Miscellaneous
PodcastGregory J, Huynh B, Tayler B, et al. High-dose vs standard-dose amoxicillin plus clavulanate for adults with acute sinusitis. A randomized clinical trial. JAMA Network Open 2021;4(3):e212713Study design: Randomized controlled trial (double-blinded) primary care offices with sinus symptoms consistent with currently accepted clinical criteria for acute bacterial sinusitis. andomly received (concealed allocation assignment) either a standard-dose regimen of amoxicillin 875 mg plus clavulanate 125 mg plus placebo twice daily for 7 days or a high-dose regimen of amoxicillin 875 mg plus clavulanate 125 mg plus amoxicillin 875 mg twice daily for 7 days. They planned to have 240 patients enrolled in the trial but then COVID happened and the authors say “ At an unplanned interim analysis prompted by COVID-19 restrictions” made us look at the data and then stop the trial. They found that there was NO difference between the high dose and the standard dosea global rating of "a lot better" or "no symptoms" occurred in 44.3% of patients in the standard-dose group compared with 36.4% of patients in the high-dose group 79 randomized to the standard dose and 78 to the high dose; 9 and 12, respectively, withdrew or were lost to follow-up Because of the high drop-out rate, the investigators assigned a negative outcome to everyone in the standard-dose group and a positive outcome to everyone in the high-dose group; the group difference in the primary outcome was still not significant.DONT DO SOEMTHING STAND THEREChina L, Freemantle N, Forrest E, et al, for the ATTIRE Trial Investigators. A randomized trial of albumin infusions in hospitalized patients with cirrhosis. N Engl J Med 2021;384(9):808-817.Study design: Randomized controlled trial (nonblinded)in hospitalized patients with decompensated cirrhosis dose Routine daily albumin infusions to target an albumin level of 30 g/L or more prevent infection, kidney dysfunction, or death? The intervention group (n = 380) received a daily 20% albumin infusion at 100 mL per hour to target an albumin level of at least 30 g/L for a maximum of 14 days or until discharge. The control group (n = 397) received standard care. The primary outcome was a composite of new infection from any cause, kidney dysfunction, or in-hospital death between trial day 3 and trial day 15 or day of discharge (whichever occurred earlier). There was no significant difference detected in the composite endpoint with an approximately 30% event rate in both groups.And whats worseThe intervention group had more severe and life-threatening adverse events, including pulmonary edema or fluid overload (6.1% vs 2.0%) and lung infections (3.9% vs 2.0%). We all want to do something but do nothing, just stand thereOr dont just do something let your patients do somethingScarinci IC, Li Y, Tucker L, et al. Given a choice between self-sampling at home for HPV testing and standard of care screening at the clinic, what do African American women choose? Findings from a group randomized controlled trial. Prev Med 2021;142:106358. Clinical questionDoes giving women the option of doing home self-sampling for human papillomavirus increase the rates of cervical cancer screening? study identified 12 rural, underserved towns and randomized the towns to either (1) a visit from a Black female community health worker with information about cervical cancer screening and encouragement to have a free Pap test at the local health department (standard care), or (2) a visit in which they were given the choice of a free Pap test at the health department or the option to do free home self-sampling for HPV (choice). Among women in the standard care group, only 16 of 170 (9.4%) were ultimately screened, compared with 63 of 165 (38.2%) in the choice group.We all want to do something but do nothing, just stand thereClinical questionWhat is the effect of a delayed prescription approach for children with respiratory tract infection? Mas-Dalmau G, Villanueva López C, Gorrotxategi Gorrotxategi P, et al, for the DAP PEDIATRICS GROUP. Delayed antibiotic prescription for children with respiratory infections: a randomized trial. Pediatrics 2021;147(3):e20201323. Study design: Randomized controlled trial (nonblinded)