1. SSRI for generalized anxiety disorder: paxil/paroxetine and lexapro/escitalopram are the only 2 SSRIs currently FDA approved for the treatment of GAD. (cymbalta/duloxetine and effexor/venlafaxine are SNRIs approved for GAD)
2. Effectiveness of Lexapro for GAD: 

{2004 RCT in Depression and Anxiety} investigated the efficacy of escitalopram (Lexapro) in the treatment of adults with generalized anxiety disorder (GAD). A total of 315 adults with GAD and Hamilton anxiety scores >=18 were randomized to receive escitalopram or placebo for 8 weeks. The escitalopram was given as 10mg/day for 4 weeks, then flexibly dosed 10-20mg/day for 4 weeks. Escitalopram statistically and clinically significantly improved Hamilton anxiety scores from week 1 to 8, with a mean change of -11.3 for escitalopram and -7.4 for placebo. Discontinuation due to adverse events was not significantly different between the two groups.

3. Effectiveness of Paxil for GAD:

{2003 RCT in Am J Psychiatry} investigated the efficacy of paroxetine (paxil) in the treatment of GAD in adults. A total of 566 patients aged 18-80 with GAD Hamilton anxiety score >=20 and no coexisting major depression were randomized to paroxetine 20mg vs paroxetine 40mg vs placebo once daily for 8 weeks. Response was defined as a rating of “very much improved” or “much improved” on the clinical global impression global improvement measure, and remission was defined as a Hamilton anxiety score <=7.

Response rates were 62% (NNT 7) and 68% (NNT 5) for paxil 20mg and 40mg respectively, vs 46% with placebo. Remission was achieved in 30% (NNT 10) and 36% (NNT 7) of those on paxil 20 and 40mg, vs 20% with placebo. Side effects were asthenia, somnolence, nausea, decreased libido, abnormal ejaculation.

4. Paxil vs Lexapro for GAD: 

{2006 RCT in Br J Psychiatry} compared the effectiveness of escitalopram and paroxetine in the treatment of adults with GAD; it also compared the effectiveness of differing doses of escitalopram. A total of 681 patients with GAD were randomized to placebo (n=139), escitalopram 5mg (n=134), 10mg (n=136), 20mg (n=133) and paroxetine 20mg (n=139). Mean change in Hamilton anxiety score was approximately 50% from baseline for all treatment groups. Specifically: for placebo the change was -14, escitalopram 5mg was -16, 10mg was  -17, 20mg -16, paroxetine -15. Escitalopram 10mg and 20mg were statistically significantly better than placebo and paxil.

The side effects that those taking taking paxil 20mg experienced that were statistically different from placebo were anorgasmia and insomnia. 

The side effects that those taking Lexapro 10mg experienced that were different than placebo: fatigue, insomnia, diarrhea, anorgasmia.

The side effects that those taking Lexapro 20mg experienced that were different from placebo were: fatigue, insomnia, diarrhea, sweating, somnolence, yawning.

5. Effectiveness of acupuncture for the management of low back pain: 

{2007 german RCT in Arch Intern Med} (multicenter) investigated the efficacy of acupuncture vs sham acupuncture vs conventional therapy in the treatment of chronic low back pain. A total of 1,162 adults with low back pain for mean 8 years were randomized to the aforementioned 3 categories. Acupuncture is the application of needles at “acupuncture points” specified by Chinese medicine. Sham acupuncture was the application of needles at nonacupuncture points, conventional therapy is a combination of drugs, physical therapy, and exercise. Both acupuncture and sham acupuncture were performed by trained practitioners of acupuncture. All interventions took place of 10-15 half hour sessions twice weekly. Response in terms of pain was defined as >33% improvement on Von Korff Chronic pain grade scale at 6 months, response in terms of function was defined as >12% improvement on hanover functional ability questionnaire at 6 months. Comparing acupuncture to sham acupuncture to conventional therapy, pain response was found in 59%, 51% and 34%, and functional response in 73% vs 65% vs 50%. There was no difference in outcomes between acupuncture and sham acupuncture, however both were significantly more effective than conventional therapy.

6. Effectiveness of acupuncture for management of chronic low back pain #2 (different group from above)

{2006 German RCT in Arch Intern Med} investigated the efficacy of acupuncture vs sham acupuncture vs no acupuncture. A total of 298 patients aged 40-75 with chronic low back pain were randomized to the three aforementioned groups, received 8 weeks of intervention (12 30-minute sessions) and were followed for 1 year. Both acupuncture and sham acupuncture were performed by trained practitioners of acupuncture Outcome was change in pain on a 100mm visual analog pain scale. There was no difference in pain outcome between acupuncture and sham acupuncture, however they were both associated with significant reduction in pain (~30mm) compared to placebo.

7. Topical tinea (cruris, magnum, pedis, corporis): topical antifungals are extremely effective in 2-4 weeks. Can use azole family (clotrimazole, micronazole, etc) or allylamine family (terbinafine = lamisil).
8. Types of skin biopsies:
-Incisional/punch: good for most cases, no need for stitches if <3mm in size.
-Excisional: with 2-3 mm margin, do it if you suspect malignant melanoma
-Shave: only for elevated lesions
9. Risk factors for recurrence/mets in cutaneous squamous cell carcinoma:
-Size >2cm
-Location on lip or ear
-History of radiation
-Immunosuppression
-Local recurrence
-Invasion depth >4mm
-Perineural or deep invasion
-Poor differentiation
10. Treatment for SCC:
-If its <2cm, no risk factors for malignancy, do wide local excision under local anesthesia. 4mm margins around visible lesion => 95% histologic cure rate.
-If its >2 cm, has risk factors for malignancy, has uneven edges or is in a cosmetically sensitive area, do Mohs surgery (remove tumor bit by bit, immediately check pathology-- good for uneven edges where you want to make sure you have margins)
-If patient refuses surgery, or it's impractical, or if its just actinic keratosis - topical 5-FU
-If patient refuses surgery, or it's impractical, and the tumor is small and non-invasive: cryotherapy or radiation. Only irradiate head & neck, not trunk or extremities-- poorer blood flow = greater risk of skin breakdown, poor healing.