatment of BMDMs from C57/BL6 WT mice with HMGB1 alone or HMGB1+Hb in the presence or absence of Hemopexin-measure TNF and IL-6 5. treatment of BMDMs from C57/BL6 WT mice with HMGB1 alone or HMGB1+Hb in the presence or absence of LPS or Pam3Cys-measure TNF and IL-6 Results and Discussion (big) Conclusions MHCI response relies on different pathways to compensate for viral inhibition vacoular pathway is described to rely on autophagy and lysosomal antigen degradation classical pathway is the bottleneck for antigen presentation pre-autophago-somal structure coil from nucleus ? experimental procedure somehow: injection of antigen fragments into classic MHCI pathway export of degradation products to cytoplasm "xenophagy" in case intracellular parasites being targeted autophagy marker viral antigen nucleus autophagosomes are formed around large portions of cytoplasm fusion of autophagosomes and lysosomes initiates degradation conventional autophagosomes hydrolytic degradation probably ER and/or nucleus Tian Lin, Fatima Sammy, Huan Yang, Sujatha Thundivalappil, Judith Hellman, Kevin J. Tracey and H. Shaw Warren

JOURNAL CLUB PRESENTATION

Transcript: Instagram and Facebook influence on young women’s’ image: how it affects their self-esteem. Instagram and Facebook influence on young women’s’ image: how it affects their self-esteem. Vitória Magalhães Machado Research tools SURREY SEARCH athenas data base EBSCO DATA BASE GOOGLE SCHOLAR Terms definition Terms Self-esteem Not only the physical aspect but also the emotional evaluation of a person’s self-worth will have an impact on self-esteem (Duschene et al., 2017). Therefore, the self-esteem is also considered as an informer of psychological well-being. (Clay, Vignoles, & Dittmar, 2005). "'Dude, I am really pretty today!' 'Girl, you really are!'" (Ilustraclementine, 2020) Social media platforms imply the presence of others, connecting to others despite the distance. Added to which, social media such as Instagram and Facebook are considered as social facilitators, whose impact will be examined further on the literature review (Wolf, Sims, & Yang, 2018) social media The perception the individual has of themselves physically and how they perceive the reaction of others to their body (Spurr, Berry and Walker 2013). BODY IMAGE "What can not miss in a 'beach body'? Sunscream!" (Ilustra Gabs, 2020) main article ARTICLE Body Dissatisfaction and Psychological distress in adolescents: is self-esteem a mediator? Duchesne, A., Dion, J., Lalande, D., Bégin, C., Èmonde, C., Lalande, G. & McDuff, P. (2016) Introduction INTRO Aim of the article test whether if self-esteem is mediator between body dissatisfaction and psychological distress During adolescence self-esteem is being shaped. Besides that, considering their body changes due puberty it reflects on how they perceive their bodies (Duchesne, A., Dion, J., Lalande, D., Bégin, C., Èmonde, C., Lalande, G. & McDuff, P., 2016). why adolescents "Just like the moon, enjoy your phases." (Ilustragabs, 2019) LITERATURE BACKUP There is a wild range of research relating body dissatisfation with anxiety and depression (Duchesne, 2016); Other authors have shown self-esteem as an influence in body dissatisfaction and depression, however only one research test it (Duchesne, 2016). METHODS OF RESEARCH (Prezi Figures, 2020) pARTICIPANTS Ethics Tests used rESULTS and discussion Results results 59,7% were dissatisfied with their bodies datas 409 participants Girls were more dissatisfied with their bodies (63,5%) and lower self-esteem; also more syntoms of psychological distress DISCUSSION The research verified that the hypothesis is true: body dissatisfaction and psychological distress are mediated by self- esteem BODY DISSATISFATION SELF-ESTEEM PSYCHOLOGICAL DISTRESS analysis

