Archives of family medicine
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The placebo effect on pain is a complex phenomenon. The unconsented use of placebo pain medication, however, raises concerns given the risks both to patient trust and to the medical profession's reputation in condoning deception, the inherent distastefulness of deception, the misuse of placebos that occurs, and the fact that the information obtained is often of negligible value. ⋯ We argue that placebo pain medication should be prescribed to patients only with their informed consent in scientifically rigorous single-patient studies. The results of such trials would constitute a particularly useful way of resolving uncertainty in the treatment of patients whose pain is poorly controlled.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Physicians and smoking cessation. A survey of office procedures and practices in the Community Intervention Trial for Smoking Cessation.
To obtain a baseline measure of tobacco control activities carried out by physicians and of tobacco control policies and practices in physician offices. ⋯ There is a positive relationship between attending training and intervening with more cessation activities. Physicians perceive themselves as prepared to help smokers, but few are providing more than advice to stop smoking.
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Dosing of pediatric medications must be accurate. Combining constants in the usual calculation for amoxicillin dosing derives the Rule of Six (6 mg/lb per dose) for dosing. ⋯ The Decimal Move Rule (0.1 mL/lb per dose) can be used to dose many over-the-counter cough and cold remedies, bronchodilators, and iron preparations. A number of helpful hints to improve compliance and three comprehensive dosing tables are presented.
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Review Case Reports
Phentolamine reversal of epinephrine-induced digital vasospasm. How to save an ischemic finger.
A 17-year-old girl accidently injected her thumb with an adult autoinjector epinephrine syringe, resulting in rapid digital ischemia. Local infiltration of 0.5% phentolamine mesylate injected at the puncture site immediately resolved the ischemia and resulted in no long-term sequelae. ⋯ Alternative attempts to restore blood flow included warm water immersion, amyl nitrite inhalations, metacarpal nerve block, and application of topical nitroglycerin paste; each was found to be ineffective. We conclude that digital ischemia secondary to accidental injection of epinephrine can be quickly and safely reversed with the use of 0.5% phentolamine locally infiltrated in the region of accidental injection.
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To determine the frequency, the clinical features, and the response to therapy of imported malaria that was diagnosed in the 1990s in a major North American city. ⋯ Imported malaria occurs frequently and usually results from the failure to use appropriate prophylaxis. Delayed diagnosis and misdiagnosis are common. Severe disease and fatal cases continue to be seen despite aggressive treatment. Drug resistance has continued to spread and now occurs with P vivax as well as P falciparum.