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Biomedical subjects

M L Neighbor

Publications and source records attributed to M L Neighbor.

5 recordsLinked to original sources
PubMed1998

Intramuscular ketorolac vs oral ibuprofen in emergency department patients with acute pain.

OBJECTIVE: To determine whether i.m. ketorolac is superior to oral ibuprofen in patients presenting to an ED in moderate to severe pain. METHODS: This prospective, randomized, double-blind study involved a convenience sample of 119 patients aged > or = 18 years who presented to an urban teaching hospital ED with a self-assessed pain intensity score of 5, 6, 7, or 8 (on a numerical rating scale of 0-10). Patients were randomized to receive either 60 mg of i.m. ketorolac and a placebo capsule or 800 mg of oral ibuprofen and a saline injection. Pain scores were measured at 0, 15, 30, 45, 60, 90, and 120 minutes after dosing. Supplemental analgesics were allowed in accordance with standard medical practice. RESULTS: There were 18 patients excluded who did not remain in the ED for the full 2-hour study period. Of those completing the trial, 53 patients received ketorolac and 48 patients received ibuprofen. There were no significant differences in pain scores between ketorolac and ibuprofen at any time during the study. However, there was a statistically significant decrease in pain over time in both treatment groups. Yet, 40% of the patients continued to report pain intensity scores of 5-8 at 2 hours after treatment. CONCLUSIONS: I.m. ketorolac and oral ibuprofen provide comparable levels of analgesia in ED patients presenting with moderate to severe pain. Unfortunately, 40% of all the patients had inadequate pain relief (pain score > or = 5) from either ketorolac or ibuprofen.

Acute Disease↗
PubMed1997

Two methods of assessing pain intensity in English-speaking and Spanish-speaking emergency department patients.

INTRODUCTION: Each year emergency departments see millions of patients' many with moderate to severe pain. The use of valid, language-sensitive pain assessment methods is a critical prerequisite to selection and evaluation of pain treatment interventions. However, scant research has been conducted on the validity of pain intensity measurements in English-speaking and non-English-speaking ED patients. This study validated two measures of pain intensity--a 0 to 10 numerical rating scale (NRS) and a word descriptor scale (WDS)--in English-speaking and Spanish-speaking ED patients and determined patient preferences for the pain rating scales. METHODS: ED patients with various medical conditions were asked to rate their pain intensity using both scales, in their language, seven times during a 2-hour study period. Patients were then asked to choose the pain scale that they preferred to use. RESULTS: Moderate to strong correlations were found between the NRS and WDS pain scales. In addition, the NRS and WDS were equally preferred by patients, whether they spoke English (n = 95) or Spanish (n = 21). DISCUSSION: We demonstrated in this study that both the NRS and the WDS scales were valid instruments for measuring pain in English-speaking and Spanish-speaking ED patients. In addition, very little difference was found in patient preference for one of the scales. ED patients in acute pain were able to use both ways of communicating their pain to health professionals. Therefore patients could be offered their choice of either of these simple pain rating scales to evaluate pain and the effectiveness of pain-relieving interventions.

Adult↗
PubMed1989

Ascites.

In summary, the diagnosis of ascites should be considered in all patients presenting with abdominal distention. A careful history and physical examination should be performed to rule out conditions that mimic ascites. Ultrasonography should be performed in questionable cases of ascites since physical examination and radiographic signs of ascites are unreliable. Paracentesis can help determine the etiology. Ascitic fluid should be examined to rule out spontaneous bacterial peritonitis, one of the few curable complications of cirrhosis. An ascitic fluid PMN count of greater than 250 per mm3 proves a sensitive indicator of infection. Medical treatment of cirrhotic ascites includes dietary sodium restriction and diuretics++. Large-volume paracentesis, with or without the use of colloid infusions, may provide useful adjunctive therapy. In rare instances, intractable ascites may be treated with a peritoneovenous shunt, although the complications and mortality rate of this procedure are significant. Peritoneovenous shunting, however, has not been shown to improve survival.

Ascites↗