Thomas Henry Huxley
Latest Critically Appraised Topics (CATS)
Below and in the Previous JC Topics link you will find a host of CATS that provide the best evidence available about various topics. These CATS have been presented at our monthly Emergency Medicine Journal Club by our residents at the EVMS emergency medicine residency program. Feel free to forward any comments or suggestions you may have.(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.
Sadosty AT, Goyal DG, Gene HH et.al. Alternatives to the conference status quo: summary recommendations
from the 2008 CORD Academic Assembly Conference Alternatives workgroup. Acad Emerg Med 2009 Dec;16 Suppl 2:S25-31.
Binstadt ES, Walls RM, White BA, A comprehensive medical simulation education curriculum for emergency
medicine residents. Ann Emerg Med 2007 Apr;49(4):495-504, 504.e1-11. Epub 2006 Dec 11.
Aldeen AZ, Gisondi MA Bedside teaching in the emergency department. Acad Emerg Med 2006 Aug;13(8):860-6. Epub 2006 Jun 9.
April 2010
Antihypertensive treatment in the asymptomatic ED patient: What are the best medication choices?
March 2010
Critically Appraised Topic Are serial lactate measurements in sepsis an alternative to Scv02?
Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy :
A Randomized Clinical Trial. JAMA. 2010 (Abstract)
D-dimer as a diagnostic tool in diagnosis of patients suspected of having a thoracic dissection (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 Forum: 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.
Our discussant, Dr Virginia Stewart's article comments as well as a summary of the current health care bill (October 2009)
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.
Giving Teeth to Comparative-Effectiveness Research — The Oregon Experience Somnath Saha, M.D., M.P.H., Darren D. Coffman, M.S., and Ariel K. Smits, M.D., MPH
January 2010
Ringers Lactate, Normal Saline or Albumin: Which is the best for fluid resuscitation?
Oral contrast and CT: Should oral contrast be the exception and not the rule?
December 2009: JC gets a pass for the Christmas New Year Holiday. We will be looking at some formatting changes coming soon so keep the ideas & suggestions coming. Have a great holiday season!
November 2009
Is there a role for steroids in patients with acute pharyngitis?
Bell's Palsy: Does the use of antivirals provide any additional benefits?
Outcomes Feedback: A thought provoking open access essay: Is no news bad news?
October 2009
A decision rule for kids with minor head injury: PICARN Abstract
Is the combination of ketamine and propofol (Ketofol) a useful adjunct in pediatric ED sedation?
September 2009
Is there a role for Rapid Flu-Testing in the Emergency Department?
Antivirals and Flu-like illness: Is there any evidence to support their routine use?
Efficacy of H1N1 Monovalent Vaccine: A Preliminary Report abstract
August 2009
Glycemic control in the ICU patient: an appraisal of the NICE-SUGAR trial.
Is there a role for vasopressin in the treatment of septic shock?
Early goal directed therapy: A look back & critical appraisal of the original Rivers article.
July 2009
Should Thiamine be used in the routine management of the chronic ETOH abuser?
Is there a role for ASA plus clopidogrel in acute ischemic stroke and TIA?
June 2009: JC Takes a break as we bid adieu to the Class of 2009 and ready ourselves for the 'newbies.'
May 2009 JC made a visit to SAEM in NOLA and two of our resident presenters offer up abstracts of interest. One sadly stayed behind and presented the PICO below
The Sellick maneuver...useful, or a hindrance to ED intubation?
Dr.Stewart's Abstracts of interest from the Annual SAEM Meeting
April 2009
Shoulder dislocations...should all reductions begin with the use of intra-articular anesthetics?
Should we be Pan-Scanning ALL blunt abdominal trauma patients?
Validation of a universal rule for pre-hospital termination of resuscitation
March 2009
GI Bleeds: Can Octreotide/Somatostatin be useful in ED patients with acute NON-variceal GI Bleeding?
Variceal Bleeding: Emergent endoscopy vs. octreotide & vasopressin. Is there a better choice?
Do NG tubes provide any utility in triaging patients suspected of having upper GI bleeds?
February 2009
Fever in ages 3-36 months...Do well appearing kids need anything other than a U/A
MMWR report on the impact of polyvalent pneumococcal vaccine Prevnar
The SWEET Study for Acute Elbow Fractures
Is C-reactive Protein a useful adjunct in evaluation ED patients with acute chest pain?
January 2009
Skin abscesses, MRSA or not: Is there any evidence in support of empiric antibiotics?
Vertigo: The Epley maneuver vs. benzodiazepines, anticholinergics or antiemetics? (link to The Epley)
Hypertonic Saline in Acute Bronchiolitis: A Critical Appraisal of an RCT
December 2008
JC gets a pass for the holidays. We will be back with new topics in January and always welcome suggestions for clinical questions. Take a look at the new voluntary PhRMA rules that go into effect January 1st. We'll avoid any commentary at this time and suggest you take a look and start stocking up on your pens. Have a great holiday.
