Ketorolac vs meperidine for the management of pain in the emergency department

OBJECTIVE: To compare the pain relief, sedation, and common side effect profiles of ketorolac tromethamine and meperidine for the management of acute pain in the emergency department (ED). METHODS: A prospective, double-blind, randomized clinical trial was conducted over a 12-month period using consecutive adult patients presenting to a university teaching hospital ED (annual census: 32,000), who required IM analgesia for acute pain. Adult patients with acute pain of various etiologies were randomly assigned to receive a single fixed IM dose of ketorolac (60 mg) or meperidine (100 mg). RESULTS: Ninety-three patients were enrolled in the study; 46 were randomized to meperidine and 47 to ketorolac. Using a visual analog scale, there was no difference in pain relief between the ketorolac and meperidine groups even after adjusting for baseline pain level. Ketorolac caused significantly (p < 0.005) less sedation than did meperidine at one hour. Rescue analgesia was required for seven of the 46 (15.2%) patients receiving meperidine and five of the 47 (10.6%) patients receiving ketorolac (p = NS). Seventeen of 45 (38%) patients receiving meperidine experienced side effects compared with eight of the 47 (17%) patients receiving ketorolac (p = 0.0452). CONCLUSIONS: When used to treat patients who had acute pain states, 60 mg of IM ketorolac produced analgesia similar to that produced by 100 mg of IM meperidine; however, the ketorolac produced fewer subjective side effects and less sedation than did the meperidine.     

Preventive medicine in geriatrics

The reasons for abandoning prophylactic vaccination against highly contagious animal diseases in the European Union on principle are illustrated. The practical implementation of control measures under the current framework are explained with respect to an outbreak of classical swine fever, emphasizing the role of the local crisis center, the veterinary diagnostic laboratories and the need for an overall control and coordination of the campaign at the regional level. In view of the continuous risk of introducing CSF virus into the domestic pig holdings different precautionary aspects under consideration are pointed out: controlled reduction of the pig unit density with the aim of establishing self-contained pig production areas versus improvement of protecting the existing individual pig holdings against introduction of infectious diseases.     

Basic science training in psychopharmacology: How much is enough?

Training psychologists to administer psychotropic medication will require acquisition of a unique knowledge base and set of skills that are generally not components of graduate education in psychology. Nevertheless, the current level of basic science training in graduate education in psychology is substantial and should, with minor modification, allow adequate preparation for students to enter into specialized training to prescribe. The direct provision of psychopharmacology requires psychologists to demonstrate competencies in addition to those required in the general provision of psychological services. Such competencies are perhaps best taught at the postdoctoral level. The authors argue that all curricula training professional psychologists should be able to train psychologists capable of practicing as independent, full-fledged health care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary care of HIV infection

Four cases illustrate some of the issues involved in treating HIV-infected patients in a primary care setting. Primary care physicians are hard-pressed to achieve the same results as infectious disease specialists, yet are increasingly responsible for performing the initial tests, choosing the therapeutic regimen, ensuring the patient's compliance with the regimen, and monitoring the results.     

A spectrophotometric glutathione S-transferase assay displaying alpha-class selectivity utilizing 1-p-chlorophenyl-4,4-dimethyl-5-diethylamino-1-penten-3- one hydrobromide

The conjugation of 1-p-chlorophenyl-4,4-dimethyl-5-diethylamino-1-penten-3- one hydrobromide (CDDP), a Mannich base of an alpha,beta-unsaturated ketone, to glutathione is catalyzed selectively by alpha-class glutathione S-transferase. The reaction of CDDP with glutathione can be monitored continuously by following the conjugation-dependent decrease in absorbance of CDDP at 307 nm. The Km and Vmax for CDDP with alpha-class glutathione S-transferase from horse liver were determined to be 226 microM and 14.6 mumol/(min.mg), respectively. CDDP is the first example of an alpha-class glutathione S-transferase selective substrate that monitors the glutathione conjugation activity, rather than the glutathione peroxidase activity of the enzyme.     

Brain volume preserved in healthy elderly through the eleventh decade

Holstein cows (n = 51) that had been diagnosed with toxic puerperal metritis were used to determine the treatment efficacy of various antibiotics. On the day of diagnosis, cows affected with toxic puerperal metritis were assigned randomly to three treatment groups. Cows in groups 1 and 2 received 22,000 IU/kg of procaine penicillin G i.m. for 5 d. In addition, cows in group 2 received an intrauterine infusion of 6 g of oxytetracycline on d 1, 3, and 5. Cows in group 3 received 2.2 mg/kg of ceftiofur sodium i.m. for 5 d. Dependent variables used to determine antibiotic efficacy included milk yield on d 1 through 12, rectal temperature on d 1 through 5, and serum haptoglobin concentration on d 1, 3, and 5. No difference was observed among groups for milk yield on d 1 and 12 or for temperature on d 1 and 5. Serum haptoglobin was elevated to > 10 mg/dl for cows in all groups; however, no difference was observed among groups on d 1 and 5. Because all groups showed a favorable response, this study suggests that there is no difference in treatment efficacy among antibiotics used to treat cows affected with toxic puerperal metritis.     

Long-term sequelae of childhood sexual abuse: Perceived family environment, psychopathology, and dissociation.

105 abused and nonabused women were examined for patterns of adult psychopathology associated with childhood sexual abuse and to test the extent to which these patterns are independent of other pathogenic properties of the family environment. Clinical and nonclinical Ss completed the Family Environment Scale, the MMPI, the Rorschach, and the Stanford Hypnotic Susceptibility Scale. Greater nonspecific impairment among abused women may be a consequence, at least in part, of pathogenic family structure rather than sexual abuse per se. However, MMPI and Rorschach responses suggest sexual abuse may render victims especially vulnerable to specific disturbances involving soma and self. Abuse was associated with greater use of dissociation, but covariance analysis revealed this effect to be accounted for by family pathology. There was no evidence that sexual trauma is associated with hypnotizability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A depth filtration model of straining within the void networks of stainless steel filters

A depth filtration model has been developed, based on the three‐dimensional void network model Pore‐Cor. The geometry of the void network is fitted, by means of an eight‐dimensional Boltzmann annealed amoeboid simplex, to the porosity and percolation characteristics of stainless steel sintered filters measured by mercury porosimetry. Preferential and critical flow paths through the network are calculated. Particles from an experimental size distribution are fed along these flow‐biased paths, and when straining occurs, the flow paths are re‐calculated. We show that the model usefully reproduces experimental filtration efficiencies as a function of pressure drop, measured by single pass tests. We also offer a critique of current measurements of filtration efficiency, suggesting the use of a new “alpha efficiency” rather than the standard beta efficiency. The model is currently being adapted to accept porometry as well as porosimetry data, hence avoiding the use of mercury. © 2009 American Institute of Chemical Engineers AIChE J, 2009