Cleveland Clinic journal of medicine
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Epidural injections of glucocorticoids may help some patients with back and leg pain. The efficacy of this therapy has not been conclusively proved; however, when weighed against the risks, cost, and outcomes of spinal surgery, epidural glucocorticoids are a reasonable alternative in selected patients whose back and leg pain is functionally limiting. We review the rationale, available data, techniques, and indications for these injections.
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Faced with a shortage of the inactivated intramuscular influenza vaccine this year, the Centers for Disease Control and Prevention (CDC) has revised its guidelines for immunization and use of antiviral agents. The most rational solution at this time is to direct the supply of scarce vaccine to patients at highest risk of influenza-related complications.
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Many physicians avoid prescribing opioid analgesics for chronic pain because of misconceptions or fears about efficacy, adverse effects, abuse, and addiction potential. We discuss these issues and offer suggestions for the rational use of opioid analgesics in patients with chronic noncancer pain.
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Review Case Reports
A practical program for preventing delirium in hospitalized elderly patients.
Delirium in hospitalized elderly patients is common and often unrecognized (especially the hypoactive type), and can lead to serious complications. A systematic program can improve the rate of recognition of this problem and decrease its incidence, and is cost-effective.