RESUMEN
BACKGROUND: Benzodiazepines are extensively used in primary care, but their long-term use is associated with adverse health outcomes and dependence. AIMS: To analyse the efficacy of two structured interventions in primary care to enable patients to discontinue long-term benzodiazepine use. METHOD: A multicentre three-arm cluster randomised controlled trial was conducted, with randomisation at general practitioner level (trial registration ISRCTN13024375). A total of 532 patients taking benzodiazepines for at least 6 months participated. After all patients were included, general practitioners were randomly allocated (1:1:1) to usual care, a structured intervention with follow-up visits (SIF) or a structured intervention with written instructions (SIW). The primary end-point was the last month self-declared benzodiazepine discontinuation confirmed by prescription claims at 12 months. RESULTS: At 12 months, 76 of 168 (45%) patients in the SIW group and 86 of 191 (45%) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 (15%) in the control group. After adjusting by cluster, the relative risks for benzodiazepine discontinuation were 3.01 (95% CI 2.03-4.46, P<0.0001) in the SIW and 3.00 (95% CI 2.04-4.40, P<0.0001) in the SIF group. The most frequently reported withdrawal symptoms were insomnia, anxiety and irritability. CONCLUSIONS: Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity. A structured intervention with a written individualised stepped-dose reduction is less time-consuming and as effective in primary care as a more complex intervention involving follow-up visits.
Asunto(s)
Benzodiazepinas/efectos adversos , Educación del Paciente como Asunto/métodos , Atención Primaria de Salud/métodos , Síndrome de Abstinencia a Sustancias/prevención & control , Trastornos Relacionados con Sustancias/terapia , Anciano , Análisis por Conglomerados , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , España , Resultado del TratamientoAsunto(s)
Osteogénesis Imperfecta/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
7 cases of acute subdural hematomas diagnosed and surgically treated during the first week of life are presented. 5 of them are alive and well at 6 and 7 months and 3, 4 and 6 years of follow-up. Free interval, raised intracranial pressure, lateralizing signs, fall of hematocrit and presence of blood in CSF were constant. Subdural puncture was negative in 6 cases, including a hemophilic patient (hemophilia B). Clinical diagnosis was ratified by means of neuroradiological procedures. The authors conclude that craniectomy is the treatment of choice and subdural tapping a useless procedure.
Asunto(s)
Hematoma Subdural/cirugía , Enfermedades del Recién Nacido/cirugía , Edema Encefálico/complicaciones , Hematoma Subdural/complicaciones , Hematoma Subdural/diagnóstico , Hemofilia B/complicaciones , Humanos , Recién Nacido , Enfermedades del Recién Nacido/complicaciones , Enfermedades del Recién Nacido/diagnóstico , Cráneo/cirugíaRESUMEN
A giant arteriovenous fistula in a newborn infant was treated by surgical occlusion of the feeding vessels at 20 days of life. Congestive heart failure responded favorably to operative treatment. Because of persistent hydrocephalus, a shunt was inserted at 2 months of age. At 9 months of age, the child remained without signs of cardiac failure. Cerebral damage was manifested by a mild left hemiparesis. Successful surgical treatment of this unusual lesion in a neonate is exceptional.
Asunto(s)
Malformaciones Arteriovenosas Intracraneales/cirugía , Angiografía Cerebral , Humanos , Recién Nacido , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Masculino , Métodos , Complicaciones PosoperatoriasRESUMEN
The authors report an unusual case of cerebellar abscess in a 6-week-old infant without an antecedent of sepsis or congenital heart disease. The abscess was treated successfully by percutaneous punction-aspiration and further excision. Shunting procedure was not necessary.