Use of a Rapid Diagnostic for Chlamydia Trachomatis and Neisseria Gonorrhoeae for Women in the Emergency Department Can Improve Clinical Management: Report of a Randomized Clinical Trial

Methodology: 3/5           Usefulness: 2.5/5 Gaydos CA et al. Ann Emerg Med. 2019 Jul;74(1):36-44. doi: 10.1016/j.annemergmed.2018.09.012. Epub 2018 Nov 2. Question and Methods: RCT of women receiving pelvic testing for CT/NG comparing standard of care test (NAAT) vs. POC test (GeneXpert). Treatment was at the discretion of the clinician Findings: CT undertreatment rate difference –46.2%; 95% CI […]

Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial.

Methodology: 3/5 Usefulness: 3/5 Butler CC, et al. Lancet. 2020 Jan 4;395(10217):42-52. Editorial: Neuraminidase inhibitors for influenza-like illness in primary care. Question and Methods: This was a pragmatic randomised controlled trial of 3266 patients, where patients were randomised to either usual care or usual care with oseltamivir. Findings: Symptom duration decreased by 1.02 days; in older patients, more severe illness, […]

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations.

Methodology: 3/5 Usefulness: 2.5/5 Butler CC, et al. N Engl J Med. 2019 Jul 11;381(2):111-120 Editorial: COPD Exacerbations – A Target for Antibiotic Stewardship. Question and Methods: This was a multicenter RCT to determine if POCT CRP testing vs usual care may help safely reduce unnecessary use of antibiotics. Findings: Antibiotics were used in 57.0% (CRP) vs 77.4% (usual) of patients; adj. […]

Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial

Methodology: 4/5 Usefulness: 2/5 Sims CA, et al. JAMA Surg. 2019 Aug 28. Question and Methods: Single-centre, double-blind, randomized control trial to determine whether low-dose vasopressin decreases the need for blood product transfusion in trauma patients with hemorrhagic shock. Findings: A total of 100 adult trauma patients were enrolled. Vasopressin significantly decreased the volume of blood products given in the […]

Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Methodology: 4/5 Usefulness: 4/5 Lyttle MD, et al. Lancet. 2019 May 25;393(10186):2125-2134. Question and Methods: Eclipse was an open label RCT that evaluated time to seizure cessation in pediatric SE between Keppra and Dilantin Findings: They found that Keppra was not superior (HR 1.2, 95%CI 0.91-1.60, p= 0.20) to Dilantin for the treatment of SE Limitations: Limited somewhat by study […]

Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial.

Methodology Score: 3/5 Usefulness Score: 3/5 Cooper DJ, et al. JAMA. 2018;320(21):2211-2220. doi:10.1001/jama.2018.17075 Question/Methods: This study was done to determine the effectiveness of early prophylactic hypothermia compared with normothermic management of patients after severe traumatic brain injury (TBI). Findings:  No statistically significant difference in favorable neurologic outcomes at 6 months was found between the hypothermic and normothermic groups (48.8% vs 49.1%, […]

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomized, placebo-controlled trial

Methodology: 3.5/5 Usefulness: 3.5/5 The CRASH-3 trial collaborators. The Lancet. 2019 Oct 14. Online First Editorial: CRASH-3: a win for patients with traumatic brain injury Question and Methods: Multi-centre, randomized, placebo-controlled trial looking at whether TXA (1g over 10 minutes followed by infusion over 8 hours) reduces mortality in patients with ICH. Findings: No difference in mortality in TXA vs. […]

Trial of Pregabalin for Acute and Chronic Sciatica

Journal Club Summary Methodology: 3.5/5 Usefulness: 4/5 Mathieson S, et al. N Engl J Med. 2017 Mar 23;376(12):1111-1120.  Question and Methods: Double blind, randomized control trial comparing pregabalin against placebo for reducing leg pain symptoms at 8 weeks in 209 patients with acute and chronic sciatica. Findings: The authors found a between group difference in leg pain reduction of 0.5, with a […]

Hydrocortisone plus Fludrocortisone for Adults with Septic Shock

Journal Club Summary Methodology: 3/5 Usefulness: 3.5/5 Annane D, et al. N Engl J Med. 2018 Mar 1;378(9):809-818.  Editorial: A Role for Hydrocortisone Therapy in Septic Shock? Question and Methods: Large multi-center, double-blinded, randomized-controlled trial comparing effects of steroids (fludrocortisone + hydrocortisone) to placebo on 90-day mortality of ICU patients in septic shock on vasopressors for at least 6 hours. Findings: […]

Hydrocortisone plus Fludrocortisone for Adults with Septic Shock

Journal Club Summary Methodology: 3/5 Usefulness: 3.5/5 Annane D, et al. N Engl J Med. 2018 Mar 1;378(9):809-818.  Editorial: A Role for Hydrocortisone Therapy in Septic Shock? Question and Methods: Large multi-center, double-blinded, randomized-controlled trial comparing effects of steroids (fludrocortisone + hydrocortisone) to placebo on 90-day mortality of ICU patients in septic shock on vasopressors for at least 6 hours. Findings: […]