This morning, the residents and many faculty grabbed a cup of coffee and a breakfast sandwich during our Clinical Decision Making Journal Club (CDMJC to most of us). We all sat back and enjoyed critical appraisal of two recent articles. These were presented by two of our PGY-3 residents.
Erica Lin, a graduate of the University of Alabama-Birmingham School of Medicine, discussed a patient who presented to her continuity clinic with nocturnal leg cramps. This prompted a search in the literature, and Erica shared one interesting article with us.
Roguin Maor N, Alperin M, Shturman E, Khairaldeen H, Friedman M, Karkabi K, Milman U. Effect of Magnesium Oxide Supplementation on Nocturnal Leg CrampsA Randomized Clinical Trial. JAMA Intern Med. 2017;177(5):617-623. doi:10.1001/jamainternmed.2016.9261
Erica included an excellent "EBM pearl" which focused on how statistical significance and minimally clinically important difference should both be considered when appraising a journal article.
Stephanie Williams, a graduate of Northeast Ohio Medical University, appraised an article discussing extended use of aromatase inhibitors in breast cancer survivors. I really appreciated her discussion of this article, as this question came up multiple times in my continuity clinic as a resident. How long do we keep breast cancer survivors on aromatase inhibitors? When/how do we decide to stop these medications? She made several excellent points about considering an individual patient, his/her needs, comorbidities, and preferences when applying evidence based medicine. She also focused on how to interpret hazard ratios and use these to guide medical practice.
Goss PE, Ingle JN, et al. Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years. New England Journal of Medicine. 2016;375(3):209-219. doi:10.1056/NEJMoa1604700
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