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Latest Journal Club Topics 

EM Journal Club
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Welcome to the Emergency Medicine Journal Club Website. 
Each month we post critically appraised topic summaries (CATS) or individual article critical appraisals in subject areas appropriate to emergency medicine were discussed in our monthly EM journal club at Eastern Virginia Medical School (EVMS).  We appreciate comments and suggestions so feel free to make contact. (mail) 
 



December 2011 (coming soon)


 November 2011

P: In children with acute bronchiolitis and no prematurity or underlying cardiopulmonary disease

I: Does the use of inhaled racemic epinephrine

C: Compared to “usual standard of care”

O: Improve respiratory status, need for hospital admission hospital.

Critical Appraisal: Plint,A, Epinephrine and Dexamethasone in Children with Brochiolitis NEJM, 2009. 360 2079-89

October 2011  
PICO Question
Population: ED patients with suspected pulmonary embolism (low, moderate, and high risk)
Intervention: Algorithm-aided diagnostic decision making 
Comparison: Routine ED care
Outcome: PE protocol CT order rates, PE-related mortality

Critical Appraisal: 


Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Suspected Pulmonary Embolism, Ann Emerg Med 2011; 57: 628-652   Link to Article

Critical Appraisal:
A computerized handheld decision-support system to improve pulmonary embolism diagnosis:  a randomized trial, Ann Intern Med 2009; 151:  677-686.  Link to Article

Critical Appraisal:
Effectiveness and acceptability of a computerized decision support system using modified Wells criteria for evaluation of suspected pulmonary embolism, Ann Emerg Med 2011;  57: 613-621   Link to article 
 

September 2011

Critically Appraised Topics (CATS) Appropriate Use vs. Harms of the Diagnostic CT Scanner

P: In patients being considered for diagnostic CT
I: Is the consideration of radiation exposure and inclusion of patient decision-making & consent 
C: Compared to deferring consent   
O: Associated with a more judicious approach to use of CT 

P: In ED patient’s undergoing CT imaging

I:  Is the routine use of IV contrast

C: Compared to deferring the use of contrast

O: Associated with significant harms (acute and chronic renal failure, death


P: In patient’s undergoing diagnostic CT whose results include incidental findings

I:  Can a structured approach to assessment/ follow-up/ clinical relevance

C: Compared to “routine” approaches to patient follow-up

O: Provide a means to identify clinically relevant findings and minimize unnecessary f/u imaging
August 2011 !!! Hurricaine IRENE Cancels JC: Residents in Despair !!!

 July 2011 

Critical Appraisal  Hypertonic Saline or Mannitol to treat elevated ICP?  Kamel H, Navi BB et al. Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: A meta-analysis of randomized clinical trials. Crit Care Med. 2011;39 (3):601-2   Link to Article

Critical Appraisal:  Vasopressors for Hypotensive Shock any Differences?  Systematic Review: Havel C, Arrich J, Losert H, Gamper G, Müllner M, Herkner H. Vasopressors for hypotensive shock. Cochrane Database of Systematic Reviews 2011, Issue 5  Link to Article

CAT (Critically Appraised Topic) Does tamsulosin (Flomax) move kidney stones along quicker?


 

June 2011 

JC gets a pass this month as we bid adieu to our seniors and  prepare for the newbies. Take a look at the recent postings in the essay and article section. We want to thank all for getting us to over 60,000 unique visitors this year. Keep visiting and providing us with your feedback  

(mail). 

May 2011 Acute Heart Failure
 Critical Appraisal:  Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes. Ann Emerg Med 2007 May;49(5):627-69           Link to Article 

Critical Appraisal:  Felker MG,  et al. Diuretic strategies in patients with acute decompensated heart
failure. N Engl J Med 2011; 364: 797-80    


 
April 2011  Topics in Atrial Fibrillation  

February 2011 Ultrasound as an initial approach in acute appendicitis 

January 2011 

Etomidate in Rapid Sequence Intubation  &  ONSD

                    December 2010: JC gets a pass...happy holidays

November 2010: Bedside US for DVT & Femoral Nerve Block                      

Femoral Nerve Blocks in Acute Hip Fracture: US may make this more attractive and accessible?     

Bedside compression ultrasonography for DVT: Effective in the hands of EM physicians?

Transcranial Doppler (TCD) in the Acute Stroke Patient

 CAT: Transcranial Doppler ultrasonography in acute stroke: Ready for prime-time or not?

Link to Transcranial Doppler review article (open access)  

October 2010: Combined EM & Peds-EM JC

CAT's:

UTI's in Children: Are there reliable clinical signs and symptoms that significantly increase the likelihood ratio for a UTI in pediatric ED patients?

