Monthly Archives: October 2012

Points to Ponder: Spironolactone versus Eplerenone

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(Posted on behalf of Chester Morris)

The results also don’t address the question of spironolactone versus eplerenone and whether one is superior/equivalent to the other and whether those with NYHA class II symptoms and higher ejection fractions could benefit. In addition as with any subjective classification NYHA could be seen as bias in stratification.

Can you share your views on the superior/equivalent nature of spironolactone versus eplerenone?

From my experience in our community there is a lack of clarity on the use of these agents especially among family physicians and guidelines are not yet updated so there is a need for education in this area.

Points to Ponder: Obtaining Representative Samples in Trials

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(Posted on behalf of Chester Morris)

I have included two points to ponder to start the discussion. Please feel free to add to the discussion.

In terms of the trial there are always problems here getting representative samples as certain ethnicities and female gender are both underrepresented in the sample.  Does anyone have anything to add or any strategies that might deal with the issue of representative samples?

Welcome to Session One

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Hi all,

Thanks for following us on the specialist journal club.
Hope you all had a nice weekend and are ready for our first journal club session.

We are going to start with a publication on the use of mineralocorticoid antagonists and mild heart failure addressing one of your topic suggestions. This is the report of the EMPHASIS-HF trial in the NEJM last year.

This paper reported on the study of mineralocorticoid antagonists and heart failure in a group of patients who had not been covered in earlier studies such as EPHESUS (eplerenone in acute myocardial infarction complicated by left ventricular
systolic dysfunction and heart failure) and RALES (spironolactone for NYHA functional class III or IV symptoms).

Specifically those with NYHA II functional class and either an LVEF ?30 percent or LVEF >30 and ?35 percent and QRS duration >130 msec.
This paper is interesting as it will change guidelines on the management of this group of patients which we all see in our offices and hospitals.

The learning objectives for this session will involve:
1) Understanding the indications for the use of these agents in heart failure
2) Commenting on the use of these agents in your practice
3) Discussing the validity and applicability of the study

ARTICLE:

Krum H, Pitt B, Pocock S.J, et al. Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. N Engl J Med. 2011. 364(1): 1-11. (NEJM Free Full Text) or click the image of the article.

       

Regards,
Chester

Journal Club Session Topics Selected

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Hi all,

Thanks for signing up to the Club. We have gone through the results of the Topics Survey and the 5 sessions of the club will be based on the following topics:

Review of internal medicine issues;
Inflammatory bowel disease;
Cardiovascular disease in the elderly;
Abnormal liver tests; and
New therapies for cardiac diseases

Please let me know if you have specific papers in mind for the sessions.  Suggestions are welcome. We would prefer open access papers but any source is fine as long as you think it is relevant.

Look forward to your responses.

Chester

Meet Your Colleagues

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Use this area to get to know the other members of the Journal Club. We encourage everyone to reply to this message and introduce yourselves!

We have provided a few key details about each member below. If you do not see your name below, or would like to modify your details, please reply to the post below or contact the UBC Admin Team (stephanie.a@ubc.ca).

 

Welcome from the Moderator

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Welcome from Dr. Chester Morris, Specialist Journal Club moderator, 2012-13.

Welcome fellow Specialist Journal Club participants. My name is Chester Morris and I will be the moderator of the journal club for this year. I am a general internal medicine specialist in Port Alberni and a senior associate at the Johns Hopkins School of Public Health.

I recently returned to BC ( 2 years ago) from working in Africa for 10 years in various areas, most recently in South Africa on the training of medical staff and the use of mHealth.

This session is for the introduction of participants and to review and discuss the learning objectives for the journal club.

Proposed learning objectives are:

  1. Analyze and critique five journal articles for the quality of the author(s) hypotheses, methods, results, and/or conclusions presented;
  2. To review pertinent clinical topics or explore new advances in internal medicine through online discussion
  3. To discuss concepts in journal articles that relate to your own clinical experiences and discuss relevance of journal article concepts to your own clinical practice.

If there are questions on the objectives please let us know.

Overall the forum will be much richer with active discussion as the papers are the starting point and the sharing of practice tips and pitfalls, personal experience, and approaches, are the real content of the forum.

We are also looking forward to input on the material and topics we cover and as much as is possible will respond to the expressed needs of you the participant. Feel free to let us know how we can make this online experience better.

Lastly,

1. Please introduce yourselves and

2. Please click on the table below to provide your feedback on the journal club session topics. These topics were suggested by participants on the registration form.

Journal Club Members

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(Moderator) – Dr. Chester Morris completed his residency at the Mayo Clinic in Rochester, Minnesota. He is interested in medical education, infectious diseases and internal medicine.

Dr. Heather Anderson completed her residency in Edmonton and Calgary, finishing in 2007. She is interested in hospital-based Internal Medicine and Critical Care.

Dr. Kathryn Bell completed her residency training at UBC, Vancouver. She is interested in Geriatric Medicine.

Dr. Avtar Dhillon completed his residency training in 2002. He is interested in Cardiology and Diabetes topics.

Dr. Anastasia Forbes completed her residency at UBC in Geriatric Medicine.

Dr. John Galbraith is a Medical Microbiologist and completed his residency at the University of Alberta. He is interested in Medical Microbiology and Infectious Diseases.

Dr. Neil Gibson completed his residency training at McMaster University. He is interested in General Internal Medicine.

Dr. Jennifer Grace completed her residency training at UBC. She is interested in stroke and cardiology.

Dr. Nasim Mahmoudi completed her residency training at UBC. She is interested in General Internal Medicine.

Dr. Jesse Morantz completed his residency training in New York.

Dr. Kristen Marosi completed her residency at McGill and fellowship at UBC. She is interested in General Internal Medicine.

Dr. William Martin completed his residency training at WSVAH Chicago. He is interested in Neurology and Systemic Disease.

Dr. Scott McKee completed his residency training at UW Seattle. He is interested in General Internal Medicine and Critical Care issues.

Dr. David Ostrow completed his residency in both Montreal and Winnipeg. He is interested in Internal Medicine.

Dr. Wai Son completed his residency at Memorial University. He is interested in cardiology.

Dr. Trace Thomas completed his residency training at UBC.

Dr. Dorothy Williams completed her residency in Edmonton, Alberta. She is interested in Geriatrics.

Dr. Ali Zentner completed her residency training in Calgary. She is interested in Obesity and Diabetes.