Programme: Thursday, May 11

Download a PDF file with MIRICM 2017 brochure (1,8 MB).

EBM and clinical practice guidelines in contemporary healthcare

Conference & workshops

Venue: Kraków, ICE Kraków Congress Centre (see Venue)
Organizer: Polski Instytut Evidence Based Medicine (Polish Institute for Evidence Based Medicine)
Co-organizers: McMaster University, Naczelna Izba Lekarska (The Polish Chamber of Physicians and Dentists), Medycyna Praktyczna

Organizing Committee

From McMaster University
Prof. Gordon Guyatt
Prof. Roman Jaeschke

In Poland
Dr. Piotr Gajewski
Dr. Maciej Hamankiewicz
Prof. Romuald Krajewski
Prof. Jerzy Kruszewski
Dr. Wiktoria Leśniak
Anna Bagińska
Ewa Chałupa
Shawn Locke

Speakers and workshop trainers

Prof. Gordon Guyatt (McMaster University, Canada), Conference Chair
Prof. Waleed Alhazzani (McMaster University, Canada)
Prof. P.J. Devereaux (McMaster University, Canada)
Prof. Roman Jaeschke (McMaster University, Canada)
Prof. Maureen Meade (McMaster University, Canada)
Prof. Victor M. Montori (Mayo Clinic, USA)

Conference

Rationale: Delivering optimal medical care requires being able to locate, understand, interpret and apply evidence from the medical literature. Trustworthy clinical practice guidelines, ideally developed using the GRADE system, are crucial to the practice of the evidence-based medicine (EBM). This series of lectures will highlight key concepts in EBM, GRADE and clinical practice guidelines.
Content: The content will include the fundamental concepts of EBM, explain the GRADE system of developing clinical practice guidelines and highlight strategies for avoiding being misled by the medical literature.
Objectives:
  1. To gain an understanding of the fundamental concepts of EBM.
  2. To be able to critically appraise and understand the presentation of results of a systematic review.
  3. To understand the GRADE approach to developing and presenting the recommendations of clinical practice guidelines.
  4. To develop strategies to avoid being misled by the medical literature.

Programme

10.00–10.10Introduction
10.10–10.30Our deceptive mind: why reasoning methods matter
Prof. Gordon Guyatt
10.30–10.50Basic language of EBM and clinical practice guidelines
Prof. Roman Jaeschke
10.50–11.10NNT, NNF, Fragility Index, CI: how to understand these numbers
Prof. P.J. Devereaux
11.10–11.30What is the best way to achieve quality assurance
Prof. Gordon Guyatt
11.30–12.00Refreshment break
12.00–12.20How to avoid being misled by clinical trials
Prof. Victor M. Montori
12.20–12.40Summarizing the evidence: from questions to facts
Prof. Gordon Guyatt
12.40–13.00How to develop trustworthy clinical practice guidelines
Prof. Waleed Alhazzani
13.00–13.20EBM, clinical practice guidelines and the patient revolution
Prof. Victor M. Montori
13.20–14.00Questions and answers (all speakers)
14.00–15.00Lunch break
15.00–17.00EBM workshops

Workshop 1: Therapy (15.00–17.00)

Rationale: Ability to critically appraise a randomized trial, which is central to the practice of EBM.
Content: This workshop will use an example, steroids for community-acquired pneumonia, to illustrate the key elements of assessing risk of bias of randomized trials, understanding the results and applying the results to clinical practice.
Objectives:
  1. To learn how to assess risk of bias in randomized trials, including issues of concealment of randomization, blinding and loss to follow-up.
  2. To gain insight into how results of randomized trials are presented, including issues of relative effects, absolute effects and confidence intervals.
  3. To gain insight into issues of applying results of randomized trials in clinical practice including patients enrolled versus the patient before you, magnitude of benefits and harms and patient values and preferences.

Workshop 2: Systematic reviews (15.00–17.00)

Rationale: Ability to critically appraise a systematic review, which is central to the practice of EBM.
Content: This workshop will use an example, steroids for community-acquired pneumonia, to illustrate the key elements of assessing the quality of a systematic review and the trustworthiness of the results it reports.
Objectives:
  1. To learn how to assess key elements of the quality of a systematic review, including question definition, search for evidence and summarization of evidence.
  2. To learn how to evaluate the credibility of the results presented in a systematic review, including issues of study design, risk of bias, precision, directness and publication bias.