PhRMA Code of Interaction with Healthcare Professionals
November 2008
Can TPA be given safely six hours after onset of an acute ischemic CVA?
The ABCD2 prediction rule for patients with TIA
Thrombectomy in acute CVA...ready for prime time or not?
October 2008
Can Serum Tryptase Serve as a Biomarker for Those Predisposed to Anaphylaxis?
Do Narcotic Analgesics impact the Accuracy of the Physical Exam in Children with Acute Abdominal
September 2008 - ELECTION 2008 This month JC took a look at the Presidential Candidates positions on healthcare. Below are our presenters summaries.
Obama's Healthcare Plan Summary
McCain's Healthcare Plan Summary
Ron Paul's Healthcare Plan Summary
August 2008
Hypotensive Resuscitation in Trauma: Slow fluids, no fluids or get out the pressure bags
Sodum Bicarbonate in Sepsis: Still crazy after all these years
Emergency Department Coronary CT-A: A new "gold standard"?
July 2008
Emergency Department Coronary MRI: Ready for prime time or not?
Contrast Induced Nephropathy: An update on fluids, NAC or sodium bicarbonate?
Critical Appraisal: Morphine, Ketorolac or both in acute renal colic?
June 2008...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 10,000 unique visitors on 4 June.
May 2008
Is oral contrast for CT necessary when evaluating patients with acute blunt abdominal trauma?
What's the evidence in support of using hypertonic saline in the acute head injured patient?
Is the re-packing of cutaneous abscesses cruel and unusual punishment?
April 2008
Critical Appraisal: The Interact Trial Should we be more aggressive about lowering systolic blood pressure in those with acute ischemic stroke? (Interact Trial Lancet Neurol. 2008 Apr 4)
Critical Appraisal: The Unload Trial Is ultrafiltration of utility in ED ptients with acute CHF? (The UNLOAD Trial J Am Coll Cardiol 2007; 49:675-83)
March 2008
Rapid Flu Testing: Is there an appropriate role for testing in the ED
Critical Appraisal: Predicting outcome after traumatic brain injury: practical prognostic models based on a large cohort of international patients. MRC Crash Trial Collaborators article BMJ 2008 Feb 23;336(7641):425-9
February 2008
JC elected to play nice in view of the In-Service exam and attending's presented the following topics and articles.
The Full Moon and Emergency Department Visits: A howlingly good PICO by Dr. Lo appears to finally put the question to sleep.
January 2008
Can B-Blockers be used safely in cocaine abusers with chest pain due to ACS?
Is the CRP or Procalcitonin a better indicator for infection than the White Blood Cell Count?
In acute CHF, can B-blockers be considered a safe and effective adjunct to typical measures?
December 2007 JC gets a pass for the Holidays. Here's a few holiday reads. Enjoy.
On Happiness: So money's not the answer after all
Art of Medicine: On admitting patients without discernable pathology (PWDP)
November 2007
Can ED OBS patients safely undergo accelerated serial enzyme determinations?
Critical Appraisal: Steroids vs. Acyclovir for Bell's Palsy?
Is CT of the C-spine in the multi-trauma patient sufficient or is MRI necessary ?
October 2007
Is Insulin Effective in Ca Channel Blocker Overdose?
How About Nebulized Mg in Acute Asthma?
Factor VII in Acute Intracranial Hemorrhage: A Critical Appraisal Original NEJM Article
September 2007
Should We be Using Absorbable Sutures More Frequently?
Canadian vs. New Orleans Head CT Rules - original articles can be found in clinical tools section
Hespan vs. Crystalloid for Fluid Resusciation
August 2007
Is D-Dimer Useful for Diagnosing Thoracic Aneurysm?
Is Ultrasound Assistance for IJ Central Lines Preferred Over Landmark Techniques?
Is NAC Effective in Preventing Contrast Induced Nephropathy?
July 2007
Are Early Thrombolitics Indicated in Submassive PE?
Do Pre-Intubation Steroids Decrease Laryngeal Edema?
June 2007- JC Takes a vacation!
May 2007
Treating Pneumonia...The 4-hour "Rule"
Should Skin Abscesses be Rx'd with Antibiotics for MRSA?
Are False Positive Troponins Common in Renal Failure?
April 2007
Should Kids with Cephalohematomas Undergo Head CT?
Is Lidocaine Necessary for RSI in Head Injury?
Should Steroids Be Used Early in Suspected Meningitis Cases?
March 2007
Is Etomidate Safe In Septic Shock?
How Does MRI compare to CT for Acute Stroke
How Does Coronary CT-A Compare to Stress Echo?
February 2007
Should we be core cooling post-resuscitation patients?
Are topical anesthetics effective for parenteral procedures?
Does counseling regarding inappropriate ED visits work?
January 2007
Are Serial Lactic Levels Useful When Managing Sepsis?
Intra-articular Anesthetics Prior to Shoulder Reduction
Ketamine vs. Etomidate for Pediatric Conscious Sedation
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