Tuesday, 30 October 2007

Changes to this Blog

I have decided to make some changes to the design of the blog page and I hope that it is now easier to read than before.

This new format should now fit the entire page of your computer and the text should be easier to read than before.

I have also removed the restrictions on this site for posting comments. You no longer require a Gmail account and you can simply post a comment although all comments will be reviewed by me, the site moderator! :)

Be warned, I will only publish comments that are relevant to this site and not comments for people wanting me to advertise their books in America !

Please pass any feedback to me on how I might be able to improve this site in future.

Monday, 29 October 2007

Navy Meeting II: Journal Club

Last night we were invited to the US Navy base in Yokosuka to partake in their alternate month Journal Club.

We started the session with delicious American pizza with some refreshing beverages followed by the presentation of two recent journal papers.

The first paper was presented by one of this years interns and it featured the topic of male circumcision for the prevention of HIV transmission. This idea was put forwards over 20 years ago when HIV was first discovered but for some reason it has taken until now to have been taken seriously. The results of the paper and several others show a 50-60% reduction in HIV transmission rates simply by circumcising men. This, apart from condom use and total abstinence, is probably one of the major factors identified for reducing HIV transmission in sexually active men.

The second paper featured the topic of obstructive sleep apnoea-hypopnoea in children. The paper discussed about adenotonsillectomy aiding children who have the OSAH problem and where diagnosis with polysomnography can be helpful to determine those patients who require surgery and those who do not.

Both papers were quite long and somewhat complicated even for natural English speakers, but both Navy interns did remarkably well and spoke very eloquently with congent perspectives on the papers.

The US and British style of Journal club activity is more combative in style with questions and opinions being thrown at each other to see what other peoples opinions are in return. In a UK or USA type journal club setting, the opinion of the person presenting the paper should also be heard.

For example, the presenter may agree with the paper's findings or on the other hand, they may find other errors with the paper and disagree with the findings. Just by conveying the Author's opinions is not enough. As doctors, we can all read a paper and appraise it ourselves without a presenter.

The purpose of the presenter is to compare, contrast and constructively criticise the quality of the paper. There are many papers produced each year, some with dubious results, each trying to persuade us to change our practise in some way or other. If we were to believe everything we read then we would be pushed and pulled in sorts of directions and not necessarily the right ones.

A journal club is there to try and concentrate the presenter to give his or her opinion why they agree or disagree with the findings and then to justify that opinion. It is not always the best way to just agree with the Authors of a paper as the Authors may be wrong and have come to the wrong conclusions. It is sometimes good to be critical because as doctors we are presented with information from drug companies each and everyday who are trying to get you to use their drug and convincing you that their drug is the best for a particular condition.

When they provide you with the 'evidence based papers' you need to be critical of such studies and try and find other studies that agree or disagree with such findings. It is a real problem because drug company studies are generally funded by the drug companies themselves and they sometimes are in control of the data collection and analysis-- this is a gross conflict of interest that the medical professional has little power to do anything about. Hence, it is sometimes dubious as to whether we can believe the findings of such papers. Therefore, the purpose of a Journal club is to teach you how to critique a paper and how to pose questions to those who produce a paper or to drug representatives.

Asking drug reps how and why we should use their drugs and what evidence they have is not something to shy away from. When we use new a treatment we need to know that it works, it is better than the previous treatment, that it does not harm the patients and if it is more expensive than before, that it is going to prove cost effective and actually make a clinically significant difference in the long run.

Hence, a Journal club is not just a nice meeting for a friendly discussion, it is a serious thing that can teach us all a great deal and it is great to hear other peoples opinions even if they are different from our own.

These meetings are proving to be very helpful and provide an insight on how matters are discussed differently among different cultures.