Current medical research and opinion
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Randomized Controlled Trial
Postoperative analgesic requirements after subarachnoid or epidural anesthesia with ropivacaine 0.75% in cesarean section. A double-blind randomized trial.
Postoperative analgesic requirements and pain scores were compared after subarachnoid versus epidural anesthesia with plain ropivacaine 0.75% for elective cesarean section. ⋯ Postoperative pain, analgesic requirements, patient satisfaction and adverse effects did not differ when subarachnoid or epidural anesthesia with ropivacaine 0.75% was used for elective cesarean section. Nevertheless, subarachnoid provides faster onset and offset of the block, compared to epidural anesthesia. The key limitation of this study is the lack of postoperative serum ropivacaine measurements taken with concurrent pain score measurements.
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Randomized Controlled Trial Multicenter Study
Efficacy and safety of celecoxib versus diclofenac and omeprazole in elderly arthritis patients: a subgroup analysis of the CONDOR trial.
To compare the safety and efficacy of celecoxib versus diclofenac slow release (SR) plus omeprazole in elderly arthritis patients. ⋯ Efficacy was comparable in the two treatment groups. There were fewer endpoints as well as fewer GI AEs reported in patients treated with celecoxib compared with diclofenac. These data may help physicians in their treatment decisions for elderly patients with arthritis.
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Randomized Controlled Trial
Efficacy and safety of linagliptin 2.5 mg twice daily versus 5 mg once daily in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, placebo-controlled trial.
Glycaemic control in patients with type 2 diabetes (T2DM) is often not achieved or not sustained using monotherapy such as metformin, necessitating the addition of other antihyperglycaemic agents. Linagliptin, a dipeptidyl peptidase-4 inhibitor, is licensed for 5 mg once-daily dosing. As metformin is administered twice daily, a fixed-dose combination of these compounds would require twice-daily administration of linagliptin. This study evaluated whether 2.5 mg twice-daily dosing of linagliptin has comparable efficacy and safety to 5 mg once-daily dosing when given in addition to metformin twice daily in patients with inadequate glycaemic control. ⋯ Linagliptin 2.5 mg twice daily had non-inferior HbA1c-lowering effects after 12 weeks compared to 5 mg once daily, with comparable safety and tolerability, in T2DM patients inadequately controlled with metformin.
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Review
Continuing evolution of opioid use in primary care practice: implications of emerging technologies.
Primary care physicians, nurse practitioners, and nurses are often the first to evaluate patients with pain and many patients depend on these clinicians for pain relief. The growing evidence supporting use of opioids for appropriately selected patients means that primary care practitioners must be knowledgeable regarding ever-evolving pain-management strategies. ⋯ The strategic use of new opioid formulations and better patient assessment may lead to more successful use of opioids in the management of pain, while limiting or lowering the risk of the development of an addiction problem, abuse or diversion.
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Multicenter Study Clinical Trial
Safety and patient perception of an insulin pen with simple memory function for children and adolescents with type 1 diabetes--the REMIND study.
NovoPen Echo * is a durable pediatric insulin pen incorporating half-unit dosing starting at 0.5 units and a last-dose memory function. The REMIND † (Rating the Effects of Memory function in pediatric INsulin Devices) study primarily examined the safety of this new device by collecting data on technical complaints (TCs) related to adverse reactions (ARs) during use in a clinical setting. ⋯ Only three device safety events were reported for NovoPen Echo. Physicians found it easy and quick to educate users. Patients/caregivers missed fewer injections and reported greater confidence in managing their insulin injections. As this was an observational study without controls or centralized laboratory testing, caution should be used in interpreting outcomes in glycemic control. Further studies are required to examine the effects of features such as memory function and half-unit dosing on HbA1c and hypoglycemia over a longer time period.