Journal Club Question

[Sparda29]

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So I'm doing a journal club right now for this trial:

Effect of fluticasone propionate/salmeterol
(250/50 mg) or salmeterol (50 mg) on COPD
exacerbations. Gary T. Ferguson a,**, Antonio Anzueto b, Richard Fei c,
Amanda Emmett d, Katharine Knobil d, Christopher Kalberg d,*

The patient population in this trial is 94% White. I'm trying to figure out if this is a strength or weakness of the trial, or if it doesn't even matter. If you take socioeconomic factors into consideration, you could say that there are more minorities living in inner cities/urban environments. Living in an urban environment with a lot of air pollution is a source of exposure that could lead to COPD and also have an effect on increasing numbers of COPD exacerbations. By having a low number of minorities participating in the trial, is it possible that there is a reduction in the amount of COPD exacerbations that are going to be recorded?

 

[All4MyDaughter]

I think this is common sense. I always want to see that a trial was conducted in a diverse population. Or at least a population that reflects the demographics of the patients who typically have the disease. Do minorities get COPD? If so, what are the consequences of not conducting the trial in many minority patients? Does it affect the internal or external validity of the study? What about the clinical significance?

 

[Venicat]

So I'm doing a journal club right now for this trial:

Effect of fluticasone propionate/salmeterol
(250/50 mg) or salmeterol (50 mg) on COPD
exacerbations. Gary T. Ferguson a,**, Antonio Anzueto b, Richard Fei c,
Amanda Emmett d, Katharine Knobil d, Christopher Kalberg d,*

The patient population in this trial is 94% White. I'm trying to figure out if this is a strength or weakness of the trial, or if it doesn't even matter. If you take socioeconomic factors into consideration, you could say that there are more minorities living in inner cities/urban environments. Living in an urban environment with a lot of air pollution is a source of exposure that could lead to COPD and also have an effect on increasing numbers of COPD exacerbations. By having a low number of minorities participating in the trial, is it possible that there is a reduction in the amount of COPD exacerbations that are going to be recorded?

As all4mydaughter noted, external validity is poor if you believe that most sufferers of COPD are people living in urban environments and, per your wild leap of logic, thus are probably minorities.

Homogenizing patient demographics makes it easier to compare between treatment groups.

 

[Sparda29]

As all4mydaughter noted, external validity is poor if you believe that most sufferers of COPD are people living in urban environments and, per your wild leap of logic, thus are probably minorities.

Homogenizing patient demographics makes it easier to compare between treatment groups.

No no, I didn't say most sufferers of COPD live in urban environments.

What I'm saying is that there are more minorities living in urban environments than there are minorities living in rural/suburban environments.

What I know about COPD is that the #1 cause is smoking. There's no socioeconomic factor there other than it is an expensive habit.

The other causes are exposure to air pollution, and chemicals/toxins in the industrial environment. I'm saying that it is more likely that minorities are exposed to this more often.

 

[All4MyDaughter]

As all4mydaughter noted, external validity is poor if you believe that most sufferers of COPD are people living in urban environments and, per your wild leap of logic, thus are probably minorities.

Homogenizing patient demographics makes it easier to compare between treatment groups.

Boo, I was hoping he'd figure out the external/internal validity question himself. I'm practicing for the teaching component of my residency. 😀

I don't necessarily agree with Sparda that most sufferers of COPD are urban. I haven't looked this up but anecdotally, I know that my state has a very high COPD rate and is mostly rural. It *is* lifestyle related though...

I think figuring out these types of questions are the major learning outcome from Journal Club. Being able to see if the trial was set up and conducted correctly, if the conclusion is justified by the evidence, strengths/weaknesses and clinical significance - too many students can't do this, at least in my experience. Especially the clinical significance part. They see that the p values say 'significant' and think that's the answer. But it often isn't.

 

[All4MyDaughter]

Looks like Sparda was posting at the same time I was. Yes, smoking is the major cause of COPD and that's why we have so much of it in my state.

I think you need to look up the prevalence/incidence rates of COPD in different racial and ethnic populations. If you brought up the 94% white thing as a strength or weakness in JC, I might ask the question, "Do minorities get COPD as much as whites do?" I also might ask why you think the trial population was 94% white. Does it have anything to do with where the trial was conducted? I would definitely ask the external validity question and expect you to be able to explain your answer.

 

[Ackj]

Looks like Sparda was posting at the same time I was. Yes, smoking is the major cause of COPD and that's why we have so much of it in my state.

I think you need to look up the prevalence/incidence rates of COPD in different racial and ethnic populations. If you brought up the 94% white thing as a strength or weakness in JC, I might ask the question, "Do minorities get COPD as much as whites do?" I also might ask why you think the trial population was 94% white. Does it have anything to do with where the trial was conducted? I would definitely ask the external validity question and expect you to be able to explain your answer.

Are demographics of smokers well documented? I'd say that a wide variety of people smoke. I might think that it is mainly uneducated low to middle class, but given the cost of smoking that may not be the case. Then there's also the stereotypical businessman with cigars.

What state do you live in that has so many smokers? I can't really think of any state that would be more prone to it, but maybe I'm just not well-traveled enough.

 

[All4MyDaughter]

Are demographics of smokers well documented? I'd say that a wide variety of people smoke. I might think that it is mainly uneducated low to middle class, but given the cost of smoking that may not be the case. Then there's also the stereotypical businessman with cigars.

What state do you live in that has so many smokers? I can't really think of any state that would be more prone to it, but maybe I'm just not well-traveled enough.

It's not so good to be number one...

 

[psychoandy]

Race and socioeconomic factors are probably the easiest factors to evaluate in the JC. During jc debates I would always pull the race card when arguing against people. Ez game.

Preceptors will care more about the intervention and "standard" therapy. Usually trials will use a substandard comparison to make the intervention look better.

 

[MindOverMatter]

Wow. >25% of adults in Kentucky, Oklahoma, and West Virginia are smokers. That's shockingly sad.

And All4, I think you're going to be a great teacher fwiw.

 

[shishquab]

Wow. >25% of adults in Kentucky, Oklahoma, and West Virginia are smokers. That's shockingly sad.

And All4, I think you're going to be a great teacher fwiw.

Shockingly sad yes, but 25% is still just a young grass hopper compared to this Shaolin master.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1766174/pdf/v014p00i45.pdf

46.7% of 18+ males in Taiwan are smokers(for those of you with no time to scan through the article). It's beyond sad. It's practically mass suicide.🙁

I also have a question. How much time does one typically have to research and prepare for a presentation?

And ditto A4MD = great teacher