Journal Club #3

Journal Club #3 – Wednesday 8th August 2018, 20:00 BST.

37 individuals joined in the discussion, sending 122 tweets, which gained 1.51 million impressions on Twitter. 

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Chair:  Chris McAloon @DrChrisMcAloon


As we move through medical school and junior years we pick and are taught lots of dogma and the ways things have always been done. But why do we do it? Do we always assume that the person telling us knows the evidence? There are questions every day as to why and how we do things.

The ability to ask questions and look for the evidence is a fundamental skill as doctors and one that isn’t done well (in my opinion). This includes myself - I have often travelled the road most travelled without questioning the evidence.

As a physician and a cardiologist, a good example is giving intravenous diuretics as boluses or infusions for acute heart failure. I normally give a bolus regime as first line and infusions when higher doses are needed because boluses aren’t working or there is renal impairment. But what is the evidence for these assumptions?

These questions several years ago lead to the Felker GM et al. study 'Diuretic Strategies in Patients with Acute Decompensated Heart Failure', published in the New England Journal of Medicine (@NEJM) in 2011. The paper is open access and can be downloaded here: 

https://www.nejm.org/doi/full/10.1056/NEJMoa1005419

For this journal club, I want you to think about a time when you have faced that classic situation with a patient in acute heart failure. What diuretics are you going to give? What is the evidence base? Does this paper back your normal practice? Is the paper one you would consider using to inform your practice? Does it apply to everybody? What does it show? Will this paper change my normal practice? 

See you at 8pm BST to discuss this paper on the 8th August and challenge some dogma.

Dr Chris McAloon


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