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PACUlit Medical Literature Dashboard

Study Title Study Design Interventions & Comparison Key Findings
TTM (2013)
  • Randomized controlled trial
  • n=950
  • Primary outcomes: All-cause mortality through the end of the trial and neurologic function at 180 days
  • Targeted temperature of 33°C for 36 hours
  • Targeted temperature of 36°C for 36 hours
  • 50% mortality in the 33°C group (235/473)
  • 48% mortality in the 36°C group (225/466)
  • Hazard ratio: 1.06 (95% CI, 0.89 to 1.28; P = 0.51)
  • 54% of the 33°C group had poor neurologic function or death at 180 days compared to 52% of the 36°C group (risk ratio: 1.02; P = 0.78)
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GUSTO (1993)
  • Randomized controlled trial
  • n=41,021
  • Primary outcomes: 30-day mortality rate
  • Accelerated t-PA: Intravenous administration with intravenous heparin
  • Streptokinase with intravenous heparin
  • Streptokinase with subcutaneous heparin
  • Combination of t-PA and streptokinase with intravenous heparin
  • 30-day mortality rate 6.3% for accelerated t-PA vs 7.2% for streptokinase, p=0.001
  • 14% reduction in mortality for accelerated t-PA compared to streptokinase strategies
  • Combined endpoint of death or disabling stroke lower in accelerated t-PA group, 6.9% vs 7.8%, p=0.006
  • Higher rates of hemorrhagic stroke with t-PA, 0.72% vs 0.49% for streptokinase, p=0.03
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ESSENCE (1997)
  • Randomized controlled trial
  • n=3,171
  • Primary outcome: composite end point of death, myocardial infarction, or recurrent angina at 14 days
  • Enoxaparin: 1 mg per kg administered subcutaneously twice daily, combined with aspirin
  • Unfractionated heparin: continuous intravenous infusion, administered with placebo injections, combined with aspirin
  • At 14 days, composite end point lower in enoxaparin group: 16.6% vs 19.8%, P=0.019
  • At 30 days, composite end point lower in enoxaparin group: 19.8% vs 23.3%, P=0.016
  • Revascularization needed less in enoxaparin group: 27.0% vs 32.2%, P=0.001
  • Higher overall bleeding incidence in enoxaparin group: 18.4% vs 14.2%, P=0.001
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OAT (2006)
  • Randomized controlled trial
  • n=2166
  • Primary outcomes: Composite of death, myocardial reinfarction, or NYHA class IV heart failure
  • Routine PCI with stenting plus optimal medical therapy
  • Optimal medical therapy alone
  • 4-year cumulative primary event rate: 17.2% PCI vs 15.6% medical therapy, P=0.20
  • Rates of myocardial reinfarction: 7.0% PCI vs 5.3% medical therapy, P=0.13
  • Rates of nonfatal reinfarction: 6.9% PCI vs 5.0% medical therapy, P=0.08
  • No interaction between treatment effect and subgroup variables
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CARP (2004)
  • Randomized controlled trial
  • n=510
  • Primary outcomes: long-term mortality and postoperative myocardial infarction
  • Coronary-artery revascularization: Percutaneous coronary intervention or CABG before elective major vascular surgery
  • No revascularization before vascular surgery
  • Mortality at 2.7 years: 22% (revascularization group) vs 23% (no revascularization group); RR 0.98 (95% CI 0.70–1.37, P=0.92)
  • Postoperative myocardial infarction within 30 days: 12% (revascularization group) vs 14% (no revascularization group, P=0.37)
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Not found
  • Randomized controlled trial
  • n=275
  • Primary outcomes: Favorable neurologic outcome at six months and mortality at six months
  • Hypothermia treatment: Target temperature 32°C to 34°C for 24 hours
  • Normothermia treatment: Standard treatment with normothermia
  • Favorable neurologic outcome: 55% in hypothermia group vs 39% in normothermia group (risk ratio 1.40, 95% CI 1.08 to 1.81)
  • Mortality at six months: 41% in hypothermia group vs 55% in normothermia group (risk ratio 0.74, 95% CI 0.58 to 0.95)
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LEADER (2016)
  • Multicenter, double-blind, placebo-controlled trial
  • n=9340
  • Primary outcomes: Composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke
  • Liraglutide: 1.8 mg subcutaneously daily
  • Placebo
  • Primary outcome occurred in fewer patients in liraglutide group: 608 of 4668 (13.0%) vs. placebo group: 694 of 4672 (14.9%) (hazard ratio: 0.87; 95% CI: 0.78 to 0.97; P<0.001)
  • Fewer cardiovascular deaths in liraglutide group: 219 (4.7%) vs. placebo group: 278 (6.0%) (hazard ratio: 0.78; 95% CI: 0.66 to 0.93; P=0.007)
  • Lower all-cause mortality in liraglutide group: 381 (8.2%) vs. placebo group: 447 (9.6%) (hazard ratio: 0.85; 95% CI: 0.74 to 0.97; P=0.02)
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ARISE (2014)
  • Randomized controlled trial
  • n=1600
  • Primary outcome: all-cause mortality at 90 days
  • EGDT: Standardized care for 6 hours with central venous oxygen saturation monitoring and fluid resuscitation
  • Usual care: Standard clinical practice without protocolized resuscitation and no ScvO2 monitoring
  • No significant difference in mortality at 90 days: 18.6% (EGDT) vs. 18.8% (usual care); P=0.90
  • Higher mean volume of fluids in EGDT group: 1964±1415 ml vs. 1713±1401 ml
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LOVIT (2023)
  • Randomized controlled trial
  • n=872
  • Primary outcomes: composite of death or persistent organ dysfunction at day 28
  • Intravenous vitamin C: 50 mg/kg every 6 hours for 96 hours
  • Matched placebo: Infusion of dextrose 5% in water or normal saline every 6 hours for 96 hours
  • Primary outcome occurred in 191 of 429 patients (44.5%) in the vitamin C group and 167 of 434 patients (38.5%) in the control group (risk ratio, 1.21; 95% CI, 1.04 to 1.40; P=0.01)
  • Death occurred in 152 patients (35.4%) in the vitamin C group and 137 patients (31.6%) in the placebo group (risk ratio, 1.17; 95% CI, 0.98 to 1.40)
  • Persistent organ dysfunction observed in 39 patients (9.1%) in the vitamin C group vs 30 patients (6.9%) in the placebo (risk ratio, 1.30; 95% CI, 0.83 to 2.05)
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VITAMINS (2020)
  • Multicenter, open-label, randomized clinical trial
  • n=216
  • Primary outcomes: Duration of time alive and free of vasopressor administration up to day 7, and 90-day mortality
  • Intervention group: IV Vitamin C (1.5 g every 6 hours), Hydrocortisone (50 mg every 6 hours), Thiamine (200 mg every 12 hours)
  • Control group: IV Hydrocortisone (50 mg every 6 hours) alone until shock resolution or up to 10 days
  • No significant difference in time alive and free of vasopressors up to day 7: 122.1 hours (IQR 76.3-145.4) vs 124.6 hours (IQR 82.1-147.0), Median difference -0.6 hours (95% CI -8.3 to 7.2, P=0.83)
  • 30-day mortality: 28.6% intervention vs 24.5% control, Hazard ratio 1.18 (95% CI 0.69-2.00)
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Analgesia-based Sedation Protocol (2013)
  • Prospective, two-phase (before-after), non-randomized multicenter study
  • n=287 (155 observational, 132 interventional)
  • Primary outcome: Ventilator-free days by day 28
  • Observation of sedation practices for 10 weeks
  • Analgesia-based, goal-directed, nurse-driven sedation protocol: Fentanyl continuous infusion 0.6-3.6 µg/kg/h, Midazolam continuous infusion 0.015-0.09 mg/kg/h
  • Proportion of deep sedation decreased from 55.2% to 44.0%
  • Ventilator-free days to day 28 were 8 (0-23) for observational and 13 (0-24) for interventional (p=0.430)
  • 28-day mortality was similar: 36.7% observational vs 34.1% interventional
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NSAIDs for Postoperative Pain After CABG Surgery (2000)
  • Randomized controlled trial
  • n=120
  • Primary outcomes: Pain control, morphine consumption, renal function
  • Diclofenac: 75 mg pr 1 hour before extubation, then 75 mg pr 12 hours later
  • Ketoprofen: 100 mg pr 1 hour before extubation, then 100 mg pr 12 hours later
  • Indomethacin: 100 mg pr 1 hour before extubation, then 100 mg pr 12 hours later
  • Placebo: Identical substances
  • Diclofenac reduced morphine consumption: mean 12.4 mg vs 19 mg in placebo (P<0.05)
  • Morphine equivalents lower in diclofenac group: 18.1 mg vs 26.5 mg in placebo (P<0.05)
  • No significant differences in postoperative creatinine levels or nausea among groups.
