Journal Club Summary

Methodology Score: 4/5                 
Usefulness Score: 2/5
Bateman DN, et al.
Lancet. 2014 Feb 22;383(9918):697-704
This 2×2 factorial, intention to treat, randomized controlled trial of paracetamol overdose showed a modified 12 h NAC protocol vs 20.25h protocol and ondansetron pre-treatment vs placebo causes less nausea and vomiting .  It is an interesting precursor to further studies that will be necessary to ascertain the efficacy and safety of modified 12 h NAC treatment to protect patients from liver toxicity; i.e. not yet ready for prime time. 
By: Dr. Noam Katz 
(presented Feb 2014)

Epi lessonDesign of Clinical Trials  

“Design” refers to the type of trial, such as parallel group or factorial, and the conceptual framework, such as superiority or non-inferiority. Trials with par­ticipants individually randomised to one of two “parallel” groups are well known but only about half of published trials have such a design. The main alternative designs are multi-arm parallel, crossover, cluster, and factorial designs. Also, most trials are set to identify the superiority of a new intervention, if it exists, but others are designed to assess non-inferiority or equivalence. These details should be described in the abstract. 
By: Dr. Ian Stiell