American journal of therapeutics
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The P values tell us the chance of making a type I error of finding a difference where there is none. In the 1970s, exact P values were laborious to calculate and were generally approximated from statistical tables, in the form of P < 0.01 or 0.05 < P < 0.10, etc. In the past decades with the advent of computers, it became easy to calculate exact P values such as 0.84 or 0.007. ⋯ Instead of concluding significantly yes/no, we are able to consider levels of probabilities from very likely to be true to very likely to be untrue. Very large P values are not compatible with a normal gaussian frequency distribution; very small P values do not completely confirm prior expectations. They must be scrutinized and may have been inadequately improved.
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ED-based observation units are becoming increasingly used for the assessment and treatment of patients who may not require inpatient management or monitoring. Although not a substitute for an inpatient unit, the ED-based observation unit can be of great value in the more efficient management of certain groups of patients. The continued patient management in the ED observational unit offers the opportunity for a better definition of the patient's problem. ED-based observation units have the potential to increase patient satisfaction, reduce length of stay, reduce inappropriate admissions, improve efficiency of the ED, and improve cost effectiveness.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Analgesic efficacy and safety of nonprescription doses of naproxen sodium compared with acetaminophen in the treatment of osteoarthritis of the knee.
Nonprescription doses of naproxen sodium, acetaminophen, and placebo were compared to determine their efficacy and safety in osteoarthritis of the knee. In two identical multicenter, randomized, double-blind, placebo-controlled, multidose, parallel-design studies, patients with osteoarthritis aged (mean +/- SD) 60.6 +/- 12.8 years were randomized to daily doses of 660 mg naproxen sodium (440 mg naproxen sodium in patients >or=65 years), 4000 mg acetaminophen, or placebo for 7 days. Naproxen sodium (440/660 mg) provided significantly greater improvements in pain at rest, on passive motion, on weight-bearing, stiffness after rest (morning), day and night pain compared with placebo, and significantly greater relief from resting pain than acetaminophen (P < 0.05). ⋯ Naproxen sodium and acetaminophen had similar safety profiles to placebo. Nonprescription doses of naproxen sodium (440/660 mg) effectively relieve pain and other symptoms of osteoarthritis. Naproxen sodium is an alternative in the initial treatment of osteoarthritis and may be preferred to acetaminophen as first-line therapy in patients with moderate or severe pain.
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Migraine is a common, chronic neurologic disorder that affects 11% of the adult population in Western countries. In this article, we review the current approaches to the pharmacologic treatment of migraine. Once migraine is diagnosed, and illness severity has been assessed, clinicians and patients should work together to develop a treatment plan based on the patient needs and preferences. ⋯ A variety of behavioral interventions are helpful. The clinicians have in their armamentariums an ever-expanding variety of medications. With experience, clinicians can match individual patient needs with the specific characteristics of a drug to optimize therapeutic benefit.
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Anticholinergic syndrome may present with a wide variety of signs and symptoms. Central manifestations range from excitatory symptoms including delirium and agitation to central nervous system depression, stupor and coma. Anticholinergic syndrome was once a common phenomenon after general anesthesia because of the frequent administration of the anticholinergic agents atropine and scopolamine. ⋯ We report a case of prolonged somnolence following general anesthesia for an MRI. A rapid improvement of mental status with physostigmine confirmed the diagnosis of anticholinergic syndrome. This case is unique in that anticholinergic syndrome-related respiratory depression was promptly reversed with physostigmine.