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ProCESS (2014)
  • Multicenter randomized trial
  • n=1,341
  • Primary outcome: 60-day in-hospital mortality
  • Protocol-based EGDT: 6 hours of resuscitation with central venous catheter and monitored therapy
  • Protocol-based standard therapy: 6 hours of resuscitation without requiring central venous catheterization
  • Usual care: standard practice without the structured approach
  • 60-day in-hospital mortality: 21.0% (EGDT), 18.2% (standard therapy), 18.9% (usual care)
  • No significant differences in mortality among groups: RR 1.04; 95% CI 0.82 to 1.31; P=0.83
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Psychiatric Outcomes of Prehospital Ketamine (2019)
  • Retrospective cohort study
  • n=141
  • Primary outcomes: Psychiatric inpatient admission and ED psychiatric evaluation
  • Intramuscular ketamine: 3-5 mg/kg
  • Intravenous ketamine: 1-2 mg/kg
  • Midazolam: 5-10 mg IM or 1-10 mg IV or 2.5-10 mg IN
  • Diazepam: 2.5-10 mg IV
  • Ketamine cohort psychiatric admission: 6.8%
  • Benzodiazepine cohort psychiatric admission: 2.4%
  • No significant difference in ED psychiatric evaluation: 8.6% ketamine vs. 15% benzodiazepines
  • Nonpsychiatric admission for ketamine: 35%
  • Nonpsychiatric admission for benzodiazepine: 51%
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PIONEER AF-PCI (2023)
  • Randomized controlled trial
  • n=2124
  • Primary outcomes: Clinically significant bleeding and major adverse cardiovascular events
  • Group 1: Rivaroxaban 15 mg once daily plus a single P2Y12 inhibitor for 12 months
  • Group 2: Rivaroxaban 2.5 mg twice daily plus DAPT for 1, 6, or 12 months
  • Group 3: Vitamin K antagonist plus DAPT for 1, 6, or 12 months
  • Clinically significant bleeding rates: 16.8% (group 1), 18.0% (group 2), 26.7% (group 3)
  • Hazard ratio for group 1 vs. group 3: 0.59 (95% CI 0.47 to 0.76, P<0.001)
  • Hazard ratio for group 2 vs. group 3: 0.63 (95% CI 0.50 to 0.80, P<0.001)
  • Major adverse cardiovascular events similar across groups: 6.5% (group 1), 5.6% (group 2), 6.0% (group 3)
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Multicenter Automatic Defibrillator Implantation Trial II (2001)
  • Randomized controlled trial
  • n=1232
  • Primary outcomes: Mortality from any cause
  • Implantable defibrillator: Prophylactic implantation in patients with ejection fraction ≤0.30
  • Conventional medical therapy: Standard medical management without defibrillator
  • Defibrillator group mortality: 14.2%, Conventional therapy group mortality: 19.8%
  • Hazard ratio for death, defibrillator vs. conventional therapy: 0.69 (95% CI 0.51 to 0.93; P=0.016)
  • Survival benefit started approximately nine months after implantation
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RED-HF (Year not specified)
  • Randomized controlled trial
  • n=2,278
  • Primary outcomes: Composite of death from any cause or hospitalization for worsening heart failure
  • Darbepoetin alfa: Administered subcutaneously to achieve a hemoglobin target of 13 g per deciliter
  • Placebo: Administered identically to mimic darbepoetin alfa dosing
  • Primary outcome: Occurred in 576 (50.7%) in darbepoetin alfa group vs. 565 (49.5%) in placebo group (HR 1.01; 95% CI 0.90–1.13; P=0.87)
  • No significant differences in secondary outcomes
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VITAL (2023)
  • Randomized controlled trial
  • n=25,871
  • Primary outcomes: Invasive cancer of any type and major cardiovascular events
  • Vitamin D3: 2000 IU daily
  • Marine n−3 fatty acids: 1 g daily
  • Placebo for both interventions
  • Vitamin D did not reduce invasive cancer incidence: HR 0.96 (95% CI 0.88 to 1.06; P=0.47)
  • No difference in major cardiovascular events: HR 0.97 (95% CI 0.85 to 1.12; P=0.69)
  • Death from cancer reduced: HR 0.83 (95% CI 0.67 to 1.02)
  • Overall mortality: HR 0.99 (95% CI 0.87 to 1.12)
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EPHESUS (2003)
  • Randomized controlled trial
  • n=6,642
  • Primary endpoints: Death from any cause; death from cardiovascular causes or hospitalization for heart failure, acute myocardial infarction, stroke, or ventricular arrhythmia.
  • Eplerenone: 25 mg daily, titrated to 50 mg daily
  • Placebo with optimal medical therapy
  • Eplerenone reduced overall mortality: RR 0.85 (95% CI 0.75–0.96), p=0.008
  • Cardiovascular mortality reduced: RR 0.83 (95% CI 0.72–0.94), p=0.005
  • Hospitalization for cardiovascular events reduced: RR 0.87 (95% CI 0.79–0.95), p=0.002
  • Sudden death from cardiac causes reduced: RR 0.79 (95% CI 0.64–0.97), p=0.03
  • Serious hyperkalemia noted in 5.5% of eplerenone group compared to 3.9% in placebo, p=0.002
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PEGASUS-TIMI 54 (Year not specified)
  • Randomized controlled trial
  • n=21,162
  • Primary outcomes: Cardiovascular death, myocardial infarction, or stroke
  • Ticagrelor 90 mg: 90 mg twice daily
  • Ticagrelor 60 mg: 60 mg twice daily
  • Placebo: Low-dose aspirin with no active treatment
  • 90 mg ticagrelor reduced composite end point: HR 0.85 (95% CI 0.75–0.96; P=0.008)
  • 60 mg ticagrelor reduced composite end point: HR 0.84 (95% CI 0.74–0.95; P=0.004)
  • TIMI major bleeding rates: 2.60% for 90 mg, 2.30% for 60 mg, 1.06% for placebo (P<0.001)
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TREC (2003)
  • Pragmatic randomized clinical trial
  • n=301
  • Primary outcomes: Patients tranquil or sedated at 20 minutes
  • Intramuscular midazolam
  • Intramuscular haloperidol plus promethazine
  • Midazolam: 134/151 (89%) tranquil or asleep at 20 minutes
  • Haloperidol-promethazine: 101/150 (67%) tranquil or asleep at 20 minutes
  • Relative risk (midazolam vs. haloperidol-promethazine): 1.32 (95% CI 1.16 to 1.49)
  • Adverse events: 1 in each group, one (midazolam) had respiratory depression, one (haloperidol) had a grand mal seizure.
