April 8, 2021

Background: Since the publication of the before and after Marik trial [1] published in 2016, there have been six randomized clinical trials trying to answer the question of the utility of the metabolic cocktail (Vitamin C, thiamine, and hydrocortisone) in septic shock (See table below). Although, each was of various methodological rigor only one had a positive primary outcome (i.e. ORANGES). It is important to note that the primary outcome of the ORANGES trial was changed after full data collection (and likely analysis) was complete (See the REBEL EM analysis HERE). We now have our 7th RCT on this topic.

April 1, 2021

Background: Respiratory tract infections (RTIs) are a common reason for medical visits in kids.  Most RTIs are self-limited and the addition of antibiotics rarely alters the course of disease. However, antibiotics are frequently prescribed for these conditions.  Antibiotic overuse is one of the main drivers of resistance to antimicrobial agents.  Additionally, antibiotic prescriptions place patients at risk for adverse events from the antibiotics themselves and makes parents believe they need to have their children seen for similar episodes in the future.

March 28, 2021

Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial data, the Pfizer vaccine was estimated to prevent 52.4% of COVID-19 before dose two and 90.5% on days 2 – 7 after dose two. However, it is important to study the effectiveness of the vaccines in a real world setting.

March 17, 2021

Background: Medicine by press release has been an unfortunate reality of the COVID-19 pandemic.  This is not the standard many physicians would use for medical decision making, but one many of us have had to face; what do I do with the information that is presented with no transparency in the data behind the statements? Despite all the debate and controversy only two treatments for hospitalized patients, have been shown to improve mortality: corticosteroids and IL-6 receptor antagonists (when combined with steroids). Two more treatment options that have been debated throughout the pandemic include convalescent plasma therapy and anticoagulation.  We now have two pre-prints that shed some more light on both of these topics.

March 11, 2021

Background: Patients who present with a transient ischemic attack (TIA) are at higher risk of subsequent stroke, especially in the short term (< 7 days). However, the majority of these patients do not experience strokes which leads to a clinical conundrum; should all TIAs be admitted for evaluation? Comprehensive investigation, aggressive treatment, and/or hospital admission is not feasible for all patients and being able to risk stratify these patients to those who would most likely benefit is crucial.