... over 626 reviews and counting...

Background and Goals

The practice of health care - and pediatric critical care is no exception - cannot be accused of being systematic and consistent when it comes to determining diagnoses, prognoses, or therapies. Why we do what we do for our patients often stems from a hodgepodge of our education, intuition, and experience. Perhaps too frequently we rely upon the opinions of experts and not enough upon critical analysis of the medical literature.

There is a growing movement in health care, broadly known as evidence-based medicine, that simply suggests we use the best evidence available in our medical decision making. Ideally, this evidence will come from appropriately designed clinical trials of sufficient rigor and statistical power that enable extrapolation of results with confidence to our patients.

We have no shortage of important clinical questions, ranging from issues like the appropriateness of regular central venous catheter changes to the efficacy of high-frequency ventilation in hypoxemic respiratory failure. Many such issues have been approached with clinical trials published in a variety of peer-reviewed medical journals. The ability of such investigations to adequately answer these pressing questions varies greatly. How do we find out about such reports, and more importantly, how do we properly evaluate them?

The PedsCCM Evidence-Based Journal Club hopes to help by regular publication of critical reviews of clinical trials pertinent to the practice of pediatric critical care. The goals of this publication are:

• To bring to the attention of the pediatric critical care community important and timely publications of clinical trials
• To provide critical analyses of such trials in a systematic fashion
• To encourage this evidence-based approach to the medical literature and to our care of patients

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Operational Issues

The PedsCCM Evidence-Based Journal Club will present critical reviews of clinical trials based upon The User's Guide to Medical Literature(now no longer available from The Canadian Centres for Health Evidence). These reviews will take full advantage of hypertext links to this excellent resource on evidence-based medicine, as well as links both locally and around the Internet to provide appropriate background on the methodology and statistical issues raised. Each review will be peer-reviewed by two of the PedsCCM EB Journal Club editors

Papers will be categorized as trials relating to:

• Prognosis
• Therapy/Prevention
• Harm
• Clinical Practice Guidelines
• Diagnosis
• Overview (Systematic Review)

And some studies may be best appraised using the following:

• How to Use an Article Measuring the Effect of an Intervention on Surrogate End Points. Heiner C et al. JAMA 1999; 282: 1371-1377. [full-text]
• Understanding articles describing clinical prediction tools. Randolph AG et al. Crit Care Med 1998;26:1603-1612. (not online)
• and others as appropriate...

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How to Participate

As with all of PedsCCM, the Evidence-Based Journal Club is intended to be a fully collaborative project. Readers are strongly encouraged to participate in one of the following ways:

To participate by:
• Suggesting a trial for review
• Signing up to write a full review of Trials Awaiting Review

  Use the EB Journal Club Sign Up Form

  NOTE:
  • Fellowship programs in Pediatric Critical Care are especially encouraged to participate; see the invitation for details

To contribute by:
• Providing feedback or comments on an existing review that will appear in a Comments section to accompany each critique
• Sending in your general feedback about this endeavor

  Use our Comment Form or e-mail the editors

  NOTE:
  • Feel free to begin or participate in a discussion of a trial or its review on The PICU list
  • If you'd like your comments recorded in the accompanying Discussion section, please "cc" one of the editors or clearly state in your comments to the list that your words may be reprinted here.

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Chief Editors

Barry Markovitz, MD MPH

Director, Critical Care Medicine

Anesthesiology Critical Care Medicine

Children's Hospital Los Angeles

USC Keck School of Medicine

e-mail: markovitz@pedsccm.org

Adrienne G. Randolph, MD, MSc
Children's Hospital
e-mail: Adrienne.Randolph@TCH.Harvard.edu

Co-editors:

Kathleen Meert, MD

Children's Hospital of Michigan

e-mail: kmeert@med.wayne.edu

Scot Bateman, MD

University of Massachusetts Medical Center

e-mail: BatemanS@ummhc.org

Mona McPherson, MD, MPH

Texas Children's Hospital

email: mlmcpher@TexasChildrensHospital.org

Al Torres, MD, MS

Nemours Children's Hospital

e-mail: atorres@NEMOURS.ORG

Kathleen Ventre, MD

Denver Children's Hospital

e-mail: kathleen.ventre@ucdenver.edu

Satid Thammasitboon, MD MHPE

Baylor College of Medicine and Texas Children's Hospital, Houston TX

e-mail: satidt@bcm.edu

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How to cite a review in the PedsCCM EB Journal Club (in a manuscript, cv, etc)

Author_last_name, initials. Critical appraisal of: Original_article_citation. In The PedsCCM Evidence-Based Journal Club, date published (can obtain from the review on the website). Available at full URL (copy and paste the URL from the address bar at the top of the page). Accessed date (the date you last accessed the review on the website)

For example:

Sehgal M. Critical Appraisal of: Smulders K, van der Hoeven H, Weers-Pothoff I, Vandenbroucke-Grauls C. A Randomized Clinical Trial of Intermittent Subglottic Secretion Drainage in Patients Receiving Mechanical Ventilation. Chest 2002;121: 858-862. In The PedsCCM Evidence-Based Journal Club, February 2, 2004. Available from: http://pedsccm.org/view.php?id=193. Accessed February 13, 2004

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Last Updated: 2012-01-27 09:58:26