I have been teaching back pain for a long time, and I have to say that there has not been a lot of change over very long period of time! American College of Physicians published the most recent guideline in Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Again narctoics! are not recommended with this kind of pain.
There are 3 recent studies regarding this subject:
- Hollingsworth et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis.
The greatest benefit might be among those with larger stones.
- Wang RC et al. Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis.
Tamsulosin significantly improves stone passage in patients with larger stones
- Pourmand et al. Tamsulosin for urolithiasis: a review of the recent literature and current controversies.
Tamsulosin may also increase patient satisfaction by reducing the invasive treatment and decreasing the time to stone passage.
Annals of Emergency Medicine in a study published in Dec 2016 showed that there is no association between discharge glucose and 7 days outcome!
A randomized double-blind study published in Annals of emergency medicine showed that Ketorolac in doses of 10, 15, or 30 mg intravenously has no differences in terms of analgesic effect at 30 minutes. This study did not go over 2 hrs and does not give us any information regarding prolonging pain medication, but for acute onset pain treatment, if there is no contraindication, ketorolac with a dose of 10 mg sounds sufficient!
The new guideline by IDSA published’ Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.” There are some answered questions that previously we were practicing based on them.
- I. Should Patients With Suspected VAP Be Treated Based on the Results of Invasive Sampling (ie, Bronchoscopy, Blind Bronchial Sampling) With Quantitative Culture Results, Noninvasive Sampling (ie, Endotracheal Aspiration) With Quantitative Culture Results, or Noninvasive Sampling With Semiquantitative Culture Results?
1. We suggest noninvasive sampling with semiquantitative cultures to diagnose VAP, rather than invasive sampling with quantitative cultures and rather than noninvasive sampling with quantitative cultures (weak recommendation, low-quality evidence).