Transcript: (A) In human cells, DSBs may be repaired through the double-strand break repair (DSBR) pathway or the non-crossover synthesis-dependent strand annealing (SDSA) pathway. Both crossover and non-crossover DSBR can occur. (B) The HBD locus from the 7 recombined 3PN embryos were similarly examined as above. * Indicates that the HBD locus failed to be amplified in two of the embryos. (C) In human embryos, repair of DSBs generated by CRISPR/Cas9 occurs mainly through NHEJ. If HDR is utilized, the non-crossover pathway is preferred. Six Cas9-cleaved embryos were randomly selected (three each from groups 2 and 3) for whole-exome sequencing. Concentrations of the Cas9/gRNAs used for injections are indicated. Candidate off-target sites were also confirmed by T7E1 assay. A representative sequencing chromatogram of the region spanning the target site in Cas9-cleaved 3PN embryos. Double peaks near the PAM sequence (green) are indicated. Five embryos with double peaks near the PAM sequence were randomly selected for the T7E1 assay. Blue arrowhead indicates the expected size for uncut PCR products. Control, amplified products from target regions with no double peaks near the PAM sequence. 293T cells were transfected with increasing concentrations (1 μg, 2 μg, 3 μg, 4 μg) of the G1 gRNA-Cas9 vector. A GFP expression vector was used as transfection control. Regions spanning the top 7 predicted off-target sites for each gRNA were PCR amplified for the T7E1 assay. OT, off-target. HBB, on-target editing in the HBB gene locus. Embryo No.16 from group 3 was used to PCR amplify sequences spanning the gRNA target regions of the HBB gene. The PCR products were then subcloned and sequenced. A total of 50 clones were examined, and the number of clones for each pattern indicated. PAM, green. G1 gRNA sequence, blue. Point mutations, red. The ssDNA was co-transfected with the G1 gRNA-Cas9 construct (pX330-G1) into 293T cells. At 48 h after transfection, genomic DNA was extracted to PCR amplify the region spanning the G1 target site. The PCR products were then subcloned into TA cloning vectors for sequencing analysis. Representative sequencing chromatographs for wild- type and edited alleles are shown with the mutated target region underlined in red. CRISPR/Cas9-mediated gene editing in human tripronuclear zygotes Four groups of 3PN zygotes were injected intra-cytoplasmically with GFP mRNA (50 ng/L) and Cas9 gRNA/ssDNA in different concentration combinations. The genomes of GFP + embryos were first amplified by multiplex displacement amplification. The region spanning the target site was then PCR amplified, subcloned into TA vectors, and sequenced. * Indicates that target fragments in 5 GFP + embryos failed to be PCR amplified. 293T cells were individually transfected with the three gRNA-Cas9 expression vectors and harvested for genomic DNA isolation 48 h after transfection. A GFP expression vector was used as a control. The regions spanning the gRNA target sites were then PCR amplified for the T7E1 assay. Blue arrowhead indicates the expected size for uncut PCR products. Off-target cleavage in human embryos was summarized here. PAM sequence are labeled in green. HBB, on-target cleavage of the HBB locus. OT1–7, the top 7 predicted off-target sites. HBD, the predicted off-target site in the HBD locus. Mismatched nucleotides compared to the HBB locus are labeled in red. Some of the off-target sites failed to be amplified by PCR in this experiment. Sequencing chromatographs of the wild-type allele and recombined allele generated by homologous recombination between HBB and HBD are shown here. The region with base substitution is underlined with red line. A ssDNA oligo (Oligo donor) encoding 6 silent mutations (indicated in red) was synthesized By: Puping Liang, Yanwen Xu, Xiya Zhang, Chenhui Ding, Rui Huang, Zhen Zhang, Jie Lv, Xiaowei Xie, Yuxi Chen, Yujing Li, Ying Sun, Yaofu Bai, Zhou Songyang, Wenbin Ma, Canquan Zhou&, Junjiu Huang The region within the HBD locus that is highly similar to the G1 gRNA-Cas9 target sequence was analyzed by a T7E1 assay. It shows that although the HBD locus is similar to the HBB locus, no cleavage occured at that site. Three gRNA targeting sites were selected for the HBB locus, and the sequence for each gRNA (G1, G2, and G3) is shown with the PAM sequence in green. The three common HBB mutations found in βB-thalassemia are indicated in red. Exons are represented by deep blue boxes with yellow arrows indicating transcriptional direction.

