Articles: outcome.
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Rofecoxib was the first specific inhibitor of cyclooxygenase-2 (COX-2) approved for the treatment of acute pain. It has been shown to provide analgesia that is significantly better than placebo and has an onset of action and efficacy similar to that of traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. In addition, the analgesic efficacy of rofecoxib has been demonstrated to be superior to that of the opioid combination of codeine 60 mg/acetaminophen 600 mg in an acute dental pain model. ⋯ Rofecoxib is a safe and highly effective alternative to previously available NSAIDs and should be considered for the treatment of acute pain conditions in adult patients, especially those at risk for developing gastrointestinal complications. It is preferred in the perioperative setting because of its analgesic efficacy and lack of platelet effects. Because of its more favorable gastrointestinal toxicity profile compared with nonselective NSAIDs, rofecoxib is safer in patients, especially older patients, for whom chronic anti-inflammatory or analgesic therapy is indicated.
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The objective of this study was to examine the programming strategies used in patients with intractable low-back pain treated with epidural spinal cord stimulation (SCS) utilizing paddle electrodes and a radio frequency (RF) stimulator. Programming strategies were examined in a group of patients implanted with a 16-contact paddle electrode and a dual channel RF receiver to treat chronic low-back pain. Baseline data included previous surgical history information, leg and low back pain severity and characteristics, and routine demographic information. ⋯ The system must provide the capability to redirect the current electronically over at least two segments of the spinal canal, to electronically steer the current in a medio-lateral direction, and to activate multiple electrical contacts simultaneously. The willingness and ability to provide extensive reprogramming in the long term follow-up is also of the utmost importance. Pain and its treatment with SCS is a dynamic process.
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Clinical outcome data was analyzed for 67 patients with contained disc herniation who underwent percutaneous disc decompression procedure using Coblation(R) technology, also referred to as Nucleoplasty after failing to respond to conservative management. Patients presented with clinical symptoms of discogenic low back pain and/or leg pain and were not considered candidates for open surgery. Follow-up data was collected up to 12 months. ⋯ Average pre-procedure pain level for all patients was reported as 6.8 while average pain level was 4.1 at the 12 month follow-up period. Statistically significant improvement was observed in 62%, 59%, and 60% of patients in sitting, standing, and walking ability at 12 months, respectively. The results of this analysis indicated that PDD using Coblation technology, also referred to as Nucleoplasty, is an effective procedure for patients presenting with discogenic back and/or leg pain who have failed conservative therapies and are not considered candidates for open surgical interventions.
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Economically disadvantaged children receive less preventive asthma care and more inpatient care. Studies have not evaluated the association of insurance status on children with severe exacerbations. We evaluated differences in severity of illness, resource use, and outcome associated with Medicaid insurance among children receiving intensive care for asthma. DESIGN: Retrospective cohort study. SETTING: Fourteen American pediatric intensive care units participating in the Pediatric Intensive Care Evaluations database. Methods: Patients with a primary diagnosis of asthma treated from May 1995 to February 2000 were identified. Demographic information and clinical data were evaluated to determine whether there was an association between Medicaid insurance, severity of illness, and length of stay. ⋯ Asthmatic children receiving Medicaid had longer pediatric intensive care unit and hospital stays and an increased risk of mechanical ventilation compared with asthmatic children with commercial or health maintenance organization insurance. Further studies are needed to evaluate differences in outcome and resource utilization for economically disadvantaged asthmatic children.
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Research has demonstrated that experienced emergency physicians can identify a subgroup of patients with shoulder dislocation for whom pre-reduction radiographs do not alter patient management. Based on that research, a treatment guideline for the selective elimination of pre-reduction radiographs in clinically evident cases of anterior shoulder dislocation was developed and implemented. The primary objective of this study was to prospectively determine whether the treatment guideline safely eliminates unnecessary radiographs. ⋯ Experienced emergency physicians are frequently certain of the diagnosis of anterior shoulder dislocation on clinical grounds alone and can comfortably and safely use this guideline for the selective elimination of pre-reduction radiographs. Compliance with the guideline substantially decreases pre-reduction radiographs. Validation of the guideline in other settings is warranted.