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Showing posts from January, 2017

Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomized feasibility trial

Journal Club SummaryMethodology Score: 3/5                    Usefulness Score: 2/5
Jairath V, et al. Lancet.2015 Jul 11;386(9989):137-44 Abstract Link
This open label, cluster randomized feasibility trial based in six university hospitals in the United Kingdom including 936 patients demonstrated no difference in measured clinical outcomes between the liberal and restrictive blood transfusion groups for acute upper gastrointestinal bleeds. Although this was a feasibility trial and many limitations of the study were identified (balance between clusters, adherence to protocol, contamination, loss to follow-up), it was felt even a large non-inferiority trial is unlikely to find a difference in patient outcomes with the two transfusion regimens. By: Dr. Shannon McCarter
Epi lessonCluster Randomized Controlled Trials
A cluster randomized trial is a trial in which individuals are randomized in groups (i.e. the group is randomized, not the individual); for example, all patients treated By: a part…

Bedside Diagnosis of the 'Red Eye': A Systematic Review

Methodology Score: 2/5                    Usefulness Score:  2/5
Narayana S, et al. Am J Med. 2015 Nov;128(11):1220-1224.e1. Abstract Link
This review study looked at the diagnostic accuracy of physical exam findings for serious causes of red eye and bacterial conjunctivitis; for red eye photophobia (direct, indirect and near synkinesis) and anisocoria had the highest LR, while for bacterial conjunctivitis complete redness of conjunctival membrane, observed purulent discharge and bilateral morning matting of the eyes had the highest LRs.  Overall the group felt this review paper was not helpful as it was not thorough enough in its literature search and many of the exam findings had insignificant LRs. By: Dr. Julia Traer
Epi lessonLikelihood Ratios For diagnostic tests, LR+ increases the post-test probability of a diagnosis and LR- decreases the post-test probability. LR values generally have this impact: a) large and conclusive (LR+ >10, LR- <0.1), b) moderate (LR+ 5 to10, LR- …

PTSD for Emergency Physicians

For many of us in Emergency Medicine, PTSD is something we don’t really think about.We might pause before using ketamine for sedation in a war veteran, or seek psychological support for victims of sexual assault, but it is not a topic that we usually discuss or associate with.It certainly isn’t something that we feel threatens us and our careers.

However studies using standardized and validated tools have shown a point prevalence of PTSD in German [1] and Belgian [2] emergency physicians, Dutch hospital physicians [3] and Vancouver ED staff [4] to be approximately 15%.By comparison, the lifetime prevalence of PTSD in the Canadian population is approximately 2.4% [5] so a point prevalence of 15% is extremely high.

Though initially surprising, these numbers start to make sense when we think about the types of cases that emergency physicians handle regularly:pediatric injuries and arrests, sexual assaults, graphic traumas, failed resuscitations.We are exposed daily to things that would sca…