Journal club presentation in Otorhinolaryngology

JOURNAL CLUB IMPORTANCE IN MEDICAL EDUCATION
PART 1 (approx 1000 words)
Journal Club (JC) is one of the oldest, most enduring, academically rich traditions in medical education. It is considered a backbone element in residency training programs worldwide because Journal Clubs operationalize the very essence of Evidence Based Medicine (EBM) inside routine postgraduate teaching. While formal lectures transmit established knowledge, Journal Clubs train the future clinician to question, critique, analyze, filter and use knowledge realistically. The ability to interpret research correctly is not an inherent skill — it must be trained, and Journal Clubs represent that academic gymnasium where this skill is built repeatedly, longitudinally and collaboratively.
Historical Context and Evolution
Journal Club originated in the 19th century and is credited to Sir William Osler, who initiated organized group discussion of journal articles at McGill University and Johns Hopkins. Although the structure of Journal Clubs has evolved, the central philosophy remains constant: clinicians must not consume research passively; they must interrogate and evaluate it. In modern medical training, where information explosion, digital access, preprints, rapidly evolving evidence and constant practice-changing data are the norm, Journal Clubs have become even more central, not less.
Why Journal Club is crucial in Medical Education
Teaches Evidence Based Medicine (EBM)
Medical practice today is required to be EBM based. Journal Clubs teach how to locate evidence, categorize it in EBM hierarchy, interpret data correctly and translate that evidence into clinical decision making. Merely reading guidelines is insufficient because guidelines themselves are based on evolving literature. Journal Clubs teach how to process primary literature directly and not be dependent entirely on expert opinion.
Critical appraisal skill building
Journal Clubs teach residents how to recognize weak methodology, inappropriate statistical interpretation, bias, confounding, unethical conclusions, sponsor influenced outcome reporting and poor study design. These are the core skills that differentiate an average clinician who only knows “what the study said” versus a clinically excellent consultant who knows “if the study is actually valid for my patient population.” This higher-level critical appraisal is impossible without systematic training — and Journal Clubs provide exactly that training.
Passive reading vs Active reading conversion
New PGs tend to read like undergraduates — absorbing information without interrogation. JC forces active reading. One must summarize, critique, and defend interpretation. This transitions a doctor from information memorization mode to analytical reasoning mode.
Bridges Research and Clinical Practice
Journal Clubs connect the bench with the bedside. When residents analyze clinical trials, meta-analyses, cohort studies or translational research — they begin to see how rese

1. JOURNAL CLUB DR. KAVERI B P MODERATOR - DR. GITANJALI JOURNAL TITLE : Treatment of Post-Tonsillectomy Hemorrhage With Nebulized Tranexamic Acid: Initial Investigation of a Novel Therapeutic Modality

2. AUTHORS : Matthew Maksimoski, MD - Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA Matthew McCauley, MD - Department of Emergency Medicine, Northwestern University, Chicago, IL, USA Muyinat Osoba , MD- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA Matthew Pirotte ,MD - Department of Emergency Medicine, Northwestern University, Chicago, IL, USA Whitney Liddy , MD - Department of Emergency Medicine, Northwestern University, Chicago, IL, USA JOURNAL NAME : Annals of Otology , Rhinology and Laryngology

3. INTRODUCTION: Tonsillectomy with or without adenoidectomy - Most common surgical procedure While most patients experience post-operative pain, post-tonsillectomy bleeding (PTB) is a far more worrisome and serious complication. Various studies have shown a prevalence rate of PTB ranging from 1% to 10% overall for adult and pediatric patients If bleeding is unable to be controlled at the bedside, operative control is required for hemostasis, necessitating repeat incubation, and general anesthesia for airway protection.

4. INTRODUCTION: Traditional methods include topical vasoconstriction, pressure,and chemical cautery. However, these modalities are limited by trans-oral access, patient gag reflex, visualisation, physician experience, and patient compliance. As such, 40% to 80% of patients presenting to the hospital for PTB require operative control in addition to these more conservative bedside interventions. Tranexamic acid (TXA) is a lysine analog that prevents conversion of plasminogen to plasmin, thus reducing clot breakdown and increasing hemostatic capacity.

5. INTRODUCTION: TXA is approved by the Food and Drug Administration (FDA) as an intravenous formulation for trauma and postpartum haemorrhage, although off-label uses have been described for intraoperative control of blood loss and topically for control of bleeding from the skin,in the nasal cavity, and in the oral cavity. Nebulization for delivery of TXA has been well-described in the literature for control of massive pulmonary hemorrhage. The current study evaluates preliminary efficacy and outcomes data for the use of nebulized TXA for post-tonsillectomy hemorrhage at a single tertiary center.

6. AIM : This study examines whether tranexamic acid resulted in change of operative intervention necessity and narcotic utilisation.

