Are oral steroids as effective as NSAIDS in relieving patient pain from gout?

OBJECTIVE: The objective of this selective EBM review is the determine whether or not, “oral steroids are as effective as NSAIDS in relieving patient pain from gout?” STUDY DESIGN: Review of three English language primary studies, published between 2008 and 2016. DATA SOURCES: Three randomized controlled trials (RCTs) were found using PubMed and Embase database. These studies analyzed the effectiveness of steroids in relieving patient pain from gout. OUTCOMES MEASURED: The major outcomes measured were improvements in joint tenderness on palpation, joint erythema, joint swelling, and joint activity measured on a 5-point Likert scale. (0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain, 4=extreme pain). Analgesic effectiveness was measured as changes in pain on a 100-mm visual analogue scale. With 1 being the least pain the patient has ever experiences and 100 being the worst. RESULTS: All three studies showed comparable efficacy between prednisolone and NSAIDS in treating gout. The Xu et al study concluded similar results between NSAIDS and Prednisolone in improving pain, tenderness, and joint activity. Furthermore, the study also stated Prednisolone may be more effective in reducing inflammation and was better tolerated. The Rainer et al and Janssen et al study found prednisolone and indomethacin have similar analgesic effectiveness, and prednisolone is a safe, and effective first line option for gout treatment. CONCLUSION: The results of all three RCT’s which compared the efficacy between prednisolone and NSAIDS in the treatment of gout concluded similar results between the two groups. Therefore, proving steroids as an effective treatment option for patients diagnosed with gout

Empirical Perspectives on Mediation and Malpractice

The use of mediation in the medical malpractice context is examined. The impact of any court-related alternative dispute resolution program is also discussed

What Is a Life Worth in North Carolina? A Look at Wrongful-Death Awards

This Article examines the amounts recovered in 123 wrongful-death cases filed in North Carolina over a five-year period. The dataset is unique in that it includes both jury verdicts and settlements. Although the injury - death - was the same in each of these cases, the amounts recovered varied greatly. Several patterns emerge from the data. First, there is a strong negative correlation between age and the amount recovered. Second, the manner in which the decedent died seems to make a difference. Violent deaths, for example, led to larger recoveries than did nonviolent deaths. Third, jury verdicts produced much larger recoveries than did settlements. Finally, the results underscore the critical role of insurance in wrongful death cases

What Is a Life Worth in North Carolina? A Look at Wrongful-Death Awards

This Article examines the amounts recovered in 123 wrongful-death cases filed in North Carolina over a five-year period. The dataset is unique in that it includes both jury verdicts and settlements. Although the injury - death - was the same in each of these cases, the amounts recovered varied greatly. Several patterns emerge from the data. First, there is a strong negative correlation between age and the amount recovered. Second, the manner in which the decedent died seems to make a difference. Violent deaths, for example, led to larger recoveries than did nonviolent deaths. Third, jury verdicts produced much larger recoveries than did settlements. Finally, the results underscore the critical role of insurance in wrongful death cases

"EXTRA!" Using the Newsvendor Model to Optimize War Reserve Storage

17 USC 105 interim-entered record; under review.The article of record as published may be found at https://doi.org/10.22594/dau.21-865.28.04The United States Marine Corps (USMC) Installation and Logistics Command requested a study for determining appropriate inventory levels of war reserve materiel to meet future operational needs under surge demands in uncertain environments. This study sought to explore a potential approach by using the common newsvendor model, but modified for a military scenario. The authors' novel version of this core concept considers the purchase and storage costs of an item and proposes an intangible cost function to capture the consequences of a shortage. Further, they show a sample application of the model using a ubiquitous military item-the BA-5590/U battery. The output of the model provides USMC with a new tool to optimize inventory levels of a given item of interest, depending on scenario inputs.USMC Installation and Logistics Command, Logistics Plans and Operations (Maritime and Geo-Prepositioning Programs) (LPO-2

Empirical Perspectives on Mediation and Malpractice

Rapporten baseras på strukturerade intervjuer och sammanlagt intervjuades 18 personer, med två till 30 års yrkeserfarenhet som aktivt deltagit i prioriteringsarbete med vertikala rangordningslistor. Resultatet av intervjuerna visade både på underlättande och försvårande faktorer för delaktighet i prioriteringsarbete. Sjuksköterskorna uttryckte svårigheter dels med att få gehör för sina synpunkter och dels med att precisera vad som enligt deras uppfattning är omvårdnad ur ett helhetsperspektiv. De framförde också att omvårdnadsåtgärder vare sig hade varit föremål för prioriteringsdiskussioner eller senare inkluderats i rangordningslistan. Bland arbetsterapeuter och sjukgymnaster upplevdes den rangordningslista de själva arbetat fram som en trygghet i kliniskt beslutsfattade och stöd för öppenhet i kommunikation med allmänheten. Representanter för samtliga vårdyrkesgrupper i undersökningen upplevde det svårt att inkludera den egna professionens yrkesspecifika åtgärder i rangordningen. Det framkom också att uppdraget med att ta fram rangordningslistor måste vara tydligt beskrivet och att prioriteringar bör diskuteras utifrån ett brett behovsperspektiv i väl förberedda multiprofessionella grupper. Arbete med öppna prioriteringar och rangordningslistor kräver många olika perspektiv och förutsätter att alla samverkande professioner har likvärdiga förutsättningar. Riktade utbildningsinsatser inom omvårdnad och rehabilitering behövs för att tillämpning av den nationella modellen för öppna vertikala prioriteringar ska få en vidare användning även inom dessa områden.　 When health services cannot meet all care needs we must set priorities. This has always been done, but seldom in a systematic way. In Sweden, the Health Services Act places the responsibility for healthcare priority setting on local governing bodies (mainly the county councils and regions). The task of priority setting is grounded in the ethical platform and must apply across all health services. In 2003, the Östergötland County Council initially decided that specific limitations must be established regarding the supply of health services. However, follow-up of the county-council-wide effort to set priorities reveals that this work has not reached far enough down into the organisation. Earlier reports from the National Centre for Priority Setting in Health Care describe the initial political decision-making process, the extent to which the policy decisions have been implemented in health care, and the progress of the county council’s prioritisation initiative from 2003 to 2006. With this report we aim to increase knowledge regarding how staff groups other than management- level physicians participated in establishing vertical ranking lists during this period and how these lists were used in Östergötland County Council

Empirical Perspectives on Mediation and Malpractice

The use of mediation in the medical malpractice context is examined. The impact of any court-related alternative dispute resolution program is also discussed