Template for journal club

Transcript: Author : Anto P. Rajkumar, MD, PhD Background Results Antipsychotic-related risks Dealing with co-morbidity : Diabetes Mellitus Background Incidence of DM Analysis lightbulb Created by Scott Lewis from the Noun Project People with schizophrenia are at increased risk for diabetes regardless of their family history of diabetes and their antipsychotic drug exposure Endogenous risk for DM Exposure to antipsychotics Max. period of follow-up : 35.96yr No statistically significant difference (Chi square=0.13, df=1, p=0.72) 1. Risks for early onset DM in young people with schizophrenia 2. Antipsychotics related risk for diabetes : first-line therapeutic decision – 1st generation vs 2nd generation 3. Adjustment for the effects of potential confounders People with Diabetes - Diabetogenic psychotropic medications : tricyclic, tetracyclic antidepressants, valproate - Gender, urbanicity - Family history of diabetes Covariates of interest Aim of the study Study sample Background - The largest sample size to date, the longest follow-up - The focus on early-onset diabetes in young people - Could not reliably distinguish between type 1 and type 2 diabetes - Limited generalizability : focusing on early onset type 2 DM predominantly Caucasian population from a single country - People from the Danish Civil Registration System - Each Danish citizen is assigned a unique 10-digit personal ID number - Cohort : all people who were born in Denmark Jan.1, 1977. ~ Jan.1, 2013. Journal Club Critique Discussions Background Antipsychotics – related metabolic syndrome “제 2의 tardive dyskinesia” 발표 : R1 김재성 지도 : 김민아 교수님 2017. 05. 16 1. Endogenous risk for diabetes Antipsychotic naive people with SPR vs. Antipsychotic naive people without SPR Follow-up : began at date of birth ended on the date of DM diagnosis, first prescription of antipsychotics, emigration, death, or on Jan. 1, 2013. 2. Antipsychotic-related risk for diabetes People with schizophrenia who were antipsychotic naive at the time of diagnosis Follow-up : began on the date of first diagnosis of SPR ended on the date of DM diagnosis, emigration, death or on Jan. 1, 2013. “Bringing them back into the community, as fully accredited human beings” Position : Clinical lecturer, King's college, London Research interest : Schizophrenia, geriatric psychiatry, mood disorders Sensitivity analyses The Danish National Patient Register, since 1977 - ICD-8 : codes 249, 250 (until the end of 1993) - ICD-10 : codes E10-14, H36.0, O24, excluding O24.4 The Danish National Prescription Registry, since 1995 - Antidiabetic drugs available only by prescription Women age 20 or more treated only with metformin : excluded Study population Methods Background - Excluding 19 people who developed diabetes more than 12 months after the last prescription for any antipsychotics - Including women ages 20 or more years receiving treatment only with metformin (N=8,551) People with schizophrenia Conclusion A total of 14,118 (0.52%) Incidence rate - People without SPR (N=2,727,565) : 0.28 (95% CI 0.28-0.29) - People with SPR (N=8,945) : 4.29 (95% CI 3.74-4.92) The Danish Psychiatric Central Research Register, since 1969 - ICD-8 : code 295, excluding 295.79 (until the end of 1993) - ICD-10 : code F20 The Danish National Prescription Registry, since 1995 Included all incident schizophrenia cases since Jan. 1, 1996 - Impression : 데이터의 위력 - 우리에게는 심평원이 있다 - More to think about Potential confounders : obesity, smoking, diet, substance abuse … 어느 쪽의 surveillance가 더 활발할까 Risk associated with selected antipsychotics The Danish National Prescription Registry, since 1995 - All oral and depot antipsychotic prescriptions - Antipsychotics subdivided into 1st generation, 2nd generation, olanzapine, aripiprazole, clozapine Blood sugar studies in dementia praecox and manic-depressive insanity (Raphael, T. & Parsons, J. P., 1921) TCF7L2 & IGF2BP2 감사합니다