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CAST (1991)
  • Randomized controlled trial
  • n=1,498
  • Primary outcomes: Mortality and morbidity in patients receiving encainide, flecainide, or placebo
  • Encainide
  • Flecainide
  • Placebo for encainide
  • Placebo for flecainide
  • Higher mortality due to arrhythmia in drug group: 43 vs 16, P = 0.0004
  • Higher deaths from nonarrhythmic cardiac causes in drug group: 17 vs 5, P = 0.01
  • No difference in nonlethal cardiac events between groups
  • Relative risk of death due to arrhythmia was 2.64 (95% CI, 1.60 to 4.36)
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ACT (Year not specified)
  • Randomized controlled trial
  • n=2308
  • Primary outcomes: Incidence of contrast-induced acute kidney injury and composite endpoint of mortality or need for dialysis at 30 days
  • Acetylcysteine: 1200 mg orally, twice daily before and after angiography
  • Placebo: Identical in appearance, taste, and smell to acetylcysteine
  • Contrast-induced acute kidney injury incidence: 12.7% in acetylcysteine group, 12.7% in placebo group (relative risk 1.00; 95% CI 0.81 to 1.25; P=0.97)
  • Composite outcome of death or need for dialysis: 2.2% acetylcysteine, 2.3% placebo (hazard ratio 0.97; 95% CI 0.56 to 1.69; P=0.92)
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Undetectable High-Sensitivity Cardiac Troponin T Level and Risk...
  • Cohort study
  • n=14,636
  • Primary outcome: Myocardial infarction risk within 30 days
  • igh-sensitivity cardiac troponin T
  • Negative predictive value for MI within 30 days: 99.8% (95% CI: 99.7 to 99.9)
  • Negative predictive value for death: 100% (95% CI: 99.9 to 100)
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Midazolam and Propofol (2014)
  • Prospective randomized study
  • n=135
  • Primary outcomes: Recovery time, extubation time, and mechanical ventilation time
  • Midazolam group: IV 0.03 to 0.30 mg/kg bolus; 0.04 to 0.20 mg/kg/hr infusion
  • Propofol group: IV 0.50 to 3.00 mg/kg bolus; 0.50 to 3.00 mg/kg/hr infusion
  • Sequential group: Start with midazolam, then switch to propofol after criteria met
  • Fentanyl for analgesia:
  • IV 1 to 2 μg/kg bolus, 1 to 2 μg/kg/hr infusion
  • Group M-P had lower incidence of agitation: 19.4% vs 48.7% (P=0.01)
  • Recovery time:
  • Group M: 58.0 hours
  • Group P: 1.5 hours
  • Group M-P: 1.0 hours
  • Extubation time:
  • Group M: 45.0 hours
  • Group P: 3.0 hours
  • Group M-P: 2.0 hours
  • Mechanical ventilation time:
  • Group M: 192.0 hours
  • Group P: 126.0 hours
  • Group M-P: 114.8 hours
  • ICU and hospital costs were lower for Group M-P compared to Group M and Group P (P<0.01)
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Intermittent vs Continuous Proton Pump Inhibitor Therapy for...
  • Systematic review and meta-analysis
  • n=1,346
  • Primary outcomes: Recurrent bleeding within 7 days, 3 days, and 30 days, need for urgent intervention, mortality.
  • Intermittent proton pump inhibitor therapy: bolus
  • Continuous proton pump inhibitor therapy: 80 mg IV bolus followed by 8 mg/h for 72 hours
  • Recurrent bleeding within 7 days: RR 0.72 (95% CI, 0.97)
  • Recurrent bleeding within 30 days: RR 0.89 (95% CI, 1.17)
  • Mortality: RR 0.64 (95% CI, 1.21)
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TTM2 (2021)
  • Randomized controlled trial
  • n=1,900
  • Primary outcomes: Death from any cause at 6 months and functional outcome at 6 months
  • Hypothermia group: cooled to 33°C for 40 hours, then controlled rewarming
  • Normothermia group: maintained temperature ≤37.5°C with early treatment of fever
  • At 6 months, 50% in hypothermia group died vs. 48% in normothermia group (relative risk with hypothermia, 1.04; 95% CI, 0.94 to 1.14; P=0.37)
  • Functional outcomes similar: 55% had moderate disability or worse in both groups (relative risk, 1.00; 95% CI, 0.92 to 1.09)
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TREC-India II (2007)
  • Pragmatic randomised controlled trial
  • n=300
  • Primary outcomes: Proportion of patients tranquil or asleep at 15 and 240 minutes
  • Intramuscular olanzapine: 10 mg
  • Intramuscular haloperidol: 10 mg + promethazine: 25 mg or 50 mg
  • Combined treatment: Haloperidol + promethazine
  • At 15 minutes, 87% olanzapine and 91% haloperidol plus promethazine were tranquil/asleep (relative risk 0.96, 95% CI 0.34 to 1.47)
  • At 240 minutes, 96% olanzapine and 97% haloperidol plus promethazine were tranquil/asleep (relative risk 0.99, 95% CI 0.95 to 1.03)
  • Additional drugs needed: 43% olanzapine vs 21% haloperidol plus promethazine (RR 2.07, 1.43 to 2.97)
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CURE (2001)
  • Randomized controlled trial
  • n=12,562
  • Primary outcomes: Composite of death from cardiovascular causes, nonfatal myocardial infarction, or stroke
  • Clopidogrel 300 mg loading dose, then 75 mg daily, with aspirin
  • Placebo 300 mg loading dose, then 75 mg daily, with aspirin
  • Primary outcome: Death from cardiovascular causes, nonfatal myocardial infarction, or stroke, 9.3% vs 11.4%, RR 0.80, P<0.001
  • Second primary outcome: Composite of primary outcome or refractory ischemia, 16.5% vs 18.8%, RR 0.86, P<0.001
  • Significantly lower severe ischemia in clopidogrel group, 2.8% vs 3.8%, RR 0.74, P=0.003
  • Increased major bleeding in clopidogrel group, 3.7% vs 2.7%, RR 1.38, P=0.001
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COLCOT (2019)
  • Randomized, double-blind trial
  • n=4745
  • Primary outcomes: Composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization
  • Low-dose colchicine: 0.5 mg once daily
  • Placebo
  • Colchicine group: 5.5% primary endpoint events vs. placebo: 7.1% (HR 0.77; 95% CI, 0.61 to 0.96; P=0.02)
  • Proportion of stroke: HR 0.26 (95% CI, 0.10 to 0.70)
  • Proportion of urgent hospitalization for angina: HR 0.50 (95% CI, 0.31 to 0.81)
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NINDS rt-PA Stroke Study (1995)
  • Randomized controlled trial
  • n=624
  • Primary outcomes: Neurologic improvement and recovery as assessed by multiple scales at 24 hours and three months
  • Intravenous alteplase: 0.9 mg/kg (max 90 mg), 10% as bolus, 90% as infusion over 60 minutes
  • Placebo: Normal saline infusion
  • Symptomatic intracerebral hemorrhage rate: 6.4% in t-PA group vs. 0.6% in placebo (P<0.001)
  • Long-term favorable outcome for t-PA: OR 1.7 (95% CI 1.2–2.6)
  • Mortality at 3 months: 17% in t-PA group vs. 21% in placebo (P=0.30)
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Pregabalin for OPCAB (2013)
  • Randomized controlled trial
  • n=40
  • Primary outcomes: Pain scores at rest and during deep breathing, tramadol consumption.
