Journal update monthly top five

This month’s update is by the Liverpool Emergency Department Research Unit Strategy Team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. There were no competing interests from any of the authors. The papers are ranked as: Topic: Toxicology Outcome rating: Worth a peek Samet et al aimed to address the opioid crisis in the USA through community-level interventions using a cluster-randomised trial design.1 Thirty-four communities were assigned to the intervention group, implementing evidence-based practices such as naloxone distribution, and 33 communities were assigned to no intervention. The primary outcome was opioid-related overdose deaths among community adults between June 2021 and June 2022. By the comparison year, there was no significant difference in opioid-related deaths between the intervention and control group (47.2 deaths per 100 000 population vs 51.7 per 100 000 population, p=0.30). Of 615 proposed strategies, only 235 strategies had been initiated by the comparison year, largely due to the workforce depletion and logistical challenges exacerbated by the COVID-19 pandemic. In addition, the large number of strategies made effective implementation difficult and prevented the determination of which strategies were effective. Generalisability of the findings may be limited as it was conducted during the pandemic. Nevertheless, the study suggests a new model for implementation of strategies, going beyond individual clinics or hospitals. Bottom line: implementation of multiple evidence-based strategies at the community level did not reduce opioid overdose deaths in this study. Topic: End of life Care Outcome rating: Head Turner Patients who …