https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771093 meta-analysis of 78 original studies, looking to find the accuracy of ECG interpretation. In this analysis they looked at studies with med students, physiciansm even cardiologist and found on average we got the right diagnosis only 55% of the time. Obviously education goes up with more education 42.0% for medical students, 55.8% for residents, 68.5% for practicing physicians, and 74.9%) for cardiologists. in the end it I think it says a couple things We all have room for improvement at reading EKGs When you don’t know what the EKG says the cardiologist only know the right answer an extra 6% of the time I am not shocked by the results. Lots of these studies had you look at 10 ekgs and say what it is. I think most people can get the easy EKGS, it is the really hard ekgs that look like a four year old drawing that are challenging to name. I think a better question would have been if the providers knew what to do. Did the providers know to start cpr or now if given a vignette, or if they should shock or push epi…like a concerning mass found on imaging, sometimes you don’t need to know the diagnosis you just need to know what to do…. https://www.acpjournals.org/doi/10.7326/M20-4187 acute sciatica—not a lot of good options for this… what about PT?? that is titled Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica A Randomized Controlled Trial single-blind, parallel-group randomized trial that took place in 2 Utah hospitals and randomized 220 to either receive early physical therapy (EPT) or UC. all participants were given a copy of The Back Book (23), a patient education booklet with evidence-based messages about the favorable prognosis of LBP and the importance of remaining active and avoiding bed rest The EPT protocol recommended 2 weekly sessions during the first 2 weeks and 1 to 2 sessions in weeks 3 and 4. The primary outcome was score on the Oswestry Disability Index (OSW) score after 6 months., Oswestry Disability Index (OSW) is a 10-item measure of LBP-related disability. OSW Scores range from 0 to 100, with higher scores indicating greater disability. our results found that EPT referral after an initial primary care visit for recent-onset LBP and sciatica resulted in greater improvement in disability Participants in the EPT group had greater improvement from baseline to 6 months for the primary outcome (relative difference, −5.4 points [95% CI, −9.4 to −1.3 points]; P = 0.009). But as they say in the paper--- Minimum important difference is 6 to 8 points for acute LBP and sciatica So the results should have said “our results found that EPT referral after an initial primary care visit for recent-onset LBP and sciatica resulted in greater stastical improvement in disability but is arguable if these changes are clinically important” The lesson is when you are using a scale to measure something in the study, also know or look for the minimally CLINICALLY important difference that is needed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772373 Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 YearsA Systematic Review and Meta-analysis in children younger than 2 years what is better for short-term treatment of fever or pain do you choose ibuprofen or do you choose acetaminophen?? The anwer is it depends where you live and which guidelines you follow For example the maximum daily dose of acetaminophen beyond the neonatal period varies from 60 mg/kg/d in New Zealand to 90 mg/kg/d in the United Kingdom and United States.5 Recommendations for ibuprofen also vary based on where you live -- The New Zealand Formulary for Children recommends ibuprofen at 5 mg/kg/dose 3 to 4 times daily star(continued)