  • Pregabalin group: 150 mg pregabalin 2 h before induction and 75 mg twice daily for 2 days post-op
  • Control group: Placebo at similar timings
  • Pain scores at 6, 12, 24, and 36 h were significantly lower in the pregabalin group (P < 0.05)
  • Tramadol consumption reduced by 60% in pregabalin group (P < 0.001)
  • No significant differences in extubation times or sedation scores.
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Midazolam versus Propofol for Sedation (1990)
  • Open randomized study
  • n=40
  • Primary outcomes: Quality of sedation, recovery time, and weaning from mechanical ventilation
  • Group A: Midazolam loading dose 50 µg/kg followed by continuous infusion starting at 50 µg/kg/h
  • Group B: Propofol loading dose 500 µg/kg followed by continuous infusion starting at 1000 µg/kg/h
  • Recovery time shorter with propofol: 24 min (SEM 8) versus 66 min (SEM 17)
  • Time to successful extubation shorter with propofol: 154 min (SEM 33) versus 243 min (SEM 44)
  • Quality of sedation similar between both groups
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Midazolam versus Propofol for Long-Term Sedation in the...
  • Randomized prospective study
  • n=67
  • Primary outcomes: Efficacy, safety, and cost of midazolam compared to propofol in prolonged sedation.
  • Midazolam: loading dose 0.11 mg/kg, continuous infusion for sedation.
  • Propofol: loading dose 1.3 mg/kg, continuous infusion for sedation.
  • Midazolam achieved sedation duration of 141 hours, propofol 99 hours (NS).
  • 68% of propofol patients had >20% decrease in systolic blood pressure versus 31% on midazolam (p < 0.001).
  • Propofol required more daily dose adjustments: 2.1 versus 1.4 (p < 0.001).
  • Nurse-rated sedation quality higher with midazolam: 8.2 vs 7.3 on VAS (p < 0.001).
  • Cost comparison: Midazolam was 4-5 times cheaper than propofol.
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OASIS-5 (Year not specified)
  • Randomized controlled trial
  • n=20,078
  • Primary outcomes: Death, myocardial infarction, or refractory ischemia; major bleeding
  • Fondaparinux: 2.5 mg daily
  • Enoxaparin: 1 mg/kg twice daily
  • Standard treatments at investigator's discretion
  • Primary outcomes similar: 579 with fondaparinux (5.8%) vs. 573 with enoxaparin (5.7%); HR 1.01 (95% CI 0.90–1.13)
  • Major bleeding lower with fondaparinux: 2.2% vs. 4.1% with enoxaparin; HR 0.52 (P<0.001)
  • Reduced deaths at 30 days: 295 (fondaparinux) vs. 352 (enoxaparin); P=0.02
  • Composite of outcomes favored fondaparinux: 737 vs. 905 events; HR 0.81 (P<0.001)
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CURRENT-OASIS 7 (2010)
  • Randomized controlled trial
  • n=25,086
  • Primary outcomes: cardiovascular death, myocardial infarction, or stroke at 30 days
  • Double-dose clopidogrel: 600 mg loading dose on day 1, then 150 mg daily for 6 days and 75 mg daily thereafter
  • Standard-dose clopidogrel: 300 mg loading dose, then 75 mg daily thereafter
  • Higher-dose aspirin: 300 to 325 mg daily
  • Lower-dose aspirin: 75 to 100 mg daily
  • Primary outcome: double-dose clopidogrel 4.2% vs. standard-dose clopidogrel 4.4% (HR 0.94; 95% CI 0.83-1.06; P=0.30)
  • Major bleeding: double-dose 2.5% vs. standard-dose 2.0% (HR 1.24; 95% CI 1.05-1.46; P=0.01)
  • Stent thrombosis: double-dose 1.6% vs. standard-dose 2.3% (HR 0.68; 95% CI 0.55-0.85; P<0.001)
  • No significant difference between higher-dose and lower-dose aspirin for primary outcome (4.2% vs. 4.4%; HR 0.97; 95% CI 0.86-1.09; P=0.61)
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Shortened Antimicrobial Treatment for Acute Otitis Media in...
  • Randomized controlled trial
  • n=520
  • Primary outcomes: clinical response, recurrence, and nasopharyngeal colonization
  • 10-day amoxicillin–clavulanate: 90 mg/kg/day divided
  • 5-day amoxicillin–clavulanate: 90 mg/kg/day for 5 days, followed by 5 days of placebo
  • Clinical failure in 5-day group: 77/229 (34%) vs. 39/238 (16%) in 10-day group; difference 17 percentage points (95% CI, 9 to 25)
  • Mean symptom scores from day 6 to 14: 1.61 in 5-day vs. 1.34 in 10-day (P = 0.07)
  • Clinical failure rates higher with exposure to 3+ children (P=0.02) and bilateral infection (P<0.001)
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APROCCHSS (2015)
  • Multicenter, double-blind, randomized trial
  • n=1241
  • Primary outcomes: 90-day all-cause mortality
  • Hydrocortisone: 50 mg IV every 6 hours for 7 days
  • Fludrocortisone: 50 μg oral daily for 7 days
  • Drotrecogin alfa (activated): Doses not detailed
  • Placebo for each of the above interventions
  • 90-day mortality: 43.0% in hydrocortisone-plus-fludrocortisone group vs. 49.1% in placebo group (P=0.03)
  • Relative risk of death: 0.88 (95% CI, 0.78 to 0.99)
  • ICU discharge mortality: 35.4% vs. 41.0% (P=0.04)
  • Hospital discharge mortality: 39.0% vs. 45.3% (P=0.02)
  • Day 180 mortality: 46.6% vs. 52.5% (P=0.04)
  • Vasopressor-free days: 17 vs. 15 days (P<0.001)
  • Organ-failure–free days: 14 vs. 12 days (P=0.003)
  • Similar ventilator-free days: 11 vs. 10 days (P=0.07)
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Comparison of Patient-Controlled Epidural Analgesia with Patient-Controlled Intravenous...
