Following on from the first episode a number of trainees and trainers in the school were involved in discussion about the journal club and how it could work most effectively. As a result we have come up with following structure to our Journal Club.

Recommended text: “How to read a paper: the basics of evidence based medicine and healthcare” by Prof Trish Greenhalgh (2019) Wiley-Blackwell (e-book ISBN: 978-1-119-48472-1 , paperback ISBN: 978-1-119-48474-5) We are recommending a text to support the journal club, because it has stood the test of time and is well evaluated. Trish Greenhalgh is a professor in primary care at Oxford University and a recognised leader in the field of evidence based practice. Her book has recently been updated to a sixth addition. It is designed to be an introduction to critical reading of the medical literature and use of critical skills in evaluating evidence to answer clinical problems. It is available as a paperback around £30 but is also available for around £18 in e-book format which can be read on the free kindle app which can be downloaded. This has the added utility that you can cut-and-paste selections of the material, create flashcards, make notes - which would make useful reflective notes for exam preparation, Continuing professional development or training portfolios.

A curriculum of sorts: The plan will be to use the different sections of the Greenhalgh book as a form of curriculum for the journal club that can run over about a two year period in support of the activities that are undertaken. The plan is not to slavishly follow the book but to use different sections in chapters to underpin the paper being considered each month. For episode 2 the following sections are particularly relevant:

Chapter 2 Searching the literature 16 - 22 & 27

What are you looking for? 17

Levels upon levels of evidence 18

Synthesised sources: systems, summaries and syntheses 19

Pre‐appraised sources: synopses of systematic reviews and primary studies 22

Exercises based on the chapter 27

Chapter 9 Papers that summarise other papers (systematic reviews and meta‐analyses) 117 - 133

When is a review systematic? 117

Evaluating systematic reviews 120

Meta‐analysis for the non‐statistician 125

Explaining heterogeneity 130

New approaches to systematic review 132

Exercises based on the chapter 133

Hosts: Each session will be co-hosted by 2-3 trainees: as main presenter and analyst. The co-hosts for the following club will be decided before each event. This month Jamie Slack and Amy Bonavia are co-hosts, with an introductory review of further work on Remdesivir presented by Ina Schim van der Loef. Ref: Beigel JH, Tomashek KM, Dodd LE, et al.

Remdesivir for the treatment of Covid-19 — preliminary report.

N Engl J Med.DOI:10.1056/NEJMoa2007764 

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

Training in critical appraisal/evidence based reading: The first half of each session may incorporate review of outcomes from the previous meeting where appropriate, but will focus mainly on review of an aspect of critical appraisal in the broadest sense. This will aim to cover aspects of critical appraisal of general value but also of relevance to the paper being considered that month. 

Paper for pre-reading and analysis: Each month the co-hosts will choose a paper for the next meeting. This will be chosen to illustrate a particular aspect of critical /evidence-based reading. That will be the basis for the next pair of hosts to lead the subsequent journal club.

Critical Appraisal Tools (CAT): Where possible we will provide links to critical appraisal tools. These are intended to aid analysis of the given paper in a structured manner. For episode 2 there is a CAT for systematic reviews which can be accessed via the following link: https://www.cebm.net/wp-content/uploads/2019/01/Systematic-Review.pdf

Information: We will wherever possible provide links to articles for consideration, plus an appropriate template for undertaking a critical appraisal of the paper. Some journal articles may not be available for free without specific access to that journal or via a institution login. Occasionally there will be supporting information relevant to aspects of the following month’s journal club. There will be links to the relevant sections of the Greenhalgh book to focus on in a particular episode, plus any other activities relevant to the first half of the journal club ( eg undertake a search of a database, create a clinical question, undertake a power calculation)

Opinions expressed in this podcast are based on the principles of evidence based medical practice, but are the individual's opinions and not those of the School of Paediatrics. Listeners are strongly advised to come to their own conclusions, based on the evidence.

Welcome to the first episode of the Northern School of Paediatrics Journal Club podcast. This was established in May 2020 as it became clear that there would be no rapid solution to the Covid-19 crisis. It was becoming challenging to continue with the usual training activities that we would deliver as a postgraduate school of paediatrics, and we wanted to have some form of activity that brought trainees in the north east of England together in a shared training environment.

After discussion amongst trainees and trainers we felt that a journal club, operated virtually using the rapidly improving video conferencing facilities that were becoming much more familiar to everyone, was something that there was an appetite for. We are a training school with trainees working in widespread geographical settings, and this was something that appealed to trainees based on feedback provided before lockdown began.

The first journal club was held in May 2020 and it was decided to look at an important early paper to emerge from China that showed how the world had turned upside down in such a short a space of time.The study reported was conceived in early January 2020, patients were recruited from late January through to April, and the paper was published at the end of April 2020 (in the new normal of pre-print un-peer reviewed early publication). By the end of May 2020 it was out of date as new, more definitive evidence emerged from studies in Europe and North America.

The podcast is comprised of an introduction and discussion of approaches to critical appraisal of randomised controlled trials, followed by review of the paper : "Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial"

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext

There is a critical appraisal tool (CAT) from the Centre for Evidence Based Medicine in Oxford, designed to help you analyse a paper describing a randomised controlled trial, which was the basis for the discussion during the podcast. https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf

We believe that evidence should be the basis for rational clinical decision making. It has been in some parts reassuring to see the level of discussion of evidence that has emerged at times during the Covid-19 crisis, and at other times deeply worrying that strong wills and opinions , even within scientific circles, often lead to poor decision making, despite there being evidence that counteracts those opinions. We hope this podcast can be a small beacon of light (or as an audio medium maybe that should be a foghorn sounding in the night), helping listeners develop a their personal skill set in reading the medical literature and considering their own potential to contribute to work that increases knowledge and understanding.

The podcast is edited to try and provide a sense of the way the journal club ran on the day. The recording was undertaken using a Presonus Firestudio Mobile digital audio workstation. Some of the dialogue was recorded using an MXL 990 condenser microphone, but some of the contributions were recorded directly from the Microsoft Teams stream, which led to some variable sound quality at times.

Opinions expressed in this podcast are based on the principles of evidence based medical practice, but are the individual's opinions and not those of the School of Paediatrics. Listeners are strongly advised to come to their own conclusions, based on the evidence.