The West Virginia medical journal
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Concerns have been raised regarding potential adverse effects and high costs of proton pump inhibitors (PPIs). Our objective was to assess issues of PPI utilization and expense in a large outpatient clinic population. ⋯ Outpatient PPI prescribing indications are not well documented and PPI use is probably excessive. H2RA therapy is likely underutilized.
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Chronic daily headaches can be debilitating. Multiple treatments have been suggested with varying degrees of success. We present a case of a 27-year-old female with greater than ten years of chronic daily headaches. ⋯ After other treatments were unsuccessful, the patient was referred to the Pain Management Center and underwent a trial of peripheral nerve stimulation with significant pain relief without complications. She then proceeded with permanent implantation of the peripheral nerve stimulator with continued pain relief. This case demonstrates the utility of peripheral nerve stimulation for the treatment of refractory chronic daily headaches and should be part of our armamentarium.
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Randomized Controlled Trial
Glove perforations with blunt versus sharp surgical needles in caesarean delivery: a randomized trial.
To compare the rate of glove perforations and surgeon satisfaction when utilizing blunt surgical needles compared to conventional sharp surgical needles. ⋯ A total 240 patients were enrolled into the study. There was no statistically significant difference in the rate of glove perforation per case between groups assigned to sharp (24%) or blunt surgical needles (26%). (RR 1.05, 95% CI 0.68-1.63). There were significant differences in the surgeon satisfaction surveys, with surgeons in the sharp needle group being more satisfied with the tissue penetration of the needle (p < .001), needle integrity (p = .01), force to penetrate tissue (p < .001) and control of bleeding at the needle insertion site (p = .001). Surveys from surgeons in the blunt needle group showed a statistically significant improvement in the perceived safety profile of the blunt needles (p < .001) CONCLUSIONS: There was no significant difference in the rate of glove perforation between blunt and sharp surgical needles during Caesarean delivery. Overall surgeons were more satisfied with the sharp surgical needles.