Ketorolac as a component of balanced analgesia after thoracotomy

Ketorolac 10 mg or 30 mg i.m., 6 hourly or placebo was givento 75 patients who had undergone thoracotomy, in a randomizeddouble-blind study. All subjects were given intercostal nerveblocks with bupivacaine and had access to i.v. patient-controlledmorphine. l.m. ketorolac improved the success rate of the analgesicregimen, with fewer patients withdrawing from the study becauseof inadequate pain relief.     

Who speaks for the children?

• ? It would probably be a truism to say that most professional nurses consider patient/client advocacy to be an essential component of their role—indeed, there is a UKCC Advisory paper (Exercising Accountability, 1989), which categorically states that this is so. ‘The introductory paragraphs of the Code of Professional Conduct, together with several of its clauses, include clearly the expectation that the practitioner will accept a role as an advocate on behalf of his or her patients/clients.’
• ? Some professional nurses, however, consider advocacy to be too altruistic an activity and prefer to leave it to others.

     

What Can Health Communication Science Offer for ACA Implementation? Five Evidence-Informed Strategies for Expanding Medicaid Enrollment

Context: Implementing the Affordable Care Act (ACA) in 2014 will require effective enrollment and outreach efforts to previously uninsured individuals now eligible for coverage.Methods: From 1996 to 2013, the Health Communication Research Laboratory conducted more than 40 original studies with more than 30,000 participants to learn how to improve the reach to and effectiveness of health information for low-income and racial/ethnic minority populations. We synthesized the findings from this body of research and used them to inform current challenges in implementing the ACA.Findings: We found empirical support for 5 recommendations regarding partnerships, outreach, messages and messengers, life priorities of low-income individuals and families, and the information environment. We translated these into 12 action steps.Conclusions: Health communication science can inform the development and execution of strategies to increase the public''s understanding of the ACA and to support the enrollment of eligible individuals into Medicaid or the Health Insurance Marketplace.     

AMINOHEXANE BISPHOSPHONATE SUPPRESSES BONE TURNOVER IN POSTMENOPAUSAL WOMEN MORE RAPIDLY THAN OESTROGEN-GESTAGEN THERAPY

Although animal studies suggest that there may be major differencesbetween the effects of bisphosphonates and ovarian hormoneson skeletal metabolism, whether this also holds for their actionsin patients is unknown. To address this question, we comparedthe effects of 12 weeks treatment with HRT on bone turnovermarkers in osteopenic postmenopausal women with those of anamino-bisphosphonate. Women within 15 yr of the menopause, witha lumbar and/or femoral neck bone mineral density 1 S.D. belowthe predicted value, received either oestradiol valerate 2 mgand dydrogesterone 5 mg (E/D; n = 16) or aminohexane bisphosphonate400 mg (AHBP; n =9). Urine and serum samples were collectedon two separate occasions before starting treatment, and 1,2, 4, 8 and 12 weeks afterwards. To assess bone resorption,we measured the urinary deoxypyridinoline/creatinine ratio (DPD/crea),while serum alkaline phosphatase (ALP), osteocalcin and C-terminalpropeptide of type I collagen (CICP) were analysed to assessbone formation. Repeated measures analysis of variance revealeda highly significant decrease in DPD/crea over the treatmentperiod. Furthermore, this pattern of response differed significantlybetween the two treatment groups, since DPD/crea was maximallysuppressed within 2 weeks of starting AHBP, while E/D showedlittle decrease until 8 weeks. AHBP was also found to suppressALP, osteocalcin and CICP more rapidly than E/D, the formerreducing these markers by 8 weeks, while E/D caused little inhibitioneven by 12 weeks. We conclude that, in the doses used in thisstudy, AHBP appears to suppress bone turnover significantlymore rapidly than E/D, suggesting that clinically importantdifferences may exist in the effects of bisghosphonates andovarian hormones on bone metabolism. KEY WORDS: Bisphosphonate, Oestrogen, Bone turnover, Postmenopausal women     

Prediction of lethal pulmonary hypoplasia and chorioamnionitis by assessment of fetal breathing

Summary. Twenty-three pregnancies with fetuses at risk for pulmonary hypoplasia were studied weekly until delivery. The amount of time spent in fetal breathing activity was recorded under controlled conditions during 1 h using real-time ultrasound. An amniotic fluid index was determined. The clinicians and the pathologist were unaware of the ultrasound findings. Eight of 23 fetuses did not breathe at the last ultrasound examination. Three babies died of pulmonary hypoplasia and two of these showed fetal breathing before birth. The three deaths were associated with rupture of the membranes at <20 weeks gestation and of ≥44 days duration. One infant developed bronchopulmonary dysplasia. The amniotic fluid index in these four pregnancies was low and the newborn infants had limb contractures. Chorioamnionitis/funisitis was noted in 13 placentas. Eight fetuses were assessed for fetal breathing within 2 days of birth. The lack of fetal breathing had sensitivity, specificity, positive and negative predictive values of 0.75 for chorioamnionitis/funisitis. In this pilot study the absence of fetal breathing was of no value in predicting lethal pulmonary hypoplasia, but was related to chorioamnionitis/funisitis. We recommend further studies of fetal breathing in relation to fetal/neonatal infections.     

Classical versus low-segment transverse incision for preterm caesarean section: maternal complications and outcome of subsequent pregnancies

Summary. In a retrospective, controlled, follow-up study of 326 women who had a primary preterm caesarean section, the risks of postoperative maternal morbidity and uterine rupture or dehiscence in subsequent pregnancies were investigated in relation to the mode of incision (classical compared with low-segment transverse incision). The classical incision was associated with a higher frequency of postpartum fever in the immediate postoperative period (16% compared with 6%, P<0·01). Of the 326 patients reviewed 286 (88%) were contacted for information about subsequent pregnancies. Information was obtained for 70 pregnancies subsequent to a classical caesarean section, and 71 pregnancies subsequent to a low-segment transverse caesarean section, which had continued for more than 20 weeks gestation. Of the pregnancies after the classical operation 13% had abnormal scars compared with none of those after the low-segment transverse operation ( P =0·0014). The frequency of scar dehiscence was 6% after a classical scar compared with none after a low-segment transverse scar (P=0·0581).