Transcript: a VCC Journal Club Presentation by Jake Kempt Minimizing General Anesthetic Use in Pediatric Radiation Therapy Overview Overview Authors Authors Stephanie M. Ntoukas BKin, RKin * Tatiana Ritchie BSc, MRT(T) * Susan Awrey BScN, RN * ^ Derek S. Tsang MD, MSc * ^ * Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada ^ Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada Research Topic and Goals Evaluate current approach to minimizing sedation Present GA utilization rates over an 8 year period Determine any predictive factors Research Topic and Goals Audience Healthcare professionals in radiation oncology RT centres treating pediatric patients Audience Journal ASTRO publication First published in January 2011 Impact factor = 2.794 Practical Radiation Oncology Analysis Analysis Patient eligibility Definition of GA use Process Baseline Characteristics Baseline Characteristics 779 Patients received 14,163 fractions (Jan. 2010 - Sept. 2018) Median age at RT = 10 Time from diagnosis to RT = 5 mo Craniospinal = 10.5 % TBI = 15.9% Non-Sedation Approach Non- Sedation Approach All patients were routinely offered these 9 interventions No record available to rank effectiveness of any given item Presence of a Dedicated Pediatric Nurse Orients patient and family to the department Nurse personally attends radiation planning sessions and at least the first treatment. Dedicated Pediatric Nurse Orientation Nurse offers patients and families tour of department and treatment areas Pictoral storybook Free mobile app Orientation Audiovisual Intervention A mobile television equipped with a portable DVD player was mounted on a medical utility pole with wheels Audiovisual Intervention Communication with Parents The parent(s) and their child could speak with each other via a two way audio microphone and speaker system. Communication with Parents Comfort Objects "My Radiation Buddy" Treatment Calendar Consistency of Treatment Staff Single treatment unit Every effort was made to keep staff consistent Consistency of Treatment Staff Dedicated Playrooms This playroom is equipped with toys, television and video games to help children feel at ease prior to daily RT Dedicated Playrooms Bribes "Reinfocing success" Toy chest Glow in the dark bravery bead Bribes Results Results 117 (15%) Patients received treatment either fully or partially under GA 1,819 fractions (12.8 %) delivered under GA GA rates for age 3 = 56.6 % GA rates for age 4 = 29.8 % Only 4 patients over the age of 6 required GA for treatment Statistical Analysis Statistical Analysis Logistic regression models created to assess the odds of requiring GA In a multivariate model, for every year increase in age, the odds of requiring GA decreased 3 fold ([OR] 0.33, 95% CI 0.26-0.42, p<0.0001) TBI and CSI techniques also represented statistically significant indicators for GA Discussion Very low GA rates (12.8%) over this 8 year period Age was the most statistically significant factor predictive of GA utilization 4 years old or greater considered cut off CSI technique complexity and commonly associated complications TBI treatment time Discussion Limitations Limitations Not able to analyze interventions independently Data on neurocognitive impairment not routinely available No data available on intrafraction motion Time considerations not addressed Unable to determine the effect of primary diagnosis or treated site because of co-linearity with other variables TBI technique Comparisons With Published Literature Comparisons With Published Literature Psychoeducational Intervention A Psychoeducational Intervention Reduces the Need for Anesthesia During Radiotherapy for Young Childhood Cancer Patients Haeberli, S., Grotzer, M.A., Niggli, F.K. et al. (2008). 223 pediatric patients treated at the University Children's Hospital of Zurich between February 1989 and January 2006 Feb 1989 - Feb 1999, 154 RT courses corresponding to 2580 RT fractions were applied with routine care Since then, patients in 90 RT courses corresponding to 1561 RT fractions received an individually tailored intervention Anesthetic rates dropped from 21.4 % to 8.9 % This represented a roughly 36% reduction in cost Audiovisual Intervention Audiovisual Interventions to Reduce the Use of General Anaesthesia with Paediatric Patients during Radiation Therapy Willis, D., Barry, P. (2010). From March 2007–May 2009, 37 pediatric patients aged 2–6 years were treated Patients could elect to (i) use a closed circuit TV system that allowed them to see their carer(s); (ii) watch a DVD movie; or (iii) listen to carer(s) on a microphone during their treatment. 24 children participated in A/V interventions, and 92% (n=22) of these children did not require the use of GA for some or all of their treatment Assessment Tool Thinking Differently About the Kids: An Innovative Approach to Improve Care Provided to Pediatric Patients Undergoing External Beam