Workshop 3: Clinical practice guidelines (15.00–17.00)

Rationale: Ability to identify a trustworthy guideline, which is central to the practice of EBM.
Content: This workshop will use an example, steroids for community-acquired pneumonia, to illustrate the key elements of assessing the quality of a clinical practice guideline.
Objectives:
  1. To learn to identify the key issues to consider in judging the trustworthiness of a clinical practice guideline.
  2. To understand strategies for mitigating the impact of conflict of interest in guidelines.
  3. To understand strategies for ensuring the best current evidence informs guidelines.
  4. To understand the role of values and preferences in the context of a guideline.
  5. To understand the meaning and significance of strong and weak recommendations emerging from a guideline.

Fees

Conference: 80 € (free for MIRCIM participants; registration required)
Workshops: 60 € per one workshop (30 € for MIRCIM participants; registration required)

EBM and Clinical Practice Guidelines in Contemporary Healthcare Conference and Workshops – This event is funded per contract 794 / P-DUN / 2017 by the Minister of Science and Higher Education, dedicated to the dissemination of science.

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Clinical workshops

Effective therapy of type 2 diabetes mellitus

Part I: New drugs for type 2 diabetes mellitus: for whom, which and when
Part II: Choosing the best model of insulin therapy in type 2 diabetes mellitus

Speakers and trainers Prof. Maciej M. Małecki (Jagiellonian University, Kraków, Poland) (Part I)
Prof. Tomasz Klupa (Jagiellonian University, Kraków, Poland) (Part II)
Time 12:00–14:20 (physicians only)
Max. number of participants 20
Fee 60 € (30 € for MIRCIM participants)
Description Rationale: A patient-centered approach to type 2 diabetes (T2DM) management has become a standard of care in recent years. As highlighted in clinical guidelines, treatment of patients with diabetes must be individualized. Such an approach to the care requires unique management plan for each patient for effective glucose control and prevention of negative long-term outcomes. There are many therapies available, including new drugs and technologies, but choosing the best treatment option for individual patient involves complex decision-making and may be challenging.
In Part I, this workshop will discuss the management of T2DM in different clinical settings, including issues related to the most accurate, personalized drug choice with special attention to new medications available. In Part 2, different models of insulin therapy will be presented, explained and discussed with the attendees.
Learning objectives:
  1. Discuss the management of patients with T2DM and the best treatment following the diagnosis.
  2. Identify patients who need treatment changes and how to choose the second drug for T2DM and further treatment.
  3. Review guideline-based medical options for the management of patients with T2DM.
  4. Focus on new drugs for T2DM introduced to the market in the recent years and discuss their potential use and safety issues.
  5. Discuss insulin products and the indications and contraindications for their use in patients with T2DM.
  6. Gain some practical skills in insulin-dose titration.
  7. Discuss personalized care planning for the patient with diabetes and learn how to make the best treatment choices for high-standard care.
  8. Discuss the diet- and exercise-related issues in insulin-treated patients with T2DM.

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Electrocardiography in acutely ill patients

Speakers and trainers Prof. Sebastian Stec (University of Rzeszów, Poland)
Time 11:00–13:00 (students only)
15:00–17:00 (physicians only)
Max. number of participants 50 (per session)
Fee 60 € (30 € for MIRCIM participants and students)
Description Rationale: ECG remains an essential investigation in acutely ill patients. Interpretation of ECG continues to be one of the basic skills expected from clinicians caring for such patients. Structured, careful and fast but detailed ECG analysis helps arriving at a correct diagnosis and improves patients’ care and outcomes.
Learning objectives: This workshop is designed to build your knowledge, skills and confidence in a step-by step rapid interpretation of ECG. In a case-based fashion, we will discuss the definition and differential diagnosis of narrow and wide QRS tachycardia as well as value of ECG in the setting of syncope, chest pain, shortness of breath and atypical symptoms. We will also explore common tricks and traps of ECG interpretation.

