Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16.
Med Teach. 2011;33(1):9-23
Authors: Harris J, Kearley K, Heneghan C, Meats E, Roberts N, Perera R, Kearley-Shiers K
Journal clubs (JCs) are a common form of interactive education in health care aiming to promote the uptake of research evidence into practice, but their effectiveness has not been established.
PMID: 21182379 [PubMed - indexed for MEDLINE]
Link to Article at PubMedPersonality factors and medical training: a review of the literature.
Med Educ. 2011 Feb;45(2):132-40
Authors: Doherty EM, Nugent E
it has been acknowledged that certain personality characteristics influence both medical students' and doctors' performance. With regard to medical students, studies have been concerned with the role of personality, and performance indicators such as academic results and clinical competence. In addition, the link between personality and vulnerability to stress, which has implications for performance, has been investigated at both undergraduate and postgraduate levels. Most of the studies cited in the literature were published before the year 2000. The authors therefore undertook a literature search to determine whether any prospective systematic studies have been published since 2000.
PMID: 21208259 [PubMed - indexed for MEDLINE]
Link to Article at PubMedEfficacy of Agents to Prevent and Treat Enteral Feeding Tube Clogs (May).
Ann Pharmacother. 2011 Apr 26;
Authors: Dandeles LM, Lodolce AE
OBJECTIVE: To review the efficacy and safety of agents used to prevent and treat clog formation in enteral feeding tubes. DATA SOURCES: A literature search was conducted through MEDLINE (1948-February 2011) and International Pharmaceutical Abstracts (1970-February 2011) using the search terms enteral feeding tube and occlusion. In addition, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All English-language publications were reviewed for applicability. DATA SYNTHESIS: Occlusion is a common complication of enteral tube feeding. With Food and Drug Administration regulations, pancreatic enzymes have recently been reformulated and previously published reports can no longer be applied to currently available agents. This has led to concern over what available products have been shown to be efficacious. Three in vitro studies, 1 randomized in vivo trial, and 1 descriptive report were reviewed. In the prevention of tube clogging, it was concluded that water was comparable in efficacy, while being more readily available and cost effective, when compared to Coca-Cola, and both were superior to cranberry juice. For resolution of an existing clog, evidence of the efficacy of any individual agents is limited and has not been reproducible. New formulations of pancreatic enzymes, a new delivery system for enzymes, and products to mechanically dismantle clogs have become commercially available, but no studies have been completed to evaluate safety and efficacy. Comparative in vivo studies of currently available products are needed to evaluate possible methods for resolving an occlusion. CONCLUSIONS: Water flushes have shown to be the most effective method in preventing enteral feeding tube clogging. Well-designed trials are needed to establish the proper place in therapy of new commercially available agents marketed for resolving clogs. In addition, well-designed in vivo trials are needed to establish the role, dosage, and extemporaneous formulation of extended-release pancreatic enzymes in treating such clogs.
PMID: 21521858 [PubMed - as supplied by publisher]
Link to Article at PubMedVancomycin-Induced Neutropenia: Is it Dose- or Duration-Related? (May).
Ann Pharmacother. 2011 Apr 26;
Authors: Black E, Lau TT, Ensom MH
OBJECTIVE: To systematically evaluate the literature to determine whether vancomycin-induced neutropenia is dose- or duration- related and provide clinicians with feasible treatment alternatives. DATA SOURCES: A literature search of PubMed (1949-November 2010), MEDLINE (1950-November 2010), EMBASE (1980-November 2010), and International Pharmaceutical Abstracts (1970-November 2010) was performed using the terms vancomycin, neutropenia, and leukopenia. Citations from publications were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: Studies and case reports were included if they reported neutropenia with vancomycin administration and excluded if they did not describe vancomycin dosages and/or concentrations, or if neutropenia resolved while the patient was still receiving vancomycin. Cases with significant confounders and those in which authors provided minimal information about patients were also excluded. DATA SYNTHESIS: Seven retrospective chart reviews (ie, case series) and 33 case reports were identified. Of these, 3 retrospective reviews and 26 case reports met inclusion criteria. To our knowledge, no prospective studies have assessed this clinical complication. Data suggest that vancomycin-induced neutropenia may not be completely related to daily dosages, total cumulative dosage, or supra- therapeutic vancomycin concentrations. Furthermore, evidence suggests that neutropenia is more likely associated with therapy longer than 7 days, with the majority of episodes occurring beyond 20 days of therapy. Given these findings, a practical approach is to monitor white blood cell (WBC) count with a differential (including absolute neutrophil count) once a week in patients who are receiving vancomycin for more than 7 days. CONCLUSIONS: Vancomycin-induced neutropenia is most likely associated with prolonged vancomycin exposure. Patients receiving vancomycin for longer than 7 days should have WBC count, differential, monitored weekly. Vancomycin should be discontinued if there is a high clinical suspicion of it causing neutropenia, and an alternative agent should be initiated. Prospective case-controlled studies are needed to better characterize this adverse event.
