My understanding from this is that echo is not useful in the investigation of unexplained syncope. This is an important message because countless numbers of useless echos are being done, with consequent adverse economic and accessibility outcomes. 

Well done, no major problems, well described cohort

Useful info about the ineffectiveness of inhaled opiods in this treatment interevention

Summary: A specialist problem; two similar drugs; little to choose between them in outcome. I think most generalists would not be interested in this 

Not the domain of a general internist

Mildly interesting --an area of some uncertainty in the past, so the data is not unuseful 

A good example of knowledge not finding its way into practice.Most UK respiratory physicians know the rationale for using combination bronchodilators for acute exacerbations or indeed stable COPD is not good but will continue to use it. By definition this is a disease where you will not see big changes in FEV1 with any treatment unless you do a big study or make measurements at many time points , so perhaps we shouldn`t be surprised. Maybe the studies need to be repeated with dyspnoea scores or quality of life measures in stable patients.

It is common practice to combine beta agonist and anticholinergic bronchodilators when treating COPD exacerbations. However, the meta-analysis does not support this practice, as the two treatments are nearly equivalent without additive benefit. Whether this knowledge might change practice remains to be seen, since both treatments have extremely good safety profiles, and the only major disadvantage of combined therapy (assuming there is no additive benefit)is one of cost. The meta-analysis appears to be well done and clearly presented and the information deserves wide dissemination.