American journal of therapeutics
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Food and Drug Administration (FDA) advisory committees have a significant influence on patterns of clinical practice worldwide. Recent guidance to the committees by the FDA has focused on attempting to eliminate sources of bias due to committee voting procedures. Nevertheless, major sources of social influence have not been addressed. ⋯ Speaking order and voting order are both determined by seating location. We therefore conclude that voting behavior on FDA expert advisory committees is strongly associated with seating location. This suggests the presence of a possible social dynamic that is not addressed by existing FDA committee procedures.
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Multicenter Study
When opioids fail in chronic pain management: the role for buprenorphine and hospitalization.
Clinicians are increasingly being challenged by patients who are treated for chronic pain with high-dose opioids that can cause medical, social, and societal harm. These patients may best be improved by psychological approaches, adjuvant medications, and opioid reduction or removal, rather than ever-escalating dosing that has become common. Opioid reduction or removal can be a difficult process that, when done incorrectly, may cause patient dissatisfaction or severe discomfort. ⋯ Median length of hospital stay was 2 days, and the median daily buprenorphine discharge dose was 8 mg. No adverse reactions or outcomes were observed. A brief hospitalization for conversion from high-dose opioid therapy to a safer, more effective buprenorphine regimen can produce life-altering improvement.
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Sarcoidosis is a multisystemic granulomatous disease, which uncommonly affects nervous system. However, when present, it may affect both central and peripheral nervous systems and potentially mimics other chronic diseases of the nervous system. ⋯ Early diagnosis and aggressive treatment of neurosarcoidosis are necessary to produce satisfactory clinical outcomes. This review discusses clinical manifestations, current diagnostic studies, and currently available modalities for management of neurosarcoidosis.