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Description: Show the big picture, zoom in on details, and explain clearly how it all relates with this Prezi executive brief or Prezi nonprofit template. The lively image and bold colors make it easy to create compelling, engaging executive brief or nonprofit presentations.

Now you can make any subject more engaging and memorable

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Result for ' club '

59 Templates are available.

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Running club deck templates

Built-in custom color palette Creative slides Scalable vectorial PowerPoint shapes and PowerPoint icons Professional and unique slides High quality, editable pre-designed slides

Free Presentation Templates - Fitness club

Creative slides 4:3 aspect ratios Landscape orientation style Easily editable data driven charts (pie, bar, line)

Horse Riding club - Free Powerpoint Template

Modern, simple, and clean design Presentation photos are included; Landscape orientation style Easy color change

Free PowerPoint Backgrounds - club Djing

Easy to edit in PowerPoint Clean, modern, and creative slides Modern, attractive, and business-friendly colors Easily editable data driven charts (pie, bar, line)

club Djing - Best PPT Template Free Download

Drag & drop image placeholders Clean, modern, and creative slides Trend template Easy color change

Running club Easy PPT Template

100% fully editable PowerPoint slides Free images and artwork Easy color change

Running club Template Design

Modern, simple, and clean design Smart and innovative presentation slides Fully editable content (graphics and text) via PowerPoint - No Photoshop needed! 16:9, 4:3 aspect ratios High quality, editable pre-designed slides

Round of Golf powerpoint presentation download

Built-in custom color palette Color, size, shading etc. can be modified Modern and clean design Professional business presentation

Festival Moments PowerPoint Templates for Presentation

Easy to edit and customize Creative slides Easy editable data driven charts (pie, bar, line) No animation template Format: PowerPoint (.pptx) - designed with Microsoft PowerPoint 2016 Drag & drop friendly

Snowboard & Ski PPT Theme

Easy customization 100% fully editable PowerPoint slides Easy editable data driven charts (pie, bar, line) Easy color change Non-animated

Winter Sports PowerPoint Presentations

Creative slides Created by professionals Professional and unique slides Suitable for creative projects Created with high quality slides

Free Powerpoint Template - White Horse

Drag & drop image placeholders Presentation photos are included; All images included Clean style

Golf Wear ppt templates powerpoint template

Quick and easy to customize Presentation photos are included; Premade color variation Changable into PDF, JPG, and PNG formats Modern layouts based on master slides

Relaxing on the Field - Free PPT Template

Creative slides Trend template Standard (4x3) version of this template also available. Easy to change colors

A Horse and Horse-riding - Free Powerpoint Templates Design

Aspect ratio - 4:3 (normal) Format: PowerPoint (.pptx) - designed with Microsoft PowerPoint 2016 Modern, attractive, and business-friendly colors Easily editable data driven charts (pie, bar, line)

Free PPT Sample - Mountain-climbing People

Professional business presentation Landscape orientation style Format: PowerPoint (.pptx) - designed with Microsoft PowerPoint 2016 Clean style

Golfing Field - Free Powerpoint Template

Non-animated No animation template Modern, attractive, and business-friendly colors Standard (4x3) version of this template also available.

A Walk on Fall - Free Powerpoint Templates Design

Professional business presentation Drag & drop image placeholders Presentation photos are included; Easy color change

A Professional Golfer - Free Powerpoint Templates Design

Free images and artwork Landscape orientation style Clean, modern, and creative slides Standard (4x3) version of this template also available.

Free Powerpoint Template - Mountain Clumbing on a Sunny Day

Trend template Image placeholders Latest Templates support version Easy color change

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