Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial.

Journal Club Summary Methodology Score: 4/5                  Usefulness Score: 2/5   Morelli A, et al. JAMA. 2013 Oct 23;310(16):1683-91 Article Link   This single centre phase 2B trial randomized septic patients still requiring vasopressors after 24hrs of EGDT to esmolol infusions to a target hear rate of between 85-94 or standard sepsis therapy and found overall mortality at 28 days of […]

Safe exclusion of pulmonary embolism using the Wells rule and qualitative D-dimer testing in primary care: prospective cohort study.

Journal Club Summary Methodology Score: 3/5                  Usefulness Score: 2.5/5   Geersing GJ, et al. BMJ. 2012 Oct 4;345:e6564. Article Link   This was a prospective cohort validation study using the Wells clinical decision rule combined with D-dimer to exclude PE in primary care. The study found in their low risk group (Wells ≤ 4 and neg d-dimer) a false negative […]

Targeted temperature management at 33°C versus 36°C after cardiac arrest

Journal Club Summary Landmark Article Series Nielsen N, et al.; TTM Trial Investigators. N Engl J Med. 2013 Dec 5;369(23):2197-206.   Methodology Score: 5/5                             Usefulness Score: 5/5   Article Link   In this multicenter, international RCT of 950 unconscious adults after out-of-hospital cardiac arrest, hypothermia at a targeted temperature of 33°C did not confer a mortality or neurologic function benefit […]

Clopridogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack

Journal Club Summary Methodology Score: 4 /5                 Usefulness Score: 3.5/5   Wang Y, Johnston SC, Wang Y. N Engl J Med. 2013 Oct 3;369(14):1376-7. Article Link     This multicenter randomized-control trial of 5,100 patients with TIA/minor stroke treated within 24 hours found clopidogrel and aspirin was superior to aspirin alone for secondary prevention of stroke within 90 days (ARR […]

Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature

Journal Club Summary Methodology Score: 4.5/5              Usefulness Score: 3/5   Dentali F, Riva N, Crowther M, Turpie AG, Lip GY, Ageno W. Circulation. 2012 Nov 13;126(20):2381-91. Article Link   This was a systematic review and meta-analysis of 12 phase II/III RCTs which found that using New Oral Anticoagulants (NOACs: dabigatran, rivaroxaban, apixaban, edoxaban) over warfarin in patients with AF reduced […]

A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial

Journal Club Summary Methodology Score: 2/5                  Usefulness Score: 3.5/5 Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M.Am J Emerg Med.2013 Sep;31(9):1389-92 Abstract Link This single centre, ED based, parallel group randomized control trial found that the topical application of an injectable form of tranexamic acid (TXA) was better than anterior nasal packing (ANP) for halting bleeding within the […]

The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis

Journal Club Summary Methodology Score: 3.5/5               Usefulness Score: 3.5/5 Quant EC, Jeste SS, Muni RH, Cape AV, Bhussar MK, Peleg AY. BMJ. 2009 Sep 7;339:b3354. doi: 10.1136/bmj.b3354. Article Link This meta-analysis of randomized controlled trials comparing the use of steroids alone vs steroids and antivirals in the treatment of Bell’s palsy found that there was no benefit to the use […]

A 2-Hour Diagnostic Protocol for Possible Cardiac Chest Pain in the Emergency Department

Journal Club Summary Methodology Score: 3.5/5                          Usefulness Score: 3/5   Than M, Aldous S, Lord SJ, Goodacre S, Frampton CM, Troughton R, George P, Florkowski CM, Ardagh M, Smyth D, Jardine DL, Peacock WF, Young J, Hamilton G, Deely JM, Cullen L, Richards AM. JAMA Intern Med. 2013 Oct 7. doi: 10.1001/jamainternmed.2013.11362. [Epub ahead of print]   Abstract Link   […]

Clinical Decision Rules to Rule Out Subarachnoid Hemorrhage for Acute Headache

Journal Club Summary Methodology Score: 4.5/5                          Usefulness Score: 4/5 Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Hohl CM, Sutherland J, Émond M, Worster A, Lee JS, Mackey D, Pauls M, Lesiuk H, Symington C, Wells GA. JAMA. 2013;310(12):1248-1255. Abstract Link    This multicentre prospective validation cohort study found that the 3 previously created subarachnoid hemorrhage (SAH) decision rules had very good sensitivity (>90%) and […]

Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest A Randomized Clinical Trial

Journal Club Summary Methodology Score: 4/5                 Usefulness Score: 2.5/5   Mentzelopoulos SD, et al. JAMA. 2013;310(3):270-279. Article Link   This randomized, multi-centered, double blind, placebo controlled trial compared vasopressin, steroids and epinephrine (VSE) vs. epinephrine for in-hospital cardiac arrest and found a 18% ARR in favour of the VSE group for ROSC > 20 mins and a 8.8% ARR in favour […]