July 05, 2007 Archives - Page 2 of 7 - Clinical Advisor

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POST-STROKE ATORVASTATIN REDUCES RISK OF SECOND STROKE AND MI

Level 1: Likely reliable evidence The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial evaluated the effect of atorvastatin (Lipitor) 80 mg once daily on risk of stroke. The subjects were 4,731 functionally independent patients who had a stroke or transient ischemic attack (TIA) within the previous one to six months, an LDL…

IBUPROFEN FOUND BEST FOR CHILDREN WITH FRACTURES

Level 2: Mid-level evidence A randomized trial evaluated the efficacy of three analgesia regimens in 336 children aged 6-17 years who presented to an emergency department (ED) with pain from a musculoskeletal injury to the extremities, neck, or back (Pediatrics. 2007;119:460-467). To be included in the trial, the injury had to occur within 48 hours…

TWO DRUGS WORK BETTER FOR MIGRAINE THAN MONOTHERAPY

Level 2: Mid-level evidence Both sumatriptan (Imitrex) and naproxen sodium (Aleve, others) are used to treat a migraine attack. A new but not yet commercially available combination tablet containing sumatriptan 85 mg plus naproxen sodium 500 mg was compared with sumatriptan monotherapy and naproxen sodium monotherapy in two placebo-controlled randomized trials funded by Bayer, the…

CLINICAL PEARL- ULTRASOUND FOR PLANTAR WARTS

Apply lubricant to the wart and use the ultrasound wand at a setting as high as tolerated for 10 minutes in six weekly sessions. Results should be evident six weeks after the final session.—Raymond Schofield, MD, Crawford, Ga. (105-26)

CLINICAL PEARL- REMOVING THE STIGMA FROM DEPRESSION TREATMENT

Cognitive therapy paired with pharmacologic therapy has a far higher success rate in treating depression than drugs alone. But it can be difficult to convince patients to attend counseling because they do not want to be labeled “unstable” or “crazy.” I ask these patients if they would try to set their own broken leg or…

CLINICAL PEARL- EASING ESOPHAGEAL SPASMS

Easing esophageal spasmsIn most cases, drinking fluid (tea, water, etc.) as hot as possible without burning yourself will relieve painful esophageal spasms in seconds.—Yanina M. Benikova, MD, Portland, Ore. This interesting suggestion may be worth a try as long as the patient is adequately cautioned about the risk for burn injury if not done carefully.…

CLINICAL PEARL- FOOLPROOF FOREIGN-BODY REMOVAL

To remove a foreign body from the nose of a child, bend the loop on a plastic ear curette to about a 25° angle. Next, place the patient in a supine position and have one assistant lie across the child’s thighs while another immobilizes the head with the child’s upraised arms. Insert the loop of…

UNUSUAL ALLERGY PRESENTATION

Several months ago, Jeffrey M. Weinberg, MD, discussed a possible diagnosis of dyshidrosis or other form of eczema in a patient with pedal cracking (Item 96-11). In 1985, a 22-year-old woman presented with a six-year history of itching, cracking, and vesiculation on the sole that frequently progressed to raw oozing. She had tried many topical…

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