IV valproate inferior for acute migraine
Friedman BW, Garber L, Yoon A, et al. Randomized trial of iv valproate vs.metoclopramide v. ketorolac for acute migraine. Neurology 2014; 82:976-983. Authors randomized 330 patients in ER to get 1000 mg, 10 mg, or 30 mg of respective drugs above over an iv drip over 15 minutes in a double blind trial. On the primary measure of pain relief, valproate lost big to the other two drugs. On secondary measures of needing a rescue medication, iv valproate also lost. Comment-- great to have this knowledge but the two winning drugs each had relatively low sustained headache rel...
Source: neurologyminutiae - April 18, 2015 Category: Neurology Source Type: blogs
Research and Reviews in the Fastlane 071
This study looks at the effect of institution of duty hour restrictions on the outcome of Medicare patients. Although the study is retrospective and derived from large database information, it gives us a peak into the bigger picture of duty hours regulations: patient outcomes. The study authors found no difference in any important outcomes. It is similarly unclear whether these restrictions have improved resident quality of education or quality of life. Large system wide changes duty hour restrictions should, in the future, be implemented not based on theory but actual data of improved outcomes. An accompanying editorial d...
Source: Life in the Fast Lane - February 18, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education Emergency Medicine Neurosurgery Pediatrics Resuscitation Trauma critical care examination Intensive Care R&R in the FASTLANE research and reviews Source Type: blogs
Research and Reviews in the Fastlane 053
This study combines the results from the WARFASA and ASPIRE trials looking at aspirin prophylaxis. The results are promising. Aspirin 100 mg reduced the rate of recurrent VTE from 7.5%/year to 5.1%/year (HR = 0.68) without a significant change in bleeding rate (0.5%/year vs 0.4%/year). We often see patients in the ED with a history of unprovoked VTE who are on no long-term prophylaxis. This article argues that we consider aspirin for all these patients.
Recommended by: Anand Swaminathan
Trauma
Stevens AC, Trammell TR, Billows GL, Ladd LM, Olinger ML. Radiation Exposure as a Consequence of Spinal Immobilization and Extri...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Alternative Medicine Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation Toxicology and Toxinology Trauma critical care literature Source Type: blogs
Cases: Second-Line Anti-emetic Therapies for Refractory Chemotherapy-Induced Nausea and Vomiting (CINV)
Discussion:Nausea and vomiting (NV) are commonly reported side effects with chemotherapy.1 The primary pathway for NV involves the chemotherapy drugs directly stimulating the chemoreceptor trigger zone (CTZ), in the area postrema at the base of the fourth ventricle. Activated receptors in the CTZ transmit signals to the vomiting center in the brainstem to produce NV. Receptors in the CTZ include serotonergic receptor 5-hydroxytryptamine type 3 (5-HT3), dopaminergic (D2) and neurokinin type 1 (NK-1) receptors. In addition, chemotherapy can damage GI mucosa causing local release of 5-HT3 neurotransmitters by gut enteroch...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 25, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Gastroparesis Awareness Month: A Day In The Life
This is my second post for Gastroparesis Awareness Month. Read my first post, Tube Love, here. My first post was a love poem to my feeding tube. :-) My second one is a little more serious and a lot longer. I apologize for the length. I have trouble reading lengthy posts myself. But sometimes I’m incapable of summarizing myself, so I have to write posts that are too long for even me to read. I hope you’ll at least be able to skim through the important parts. I’ve tried to break up the text with lots of photos, to see if that helps any.
A DAY IN THE LIFE
My day starts when my morning careg...
Source: Ballastexistenz - August 23, 2014 Category: Autism Authors: Mel Baggs Tags: Adrenal insufficiency Aspiration pneumonia Bronchiectasis Education Feeding tube Food Gastroparesis Life Skills Medical Medical stuff Personal history Treatment adult tubie adult tubies awareness awareness months bipap ce Source Type: blogs
The Role Of Black Box Warnings In Safe Prescribing Practices
TweetNote: In addition to Lara Maggs, Aaron Kesselheim also coauthored this post.
In the Health Affairs article, “Era of Faster Drug Approval Has Also Seen Increased Black-Box Warnings and Market Withdrawals,” published in the August issue, Cassie Frank and coauthors compare the number of approved prescription drugs that received black-box warnings or were withdrawn from the market for safety-related reasons prior to the 1992 Prescription Drug User Fee Act (PDUFA) with black-box warnings and safety-related withdrawals in the post-PDUFA era.
PDUFA for the first time authorized FDA to collect user fees from brand-name...
Source: Health Affairs Blog - August 20, 2014 Category: Health Management Authors: Lara Maggs and Aaron Kesselheim Tags: All Categories Bioethics Patient Safety Pharma Policy Public Health Source Type: blogs
Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it.
Recommended by: Anand Swaminathan
Read More: Nausea? We’ve Got Placebo for That
The Best of the Rest
Emergency Medicine, Pulmonary
1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine Featured General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendatio Source Type: blogs
Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it.
Recommended by: Anand Swaminathan
Read More: Nausea? We’ve Got Placebo for That
The Best of the Rest
Emergency Medicine, Pulmonary
1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865567
This Cochr...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations resear Source Type: blogs
Cases: "Am I really going to have to live like this?": The Role of Octreotide in Patients with Persistent Nausea and Vomiting after Venting Gastrostomy
Discussion:Malignant bowel obstruction can occur with any cancer but is most commonly associated with advanced ovarian cancer, where it occurs in up to 50% of patients. It generally indicates a poor prognosis and carries a heavy symptom burden predominated by nausea, vomiting and abdominal pain. Patients with carcinomatosis, like Ms BB, are generally not candidates for surgical correction of the obstruction or endoscopic stenting. Fortunately, medical management can be very effective. Abdominal pain is treated with opioids and nausea is treated with metoclopramide in partial obstructions and haloperidol in complete obstruc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 10, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Buy Codeine Online for cough, fever, pain and diarrhea
If you are staying anywhere in UK then there’s good news for you. You can buy codeine from the internet and this is really quite simple. You just got to have a computer at home from where you can opt for online buying option and in this way you can get the desired medication and in this case codeine at your door steps. Also, the online deal would be a bit cheaper as compared to the offline option. There are many problems that can be treated with the help of codeine. Just go through the information given below and you will understand how useful codeine is.
Codeine is useful for many health issues
Lots of studies have been...
Source: Mental Nurse - December 26, 2013 Category: Nurses Authors: Iqcguest Tags: Health amily planning cough drug interactions fever pain and diarrhea Source Type: blogs
Acupuncture is a theatrical placebo: the end of a myth
Conclusions
It is clear from meta-analyses that results of acupuncture trials are variable and inconsistent, even for single conditions. After thousands of trials of acupuncture, and hundreds of systematic reviews (Ernst et al., 2011), arguments continue unabated. In 2011, Pain carried an editorial which summed up the present situation well.
“Is there really any need for more studies? Ernst et al. (2011) point out that the positive studies conclude that acupuncture relieves pain in some conditions but not in other very similar conditions. What would you think if a new pain pill was shown to reliev...
Source: DC's goodscience - May 30, 2013 Category: Professors and Educators Authors: David Colquhoun Tags: Academia acupuncture badscience Bait and switch quackademia CAM quackery Source Type: blogs
Cases: Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and mus...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and mus...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
