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PACUlit Medical Literature Dashboard

Study Title Study Design Interventions & Comparison Key Findings
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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