American journal of therapeutics
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Multicenter Study Comparative Study Clinical Trial
Comparing patient telephone callback rates for different hormonal birth control delivery systems.
This study was conducted to determine the number of office telephone callbacks in the first 3 months after initiating use of the vaginal ring, the transdermal patch, or an oral contraceptive. If a patient called back, the reason for her call was noted. Patients were prospectively followed from sites in New Jersey and Florida for 3 months after initiation of hormonal contraception (oral, transdermal, vaginal) and the number of callbacks for each method was assessed. ⋯ Rate of callbacks after initiation of hormonal contraception was the least with the vaginal ring. Use of oral contraception, often considered the gold standard, resulted in a callback rate that was midway between the number of callbacks for the vaginal ring and the number of callbacks for the transdermal patch. The lower observed rate of callbacks with the vaginal ring compared with oral and transdermal contraception may provide clinicians the confidence that this method is well tolerated by their patients.
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We sought to examine hospital compliance with poison center antidotal alcohol dehydrogenase inhibition recommendations in cases of ethylene glycol (EG) and methanol (ME) ingestion. A 2-year analysis of all potential EG and ME ingestion cases reported to a regional poison center was conducted. Excluded from analysis were exposures without an ingestion, without a confirmatory EG or ME serum assay, or without complete medical charting. ⋯ The mean time to antidote administration was 3 times longer in cases where a choice in antidote was given [57 min (95% confidence interval, 43-70) vs. 146 min (95% confidence interval, 93-200)]. Despite its ease of administration, fomepizole is used less frequently than recommended by poison center staff. Delays to antidote administration occurred more commonly in cases where the poison center gave a choice in antidotal therapy.
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Acute toxic methemoglobinemia is an infrequent complication of the use of topical anesthetics, most notably benzocaine. The clinical picture is characterized by sudden development of tissue hypoxia without underlying cardiac or respiratory dysfunction, and deceptively normal oxygen saturation on conventional arterial blood gas analysis. This condition may be rapidly fatal and management depends upon prompt recognition, confirmation of clinical suspicion using cooximetry of arterial blood, and quick institution of therapy. We describe the first reported case of cardio-respiratory failure associated with acute toxic methemoglobinemia, which was initially misconstrued as an evolving acute coronary event and rapidly responded to methylene blue therapy.