JOURNAL CLUB article presentation .pptx

Jounarl club

1. JOURNAL CLUB DR. TURYABAHIKA ARINDA LINDA 15/09/2020.

2. OBJECTIVES INTRODUCTION AND SUMMARY. RELEVANCE OF THE ARTICLE. CRITIQUE REPLICABILITY TAKE HOME MESSAGE

3. RANDOMIZED CONTROL TRIAL COMPARING AN ALVARADO SCORE-BASED MANAGEMENT ALGORITHM AND CURRENT BEST PRACTICE IN THE EVALUATION OF SUSPECTED APPENDICITIS. In their article, basing on the current management of suspected appendicitis in their hospitals being surgeon dependent ; basing on the individual’s clinical acumen, preference for CT scan and threshold for surgery, posed a significant radiation exposure concern particularly in young patients most susceptible to getting appendicitis. The RCT was carried out in Singapore in 02 hospitals; Acute Care Surgery Service of Singapore General Hospital and Sengkang General Hospital, and targeted patients aged between 16 and 80 years with a diagnosis of suspected appendicitis.

4. C’TD In a prior publication, the Alvarado Score (AS) had been validated on 500 consecutive cases of suspected appendicitis. Comparing the diagnostic performance measures of CT scan with the AS, there were ranges where patients are unlikely to benefit from CT evaluation. Based on these findings, an algorithm for the management of suspected appendicitis guided by the Alvarado Score was formulated. The aim of the algorithm was to guide CT utilization and reduce the number of CT scan with an acceptable negative appendicectomy rate.

5. RELEVANCE Appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention, with a lifetime risk of 8.6% for males and 6.7% for females. In this modern era of diagnostics, negative appendicectomies are no longer the norm, and with our patient population becoming continually exposed to information online, knowing the different medical approaches to diagnoses and management can lead to law suits and reprimanding should we be careless.

6. Relevance c’td Clinical examination coupled with the ALVARADO SCORE are the basic assessment means we use at our emergency room. Supplemented by imaging-more commonly the ultrasound scan (which is operator dependent) to further confirm the diagnosis, c/f Ct scan which is not often used here. The article aids in us comparing the situation here at Nsambya hospital with that in a general hospital of a developed hospital to provide means of stepping up our diagnostic process.

7. C’td The research failed to demonstrate any difference in terms of its primary outcome of a reduction in CT utilization, and neither were there any differences in the missed diagnoses, negative appendicectomy rates, length of stay and cost of stay. >> this proves that with clinicians’ acumen and good examination skills (in-cooperating the Alvarado score in assessment) can sufficiently diagnose acute appendicitis, and this can be supplemented by radiology imaging (? Usscan vs ct scan) Doing more diagnostic laparoscopies (with appropriate interventions)

8. CRITIQUE TITLE ; >> STRENGTHS; It is precise and concise able to comprehensively to give details of entire project including content of work, study population, no jargon or buzz words. Weakness; “current best practice” was meant to challenge the use of CT scan in the diagnosis of appendicitis and it is not brought out clearly

9. ABSTRACT Strengths Abstract contains 255 words that are recommended for a journal. It is structured ( IMRAD ) with subtitles to guide the reader It is informative enough and precise.

10. INTRODUCTION >> STRENGTHS Briefly insights on the condition appendicitis, the origin of the study and problem that is trying to be addressed. Explains the “current best practice” Explains how the study was going to influence the diagnosis of appendicitis and reduction in radiation exposure by offering an algorithm to select who gets a CT SCAN.

11. METHODOLOGY >> STRENGTHS ; RCT design was appropriate for the study. Study area mentioned Study population stated Inclusion and exclusion criteria stated Sample size mentioned Intervention and control arm clearly stated Sampling procedure mentioned Informed consent was sought Prospective study >>WEAKNESS- Data collection tool on socio demographic and other independent variables not clearly stated, though other pre, peri and post data tools were stated

12. RESULTS AND DISCUSSION STRENGTHS; Appropriate display of results in tables, and flow diagrams. Stating the influencers in the study Stating their limitations

13. GENERAL OBSERVATION of the article Was unable to achieve its aim, because of surgical preference of surgeons, and also patients’ preference to have a CT scan done rather than risk a negative surgery. Brought out the alternative of limited range CT (from top of L2 to the symphysis pubis) which has shown promise among the pediatric patients with close to 50%reduction in exposed radiation, although this could not be applied to adults. Low dose CT (2-4mSv) is a more promising alternative, with recent studies indicating performance characteristics comparable to those of standard CT(8-10mSv)

14. TAKE HOME MESSAGE CLINICAL ACUMEN IS PARAMOUNT in the diagnosis and management of appendicitis (as other surgical conditions) Application of the Alvarado score aids in confirmatory diagnosis of the condition as well as radiological investigations Though abdominal ultrasonography is protocol here in Nsambya Hospital, in most developed countries the CT SCAN is used more often. We could occasionally opt for it as a means for a diagnosis

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