Clinical therapeutics
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Clinical therapeutics · Nov 2013
Randomized Controlled Trial Comparative StudyReducing the pain of microemulsion propofol injections: a double-blind, randomized study of three methods of tourniquet and lidocaine.
Although the new formulation of lipid-free microemulsion propofol (MP) has some advantages over the lipid emulsion, it reportedly produces more injection pain than lipid-based propofol. Intravenous lidocaine with application of a rubber tourniquet before administration of propofol is considered to be the best method for reducing injection pain; however, this technique is not perfect. ⋯ UMIN000010725.
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Clinical therapeutics · Nov 2013
ReviewGuanfacine extended release: a novel treatment for attention-deficit/hyperactivity disorder in children and adolescents.
Guanfacine extended release (GXR) has reported efficacy for the treatment of attention-deficit/hyperactivity disorder (ADHD) as monotherapy and adjunctive therapy to psychostimulant medications. ⋯ Current evidence indicates that GXR is an effective treatment option for children and adolescents with ADHD. AEs are typically mild to moderate, although severe AEs and discontinuations due to AEs have been observed.
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Clinical therapeutics · Nov 2013
Randomized Controlled TrialEfficacy of periosteal stimulation for chronic pain associated with advanced knee osteoarthritis: a randomized, controlled clinical trial.
Because of morbidity associated with painful knee osteoarthritis (OA) and commonly prescribed analgesics, patients often pursue complementary and alternative modalities (eg, acupuncture). Clinical trials have demonstrated modest therapeutic efficacy of traditional Chinese acupuncture for knee OA pain, and patients with advanced disease have largely been excluded. We have previously demonstrated preliminary short-term tolerability and efficacy of periosteal stimulation therapy (PST) (ie, electrical stimulation of the periosteum facilitated by acupuncture needles) for older adults with advanced knee OA. ⋯ PST plus PST boosters in patients age >50 with advanced knee OA were well-tolerated and modestly reduced pain. ClinicalTrials.gov identifier: NCT00865046.
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Clinical therapeutics · Nov 2013
Longitudinal use of complementary and alternative medicine among older adults with radiographic knee osteoarthritis.
Osteoarthritis (OA), a chronic and often painful disease for which there is no cure, accounts for more mobility issues in older adults than any other disease. Cross-sectional studies have found that arthritis is the most common reason for older adults to use complementary and alternative medicine (CAM). Although previous research has profiled the sociodemographic and clinical characteristics of CAM users, few studies have provided information on variation in CAM use over time and most only considered use of any CAM, which was often a mixture of heterogeneous therapies. ⋯ Patterns of CAM use are, to some extent, inconsistent with current guidelines for OA treatment. Evaluating the potential risks and benefits in older adults from commonly used CAM modalities, with or without combination use of conventional analgesics, is warranted.
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Clinical therapeutics · Nov 2013
Case ReportsKyphoplasty for vertebral augmentation in the elderly with osteoporotic vertebral compression fractures: scenarios and review of recent studies.
Vertebral compression fractures caused by osteoporosis are among the most common fractures in the elderly. The treatment focuses on pain control, maintenance of independence, and management of the osteoporosis. Elderly patients often encounter adverse effects to pain medications, do not tolerate bed rest, and are not ideal candidates for invasive spinal reconstructive surgery. Percutaneous vertebral augmentation (vertebroplasty or kyphoplasty) has become popular as a less-invasive alternative. However, studies have questioned the effectiveness of these procedures. ⋯ Selecting patients on an individual case-by-case basis can optimize the effectiveness and outcomes of a vertebral augmentation. This process includes the documentation of an osteoporotic vertebral compression fracture with the aide of imaging studies, including the acuity of the fracture as well as the correlation with the physical examination findings. Patients who are functional and improving under a conservative regimen are not candidates for kyphoplasty. However, if the conservative management is not successful after 4 to 6 weeks and the patient is at risk to become bedridden, an augmentation should be considered. A kyphoplasty procedure may be preferred over vertebroplasty, given the lower risk profile and better outcomes regarding spinal alignment.