7. METHODOLOGY Study Setting :Northwestern University Study Duration :3/1/2018 and 7/1/2020. Study Participants: Patients who presented to the hospital for post-tonsillectomy bleed Study Design : Retrospective cohort study Sample Size : 21

8. INCLUSION CRITERIA Patients who presented to the hospital for post-tonsillectomy bleed matching into any of the following codes

9. EXCLUSION CRITERIA Cases that are not truly post tonsillectomy haemorrhage. Cases lacking complete patient records.

10. DATA COLLECTION Data collected included demographic information, interventions used for hemostasis, presence of further operative interventions, and need for further pain medication prescription following control of hemorrhage and discharge from the hospital. Opioid usage was calculated as milligram morphine equivalents per hour of admission.Anesthetic usage of opioids was excluded from final analysis to isolate opioid use related to pain. Additionally, length of admission, return to the emergency department, and complications were noted.

11. TXA was nebulized using a 100 mg/mL concentration with 500 mg total of medication (5 mL) which was nebulised using 6L of oxygen through a nebulizer attached to a face mask and secured to the patient's face. The nebulization takes 10 to 15 minutes to be completed. The collected patient information was reviewed and statistical analysis was performed using SPSS statistical software. Specifically, Fisher's exact test, 2 sample t test were used for statistical analysis of the data.Level of significance was set at p< 0.05. DATA ANALYSIS

12. RESULTS

13. RESULTS A total of 21 patients were identified who presented a total of 23 times with bleeding events. Age range of patients was 18 to 54 years old. Operative intervention for hemostasis was necessary in 8 patients (47.1%) not receiving TXA and none (0.0%) of the patients treated with TXA nebulizers.Absolute risk reduction was 47.1% and relative risk reduction was 100%.

14. RESULTS Opioid usage was calculated as milligram morphine equivalents per hour of admission. Evaluation of pain medication use showed statistically significant differences between the 2 groups in regards to the need for opioid prescription refills. In patients primarily treated with nebulized TXA, 0.0% of patients required opioid refills, versus 70.6% (P=.010) in the group without nebulized TXA as an intervention. Separate analysis showed no significant difference in pain medication usage when analysed by sex, age.

15. DISCUSSION The primary purpose of this retrospective study was to evaluate control rates for post-tonsillectomy bleeding with nebulized TXA versus other interventions, with a secondary aim to compare pain outcomes for the 2 groups. Nebulizing TXA leads to expansive coverage throughout the upper aerodigestive system and is a non-invasive way of providing contact with the solution to any open wound in this location. The benefits of this choice of treatment at the bedside include the lack of an invasive procedure with increased patient comfort and prevention of the placement of foreign bodies into the oropharynx, which could lead to aspiration risk or other injuries.

16. DISCUSSION However, this is an off-label utilization of TXA (similar to its use for pulmonary hemorrhage) and important patient counseling should be undertaken by the treating physician prior to its use. Although this study population is small, the significant reduction in need for surgical control of hemorrhage in the TXA group, along with the demographic similarities to other post-tonsillectomy study populations in the literature, supports consideration of wider application of this treatment modality outside of this institution, at least in the adult population.

17. DISCUSSION Considering tonsillectomy is much more common in pediatric patients, a treatment modality that is non-invasive is particularly appealing for the potential reduction in significant psychosocial stress, which has been proven to impact long-term utilization of medical care throughout adulthood. Opioid use and general anaesthesia in childhood have both been shown to have significant long-term effects on the lives of patients. Based on these conclusions , nebulized TXA is in alignment with these goals.

18. CONCLUSION The study supports nebulized TXA as an effective, non-invasive mode of hemostasis in patients presenting to the emergency department for post-tonsillectomy hemorrhage. Nebulized TXA may prevent the need for general anesthesia and operative intervention. Otolaryngologists should consider addition of this novel treatment appropriation of TXA to their management options for postoperative tonsillar hemorrhage.

19. LIMITATIONS SMALL SAMPLE SIZE UNI - CENTRIC STUDY UNMATCHED STUDY - RETROSPECTIVE COHORT STUDY

20. REFERENCES Windfuhr JP, Chen YS. Incidence of post-tonsillectomy hemorrhage in children and adults: a study of 4,848 patients. Ear Nose Throat J. 2002;81(9):626-628, 30, 32 passim. -Collison PJ, Mettler B. Factors associated with post-tonsillec-tomy hemorrhage. Ear Nose Throat J. 2000;79(8):640-642, 4,6 passim. -Deitmer T, Neuwirth C. 105 cases of post-tonsillectomy hem-orthage revisited. Laryngorhinootologie. 2010;89(7):424-428. -Kim DW, Koo JW, Ahn SH, Lee CH, Kim JW. Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx. 2010;37(4):456-460. -Myssiorek D, Alvi A. Post-tonsillectomy hemorrhage: an assessment of risk factors. Int J Pediatr Otorhinolaryngol.1996;37(1):35-43. -Walker P, Gillies D. Post-tonsillectomy hemorrhage rates: are they technique-dependent? Otolaryngol Head Neck Surg.2007;136(4 Suppl): S27-S31.

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