  • Randomized, double-blind crossover study
  • n=80
  • Primary outcome: Pain scores and analgesic consumption post-caesarean section
  • Pethidine: patient-controlled epidural analgesia (PCEA)
  • Pethidine: patient-controlled intravenous analgesia (PCIA)
  • Fentanyl: patient-controlled epidural analgesia (PCEA)
  • Fentanyl: patient-controlled intravenous analgesia (PCIA)
  • Pethidine: Pain scores lower with PCEA vs PCIA from 4 to 16 h (P<0.05)
  • Pethidine consumption lower with PCEA vs PCIA from 12 to 24 h (P=0.0005)
  • Patient preference for PCEA > PCIA (P=0.015)
  • Fentanyl: Pain scores lower with PCEA at 12 h (P=0.045)
  • Fentanyl consumption lower with PCEA vs PCIA from 0 to 12 h (P=0.0007)
  • Plasma fentanyl higher with PCIA at 12 h (P=0.002)
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Intramuscular and Epidural Morphine (1984)
  • Randomized double-blind trial
  • n=30
  • Primary outcomes: Postoperative analgesia, ambulation, gastrointestinal motility
  • Intramuscular morphine: Dosing not specified
  • Epidural morphine: Dosing not specified
  • Epidural morphine produced fewer pulmonary complications
  • Earlier postoperative recovery of peak expiratory flow and bowel function
  • Shorter hospitalization in patients receiving epidural morphine
  • No evidence of prolonged respiratory depression
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GUSTO (1993)
  • Randomized controlled trial
  • n=41,021
  • Primary outcomes: 30-day mortality rate
  • Accelerated t-PA: Intravenous administration with intravenous heparin
  • Streptokinase with intravenous heparin
  • Streptokinase with subcutaneous heparin
  • Combination of t-PA and streptokinase with intravenous heparin
  • 30-day mortality rate 6.3% for accelerated t-PA vs 7.2% for streptokinase, p=0.001
  • 14% reduction in mortality for accelerated t-PA compared to streptokinase strategies
  • Combined endpoint of death or disabling stroke lower in accelerated t-PA group, 6.9% vs 7.8%, p=0.006
  • Higher rates of hemorrhagic stroke with t-PA, 0.72% vs 0.49% for streptokinase, p=0.03
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GISSI-3 (1994)
  • Randomized controlled trial
  • n=19,394
  • Primary outcomes: 6-week mortality and combined endpoint of mortality and severe ventricular dysfunction
  • Oral lisinopril: 5 mg initial dose, then 10 mg daily for 6 weeks
  • Transdermal glyceryl trinitrate: Intravenous for 24h, then 10 mg daily
  • Combination therapy: Lisinopril and transdermal glyceryl trinitrate
  • Open control for lisinopril
  • Open control for glyceryl trinitrate
  • No treatment for both
  • Lisinopril reduced overall mortality: OR 0.88 (95% CI 0.79–0.99)
  • Combined therapy reduced mortality: OR 0.83 (95% CI 0.70–0.97)
  • Lisinopril reduced composite endpoint (mortality and severe ventricular dysfunction): OR 0.90 (95% CI 0.84–0.98)
  • No independent effect of GTN on outcomes: OR 0.94 (95% CI 0.84–1.05)
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Efficacy and safety of topical ciprofloxacin/dexamethasone versus neomycin/polymyxin...
  • Randomized, observer-masked, parallel-group, multicenter study
  • n=468
  • Primary outcomes: Signs and symptoms of AOE, microbiologic eradication, frequency of adverse events
  • CIP/DEX: 0.3% ciprofloxacin and 0.1% dexamethasone, 3-4 drops twice daily for 7 days
  • N/P/H: 0.35% neomycin, 10,000 IU/mL polymyxin B, and 1.0% hydrocortisone, 3-4 drops three times daily for 7 days
  • Clinical cure rates at Day 18: 90.9% CIP/DEX vs 83.9% N/P/H (p = 0.0375)
  • Microbiologic eradication rates: 94.7% CIP/DEX vs 86.0% N/P/H (p = 0.0057)
  • Significantly better clinical response with CIP/DEX at Days 3 and 18 (p = 0.0279 and p = 0.0321)
  • Reduction in ear inflammation at Day 18: p = 0.0268
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RIVERS trial: Goal-directed therapy for septic shock (2001)
  • Randomized controlled trial
  • n=263
  • Primary outcomes: In-hospital mortality
  • Early goal-directed therapy: Six hours of goal-directed therapy before ICU admission
  • Standard therapy: Standard care in the emergency department
  • In-hospital mortality: 30.5% early goal-directed therapy vs 46.5% standard therapy, P=0.009
  • Mean central venous oxygen saturation: 70.4% vs 65.3%, P<0.001
  • Mean lactate concentration: 3.0 mmol/L vs 3.9 mmol/L, P<0.001
  • Mean APACHE II score: 13.0 vs 15.9, P<0.001
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Clinical Efficacy of Beta-1 Selective Beta-Blockers Versus Propranolol...
  • Retrospective cohort study
  • n=2462
  • Primary outcomes: In-hospital mortality rates
  • Beta-1 selective beta-blockers: IV landiolol, esmolol, oral bisoprolol, metoprolol, atenolol, betaxolol
  • Propranolol: IV and oral forms
  • Comparison between beta-1 selective beta-blockers and propranolol
  • Crude in-hospital mortality rates: 9.3% for beta-1 selective vs 6.2% for propranolol
  • Adjusted in-hospital mortality: 6.3% for beta-1 selective vs 7.4% for propranolol; OR 0.85 (95% CI 0.57–1.26)
  • No significant difference in mortality observed in patients with acute heart failure
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Evaluating a novel pharmacist-led buprenorphine outreach service for...
  • 3-month pre-and-post interventional pilot study
  • n=38
  • Primary outcomes: Treatment adherence defined as 80% prescription days covered (PDC) in a 3-month period.
  • Pharmacist-led outreach service: 3-month duration, onsite care, medication delivery, clinical assessment
  • Traditional initiation: 8 mg twice daily
  • 7-day low-dose overlap initiation: Gradually increasing doses
  • 3-day rapid low-dose overlap initiation: Quicker titration
  • 37% (N = 14) achieved ≥80% PDC post-intervention compared to 3% (N = 1) pre-intervention (p = 0.0009)
  • Mean PDC increased from 8% (SD = 22%) pre-intervention to 58% (SD = 36%) post-intervention (p < 0.00001)
  • 83% (N = 30) successfully initiated BUP treatment
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Aspirin and dipyridamole in the prevention of acute...
  • Retrospective study
  • n=263
  • Primary outcomes: Incidence of thrombus and clinically significant thrombus
  • Group 1: No aspirin, with or without dipyridamole
  • Group 2: Aspirin with or without dipyridamole
  • Group 3: Both aspirin and dipyridamole before admission and in hospital
  • Thrombus detected at 14.8% PTCA sites
  • Clinically significant thrombus at 5.7% PTCA sites
  • Group 1: Thrombus 21.5%, Clinically significant thrombus 10.7%
  • Group 2: Thrombus 11.8%, Clinically significant thrombus 1.8%
  • Group 3: No thrombus, No clinically significant thrombus
  • Higher platelet count and inadequate pretreatment associated with thrombus
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Calcium Replacement Protocol Impact at Level 2 Trauma...
