Skip to main content

Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial.

Journal Club Summary


Methodology Score: 3/5                   
Usefulness Score:  3.5/5
Nijssen EC, et al
Lancet. 2017 Feb 20. [Epub ahead of print]


This prospective, open-label, single centre, randomized trial of 660 patients found no hydration (2.7% incidence CIN) to be non-inferior compared to iv hydration (2.6% incidence CIN) in preventing contrast induced nephropathy in patients with reduced renal function undergoing elective procedures requiring contrast; there were no related deaths and no patients required haemodialysis within 35 days. While the study excluded patients with eGFR<30 and ER patients, the results are reassuring and will be helpful in shared decision making with patients and our radiology colleagues. 
By: Dr. Rebecca Brown

 Epi lesson

Minimization                                           
The purpose of randomization is to minimize imbalance between groups. Sometimes, we know certain factors are likely to influence outcomes and ought to be equally distributed (e.g. male, female). A strategy to ensure this stratifies participants according to important factors, then uses separate randomization lists for each sub-groups. This becomes impractical when a large number of factors need to be taken into account. Minimization calculates the imbalance between groups that would result from a particular assignment, and uses a strategy favoring assignment to the group that would minimize this imbalance between comparison groups.

By: Dr. Christian Vaillancourt  

Comments

Popular posts from this blog

Tips for Success in your Emergency Medicine Rotation

Our wonderful medical students are preparing to start their first clinical rotations. With this in mind here are some of the top tips for success in your EM rotation
1)Be On Time – show up to your shifts on time, better yet 5 minutes early.That first impression is immensely important.
2)Introduce yourself to the team - “Hi my name is John Doe, I am the medical student on shift today” introduce yourself to the attending, residents, nurses, etc.You will be called on a lot more to help when there is something interesting going on if they know your name.
3)Be goal-oriented – have a goal for each shift, whether it’s a procedure or a type of presentation to see.
4)Don’t just stand there, do something – whenever there is a trauma or code, come to the bedside.Get gowned up for traumas and pay attention.Help with things that are within your scope of practice: chest compressions, moving patient, cardioversion
5)Don’t just stand there, do nothing – there are times in medicine when the best thing to d…

The Canadian Syncope Risk Score

Guest post by Dr. Venkatesh Thiruganasambandamoorthy.
Syncope is an commonly encountered problem in Emergency Medicine, with the potential for significant morbidity and mortality to patients. Unfortunately, to date, there have not been any reliable decision tools or instruments to help us in our assessment of the syncope patient.  This week, Venkatesh Thiruganasambandamoorthy and colleagues at the Ottawa Hospital have published an new Canadian Syncope Risk Score to identify patients at risk of serious adverse events, published in CMAJ.1 Here, Dr. Venk helps provides some further insight and potential utilization of the risk score, he may also be heard discussing this rule on the March edition of Canadian EMRAP.


BackgroundSyncope constitutes 1% of Emergency Department (ED) visits, and approximately 10% of these patients will have serious underlying conditions causing syncope (arrhythmia, MI, serious structural heart disease, pulmonary embolism, subarachnoid or severe hemorrhage). Alarmin…

2014 Canadian Guidelines for AF Management: Part 1: Introduction and CCS “CHADS-65” Algorithm

by Ian Stiell MD @EMO_Daddy














In this and subsequent postings we will discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation
The 2014 Focused Update uses the GRADE system of evidence evaluation as was the case in the comprehensive 2010 AF Guidelines and the 2012 Update. The CCS AF Guidelines Panel is comprised of Canadian cardiologists plus physicians from internal medicine, family medicine, neurology, and emergency medicine. This 2014 Update provides evidence review and recommendations for 8 aspects of AF care, including ED Management (written by myself and Dr. Laurent Macle of the Montreal Heart Institute). The 2014 Update focuses on advances in oral anticoagulant (O…