Clinical therapeutics
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Clinical therapeutics · Feb 2009
Review Meta AnalysisGabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis.
Various nonhormonal agents have been used for the treatment of hot flashes in women with natural or tamoxifen-induced menopause. Some studies have reported that gabapentin appears to be an effective and well-tolerated treatment modality. ⋯ Comparisons of gabapentin and placebo revealed reductions of 20% to 30% in the frequency and severity of hot flashes with gabapentin, although data across the studies were too heterogeneous to provide a reliable summary effect. Clusterings of dizziness/unsteadiness and fatigue/somnolence were the most frequently reported adverse events associated with gabapentin and resulted in a higher dropout rate due to adverse events in the gabapentin-treated patients than in the controls. More studies are needed to consolidate the outcomes and elucidate useful details regarding this treatment.
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Clinical therapeutics · Jan 2009
Review Meta AnalysisEffectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: systematic review and meta-analyses.
Immunization is the most common cause of iatrogenic pain in childhood. Despite the availability of various analgesics to manage vaccine injection pain, they have not been incorporated into clinical practice. To date, no systematic review has been published on the effectiveness of pharmacologic and combined interventions for reducing injection pain. ⋯ Topical local anesthetics, sweet-tasting solutions, and combined analgesic interventions, including breastfeeding, were associated with reduced pain during childhood immunizations and should be recommended for use in clinical practice.
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Clinical therapeutics · Jan 2009
Review Meta AnalysisPhysical interventions and injection techniques for reducing injection pain during routine childhood immunizations: systematic review of randomized controlled trials and quasi-randomized controlled trials.
Vaccine injections are the most common reason for iatrogenic pain in childhood. With the steadily increasing number of recommended vaccinations, there has been a concomitant increase in concern regarding the adequacy of pain management. Physical interventions and injection techniques that minimize pain during vaccine injection offer an advantage over other techniques because they can be easily incorporated into clinical practice without added cost or time. Their effectiveness, however, has not previously been studied using a systematic approach. ⋯ Pain during immunization can be decreased by: (1) injecting the least painful formulation of a vaccine; (2) having the child sit up (or holding an infant); (3) stroking the skin or applying pressure close to the injection site before and during injection; (4) injecting the least painful vaccine first when 2 vaccines are being administered sequentially during a single office visit; and (5) performing a rapid intramuscular injection without aspiration.
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Clinical therapeutics · Jan 2009
Review Meta AnalysisPsychological interventions for reducing pain and distress during routine childhood immunizations: a systematic review.
Immunizations are a common source of pain and distress for children. Psychological interventions consist of a variety of techniques for relaxing and distracting children during immunization with the goal of reducing pain and distress. ⋯ Evidence suggests that breathing exercises, child-directed distraction, nurse-led distraction, and combined cognitive-behavioral interventions are effective in reducing the pain and distress associated with routine childhood immunizations. Although additional well-designed trials examining psychological interventions are needed, parents and health care professionals should be advised to incorporate psychological interventions to reduce the pain and distress experienced by children during immunization.
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Clinical therapeutics · Oct 2008
Meta AnalysisShort- versus long-course antibiotic therapy for acute pyelonephritis in adolescents and adults: a meta-analysis of randomized controlled trials.
Despite the high incidence of acute pyelonephritis in the community setting, there is no consensus on the optimal duration of treatment. A potential reduction in the duration of the administered antibiotic regimens could contribute to avoiding further development of antimicrobial resistance. ⋯ This meta-analysis failed to identify any significant differences, with regard to effectiveness and tolerability, between short- and long-course treatment with the same antibiotic.