  • Retrospective, single-center, pre-post study
  • n=67
  • Primary outcomes: Incidence of hypocalcemia within 24 hours of MTP initiation
  • Before protocol: Reactive calcium replacement
  • After protocol: Protocolized calcium replacement with 2 g initial calcium chloride IV push, then 1 g IV for each subsequent round
  • Post-protocol hypocalcemia incidence: 63% vs 95.2% pre-protocol (P = 0.006)
  • Time to first calcium dose: Median 5.5 minutes post vs 43 minutes pre (P < 0.0001)
  • Total calcium dose within 4 hours: 40.8 mEq post vs 27.2 mEq pre (P = 0.005)
  • Resolution of hypocalcemia in 24 hours: 89.6% post vs 65% pre (P = 0.035)
  • No significant differences in severe hypocalcemia: 39.1% post vs 69.1% pre (P = 0.083)
  • No difference in mortality: 30.4% post vs 52.4% pre (P = 0.085)
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Nebulized Medications in the Emergency Department (2024)
  • Narrative review
  • n=Not Specified
  • Aerosolized drug delivery
  • Nebulized medication therapies
  • Nontraditional agents
  • Traditional intravenous administration
  • Intramuscular therapies
  • Intranasal therapies
  • Emerging evidence supports nebulized calcium gluconate, fentanyl, hydromorphone, ketamine, naloxone, sodium bicarbonate.
  • Further evidence needed for furosemide, magnesium, nitroglycerin, tranexamic acid.
  • Nebulization provides rapid, less invasive access.
  • Potential for improved therapeutic response with minimized systemic effects.
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ATLAS ACS 2–TIMI 51 (2011)
  • Randomized controlled trial
  • n=15,526
  • Primary outcomes: Composite of death from cardiovascular causes, myocardial infarction, or stroke
  • Twice-daily rivaroxaban: 2.5 mg or 5 mg for mean 13 months (up to 31 months)
  • Placebo: equivalent twice-daily administration during the same period
  • Rivaroxaban reduced primary endpoint: 8.9% vs. 10.7% (hazard ratio 0.84; 95% CI 0.74-0.96; P=0.008)
  • 2.5 mg dose reduced cardiovascular death: 2.7% vs. 4.1% (hazard ratio 0.66; P=0.002)
  • Major bleeding increased in rivaroxaban group: 2.1% vs. 0.6% (hazard ratio 3.96; P<0.001)
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Rabies Post-Exposure Prophylaxis (2024)
  • Retrospective chart review
  • n=143
  • Primary aims: Compliance with rabies vaccine series, differences in compliance between campuses, impact of dose rounding on cost savings.
  • Rabies immunoglobulin administration
  • Rabies vaccine series
  • Patient education
  • NMC outpatient infusion center
  • BMC 'Nurse Only' visits
  • No dose rounding policy
  • Completion rate of vaccine series was 78.3%
  • NMC completion rate 82% vs BMC 69%, p=0.12
  • Statistically significant completion for payor and exposure type
  • Potential cost savings of $57,928.64 with dose rounding
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SCAPE Trial (2024)
  • Randomized controlled trial
  • n=54
  • Primary outcomes: Symptom resolution at 6 hours and 12 hours
  • High-dose GTN infusion with bolus dose and BIPAP
  • Low-dose GTN infusion without bolus and standard treatment
  • Symptom resolution at 6 hours: 65.4% vs 11.5%, p<0.001
  • Symptom resolution at 12 hours: 88.5% vs 19.2%, p<0.001
  • Longer median hospital stay in low-dose group: 72 hours vs 12 hours, p<0.001
  • More frequent MACE in low-dose group: 26.9% vs 3.8%, p=0.02
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NATALEE (2024)
  • Randomized controlled trial
  • n=5,101
  • Primary outcomes: invasive disease-free survival at 3 years
  • Ribociclib: 400 mg daily
  • Nonsteroidal aromatase inhibitor: Letrozole 2.5 mg or Anastrozole 1 mg daily for ≥5 years
  • Goserelin: every 28 days for premenopausal women
  • Nonsteroidal aromatase inhibitor alone
  • No goserelin for men
  • No additional treatments
  • Invasive disease-free survival at 3 years: 90.4% vs 87.1%, P=0.003
  • Distant disease-free survival at 3 years: HR 0.74
  • Recurrence-free survival at 3 years: HR 0.72
  • Overall survival HR: 0.76 (95% CI 0.54 to 1.07)
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Effect of Thiamine on Lactate Clearance in Septic...
  • Retrospective, matched cohort study
  • n=369
  • Primary outcomes: Lactate clearance and 28-day mortality
  • IV thiamine supplementation: Administered within 24 hours, high-dose thiamine (500 mg)
  • Matched cohort without thiamine: Control group of 246 patients with septic shock
  • Improved lactate clearance, SHR 1.307 (95% CI, 1.002–1.704)
  • Reduced 28-day mortality, HR 0.666 (95% CI, 0.490–0.905)
  • No differences in secondary outcomes
  • Greater benefit observed in female patients
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Push-Dose vs Continuous Infusion Epinephrine and Phenylephrine Simulation...
  • Crossover simulation study
  • n=16
  • Primary outcomes: Total preparation time and major preparation errors
  • Push-dose epinephrine: Prepared as 100 µg in 10 mL NS PD syringe
  • Push-dose phenylephrine: Prepared with 1000 µg in 10 mL NS PD syringe
  • Continuous infusion epinephrine: Prepared as 8 mg in 250 mL NS CI bag
  • Continuous infusion phenylephrine: Prepared as 100 mg in 250 mL NS CI bag
  • Push-dose had 70 seconds faster total preparation time, p=0.003
  • Push-dose had 18.8% major preparation errors (6/32)
  • Continuous infusion had no major errors
  • Administration time for push-dose was significantly faster, p<0.001
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ANNEXA-4
  • Retrospective cohort study
  • n=22
  • Primary outcomes: Hemostatic efficacy in FXaI-associated gastrointestinal bleeding
  • Andexanet alfa administration for the management of FXaI-associated GIB
  • Assessment of hemostatic efficacy
  • Comparison of hemostatic efficacy groups and assessment of transfusion requirements
  • No control group
  • 46% achieved excellent hemostatic efficacy, 23% good, 32% poor
  • No significant difference in RBCs received between efficacy groups
  • 30-day mortality rate was 27% (n=6)
  • 9% had arterial thrombotic events within 30 days
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Evaluating the Impact of a Discharge Pharmacy in...
  • Cohort study
  • n=78,660
  • Primary outcomes: ED revisits within 7 days, hospitalizations within 30 days
  • Medications provided at discharge
  • E-prescriptions to outside pharmacies
  • Printed prescriptions without e-prescriptions
  • Patients using ED pharmacy had 31.6% lower revisits, p<0.001
  • Patients with e-prescriptions 10.4% more likely to revisit, p=0.017
  • 29.2% higher hospitalization rates with e-prescriptions, p<0.001
  • 59.5% higher hospitalization rates with mixed prescriptions, p<0.001
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Tranexamic Acid for ACE-Inhibitor Induced Angioedema (2024)
  • Retrospective cohort study
  • n=262
  • Primary outcomes: Length of stay (LOS), ICU admissions, intubation rates
  • Tranexamic acid administration to patients with ACE-I angioedema
  • Control group: Patients with ACE-I angioedema not receiving tranexamic acid
  • Median length of stay longer in treatment group: 40.28 h vs 21.08 h, p < 0.0001
  • ICU admission rates higher in treatment group: 45.2% vs 15.9%, p < 0.0001
  • Intubation rates higher in treatment group: 12.3% vs 6.4%, p = 0.11
  • No significant difference in 7-day return or mortality
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Opioid Prescribing by Emergency Physicians (2024)
  • Retrospective cross-sectional study
  • n=63,586
  • Trends in opioid prescriptions among Medicare Part D prescriber data from 2013-2019
  • Analysis of opioid claims
  • Trends in opioid prescriptions
  • Cost analysis of opioid drugs
  • Comparison between emergency physicians and other prescribers
  • Opioid prescription rates over time
  • Regional variations in prescribing
  • Opioid prescribing decreased from 14.45% to 11.55%, p<0.001
  • Cost of opioid drugs declined by 50%
  • Hydrocodone-acetaminophen prescriptions decreased significantly
  • Increased prescriptions for tramadol and acetaminophen-codeine
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Prothrombin complex concentrate administration timing in warfarin-associated intracranial...