Subcutaneous IV fluid rehydration in kids (hypodermoclysis): Ready for prime-time or not?

Critical Appraisal: 

Oral Ivermectin for head lice infestation: Is this an safe and effective therapy?

Article: Chosidow O, Giraudeau B, Cottrell J, et al. Oral ivermectin versus malathion lotion for difficult-to-treat head lice. N Engl J Med 2010;362:896-905 

September 2010: The Bleeding Patient 

This marked an amazing multidisciplinary JC as we attempted to look at the evidence regarding patients with bleeding diathesis (usually from warfarin) who require emergent reversal of INR's because of intracranial hemorrhage, or other life threatening bleeding diatheses.  The use or rVIIa and PCC's vitamin K and FFP were all part of a robust discussion.  Additionally the issues 

of RBC to FFP ratios and the role of tranexamic acid in the bleeding trauma patient was discussed.

 

CATs:

Should patients with elevated INR's who present to the ED with Intracranial Hemorrhage (ICH) be considered to receive prothrombin complex concentrates or factor rVIIa?

Should we be more aggressive in timing of or FFP:RBC ratio's in

the bleeding patient?

 



July 2010 

CATs:

Are coronary calcium scores a useful alternative to stress echo in low risk ED chest pain observation unit patients? 

Can the use of a delta troponin I at 3 hours safely rule out AMI in patients presenting to the ED at 6 hours after the onset of their chest pain?     

Yes! Another shoulder reduction technique - the FARES technique

Article - Reduction of Acute Anterior Dislocations: A Prospective Randomized Study Comparing a New Technique with the Hippocratic and Kocher Mathods

 

June 2010 

 

JC gets a pass this month as we bid adieu to our seniors and  prepare for the newbies. Take a look at the recent postings in the essay and article section. We want to thank all for getting us to over 60,000 unique visitors this year. Keep visiting and providing us with your feedback 

(mail). 

 

May 2010 

 


Novel and Innovative Approaches to EM Resident Education - We elected to close out the year by reviewing a few articles and discussing alternatives to the standard didactic approach to resident learning. Seems like most at JC agreed that there is plenty of room for some innovation regarding resident learning. This may take the form of podcasts, simulation medicine, Petcha Kucha, tweeting, video formats and other novel ideas. Below are links to some of the articles discussed as well as links to some open source examples. 

 

Articles - 
Alternatives to the conference status quo: summary recommendations from the 2008 CORD Academic Assembly Conference Alternatives workgroup.

A comprehensive medical simulation education curriculum for emergency medicine residents.

Bedside teaching in the emergency department.

What is a Wiki, and How Can it be Used in Resident Education? J Digit Imaging

April 2010

CATs:

Asymptomatic hypertension in the ED. Should we be initiating treatment of simply referring for follow-up?

Screening studies for hypertension: Is there evidence in support of routine ECG, U/A, BNP assessment for the asymptomatic hypertensive ED patient?

Antihypertensive treatment in the asymptomatic ED patient: What are the best medication choices?

March 2010

CAT:

Are serial lactate measurements in sepsis an alternative to Scv02?

Critical Appraisals:

Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy: A Randomized Clinical Trial

Article - (Abstract)

D-dimer as a diagnostic tool in diagnosis of patients suspected of having a thoracic dissection   

Article - (Abstract)

 

February 2010  

Health Care Policy: This month JC decided to take a look at a few interesting articles regarding the healthcare policy debate.  

The Cost Conundrum by Dr Atul Gawandi New Yorker June 1, 2009 - 

A thought provoking article on healthcare costs and how sometimes "the most expensive piece of medical equipment is a doctors pen."  Also included are article discussion points by our discussant Dr. Michelle Clinton. Also, see Dr. Atul Gawgandi's website for additional content such as his article The Checklist.

Ending End-of-Life Phobia — A Prescription for Enlightened Health Care Reform  Benjamin W. Corn, M.D.  - 

An open access article from the NEJM regarding end of life issues and their impact of health care policy.

Sunday Form: Suck it up, America - 

We have become a nation of whining hypochondriacs, and the only way 

to fix a broken health-care system is for all of us to get a grip. by Dr. Thomas Boyle  An open access article from the Pittsburgh Post-Gazette that gives an ED physicians perspective on Americans and their sometimes unreasonable expectations as ED patients.

 

Here are Dr Virginia Stewart's comments and summary of the current health care bill (October 2009).

Also, here are two excellent open access NEJM articles on how comparative-effectiveness research could be a hedge against healthcare costs.

 Health Care Reform and the Need for Comparative-Effectiveness Research Alvin I. Mushlin, M.D., and Hassan Ghomrawi, Ph.D., M.P.H.  


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