First10EM Journal Club: September 2025

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Welcome back to a somewhat delayed, yet typically on target episode of the Journal Club with Dr Morgenstern.

This month is a really eclectic bunch of papers from all walks of science – bench science to the purely clinical and a bit about fruit in the mix there.

Papers are listed below for reference. Enjoy over a long drive or a slow shift !

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Antibiotics in strep pharyngitis: another example of why non-inferiority trials are clearly inferior 

Gualtieri R, Verolet C, Mardegan C, Papis S, Loevy N, Asner S, Rohr M, Llor J, Heininger U, Lacroix L, Pittet LF, Posfay-Barbe KM. Amoxicillin vs. placebo to reduce symptoms in children with group A streptococcal pharyngitis: a randomized, multicenter, double-blind, non-inferiority trial. Eur J Pediatr. 2024 Nov;183(11):4773-4782. doi: 10.1007/s00431-024-05705-1. Epub 2024 Aug 31. PMID: 39215861

Related: You don’t understand non-inferiority trials (and neither do I)

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Maternal and neonatal outcomes following resuscitative hysterotomy

Leech C, Nutbeam T, Chu J, Knight M, Hinshaw K, Appleyard TL, Cowan S, Couper K, Yeung J. Maternal and neonatal outcomes following resuscitative hysterotomy for out of hospital cardiac arrest: A systematic review. Resuscitation. 2025 Feb;207:110479. doi: 10.1016/j.resuscitation.2024.110479. Epub 2024 Dec 29. PMID: 39736393

This paper is not going to change your day to day clinical practice, but might help set our expectations if you are faced with performing a perimortem hysterotomy.

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SSRIs as a cancer treatment?

Li B, Elsten-Brown J, Li M, Zhu E, Li Z, Chen Y, Kang E, Ma F, Chiang J, Li YR, Zhu Y, Huang J, Fung A, Scarborough Q, Cadd R, Zhou JJ, Chin AI, Pellegrini M, Yang L. Serotonin transporter inhibits antitumor immunity through regulating the intratumoral serotonin axis. Cell. 2025 Jul 10;188(14):3823-3842.e21. doi: 10.1016/j.cell.2025.04.032. Epub 2025 May 21. PMID: 40403728

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Deliberate clinical inertia: A paradoxical strategy to improve patient flow

Keijzers G. Deliberate clinical inertia: A paradoxical strategy to improve patient flow? Emerg Med Australas. 2025 Apr;37(2):e70016. doi: 10.1111/1742-6723.70016. PMID: 40045755

Deliberate clinical inertia: the conscious process of ‘doing nothing’ as a positive response to clinician and system intervention bias.

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The floppy iris syndrome

Zaman F, Bach C, Junaid I, Papatsoris AG, Pati J, Masood J, Buchholz N. The floppy iris syndrome – what urologists and ophthalmologists need to know. Curr Urol. 2012 May;6(1):1-7. doi: 10.1159/000338861. Epub 2012 Apr 30. PMID: 24917702

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Our endless quest to treat the number not the patient

Endo A, Yamakawa K, Tagami T, et al. Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial. Intensive Care Med. 2025 May;51(5):883-892. doi: 10.1007/s00134-025-07910-4. Epub 2025 May 13. PMID: 40358717

Bottom line: Although I don’t think the massive mortality difference is believable, everything in this trial points at harm from targeting higher MAPs. 65 is the target.

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Virtual reality and music therapy? Does that sound like any emergency department you have ever worked in?

Dönmez S, Şener A, Işık Nİ, Koca S, Akbaş İ. Analgesic and Anxiolytic Effects of Virtual Reality and Classical Music Therapy on Tension-Type Headache: A Randomized Controlled Trial. Ann Emerg Med. 2025 Jun 4:S0196-0644(25)00278-1. doi: 10.1016/j.annemergmed.2025.04.032. Epub ahead of print. PMID: 40464717

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Does ozempic make you puke?

Chen YH, Zink T, Chen YW, Nin DZ, Talmo CT, Hollenbeck BL, Grant AR, Niu R, Chang DC, Smith EL. Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists. JAMA Netw Open. 2025 Mar 3;8(3):e250081. doi: 10.1001/jamanetworkopen.2025.0081. PMID: 40036031

Bottom line: Although there are anecdotal reports coming from anesthesia about an increased risk of aspiration with GLP1 agonists, that concern does not appear to be supported by this large observational data set. 

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Comparing apples and oranges: a randomised prospective study

Barone JE. Comparing apples and oranges: a randomised prospective study. BMJ. 2000 Dec 23-30;321(7276):1569-70. doi: 10.1136/bmj.321.7276.1569. PMID: 11124178

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