The Journal of family practice
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Randomized Controlled Trial Comparative Study Clinical Trial
Treatment of mild to moderate pain of acute soft tissue injury: diflunisal vs acetaminophen with codeine.
Acute soft tissue injuries create pain and limitation of function. Treatment requires analgesia and time for full recovery. Acetaminophen with codeine (650 mg plus 60 mg, respectively, every 4 to 6 hours) is used frequently as the analgesic of choice. ⋯ However, 65 percent of acetaminophen with codeine patients experienced side effects, with 35 percent of these patients stopping the medication because of intolerable side effects. In the diflunisal group, 28 percent of the patients experienced side effects and 5 percent had to stop the medication early. Diflunisal was found to be an effective analgesic in mild to moderate pain of acute soft tissue injuries, and caused fewer and more tolerable side effects than did acetaminophen with codeine.
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Advance directives have emerged in medicine as an important method by which patients can express future treatment wishes. The major reasons medical professionals have been reluctant to use advance directives are not because of theoretical defects with advance directives, but because of procedural difficulties. ⋯ Additionally, that they are often formulated in ambiguous terms and under situations where the patient's competence is in question can be minimized. More widespread and effective use of advance directives will occur if the family physician takes an active role in identifying patients for whom an advance directive would be desirable, effectively communicating information about advance directives, advising their patients about the most effective way to state their directive in medically precise terminology, and explaining when necessary the patient's wishes to other medical specialists and family members.
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The febrile infant is a common clinical problem for the primary health care provider. This paper employs the example of a young infant with fever to describe an important epidemiologic concept that is useful in the interpretation of diagnostic data--the likelihood ratio. ⋯ Using likelihood ratios in the practice of primary care medicine should reduce the number of patients with false-positive or false-negative results, sparing some patients needless therapy as well as minimizing the number of patients denied efficacious interventions. Support for likelihood ratios within the primary care medical community will hasten their availability in laboratories of clinical medicine.