JAMA : the journal of the American Medical Association
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The Agency for Health Care Policy and Research (AHCPR) has recently published guidelines for the management of patients with acute low back pain, which include recommendations for the use of lumbar radiographs, based on the identification of "red flags" for fractures, tumors, or infections. The purpose of this study was to evaluate the potential impact of these guidelines in patients with new episodes of low back pain seen in primary care settings. ⋯ The implementation of the AHCPR guidelines for the initial use of radiographs in patients with low back pain may increase utilization and economic costs. A more restricted and cost-efficient set of guidelines should be proposed.
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Randomized Controlled Trial Clinical Trial
Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study.
To compare the efficacy of methylprednisolone administered for 24 hours with methyprednisolone administered for 48 hours or tirilazad mesylate administered for 48 hours in patients with acute spinal cord injury. ⋯ Patients with acute spinal cord injury who receive methylprednisolone within 3 hours of injury should be maintained on the treatment regimen for 24 hours. When methylprednisolone is initiated 3 to 8 hours after injury, patients should be maintained on steroid therapy for 48 hours.
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Randomized Controlled Trial Clinical Trial
A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations.
To assess the effectiveness of a new tissue adhesive for laceration closure. ⋯ Octylcyanoacrylate tissue adhesive effectively closes selected lacerations. This relatively painless and fast method of wound repair can replace the need for suturing several million lacerations each year.