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Showing posts from July, 2015

Prehospital ticagrelor in ST-segment elevation myocardial infarction

Methodology Score: 4/5Usefulness Score: 3/5
Montalescot G, van 't Hof AW, Lapostolle F, et al. for the ATLANTIC Investigators. N Engl J Med.2014 Sep 11;371(11):1016-27.
Full Article
This corporate-sponsored international, multicenter, RCT randomized 1,862 STEMI patients to receive ticagrelor prehospital vs in-hospital and found no difference in outcomes (70% or greater reduction of ST-segment elevation prior to PCI and/or a relatively good flow in the culprit artery (TIMI grade 3)); there was also no difference in morbidity and mortality at 30 days. These results should discourage EMS services from administering prehospital ticagrelor. By: Dr. Jaroslav Fabian (Presented March 2015)

Epi lesson: Concealment versus Blinding These clinical trial terms have different meanings but are often confused. Concealment refers to the processwhereby the treatment allocation is made unknown or concealed prior to patient randomization. This helps prevent selection bias by ensuring that health providers …

Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings

Methodology Score: 3.5/5                 Usefulness Score: 4/5
Orr SL, et al. Cephalalgia. 2014 May 29. http://www.ncbi.nlm.nih.gov/pubmed/24875925
This Canadian Headache Society guideline for ED management of acute migraine gave a strong recommendation for 5 treatments: ketorolac, metoclopramide, sumatriptan (if presenting within 2 hours), prochlorperazine and lysine-ASA (the latter 2 are unavailable in Canada). Despite some concerns about lack of appropriate stakeholders and external review, JC attendees agreed with the recommendations that dihydroergotamine should be considered for rescue therapy whereas corticosteroids and opioids for acute pain relief should be avoided.   By:Dr. Krishan Yadav (Presented February 2015)

Epi Lesson: AGREE-II Tool for Evaluation of Clinical Practice Guidelines
Clinicians frequently use clinical practice guidelines (CPGs) to inform their practice. Often these also form standards of care. It is important to critically appraise CPGs as you would other articles i…

Epi Lessons - Part 5 - PROGNOSIS AND OTHER ARTICLES

As part of our Journal Club summaries our JC Chairs (Drs. Lisa Calder and Ian Stiell@EMO_Daddy) have been tasked with explaining Epidemiological concepts so that everyone in our department can analyze the literature and appraise articles on their own. For this Blog post we have all the "Epi Lesson" as they relate to "Prognosis and Miscellaneous Articles". That completes our 5 part series on Epi Lessons!

Effect of Provider Experience on Clinician-Performed Ultrasonography for Hydronephrosis in Patients With Suspected Renal Colic

Methodology Score: 3/5                    Usefulness Score: 3.5/5
Herbst MK, Rosenberg G, Daniels B, Gross CP, Singh D, Molinaro AM, Luty S, Moore CL. Ann Emerg Med. 2014 Sep;64(3):269-76.
Abstract Link
This prospective study of ED patients undergoing CT scan for renal colic found that bedside ultrasound performed by the emergency provider had excellent test characteristics for diagnosing hydronephrosis if the provider had fellowship training in ultrasound, but was only moderately helpful if the provider did not have an ultrasound fellowship. While JC attendees had concerns about the possibility of selection bias due to the number of excluded patients, this paper showed that with proper training, bedside ultrasound can be useful for the diagnosis of renal colic.  By:Dr. Brandon Ritcey (Presented February 2015) 

Epi Lesson:The Value of Consecutive Enrollment in Prospective Cohort Studies

Epi Lessons - Part 4 - DECISION RULE ARTICLES

As part of our Journal Club summaries our JC Chairs (Drs. Lisa Calder and Ian Stiell@EMO_Daddy) have been tasked with explaining Epidemiological concepts so that everyone in our department can analyze the literature and appraise articles on their own. For this Blog post we have all the "Epi Lessons" as they relate to "Decision Rules Articles". More to follow in the coming weeks.

Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial.

Methodology Score: 3/5                    Usefulness Score: 2/5
Abas MN, Tan PC, Azmi N, Omar SZ. Obstet Gynecol. 2014 Jun;123(6):1272-9.
Abstract Link This small RCT found that ondansetron was not superior in efficacy to metaclopramide for patients with hyperemesis gravidarum. Although ondansetron seemed better tolerated by patients, the clinical significance of the documented adverse effects of metoclopramide were questioned by JC attendees. With the stronger fetal safety profile of metaclopramide, its use in hyperemesis gravidarum should still be considered before ondansetron. By:Dr. Jean Christophe Ghazal (Presented February 2015)

Epi Lesson: Validity of Visual Analogue Scales Visual Analogue Scales (VAS) are assessment tools frequently used to determine the degree of symptoms experienced by patients. When you see a study using a VAS, it is important to ask whether the tool has been validated. This can occur by comparing the tool to existing tools or to another reference gold standard. Th…