Clinical therapeutics
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Clinical therapeutics · Jan 2008
Randomized Controlled Trial Multicenter StudyAnalgesic effectiveness of celecoxib and diclofenac in patients with osteoarthritis of the hip requiring joint replacement surgery: a 12-week, multicenter, randomized, double-blind, parallel-group, double-dummy, noninferiority study.
The hip is the second most common large joint that is affected by osteoarthritis (OA), with prevalence ranging from 3% to 11% in patients aged > or = 35 years. OA is often associated with significant pain, disability, and impaired quality of life. Treatment should be tailored according to the level of pain, disability, and handicap. Pharmacologic treatment options for hip OA include acetaminophen (recommended by the European League Against Rheumatism as a first-line treatment), NSAIDs such as diclofenac, and cyclooxygenase-2-selective NSAIDs such as celecoxib. ⋯ This study did not demonstrate noninferiority of celecoxib 200 mg QD to diclofenac 50 mg TID in treating arthritis pain in patients with OA of the hip requiring joint replacement.
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Clinical therapeutics · Jan 2008
ReviewBenefits and risks of clopidogrel use in patients with coronary artery disease: evidence from randomized studies and registries.
Aggressive antiplatelet treatment is currently an established practice in patients with coronary artery disease. ⋯ Suppression of platelet activity through the use of antithrombotic agents should be balanced against the risk of atherothrombotic events. In patients with ACS, inhibition of platelet activation beyond that produced by clopidogrel 600 mg has been associated with an increased bleeding risk. In patients undergoing elective PCI, pretreatment with clopidogrel 300 mg administered >15 hours before the procedure achieved the optimal risk-benefit ratio. In cases of unplanned PCI, administration of clopidogrel 600 mg immediately after diagnostic catheterization was well tolerated and effective.
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Clinical therapeutics · Jan 2008
Randomized Controlled TrialTopical amethocaine gel 4% for intramuscular injection in term neonates: a double-blind, placebo-controlled, randomized trial.
Topical local anesthetic agents such as amethocaine penetrate intact skin and block pain signals originating from the dermis during medical procedures. They have been found to attenuate pain from various procedures, including intramuscular (i.m.) injection of vaccines. Published data on their effectiveness for i.m. injection of vitamin K in neonates were not identified. ⋯ Topical amethocaine gel 4% was ineffective in reducing pain on i.m. injection of vitamin K in these full-term neonates. Treatment was generally well tolerated and nurses concluded that, given the choice, they would use a topical anesthetic.
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Clinical therapeutics · Jan 2008
Clinical TrialColistin serum concentrations after intravenous administration in critically ill patients with serious multidrug-resistant, gram-negative bacilli infections: a prospective, open-label, uncontrolled study.
The emergence of multidrug-resistant nosocomial pathogens, such as Pseudomonas aeruginosa and Acinetobacter baumannii, has led to the revival of the systemic use of antimicrobial agent colistin in critically ill patients, but only limited data are available to define its pharmacokinetic profile in these patients. ⋯ CMS dosage regimens administered to these critically ill adult patients were associated with suboptimal Cmax/MIC ratios for many strains of gram-negative bacilli currently reported as sensitive (MIC, < or = 2 microg/mL).
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Clinical therapeutics · Jan 2008
Economic assessment of early initiation of inhaled corticosteroids in chronic obstructive pulmonary disease using propensity score matching.
Chronic obstructive pulmonary disease (COPD), characterized by airway obstruction and inflammation leading to chronic bronchitis and emphysema, is an important cause of morbidity, mortality, and increased health care utilization and expenditures. ⋯ ICS treatment initiated along with bronchodilators reduced COPD exacerbation events and expenditures in these managed care plans. Further research is needed to address potential selection bias due to unobserved factors.