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How to read a chest X-ray: primer for non-radiologists

Speakers and trainers Prof. Julian Dobranowski (McMaster University, Canada)
Time 13:20–14:50 (students only)
15.30–17.00 (physicians only)
Max. number of participants 30 (per session)
Fee 60 € (30 € for MIRCIM participants and students)
Description Rationale: Despite the introduction of various technological advancements in medical imaging, the chest x-ray remains the most frequently requested radiological investigation. Learning how to interpret a chest x-ray is among the most important and challenging skills to master in caring for patients. However, many practicing physicians find themselves ill-equipped to make confident chest x-ray interpretations. The interpretive process need not stir up negative emotions. With the proper grounding in knowledge, procedures and principles, chest x-ray interpretation can be rewarding to the learner and, more importantly, can lead to accurate extraction of information, leading to better patient outcomes.
Learning objectives: This workshop is designed to build your confidence in the interpretive process using a step-by-step algorithm. Participants will learn how to confidently distinguish between a normal and an abnormal chest x-ray and acquire specific interpretive skills that can be applied to daily practice. The workshop will also focus on practicing the newly acquired interpretive skills with numerous relevant clinical cases.

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Ultrasound in rheumatology: small joint examination course

Speakers and trainers Prof. Bhaskar Dasgupta (Southend University Hospital, UK)
Dr. Artur Bachta (Military Institute of Medicine, Warsaw, Poland)
Dr. Jacek Fliciński (Pomeranian Medical University, Szczecin, Poland)
Dr. Aleksandra Juszkiewicz (Military Institute of Medicine, Warsaw, Poland)
Dr. Renata Sokolik (Wroclaw Medical University, Poland)
Dr. Anetta Chrzanowska (Department of Rheumatology, Józef Dietl Hospital, Kraków Poland)
Dr. Monika Krężołek (Department of Rheumatology, Józef Dietl Hospital, Kraków Poland)
Time 11.00–17.00 (physicians only)
Max. number of participants 25
Fee 180 € (90 € for MIRCIM participants)
Description Target audience: Rheumatologists, internists, trainees, sonographers, allied health professionals.
Learning objectives: Attendees will be familiarized with:
  1. Applied sono-anatomy of the small joints, ie, hand, wrist, ankle and foot. This will allow greater precision in anatomical localization of a musculoskeletal diagnosis, including more accurate placement of joint injections.
  2. Basic skills required for ultrasound examination of the small joints of the hand, foot, wrist and ankle. This will include a demonstration of the sonographic examination method followed by plenty of opportunities for hands-on practical examination.
  3. Common inflammatory and non-inflammatory pathologies that affect small joints of the hands and feet. This will include identification of synovitis, erosions, tenosynovitis and sonographic abnormalities of joints, tendons and nerves. Conditions covered will include rheumatoid arthritis, psoriatic arthritis, spondyloarthritis as well as local conditions such as carpal tunnel syndrome, plantar fasciitis and Achilles tendonitis.
By the end of the course, attendees will have sufficient hands-on experience at scanning joints of the hands, wrists, ankles and feet to take the first steps toward starting a musculoskeletal ultrasound service in their place of work.

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Compression ultrasound in diagnosing deep vein thrombosis

Speakers and trainers Dr. Marzena Frołow (Jagiellonian University, Kraków, Poland)
Time 11:00–12:40 (physicians only)
Max. number of participants 15
Fee 60 € (30 € for MIRCIM participants)
Description Rationale: B-mode compression ultrasound (CUS) has become the diagnostic modality of choice for deep vein thrombosis (DVT). The 3-point CUS has high sensitivity and specificity for DVT. It allows for diagnosis at the point of care and decreased demand on radiology departmental services. Standard 3-point CUS includes examination of the upper femoral vein, lower femoral vein and popliteal fossa.
Learning objectives: Attendees will be familiarized with:
  1. Basic ultrasound unit settings for CUS.
  2. Applied sonoanatomy of deep veins of lower extremities.
  3. Technique of 3-point CUS.
No basic skills for ultrasound examination are required from participants.

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Point-of-care ultrasound (PoCUS) in volume status examination

Speakers and trainers Prof. Khalid Azzam (McMaster University, Canada)
Time 11:00–12:45 (physicians only)
Max. number of participants 25
Fee 60 € (30 € for MIRCIM participants)
Description Rationale: Point-of-care ultrasound (PoCUS) is a limited ultrasound examination performed and interpreted by the clinician at the bedside or in the ambulatory setting to answer a focused clinical question or guide the performance of an invasive procedure. PoCUS is known to increase the accuracy of the physical examination. There is an increasing interest among clinicians to use PoCUS for diagnostic application but hands-on training opportunities continue to be limited. This workshop is an introduction to PoCUS with a focus on volume status assessment. Physical examination for volume status is usually inaccurate and jugular venous pressure examination has large inter-rater variability. This hands-on interactive workshop will introduce participants to the practice of using bedside ultrasound for volume status examination. It will cover lung ultrasound (lung sliding, A-line, B-line, pleural effusion), abdominal fluid, inferior vena cava measurement and interpretation and volume responsiveness.
Learning objectives: At the end of this workshop, participants will be able to:
  1. Understand the basics of ultrasound technology and indications for its use.
  2. Appreciate how PoCUS can assist in answering focused clinical questions and augment bedside clinical care with a focus on volume status examination.
  3. Practice PoCUS to augment the physical examination for volume status assessment.
Previous knowledge or experience with ultrasound is not required.