PMID: 21521866 [PubMed - as supplied by publisher]
Link to Article at PubMedRole of {alpha}2-Agonists in the Treatment of Acute Alcohol Withdrawal (May).
Ann Pharmacother. 2011 Apr 26;
Authors: Muzyk AJ, Fowler JA, Norwood DK, Chilipko A
OBJECTIVE: To evaluate literature reporting on the role of norepinephrine in alcohol withdrawal and to determine the safety and efficacy of ?2-agonists in reducing symptoms of this severe condition. DATA SOURCES: Articles evaluating the efficacy and safety of the ?2-agonists clonidine and dexmedetomidine were identified from an English-language MEDLINE search (1966-December 2010). Key words included alcohol withdrawal, delirium tremens, clonidine, dexmedetomidine, ?2-agonist, norepinephrine, and sympathetic overdrive. STUDY SELECTION AND DATA EXTRACTION: Studies that focused on the safety and efficacy of clonidine and dexmedetomidine in both animals and humans were selected. DATA SYNTHESIS: The noradrenergic system, specifically sympathetic overdrive during alcohol withdrawal, may play an important role in withdrawal symptom development. Symptoms of sympathetic overdrive include anxiety, agitation, elevated blood pressure, tachycardia, and tremor. Therefore, ?2-agonists, which decrease norepinephine release, may have a role in reducing alcohol withdrawal symptoms. The majority of controlled animal and human studies evaluated clonidine, but the most recent literature is from case reports on dexmedetomidine. The literature reviewed here demonstrate that these 2 ?2-agonists safely and effectively reduce symptoms of sympathetic overdrive and concomitant medication use. Dexmedetomidine may offer an advantage over current sedative medications used in the intensive care unit, such as not requiring intubation with its use, and therefore further study is needed to fully elicit its benefit in alcohol withdrawal. CONCLUSIONS: Clonidine and dexmedetomidine may provide additional benefit in managing alcohol withdrawal by offering a different mechanism of action for targeting withdrawal symptoms. Based on literature reviewed here, the primary role for clonidine and dexmedetomidine is as adjunctive treatment to benzodiazepines, the standard of care in alcohol withdrawal.
PMID: 21521867 [PubMed - as supplied by publisher]
Link to Article at PubMedHands-off time during insertion of six airway devices during cardiopulmonary resuscitation: A randomised manikin trial.
Resuscitation. 2011 Apr 6;
Authors: Ruetzler K, Gruber C, Nabecker S, Wohlfarth P, Priemayr A, Frass M, Kimberger O, Sessler DI, Roessler B
INTRODUCTION: Cardiopulmonary resuscitation (CPR) guidelines recommend limiting interruptions of chest compressions because prolonged hands-off (i.e., non-compression) time compromises tissue perfusion. 2010 European Resuscitation Council guidelines suggest that chest compressions should be paused less than 10s during airway device insertion. METHODS: With approval of the local ethics committee of the Medical University of Vienna and written informed consent, we recruited 40 voluntary emergency medical technicians, none of whom had advanced airway management experience. After a standardised audio-visual lecture and practical demonstration, technicians performed airway management with each six airway devices (endotracheal tube, Combitube, EasyTube, laryngeal tube, Laryngeal Mask Airway, and I-Gel) during on-going chest compressions in a randomised sequence on a Resusci Anne Advanced Simulator. Data were analysed using a mixed-effects model accounting for the repeated measurements and pair-wise comparisons among the airway devices. RESULTS: The hands-off time associated with airway management using an endotracheal tube (including all intubation attempts) was 48s (95% confidence interval: 43-53). The hands-off time for airway management using a laryngeal tube was 8.4 (3.4-16.4)s, Combitube 10.0 (4.9-15.1)s, EasyTube 11.4 (6.4-16.4)s, LMA 13.3 (8.2-18.3)s and for I-Gel 15.9 (10.8-20.9)s. Hands-off time was significantly longer with the conventional endotracheal tube than with any of the other airway systems. Only a third of the technicians successfully inserted an endotracheal tube whereas all of them successfully positioned each supraglottic device. CONCLUSION: Supraglottic devices appear to be a reasonable emergency airway management strategy, even for inexperienced personnel.
PMID: 21514986 [PubMed - as supplied by publisher]
Link to Article at PubMed