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#PIWTR

This is the log of “Papers that I want to read”

It might be seen as a wish list of research for budding young Docs to take on, identified gaps in our knowledge base that other clinicians have shared with me.

Click on the clinical question to see a description of the background and how one might answer it.

There have been RCTs into Dex + ABs and they appear to be effective as a combo. But we hate prescribing unnecessary ABs. So we need an RCT of dex vs. placebo (+/- combo with ABs in 3rd arm) to assess the relative efficacy of dex alone, vs combo vs placebo. Easy enough study yo do in with primary care of Paeds ED cohort. Croup trials with dex have shown safety of a dose or 2. Arguable placebo is “standard care” as ABs not really seen as “best practice”

This is a great one from @KirstyChallen. Would seem easy to do – blinded bags of each NS and CSL. Patients get one or the other for their fluid rx. Monitor things like VBG, electrolytes – but need a pt-oriented primary outcome – death? Tougher to do in practice as NS is so ubiquitous! Hard to shake… Bellomo et al did a similar trial at the Ausin Hospital – looking at a pre & post intervention observational trial. Chloride rich vs Cl low fluids (e.g. CSL or Plasmalyte in Aust) – showed an association with better kidney outcomes.

Another pearler from @KirstyChallen TXA seems to get an RCT for most trauma / bleeding diseases – so why not the common NOF? Placebo controlled RCT, needs to have a tight time window ? < 3 hours from fracture? Outcomes – death, need for TFx, VTE rates, and LOS / rehab requirements etc. I’d imagine a large n = 10,000 to show a benefit / harm as this group have a lot of confounders

This one is from Paolo Balzaretti in Turin, Italy. IVC US has had its champions and naysayers – there is a nice SMACC talk from 2013 by Justin Bowra (Ultimate Myth of IVC). Problem is all the trials compare IVC to a “gold standard” such as CVP or other – these are not great comparators. So it would be great to see a trial with a pragmatic design that asked the question – does the use of IVC-guided Resus lead to better outcomes – death, ICU stay, renal failure, etc Would have been a great tack onto some of the recent big sepsis papers. my guess is it would be tough to prove!

There is some great numbers looking at US of the lungs for pneumonia. Problem is all small trials done in expert clinicians – we need to see how the average Joe performs vs. CXR

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