Journal Club Summary

Methodology Score: 3/5                 
Usefulness Score: 2.5/5
Rahimi RS, Singal AG, Cuthbert JA, Rockey DC.
JAMA Intern Med. 2014 Nov;174(11):1727-33

Full Article

Polyethylene Glycol for Hepatic Encephalopathy Polyethylene A New Solution to Purge an Old Problem?
Doran AE, Shah NL
JAMA Intern Med. 2014;174(11):1734-1735
This small, non-blinded, government funded, randomized trial found that PEG was significantly more effective than lactulose for the treatment of acute hepatic encephalopathy (NNT 3.5 to produce a significant positive change in the hepatic encephalopathy score).  However, methodological limitations (small n, non-blinded, per-protocol analysis, no follow up) currently limit its applicability in the ED – look for future studies of PEG in the treatment of acute hepatic encephalopathy.  
By: Dr. Matthew Carere
(Presented June 2015)

Epi lesson: Allocation Concealment vs. Blinding

These clinical trial terms have different meanings but are often confused. Concealment refers to the process whereby the treatment allocation is made unknown or concealed prior to patient randomization. This helps prevent selection bias by ensuring that health providers and research staff are not tempted to include or exclude cases according to their views on the allocated treatment. Blinding refers to the methods employed after randomization to ensure that patients, health care providers, and research staff cannot determine whether the patient is receiving the study or the control treatment. This reduces ascertainment bias (the likelihood of differential assessment of outcome).
By: Dr. Ian Stiell