  • Retrospective observational study
  • n=39
  • Primary outcomes: Achievement of effective hemostasis, in-hospital mortality, and hospital/ICU length of stay
  • 4-factor prothrombin concentrate administered for ICH
  • Timing of administration: 90 min
  • No significant difference in effective hemostasis achievement: 85.7% vs 73.3% vs 90%, p=0.514
  • No significant difference in in-hospital mortality: 14% vs 33% vs 10%, p=0.283
  • No significant difference in hospital length of stay: 10 vs 8 vs 6 days, p=0.101
  • No significant difference in ICU length of stay: 4.5 vs 4.5 vs 2.5 days, p=0.255
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Impact of Emergency Medicine Clinical Pharmacist Practitioner-Driven Sepsis...
  • Retrospective comparison
  • n=144
  • EM CPP-driven protocol: Antimicrobial selection based on individual patient profiles, historical admissions, culture data, and allergy profiles
  • No pharmacist intervention: Standard antibiotic ordering
  • Sepsis consult to pharmacy: Antimicrobial interventions
  • Appropriate empiric antibiotic selection improved from 57.5% to 86%, p < 0.01
  • Time-to-first antibiotic administration decreased by 64 minutes, p < 0.01
  • No significant difference in in-hospital mortality across groups
  • No significant difference in hospital length of stay
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Intermittent vs Continuous Proton Pump Inhibitor Therapy for...
  • Systematic review and meta-analysis
  • n=1,346
  • Primary outcomes: Recurrent bleeding within 7 days, 3 days, and 30 days, need for urgent intervention, mortality.
  • Intermittent proton pump inhibitor therapy: bolus
  • Continuous proton pump inhibitor therapy: 80 mg IV bolus followed by 8 mg/h for 72 hours
  • Recurrent bleeding within 7 days: RR 0.72 (95% CI, 0.97)
  • Recurrent bleeding within 30 days: RR 0.89 (95% CI, 1.17)
  • Mortality: RR 0.64 (95% CI, 1.21)
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Operationalizing DEA Exception for Methadone (2024)
  • Descriptive Report
  • n=42
  • Dispensing methadone at discharge
  • Multidisciplinary educational materials
  • Electronic health record order set
  • Standard discharge without methadone
  • Previous methadone dispensing methods
  • 36 out of 42 requests approved, 86%
  • 79 methadone doses dispensed in 3 months
  • 86% approval rate for inpatient requests
  • Potentially avoided up to 64 hospital days
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ESSENCE (1997)
  • Randomized controlled trial
  • n=3,171
  • Primary outcome: composite end point of death, myocardial infarction, or recurrent angina at 14 days
  • Enoxaparin: 1 mg per kg administered subcutaneously twice daily, combined with aspirin
  • Unfractionated heparin: continuous intravenous infusion, administered with placebo injections, combined with aspirin
  • At 14 days, composite end point lower in enoxaparin group: 16.6% vs 19.8%, P=0.019
  • At 30 days, composite end point lower in enoxaparin group: 19.8% vs 23.3%, P=0.016
  • Revascularization needed less in enoxaparin group: 27.0% vs 32.2%, P=0.001
  • Higher overall bleeding incidence in enoxaparin group: 18.4% vs 14.2%, P=0.001
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EPHESUS (2003)
  • Randomized controlled trial
  • n=6,642
  • Primary endpoints: Death from any cause; death from cardiovascular causes or hospitalization for heart failure, acute myocardial infarction, stroke, or ventricular arrhythmia.
  • Eplerenone: 25 mg daily, titrated to 50 mg daily
  • Placebo with optimal medical therapy
  • Eplerenone reduced overall mortality: RR 0.85 (95% CI 0.75–0.96), p=0.008
  • Cardiovascular mortality reduced: RR 0.83 (95% CI 0.72–0.94), p=0.005
  • Hospitalization for cardiovascular events reduced: RR 0.87 (95% CI 0.79–0.95), p=0.002
  • Sudden death from cardiac causes reduced: RR 0.79 (95% CI 0.64–0.97), p=0.03
  • Serious hyperkalemia noted in 5.5% of eplerenone group compared to 3.9% in placebo, p=0.002
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Early Metoprolol (2005)
  • Randomized controlled trial
  • n=45,852
  • Co-primary outcomes: composite of death, reinfarction, or cardiac arrest; death from any cause
  • Intravenous metoprolol: up to 15 mg
  • Oral metoprolol: 200 mg daily until discharge or up to 4 weeks
  • Standard treatment
  • Matching placebo
  • Standard treatment
  • No β-blocker therapy
  • No significant reduction in death, reinfarction, or cardiac arrest: OR 0.96, p=0.1
  • No significant reduction in all-cause mortality: OR 0.99, p=0.69
  • 5 fewer reinfarctions per 1000 with metoprolol: OR 0.82, p=0.001
  • 11 more cardiogenic shocks per 1000 with metoprolol: OR 1.30, p<0.00001
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COLCOT (2019)
  • Randomized, double-blind trial
  • n=4745
  • Primary outcomes: Composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization
  • Low-dose colchicine: 0.5 mg once daily
  • Placebo
  • Colchicine group: 5.5% primary endpoint events vs. placebo: 7.1% (HR 0.77; 95% CI, 0.61 to 0.96; P=0.02)
  • Proportion of stroke: HR 0.26 (95% CI, 0.10 to 0.70)
  • Proportion of urgent hospitalization for angina: HR 0.50 (95% CI, 0.31 to 0.81)
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OAT (2006)
  • Randomized controlled trial
  • n=2166
  • Primary outcomes: Composite of death, myocardial reinfarction, or NYHA class IV heart failure
  • Routine PCI with stenting plus optimal medical therapy
  • Optimal medical therapy alone
  • 4-year cumulative primary event rate: 17.2% PCI vs 15.6% medical therapy, P=0.20
  • Rates of myocardial reinfarction: 7.0% PCI vs 5.3% medical therapy, P=0.13
  • Rates of nonfatal reinfarction: 6.9% PCI vs 5.0% medical therapy, P=0.08
  • No interaction between treatment effect and subgroup variables
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FRISC II (1999)
  • Prospective randomised multicentre study
  • n=2457
  • Primary outcomes: Composite endpoint of death or myocardial infarction
  • Early invasive treatment strategy: Placebo-controlled low-molecular-mass heparin, coronary angiography
  • Non-invasive treatment strategy: Placebo-controlled low-molecular-mass heparin, no coronary angiography
  • Composite endpoint of death or myocardial infarction decreased: 9.4% invasive vs 12.1% non-invasive, RR 0.78, p=0.031
  • Significant decrease in myocardial infarction: 7.8% invasive vs 10.1% non-invasive, RR 0.77, p=0.045
  • Non-significantly lower mortality: 1.9% invasive vs 2.9% non-invasive, RR 0.65, p=0.10
  • Symptoms of angina and re-admission halved by invasive strategy
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CAPRICORN (2001)
  • Randomized controlled trial
  • n=1,959
  • Primary outcomes: All-cause mortality or hospital admission for cardiovascular problems
  • Carvedilol: Initial dose 6.25 mg, increased to 25 mg twice daily
  • Placebo
  • No significant difference in primary endpoint: Carvedilol 35% vs Placebo 37%, HR 0.92 (95% CI 0.80-1.07)
  • Reduced all-cause mortality with Carvedilol: 12% vs 15%, HR 0.77 (95% CI 0.60-0.98), p=0.03
  • Reduced cardiovascular mortality and non-fatal myocardial infarctions with Carvedilol
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ECPR Study (2024)
  • Retrospective cohort study
  • n=51
  • Primary outcomes: Neurologic outcome at hospital discharge based on cumulative epinephrine dosage
  • Low dose (≤ 3 mg) epinephrine group
  • High dose (> 3 mg) epinephrine group
  • Favorable neurologic outcome at discharge: 55% (low dose) vs 24% (high dose), p=0.025
  • Odds ratio for unfavorable outcome in high-dose group: 4.6, 95% CI 1.3-18.0, p=0.017
  • Mean cumulative epinephrine dose: 6.2 mg, range 0-24 mg
  • Survival to hospital discharge: 61% (low dose) vs 27% (high dose), p=0.018
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Full-dose challenge of moderate, severe, and unknown beta-lactam...
