Both magnesium & placebo reduce the frequency of leg cramps with a non-significant difference between the two groups. The Cochrane review analysed four RCTs (n=322), two of which were deemed to have a high risk of bias and the remaining two trials had a combined total of 86 participants – better quality evidence needed.
Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study
BMJ2017; 357doi: https://doi.org/10.1136/bmj.j1415(Published 12 April 2017)Cite this as: BMJ 2017;357:j1415
Cohort study of more than 1.5 million adults 30 days of initiating these drugs, even at relatively low doses, users had:
a nearly 2x increased risk for fracture
3x risk for VTE and
5xrisk for sepsis
> one in five adults included in the Clinformatics DataMart, a large national database of commercial insurance claims, received prescriptions for short-term oral corticosteroids during the 3-year study, which ran from January 1, 2012, to December 31, 2014.
Of 1,548,945 adults aged 18 to 64 years included in the database, 327,452 (21.1%) received at least one outpatient prescription for short-term oral corticosteroids (30 or fewer days). The mean age of users was 45.5 years (standard deviation [SD], 11.6 years) compared with 44.1 years (SD, 12.2 years) for nonusers (P < .001). The median duration of use was 6 days (interquartile range, 6 – 12 days).
The six most common indications for the drugs were upper respiratory tract infections, spinal conditions, intervertebral disc disorders, allergies, bronchitis, and nonbronchitic lower respiratory tract disorders.
Within 30 days of drug initiation, there was an increase in incidence rate of the following: sepsis, with a rate ratio of 5.30 (95% CI, 3.80 – 7.41); venous thromboembolism, with a rate ratio of 3.33 (95% CI, 2.78 – 3.99); and fracture, with a rate ratio of 1.87 (95% CI, 1.69 – 2.07).
Rate ratios decreased during the following subsequent 31 to 90 days, however.
Recommendation: prescribing the smallest possible amount of corticosteroids for treating the condition in question. “If there are alternatives to steroids, we should be use those when possible,”
Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P. Gradual versus abrupt smoking cessation. A randomized, controlled noninferiority trial. Ann Intern Med 2016;164(9):585-592.
Patients in the “abrupt cessation group” were asked to stop smoking on their quit day. Participants in the “gradual cessation group” were also given short-acting nicotine products (gum, lozenges, nasal spray, sublingual tablets, inhalator, or mouth spray) and asked to reduce smoking to half of the baseline amount by the end of the first week and to a quarter of the baseline amount at the end of the second week.
At both 1 month and 6 months, validated abstinence rates were higher in the abrupt cessation group: 49.0% vs 39.2% at 1 month (relative risk [RR] 0.80; 95% CI 0.66 to 0.93) and 22.0% vs 15.5% (RR 0.71; 0.46 to 0.91) at 6 months.
At 1 month, one additional patient will be successful for every 13 patients who abruptly stop instead of stopping gradually (number needed to treat [NNT] = 12.8; 7.5 – 38.4). At 6 months, the benefit is not quite as large (NNT = 22.2; 11.9 – 71.7).
A. For motivated patients, quitting abruptly on a set date, preceded by 2 weeks of nicotine replacement via a patch, is more effective than doing the same preparation but gradually cutting down before stopping, even when each omitted cigarette is replaced with a hit of nicotine.
10 predictors with total score between 0 -15: sex, age, wheeze without colds, wheeze frequency, activity disturbance, shortness of breath, exercise-related and aeroallergen-related wheeze/cough, eczema, and parental history of asthma/bronchitis
1226 symptomatic children, 345 (28%) had asthma 5 years later
840 (69%) children were at low risk (score <5) 16% with asthma at school age
288 (23%) were at medium risk (score >6 and <9) 48% with asthma at school age
98 (8%) were at high risk (score >10) 79% with asthma at school age
“Of the 8 patients with airway obstruction, 6 required a nasopharyngeal airway or jaw thrust briefly, 1 was repositioned on the side, and 1 was intubated but had taken a tricyclic antidepressant overdose.”
Droperidol, 10mg, is safe and effective both IM and IV
Perindopril is the only ACE inhibitor to show a real dose-response curve for BP decrease. While the effectiveness of RAS blockers on target organ damage is dose dependent and at least partially unrelated to BP control, there is evidence that the only way to obtain a beneficial effect is to use them at full dose.
Authors Conclusions: We observed no significant difference between IAL and IVAS with regard to the immediate success rate of reduction, pain during reduction, post-reduction pain relief and reduction failure. Compared to IVAS, IAL may be less expensive and may be associated with fewer adverse effects and a shorter recovery time.
Ill let him sleep and get back to bed sooner myself.