A few quick snippets from the 19th Nov BMJ:
- Duloxetine increases the risk of adverse psychiatric events – anxiety, agitation, self-harm, psychotic behaviour – by more than five times, according to a new Nordic Cochrane Centre meta-analysis although this article didn’t give NNHs. Efficacy was slight and questionable. Harms are therefore now thought to outweigh benefits, and it is recommended that women on the drug should gradually come off it (not sure how to do ‘gradually’, since it doesn’t allow for much dose tapering).
- Adding supervised physiotherapy to usual early care of grade 1 and 2 ankle sprains in adults doesn’t help recovery, meaning that there’s no benefit in trying to get these patients in to early physio programmes. However, it isn’t clear whether this was due to the large proportion of participants with recurrent sprain in a chronically unstable ankle.
- When speaking to a patient with chronic insomnia, don’t advise the kind of measures you would in acute insomnia (wait & see, short-term sleepers). It isn’t the same kind of problem, they’ve already waited to see, and they find this irritating.