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Showing posts from July, 2014

Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial

Methodology Score: 4/5                  Usefulness Score: 2/5
Bateman DN, et al. Lancet. 2014 Feb 22;383(9918):697-704
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This 2x2 factorial, intention to treat, randomized controlled trial of acetaminophen 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 lesson: Design 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…

Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage

Methodology Score: 4/5                  Usefulness Score: 2/5
INTERACT2 Investigators. N Engl J Med. 2013 Jun 20;368(25):2355-65.
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This large multicentre, partially blinded RCT compared aggressively lowering SBP to <140 vs. standard care in acute non-traumatic intracerebral hemorrhage and found no significant difference in rates of death or major disability between the two groups, although their secondary outcome was statistically significant for a improved functional outcomes in the study group. The overall opinion of our group was that this study will not change practice patterns.  By: Dr. Sebastian Dewhirst (Presented Feb 2014)

Epi lesson - Flow Diagram   Investigators and editors developed the CONSORT Statement (revised 2010 to improve the reporting of randomized controlled trials (RCTs) by means of a checklist and flow diagram. The flow diagram is intended to depict the passage of participants through an RCT and depicts numbers and ex…

Efficacy of pain control with topical lidocaine–epinephrine–tetracaine during laceration repair with tissue adhesive in children: a randomized controlled trial

Methodology Score: 4.5/5                  Usefulness Score: 3.5/5 Harman S, Zemek R, Duncan MJ, Ying Y, Petrcich W. CMAJ. 2013 Sep 17;185(13):E629-34.
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This study was a double blind RCT which demonstrated that using topical LET on minor lacerations before wound closure with tissue adhesive, reduced pain associated with the procedure as a primary outcome, and, resulted in improved hemostasis and significantly increased the number of pain free procedures (NNT=4) as a secondary outcome. The study used excellent methodology which controlled for many confounding variables. The group agreed that the clinical impact was limited by the fact that most children in the placebo group, rated pain associated with the procedure as 1/10 on a visual analogue scale.  By: Dr. Bharat Bahl (Presented February 2014)

Epi lesson - Intention-to-treat (ITT) Analyses   Intention-to-treat (ITT) analyses are widely recommended as the preferred approach to the analysis of most clinical trials. The basic intenti…