Ryan P. Radecki

Global Emergency Medicine Journal Club: Social Media Responses to the November 2013 Annals of Emergency Medicine Journal Club

The Annals November 2013 Journal Club issue marked one of the first collaborations with Academic Life in Emergency Medicine, a medical education blog, in an effort to promote a worldwide, transparent, online effort to perform critical appraisals of journal articles. The Global Emergency Medicine Journal Club was hosted on the blog for 1 week during November 18 to 24, 2013, with comments moderated on the blog and on Twitter. This summary article compiles the discussion and insights.

Ten Steps for Setting Up an Online Journal Club

Journal clubs have an extensive history that dates back to the time of Sir William Osler. They provide a venue to discuss the latest medical literature among groups of peers and are an innovative method for translating knowledge into practice within individual institutions. With advances in social media, journal clubs are poised to take an evolutionary step by harnessing digital connectivity. Online journal clubs are uniting hundreds of medical practitioners from around the world under the banner of one cause: enhancing knowledge translation of the medical literature without the limitations of geography. This article describes 10 steps for creating online journal clubs based on the experiences of a multidisciplinary team of clinicians and medical educators.

rt-PA and Stroke: Does IST-3 Make It All Clear or Muddy the Waters? Answers to the November 2012 Journal Club Questions

Editor’s Note: You are reading the 30th installment of Annals of Emergency Medicine Journal Club. This Journal Club refers to the Third International Stroke Trial (IST-3) that was published in Lancet. Information about the journal club can be found at http://www.annemergmed.com/content/ journalclub. Readers should recognize that these are suggested answers. We hope they are accurate; we know that they are not comprehensive. There are many other points that could be made about these questions or about the article in general. Questions are rated novice “ ,” intermediate “ ,” and advanced “ “ so that individuals planning a journal club can assign the right question to the right student. The “novice” rating does not imply that a novice should be able to spontaneously answer the question. “Novice” means we expect that someone with little background should be able to do a bit of reading, formulate an answer, and teach the material to others. Intermediate and advanced questions also will likely require some reading and research, and that reading will be sufficiently difficult that some background in clinical epidemiology will be helpful in understanding the reading and concepts. We are interested in receiving feedback about this feature. Please e-mail journalclub@acep.org with your comments.

Outcomes of Patients Requiring Blood Pressure Control Before Thrombolysis with tPA for Acute Ischemic Stroke

Introduction The purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis. Methods We performed a retrospective review of patients treated with tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) between 2004–2011. We compared the outcomes of patients treated with tPA for AIS who required aggressive BP control prior to thrombolysis to those requiring standard or no BP control prior to thrombolysis. The primary outcome of interest was safety, defined by all grades of hemorrhagic transformation and neurologic deterioration. The secondary outcome was efficacy, determined by functional status at discharge, and in-hospital deaths. Results Of 427 patients included in the analysis, 89 received aggressive BP control prior to thrombolysis, 65 received standard BP control, and 273 required no BP control prior to thrombolysis. Patients requiring BP control had more severe strokes, with median arrival National Institutes of Health Stroke Scale of 10 (IQR [6–17]) in patients not requiring BP control versus 11 (IQR [5–16]) and 13 (IQR [7–20]) in patients requiring standard and aggressive BP lowering therapies, respectively (p=0.048). In a multiple logistic regression model adjusting for baseline differences, there were no statistically significant differences in adverse events between the three groups (P>0.10). Conclusion We observed no association between BP control and adverse outcomes in ischemic stroke patients undergoing thrombolysis. However, additional study is necessary to confirm or refute the safety of aggressive BP control prior to thrombolysis.

Dabigatran reversal with idarucizumab

n engl j med 377;17 nejm.org October 26, 2017 1690 and their skill level, and a possible tendency to be selected on a team to allow a more flexible strategy.4 We speculate that players who throw right-handed and bat left-handed enjoy an additional biomechanical advantage, with the dominant (throwing) hand being placed further from the hitting end of the bat, providing a longer lever with which to hit the ball (potentially at the expense of bat control5). Given these sportspecific explanations, our findings argue against any advantage due to hemispheric lateralization.

Acute Ischemic Stroke and Timing of Treatment

that reflect the small sample size and may indicate unstable estimates. Also, we cannot eliminate the possibility that seropositive controls may have had undiagnosed Sjögren syndrome (3-11 years diagnostic delay has been reported)5,6 or may develop the disease in the future. Autoantibody profiling may identify individuals at risk many years before disease onset. However, the significance of these presymptomatic autoantibodies for determining prognosis and treatment remains to be determined.

How Might Procalcitonin Testing and Bougies Affect Your Clinical Practice? A Review of These Emergency Department–Based Investigations

Editor’s Note: You are reading the 65th installment of Annals of Emergency Medicine Journal Club. As the Journal Club enters its second decade of publication, we are making a number of changes to the format. Dr. David Schriger, the originator of the Annals of Emergency Medicine Journal Club and its first editor, has retired from his Journal Club editorial role. The journal and his fellow editor are indebted to Dr. Schriger for his outstanding contributions and the success of this educational section. The Journal Club section welcomes Dr. Ryan Radecki and Dr. Rory Spiegel to the editorial staff. The Journal Club format has been revised and will focus on succinct review of high-impact articles from this journal and other premier medical journals relevant to emergency medicine. The reviews are followed by questions demonstrating principles by which readers—be they clinicians, academics, residents, or medical students—may critically appraise the literature. We are interested in receiving feedback about this feature. Please e-mail journalclub@acep.org with your comments.

Laboring under the stone: answers to the January 2015 Annals of Emergency Medicine Journal Club.

Editor’s Note: You are reading the 43rd installment of Annals of Emergency Medicine Journal Club. This Journal Club refers to the article by Smith-Bindman et al published in the September 18, 2014, edition of the New England Medical Journal. Information about journal club can be found at http://www.annemergmed. com/content/journalclub. Readers should recognize that these are suggested answers. We hope they are accurate; we know that they are not comprehensive. There are many other points that could be made about these questions or about the article in general. Questions are rated “novice,” ( ) “intermediate,” ( ) and “advanced ( ) so that individuals planning a journal club can assign the right question to the right student. The “novice” rating does not imply that a novice should be able to spontaneously answer the question. “Novice” means we expect that someone with little background should be able to do a bit of reading, formulate an answer, and teach the material to others. Intermediate and advanced questions also will likely require some reading and research, and that reading will be sufficiently difficult that some background in clinical epidemiology will be helpful in understanding the reading and concepts. We are interested in receiving feedback about this feature. Please e-mail journalclub@ acep.org with your comments.

Letter by Radecki Regarding Article, “Safety of Thrombolysis in Stroke Mimics: Results From a Multicenter Cohort Study”

To the Editor: It is with great interest I read the recent publications regarding identification and treatment of stroke mimics (SM). Zinkstok et al1 describe an exceedingly low incidence of SM treated with thrombolytic therapy in their multicenter cohort, atypical of other published literatures. Guerrero et al,2 in their editorial, comment this low incidence is likely the result of very narrow criteria for diagnosis of SM, requiring the presence of a convincing alternative diagnosis. Furthermore, Guerrero et al2 suggest the lack of use of magnetic resonance imaging (MRI) with diffusion-weighted sequences (DWI) as a confirmatory study impaired their ability to discriminate …