Archives of family medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. The University of Montreal Orthopaedic Research Group.
To evaluate the efficacy of an oral nonsteroidal anti-inflammatory drug in the treatment of lateral epicondylitis. ⋯ Taking into account the limited improvement noted over rest and cast immobilization and the number of associated adverse events, it is difficult to recommend the use of diclofenac in the treatment of lateral epicondylitis at the dosage used in this study.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A randomized controlled trial of a physician-directed treatment program for low-income patients with high blood cholesterol: the Southeast Cholesterol Project.
To assess the effectiveness of a cholesterol-lowering intervention designed to facilitate the management of hypercholesterolemia by primary care clinicians. ⋯ Total cholesterol and LDL-C decreased more in the intervention group than in the control group. Overall, the difference in lipid reduction between groups was modest and of borderline statistical significance; among participants who did not take lipid-lowering medication during follow-up, the difference in lipid reduction between groups was larger. We conclude that primary care clinicians can be trained to give a cholesterol-lowering intervention to low-income patients that results in modest, short-term reductions in total cholesterol and LDL-C.
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To describe the screening and management of patients who smoke by primary care physicians and to review practice factors associated with smoking services. ⋯ Physician screening and management of their practice patients is higher than reported in population surveys. Most patients who smoke report that they were asked whether they smoke, but smoking status is not routinely documented or updated. Significant variability is noted between physicians in smoking-related screening and interventions, and proved methods to improve services are infrequently used.
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Case Reports
Nocturnal vertebral compression fracture. A presenting feature of unrecognized epileptic seizures.
Bone fractures, especially vertebral compression fractures, are well-known complications of convulsive seizures. Acute vertebral fractures of unclear cause, often labeled idiopathic, may be due to unwitnessed epileptic seizures. We reviewed the records of 2 patients with new onset of seizures seen at the Adult Epilepsy Clinic at the Henry Ford Hospital, Detroit, Mich, who had a history of vertebral compression fractures preceding the diagnosis of epilepsy. ⋯ X-ray films revealed thoracic vertebral fractures in both patients. The first recognized seizure occurred 1 week later in 1 patient and 6 months later in the other. Nocturnal vertebral compression fractures may be the presenting feature of unwitnessed convulsive seizures, and evaluation for epilepsy should be considered in cases of idiopathic vertebral compression fractures.
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The United States has a greater percentage of households with guns and more acts of violence than any other country in the western world. Suicide is the nation's eighth leading cause of deaths in the United States, of which 60% are caused by firearms. ⋯ Most of these deaths can, in part, be attributed to inappropriate behaviors (eg, keeping a loaded and inadequately secured firearm in the home). As respected professionals in the community, family physicians have a unique opportunity to promote behaviors in patients that reduce the risk of firearm-related injuries in patients and their families.