Journal Club by CanadiEM E01: Meet the Team

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Journal Club by CanadiEM is a podcast designed to help medical learners at all stages of training develop the skills necessary to properly appraise, interpret, and apply medical research to the practice of Emergency Medicine, all in the spirit of evidence based medicine. 

Hosts 

From the West to the East coast:

  • Dylan Collins – 4th year medical student at the University of British Columbia in Vancouver 
  • Levi Johnston – Family Medicine R2 at the University of Calgary 
  • Dakoda Herman – 4th year medical student at the University of Toronto
  • Jake Domm – 3rd year medical student at Dalhousie University in Halifax
  • Jayneel Limbachia – Ethnic Diversity researcher (MSc), McMaster University

Clinical Case 

You are asked by your preceptor to see a 25-year-old male who is complaining of right ankle pain after rolling it during a soccer game. He was able to weight bear both immediately and in the ED, but he does have bony tenderness over his medial malleolus. Should you obtain an ankle x-ray series? 

  • The Ottawa Ankle Rules were developed to help answer this question. Can we apply them to this patient? 
  • What if the patient was 11 years old or 90 years old? What if they were intoxicated or pregnant? 
  • How were the Ottawa Ankle Rules developed and can we trust their validity? 

Clinical Pearl – Ottawa Ankle Rules 

While the primary goal of our podcast is to focus on the fundamentals of evidence-based practice in general, we will be sure to include clinical pearls that are relevant to emergency medicine in each episode. 

For this introductory episode, let’s take this opportunity to review the Ottawa Ankle Rules. The Ottawa Ankle Rules were developed by Dr. Ian Stiell and his team from the University of Ottawa. It is a clinical decision rule that can be used to determine the need for diagnostic imaging for ankle and/or foot trauma. 

  • Sensitivity: 96.4 to 99.6 percent
  • Specificity varies widely: 10 to 79 percent
  • Reduces the number of unnecessary radiographs by 30 to 40 percent

Source: Maughan, KL. Ankle Sprain. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2020.

An ankle X-ray series is only required if there is any pain in the malleolar zone AND…

  1. Bone tenderness at the posterior edge or tip of the lateral (A) 

OR

2. Bone tenderness at the posterior edge or tip of the medial malleolus (B)

OR

  • An inability to bear weight both immediately and in the emergency department for four steps
Diagram

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 A foot X-ray series is only required if there is any pain in the midfoot zone AND…

  • Bone tenderness at the base of the fifth metatarsal (C)

OR

  • Bone tenderness at the navicular (D)

OR

  • An inability to bear weight both immediately and in the emergency department for four steps
Diagram

Description automatically generated

Clinical judgment should prevail over the rules if the patient:

  • Is intoxicated or uncooperative 
  • Has other distracting, painful injuries 
  • Has diminished sensation in their legs 
  • Has gross swelling which prevents palpation of the malleolar bone tenderness

If the patient can transfer weight twice to each foot (four steps), he or she is considered able to bear weight even if he or she limps. 

Our Approach to the Journal Club Podcast 

In the true spirit of Evidence Based Medicine, we will be using the learning objectives found in the article, Core Competencies in Evidence-Based Practice for Health Professionals, by Loai et. Al, published in JAMA on June 22, 2018, to help structure our initial podcasts. 

Please refer to Table 2 in this paper for a complete set of the Evidence-Based Practice (EBP) core competencies. In this episode, we would like to briefly highlight the following items. 

Understand EBP defined as the integration of the best research evidence with clinical expertise and the patient’s unique values and circumstances. 

Our first five core content episodes will cover an approach to appraising and interpreting the five main different types of research studies, including:

  1. Treatment studies 
  2. Systematic reviews
  3. Diagnostic accuracy studies 
  4. Prognostic studies 
  5. Qualitative studies 

The 5 Steps of EBP are as follows 

  1. Ask a clinical question.
  2. Acquire relevant evidence. 
  3. Appraise and Interpret the gathered evidence.
  4. Apply the best available evidence to clinical practice.
  5. Evaluate individual-level barriers to knowledge translation and recognize the process of reflective clinical practice. 

Prepping for Journal Club 

  1. Core Competencies in Evidence-Based Practice for Health Professionals by Loai et. Al. 
  • Albarqouni L, Hoffmann T, Straus S, et al. Core Competencies in Evidence-Based Practice for Health Professionals: Consensus Statement Based on a Systematic Review and Delphi Survey. JAMA Netw Open. 2018;1(2):e180281. doi:10.1001/jamanetworkopen.2018.0281
  1. Sketchy EBM at http://www.sketchyebm.com/
  2. How to Read a Paper: The Basics of Evidence-Based Medicine by Trisha Greenhalgh
  3. The Centre for Evidence-Based Medicine at https://www.cebm.net/
  4. Stay tuned for our upcoming podcasts! 

Produced by Dr. Kevin J Dong

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Jakob Domm

Jakob Domm

Jake is a 3rd year medical student at Dalhousie Medical School. He has interests in EM and research, completing his MSc. at Guelph University in pathobiology. Outside of medicine, Jake enjoys crossfitting with his wife and hiking with their dog.
Jakob Domm
- 1 month ago