Research and Reviews in the Fastlane 600

Welcome to the 132rd edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the : Overview; Archives and Contributors

This Edition’s R&R Hall of Famer

RR Hall of FAMER

Saini P et al. Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews. BMJ  349:g6501. 2014. PMID: 25416499

  • These authors looked at how accurately harms are reported in studies. Looking at a general cohort of studies, the found that the studies either didn’t report harms, or only partially reported harms 76% of the time. It is an important reminder that we tend to minimize our discussions of harm. For most therapies, it is likely that the true harms are greater than those reported in clinical trials.
  • Recommended by: Justin Morgenstern

Schultz L et al. Top Ten Myths Regarding the Diagnosis and Treatment of Urinary Tract Infections. J Emerg Med 2016. PMID: 27066953

  • Misinterpretation of the urinalysis is a common issue in the Emergency Department. This article reviews 10 myths about the UA and UTIs. A common theme that permeates the article is that an abnormal UA is not diagnostic of a UTI: symptoms must be present as well since a significant portion of patients will have chronic colonization. A good lesson to keep in mind the next time you work clinically.
  • Recommended by: Anand Swaminathan
RR Eureka

Friedman BW et al. The association between headache and elevated blood pressure among patients presenting to an ED. The American journal of emergency medicine. 32(9):976-81. 2014. PMID: 24993684

  • More data that BP & HA aren’t related. To be fair, the patients with headaches had higher BPs, but lowering BPs didn’t make a difference. One more reason to explain to the patient, the referring doc, the floor staff, etc, that no, their head is not about to explode.
  • Recommended by: Seth Trueger
RR Game Changer

Konopasek L, Slavin S. Addressing Resident and Fellow Mental Health and Well-Being: What Can You Do in Your Department? J Pediatr. 2015 Dec;167(6):1183-1184.e1. PMID: 26611453

  • Although some of our medical elders laugh about how easy residents have it as compared to the ‘good old days’, residency is still incredibly stressful and residents are at high risk for burnout and depression. We need to look after our own. Some suggestions from this article: try to decrease the stigma around mental health in medicine, role model healthy behaviours, make mental well being an emphasis during orientation, and specifically check in with residents to see how they are coping.
  • Recommended by: Justin Morgenstern

Tseng HJ et al. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015. PMID: 26320521

  • An excellent, in depth review of finding and managing foreign bodies that are ingested, aspirated or inserted. The authors create some great tables that can act as rapid access guides on your smart device for just in time clinical guidance.
  • Recommended by: Anand Swaminathan
RR Eureka

Zipkin DA, et al. Evidence-based risk communication: a systematic review. Annals of internal medicine. 161(4):270-80. 2014. PMID: 25133362

  • Statistics are easily gamed and, are increasingly called upon as we engage patients in shared decision making, Communicating with patients – Think the number need to treat (NNT) is the best way? That’s not what this review found. They found that participants most accurately perceived risk when presented with absolute risk reduction but were most swayed by relative risk.
  • Recommended by: Lauren Westafer
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Community emergency physician with a passion for education, evidence based medicine, and life, working in the Greater Toronto Area (that’s in Canada) | @First10EM | Website |

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