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Airway management (No more spaces available)

Speakers and trainers Dr. Grzegorz Cebula (Jagiellonian University, Poland)
Dr. Jarosław Gucwa (County Hospital, Bochnia, Poland)
Time 11:00–13:00 (students only)
Max. number of participants 18
Fee 30 € (student fee)
Description Securing airways is frequently the most time-sensitive and anxiety-provoking challenge faced by clinicians. Although short, this workshop is intensive, practical and hands-on. It will provide the participants with the opportunity to practice airway management involving a variety of techniques, including laryngoscopy, supraglottic airway use and even cricothyroidotomy.
To get the most out of this workshop, it is crucial that you attend the session prepared. Please help us by familiarizing yourself with the following resources:
  1. Laryngoscopy:
    https://www.youtube.com/watch?v=N6K35fvBjn4
    https://vimeo.com/98836096
    https://vimeo.com/129280563
  2. Supraglottic airway:
    http://openairway.org/airway-devices/supraglottics/
    https://www.youtube.com/watch?v=tYf8rTB9eeY
    https://www.youtube.com/watch?v=53VYGr4NZZs
    https://www.youtube.com/watch?v=fdRKXUTJ-R0
  3. Surgical airway:
    https://vimeo.com/37340167
    https://vimeo.com/132394603
    https://vimeo.com/132394890

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Cardiac arrest management (No more spaces available)

Speakers and trainers Dr. Grzegorz Cebula (Jagiellonian University, Poland)
Dr. Jarosław Gucwa (County Hospital, Bochnia, Poland)
Time 14:20–17:00 (students only)
Max. number of participants 18
Fee 30 € (student fee)
Description Rationale: Cardiac arrest is the most time-sensitive and demanding challenge faced by clinicians. Rapid assessment and life-saving treatments have to be implemented immediately.
The goal of this cardiac arrest simulation (CAS) workshop is to equip participants with practical skills. The workshop will provide a number of stations simulating acute clinical situations.
Learning objectives: By the end of this workshop, the participants should be able to:
  1. Understand the concept of CAS training, including the concept of role-playing and the importance of non-technical skills in resuscitation attempts.
  2. Understand the importance of teamwork and leadership in managing a cardiac arrest.
  3. Understand the shockable and non-shockable treatment algorithms.
  4. Apply the current guidelines and skills taught in the workshop to the practical management of the patient in cardiac arrest.
  5. Apply the skills attitude and knowledge required to function as a member of a resuscitation team.
  6. Apply the skills attitude and knowledge required to lead a resuscitation team.
  7. Manage the post-resuscitation and stabilization phase of the care of the patient after cardiac arrest.
  8. Understand the use of non-technical skills in cardiac arrest teams.

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Current and future management of cystic fibrosis

Speakers and trainers Prof. Andreas P. Freitag
The Polish Cystic Fibrosis Society (Polskie Towarzystwo Mukowiscydozy) is an official patron of the workshop.
Time 15:00–17:00 (physicians only)
Max. number of participants 25
Fee 60 € (30 € for MIRCIM participants)
Description Rationale: The number of adult cystic fibrosis (CF) patients is growing in most countries. Managing a CF patient is a complex process involving a multidisciplinary team. During the workshop, evidence-based information on state-of-the-art CF management will be discussed. The workshop will be case-based, aimed at acquiring practical skills.
Learning objectives: Upon completion of this interactive workshop, participants will improve their skills on the general approach to an adult CF patient; controlling infections in the chronic care; physiotherapy and nutrition (from the internist’s point of view); treatment of exacerbations, including appropriate antibiotic therapy and respiratory support; when and whom to consult (multidisciplinary care in practice); effective communication with the patient (including family planning and end-of-life issues); and providing end-of-life care.

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