  • Retrospective, descriptive study
  • n=184
  • Primary outcomes: Allergic reactions following full-dose beta-lactam challenge
  • Full-dose beta-lactam challenge: Administered in the ED without prior tolerance documentation
  • Ceftriaxone: Most commonly administered (83.2%)
  • Piperacillin-tazobactam: Administered in a small number of cases
  • Allergic reactions: 5 patients (2.7%) experienced reactions, all mild
  • No anaphylactic reactions occurred
  • 86.4% of beta-lactam antibiotics continued inpatient
  • 73.4% of allergy profiles updated post-challenge
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CHAMPION PHOENIX (2013)
  • Randomized controlled trial
  • n=11,145
  • Primary outcomes: Composite of death, myocardial infarction, ischemia-driven revascularization, and stent thrombosis at 48 hours after randomization
  • Cangrelor: Bolus of 30 μg/kg followed by continuous infusion of 4 μg/kg/min during PCI
  • Clopidogrel: Loading doses of 600 mg or 300 mg prior to PCI
  • Comparison against standard therapy with clopidogrel
  • Placebo infusion comparable to cangrelor
  • Primary efficacy end point: 4.7% cangrelor vs 5.9% clopidogrel, OR 0.78 (95% CI 0.66–0.93, P=0.005)
  • Stent thrombosis: 0.8% cangrelor vs 1.4% clopidogrel, OR 0.62 (95% CI 0.43–0.90, P=0.01)
  • 30-day composite efficacy end point: 6.0% cangrelor vs 7.0% clopidogrel, OR 0.85 (95% CI 0.73–0.99, P=0.03)
  • Transient dyspnea: 1.2% cangrelor vs 0.3% clopidogrel, P<0.001
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CAST (1991)
  • Randomized controlled trial
  • n=1,498
  • Primary outcomes: Mortality and morbidity in patients receiving encainide, flecainide, or placebo
  • Encainide
  • Flecainide
  • Placebo for encainide
  • Placebo for flecainide
  • Higher mortality due to arrhythmia in drug group: 43 vs 16, P = 0.0004
  • Higher deaths from nonarrhythmic cardiac causes in drug group: 17 vs 5, P = 0.01
  • No difference in nonlethal cardiac events between groups
  • Relative risk of death due to arrhythmia was 2.64 (95% CI, 1.60 to 4.36)
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NINDS rt-PA Stroke Trial (1995)
  • Randomized controlled trial
  • n=624
  • Primary outcomes: Improvement in NIHSS score at 24 hours; favorable outcome at three months on Barthel index, modified Rankin scale, Glasgow outcome scale, and NIHSS
  • t-PA: 0.9 mg/kg (maximum 90 mg) administered intravenously, with 10% as a bolus and 90% as a continuous infusion over 60 minutes
  • Placebo: Comparable volume administered intravenously
  • No significant difference in neurologic improvement at 24 hours between t-PA and placebo
  • At three months, t-PA group had 30% more likely to have minimal or no disability (OR 1.7; 95% CI, 1.2 to 2.6)
  • Symptomatic intracerebral hemorrhage occurred in 6.4% of t-PA patients vs 0.6% placebo (P<0.001)
  • Mortality at three months: 17% t-PA vs 21% placebo (P=0.30)
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Pharmacist-driven Deprescribing Protocol (2024)
  • Single-center, prospective, observational, pre-post intervention study
  • n=89
  • Primary outcomes: Days free of antibiotics
  • Pharmacist-driven deprescribing protocol for negative urine and STI cultures
  • Comparison against standard care without deprescribing
  • Antibiotic-free days: Preintervention 0/465 (0%) vs Postintervention 150.5/187 (80.5%)
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Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome...
  • Randomized controlled trial
  • n=340
  • Primary outcomes: 90-day mortality rate
  • Cisatracurium: 150 mg formulation, 48 hours intravenous infusion
  • Placebo: Identical regimen without active drug
  • Hazard ratio for death at 90 days: 0.68 (95% CI, 0.48 to 0.98; P=0.04)
  • Crude 90-day mortality: 31.6% cisatracurium vs 40.7% placebo (P=0.08)
  • Mortality at 28 days: 23.7% cisatracurium vs 33.3% placebo (P=0.05)
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TTM2 (2021)
  • Randomized controlled trial
  • n=1900
  • Primary outcomes: Death from any cause at 6 months
  • Hypothermia: Target temperature of 33°C for 40 hours followed by controlled rewarming
  • Normothermia: Target temperature of 37.5°C or less with early treatment of fever
  • Death at 6 months: 50% in hypothermia group vs 48% in normothermia group, relative risk 1.04 (95% CI 0.94 to 1.14, P=0.37)
  • Functional outcome (modified Rankin scale score 4 to 6): 55% in both groups
  • Arrhythmia resulting in hemodynamic compromise: 24% in hypothermia vs 17% in normothermia, P<0.001
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BICAR-ICU (2018)
  • Randomized controlled trial
  • n=389
  • Primary outcomes: Composite of death from any cause by day 28 and the presence of at least one organ failure at day 7
  • Bicarbonate group: 4.2% intravenous sodium bicarbonate infusion to maintain arterial pH above 7.30
  • Control group: No sodium bicarbonate infusion
  • Primary outcome: 138 (71%) control vs 128 (66%) bicarbonate, absolute difference –5.5%, 95% CI –15.2 to 4.2, p=0.24
  • Day 28 mortality: 104 (54%) control vs 87 (45%) bicarbonate, absolute difference –9.0%, 95% CI –19.4 to 1.4, p=0.07
  • In AKIN scores of 2 or 3: 74 (82%) control vs 64 (70%) bicarbonate, absolute difference –12.3%, 95% CI –26.0 to –0.1, p=0.0462
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