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 […]

Sepsis and Septic Shock

The Surviving Sepsis Guidelines define sepsis as a “life-threatening organ dysfunction caused by a dysregulated host response to an infection”. Septic shock is further defined as sepsis with hypotension (MAP ≤65) and/or lactate ≥2.0 despite adequate fluid resuscitation(1,2). This definition of septic shock highlights the importance of factoring in both macrocirculatory (blood pressure) and microcirculatory markers (lactate) when treating patients. […]

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, […]

Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial

Methodology: 4/5 Usefulness: 3/5 Fujii T, et al. JAMA. 2020 Jan 17. doi: 10.1001/jama.2019.22176. [Epub ahead of print] Editorial: Lack of Benefit of High-Dose Vitamin C, Thiamine, and Hydrocortisone Combination for Patients With Sepsis. Question and Methods: International, multicenter, open-label RCT to determine whether HAT (hydrocortisone, ascorbate, thiamine) compared with hydrocortisone alone, improves the duration of time alive and free […]

CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions

Journal Club Summary Methodology Score: 2.5/5 Usefulness Score: 3/5 Prins HJ, et al. Eur Respir J. 2019 May 23;53(5).  Question and Methods: The CATCH Study was a multicentre, randomised, controlled open intervention clinical trial comparing CRP guided antibiotics for COPDE vs the Gold Strategy Findings: The study had a 14.5% AAR in antibiotic use within 24 hours with a NNT […]

Abscess Incision and Drainage With or Without Ultrasonography: A Randomized Controlled Trial

Journal Club Summary Methodology Score: 2.5/5 Usefulness Score: 2/5 Gaspari RJ, et al. Ann Emerg Med. 2019 Jan;73(1):1-7 Question and Methods: Unblinded single-centre RCT comparing POCUS vs. physical exam guided I&D of abscesses in systemically well patients, comparing treatment failure at 10d defined by repeat I&D producing purulence. Findings: In 107 patients who achieved follow-up, the POCUS group had a […]

Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children

Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 3/5 Shaikh N, Hoberman A, Hum SW, Alberty A, Muniz G, Kurs-Lasky M, Landsittel D, Shope T. JAMA Pediatr. 2018 Jun 1;172(6):550-556. Question and Methods: The objective was to develop a risk-tool (UTICalc) to aid physicians in deciding when to perform urinanalysis and when to empirically treat febrile children 2 to 23 months of age. […]

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: […]

Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study

Methodology Score: 2.5/5                Usefulness Score:  2.5/5 Little P, et al. BMJ. 2017 May 22;357:j2148. Editorial: Controlling antibiotic prescribing for lower respiratory tract infections Scott AM et al. BMJ. 2017 May 22;357:j2398. doi: 10.1136/bmj.j2398. Question and Methods: This is a large, prospective, observational study of ambulatory patients with acute cough treated with no, immediate or delayed antibiotics that compared rates of re-consultation, admission and […]