Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia (Cummings JL et al. 2015)
One Journal Club Forward! As my first journal club facilitation, I was admittedly nervous. However once my role shifted from presenter to facilitator of the discussion, I surprised myself in my ability to exchange ideas with experts in Alzheimer’s dementia and related agitation. It was a valuable opportunity for me to explore their opinions regarding the difference between statistical and clinical significance. It was interesting to hear the varying perspectives of the geriatricians with regards to the possible applicability of the treatment to their practice based on risk vs. benefit. On one hand, there was the consideration of geriatric out patients with a high risk of serious side effects of the medication. Given the PD and PK changes that occur with aging and the high morbidity and mortality related to falls, the potential benefit of DMQ might be questionable. Conversely, in a highly agitated institutionalized patient, the potential benefit of an additional option for treatment sounded appealing. This discussion was a good example of the importance of assessing patient specific factors prior to considering a treatment.
This exercise contributed to my residency learning goal 5) I will demonstrate the ability to critically appraise literature in a systematic fashion and determine the applicability of the study to a specific patient.
Precepting Journal Club (1 1/2) – Facilitation
Today my and Scott’s preceptees presented their first journal club to the group at VGH. The two student critically appraised an RCT assessing the efficacy of vortioxetine in improving cognitive function in major depressive disorder (MDD) !independently of the antidepressant effects. We had coached them in anticipation of questions that may be asked and they appeared well prepared. I believe it may have been more anxiety provoking for myself than the student. Perhaps it was because it was no longer in my control or maybe because I recalled being nervous for my journal club. Nonetheless, they did well and I was afforded an opportunity to provide direct feedback. Providing feedback is a skill in itself and I was relieved that it was well received. The main constructive criticism was slightly ironic as it is a concept I continue to grapple with: trust yourself and be confident when you know the answer to a question. Below is the result of their (and our) hard work.
Additional information for all of the pharmanerds out there: just the week prior to their presentation, the FDA rejected the expanded claim of vortioxetine as a cognitive enhancer in MDD based on this and the FOCUS trial. Hot of the press!
Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients with Agitated Delirium (DahLIa): A Randomized Clinical Trial. (Reade MC, et al. JAMA. 2016;315(14):1460-1468.)