Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills? / 전남의대학술지

This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.

Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills? / 전남의대학술지

This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.

55-year old man with acute painful flank mass, a case report

Lumbar hernias [LH] accounts for less than 1.5% of total hernia incidence. It can occur in two separate triangular areas of the flank. About 300 cases have been reported in the literature. Here, we report a 55-year old man with acute painful left side flank mass and final diagnosis of LH. The mass was appeared about three hours before admission and his pain was slight at first but became more severe gradually. He had stable vital sign and the only positive finding on his physical examination was the sphere shape, firm, mobile, and mild tender mass at his left flank

effects of gluten-free diet on hypertransaminasemia in patients with celiac disease

Celiac disease [CD] is an immune mediated condition that leads to small bowel atrophy that resolves with a gluten free diet [GFD]. Extra-intestinal manifestations of CD include hypertransaminasemia. In this study, the effects of a GFD on hypertransaminasemia in patients with newly diagnosed CD were studied. Ninety eight new diagnosed consecutive patients with CD 40 males and 58 females] with mean age of 32 +/- 17.1 were studied. All patients with CD were treated with a GFD. Patients with hypertransaminasemia, at diagnosis, had a cirrhosis screen performed. Patients with a negative cirrhosis screen were reviewed, 6 months after the introduction of a GFD, and serum levels of liver transaminases were measured again. Nine patients had hypertransaminasemia. One patient was Hepatitis B surface antigen positive and was excluded from this study. The 8 remaining patients had no obvious cause for the hypertransaminasemia. Mean [ +/- SD] of baseline aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels were 42.6 +/- 16.5 IU/L [range: 16-66 IU/L] and 69.3 +/- 9.3 IU/L [range: 52-81 IU/L]. Six months after treatment with a GFD, mean AST and ALT levels decreased to 24.5 +/- 5.1 IU/L [range: 18-31 IU/L] [P: 0.04] and 24.6 +/- 6 IU/L [range: 17-32 IU/L] [P: 0.01], respectively. In 7 patients the hypertransaminasemia, at diagnosis had resolved. This study provides further evidence that some patients with CD have a reversible hypertransaminasemia that resolves with a GFD

Comparing the efficacy of alpha-interferon and lamivudine in patients with chronic hepatitis B

Hepatitis B virus [HBV] infection is a worldwide health concern. Alpha-interferon and lamivudine have been approved for HBV patients; however, their efficacy remains a matter of controversy. The present study compares these two antiviral regimens in a group of Iranian patients with chronic hepatitis B. It was a randomized controlled clinical trial. Totally, 32 newly diagnosed hepatitis B patients were assigned in 2 groups of lamivudine [100mg per day orally] and alpha-interferon 2a [9 million units every other days subcutaneously]. Both groups were evaluated at weeks 0,1,2,4, and monthly after till the 6[th] month at Tehran Hepatitis Center. HBV DNA, HBeAg, anti-HBe, ALT activity, liver biopsy according to Knodell scoring system and drug side effects were determined, when appropriate. The mean age of the patients was 31.4 +/- 8.8 years. PCR studies revealed negative in 13 [81.3%] interferon- and 15 [93.8%] larnivudine-treated subjects after 6 months of therapy. Among 17 patients with ALT activity of less than 70IU/l prior to therapy, 9 [90%] interferon- and 7 [100%] lamivudine-treated patients were found to have negative PCR results following the therapy [p<0.001]. Primary response to therapy was detected in 3 interferon- and 6 lamivudine-treated subjects, while secondary response was reported in 8 [50%] interferon- and 12 [75%] lamivudine-treated patients. No lamivudine-associated side effect was demonstrated. Lamivudine is a well-tolerated cost-effective antiviral drug for hepatitis B patients. It could be prescribed as the initial drug for patients with chronic hepatitis B