6. linear lac
<8 cm
trunk or extremities
-facial lac
-non-linear
-over area of tension
-dirty or > 12 h
-steroids or sig PMH
X
3 mo: cosmetic outcome
vicryl
n=55
proline
n=58
15. simple corneal abrasion
>36 hours after injury
prior eye surgery or cataract
contact lens wear
bilateral eye injury
infection
unable to follow up within 48 h
X
safety and healing
saline
n=61
tetracaine
n=61
24. Dr. Keiji Hayashi
“We have some questions on the
conclusion in your Oseltamivir review,
especially about the prevention of
complications... we have found that this
conclusion is based on [another] review
(Kaiser 2003) and not on your own data
analysis. The authors of the review were
four employees of F. Hoffman-La Roche
Ltd... Kaiser’s review included 10 RCTs;
[only] two RCTs (Nicholson 2000 and
Treanor 2003) were published... in the
peer-reviewed medical journal (JAMA and
Lancet)... the lower respiratory tract
complication rates of these articles
[showed] no significant difference
between Oseltamivir and placebo, and
their ORs were 1.81. But the OR of the
other 8 [unpublished] RCTs were 4.37...”
27. Beginning EndMiddle
•explicit & appropriate
eligibility criteria?
• biased selection and
reporting of studies?
•what is the overall
quality of the evidence?
• primary studies of high
methodologic quality?
• were results similar
from study to study?
•were all patient-
important outcomes
considered?
•assessments of reviews
reproducible?
•did results rely heavily
on data from one trial?
•are benefits worth
costs and risks?
X
X
Silva S,Wyer P. The roadmap tutorial. 2010.
35. ED discharge diagnosis: “allergic reaction”
< 17 years old
Dx: “asthma with allergic reaction”
left without being seen
pre-existing non-allergic angioedema
7-day: biphasic reaction
anaphylaxis
n=496
X
allergy
n=2,323
48. Beginning EndMiddle
• are patients, variables
and outcomes clearly
defined?
• is the spectrum of
patients to whom the
rule will be applied well-
represented?
• was the rule validated
in a different group of
patients?
• were predictors and
outcomes evaluated in a
blinded fashion?
• were predictors and
outcomes evaluated in
the entire sample and in
the same way?
• were the statistical
methods clearly
described?
Silva S,Wyer P. The roadmap tutorial. 2010.
x x
57. CT “flank pain protocol”
lack of flank pain
hx trauma
infection: fever, urine leuks
malignancy
renal disease
prior urologic procedure
X
covariates:
PMH,VS, exam, ED rx
dx ureteral stone
58.
59. Beginning EndMiddle
• are patients, variables
and outcomes clearly
defined?
• is the spectrum of
patients to whom the
rule will be applied well-
represented?
• was the rule validated
in a different group of
patients?
• were predictors and
outcomes evaluated in a
blinded fashion?
• were predictors and
outcomes evaluated in
the entire sample and in
the same way?
• were the statistical
methods clearly
described?
Silva S,Wyer P. The roadmap tutorial. 2010.
x
68. ED pts with clinical suspicion of PE
employing new diagnostic strategy
(if age>50: cutoff = age*10)
AC
contrast allergy
CRI
life expectancy < 3 mos
pregnant
inaccessible for follow-up
X
3-months: VTE & death - all comers
3-months: VTE & death - 500<d-dimer<age*10
77. imaging-confirmed CVA
<48 h onset
SBP 140-220
- BP >220/140
-MI, CHF,AF, dissection
-cerebrovascular stenosis
-deep coma
X
14 d: death and major disability
BP lowering by
10-25% in 24 h
n=2,038
no BP treatment
n=2,033
94. controversy?
“one concern I have is that
this hypothesis has been
accepted almost without
debate by so many people”
“the new therapy costs about
$1,100 more per patient”
“Pittsburgh Pirates... ”
“thinly-veiled academic
lynching”
99. sepsis suspected
2+ criteria for SIRS
refractory hypotension
or lactate ≥4
-primary neuro, CV or pulm dx
-OD, burn or trauma
-need for immediate surgery
-CD4<50
X
60 d: in-hospital mortality
usual care
n=458
EGT
n=445
protocol-based
standard tx
n=448
