Validity and responsiveness of the ankle function score after acute ankle injury.

The purpose of this study was to examine prognostic validity, concurrent validity and responsiveness of ankle function score (AFS) for patients with acute ankle injury. In a prospective cohort study, AFS was compared with Olerud and Molander ankle score (OMAS), patient-specific complaints (PSC), and global perceived effect. Sensitivity and specificity were calculated to estimate prognostic validity; correlation was calculated for concurrent validity. Effect Size, Standardized Response Mean, and Responsiveness Ratio were calculated to estimate responsiveness. The sensitivity of AFS was 76% and the specificity was 57%. Correlation between AFS and OMAS at baseline, end of treatment and difference was 0.82, 0.70 and 0.79, respectively. Outcomes for responsiveness of AFS were comparable to outcomes for OMAS and PSC. This study found limited evidence for the AFS as a prognostic and evaluative instrument. The AFS is a simple instrument based on basic functional outcomes (pain, stability, weight bearing, swelling and gait) and may be used in addition to subjective clinical judgment as a prognostic and evaluative tool for recovery after acute ankle injury.

A comparison of the effect of intramuscular diclofenac, ketorolac or piroxicam on post-operative pain following laparoscopy.

Sixty patients presenting for in-patient gynaecological laparoscopic surgery were randomly allocated to receive either diclofenac 75 mg (n = 20), ketorolac 30 mg (n = 20) or piroxicam 20 mg (n = 20) as an intramuscular (i.m.) injection immediately after induction of anaesthesia. Post-operative Visual Analogue Scores at rest, over the first 24 h after surgery, using a 10 cm scale, ranged from 3.2-0.5 in the diclofenac group, 2.7-0.85 in the ketorolac group and 2.8-0.5 in the piroxicam group. The scores did not differ significantly between the three groups (P > 0.05). Mean time (SD) to first analgesia was 27 (94) min in the piroxicam group, 16 (30) min in the diclofenac group and 62 (120) min in the piroxicam group. Six out of 20 patients in the diclofenac group required further analgesia compared with nine out of 20 in the other two drug groups, this was not significant. There were no reports of increased bleeding, bronchoconstriction, bleeding from the upper gastrointestinal tract, renal impairment or pain from the intramuscular (i.m.) injection site in any of the groups. The administration of a non-steroidal anti-inflammatory drug to patients presenting for laparoscopic surgery reduces post-operative pain and analgesic requirements, and piroxicam 20 mg provides a suitable alternative to 75 mg diclofenac and 20 mg ketorolac.

A comparison of the effect of intramuscular diclofenac, ketorolac or piroxicam on postoperative pain following laparoscopy.

Sixty patients presenting for in-patient gynaecological laparoscopic surgery were randomly allocated to receive either diclofenac 75 mg (n = 20), ketorolac 30 mg (n = 20) or piroxicam 20 mg (n = 20) as an intra-muscular injection immediately after induction of anaesthesia. Postoperative visual analogue scores over the first 24 hours, using a 10 cm scale, ranged from 3.2-0.5 in the diclofenac group, 2.7-0.85 in the ketorolac group and 2.8-0.5 in the piroxicam group. The scores did not differ significantly between the three groups (p > 0.05). Mean time (SD) to first analgesia was 27(94) minutes in the piroxicam group, 16 (30) minutes in the diclofenac group and 62 (120) minutes in the piroxicam group. Six out of twenty patients in the diclofenac group required further analgesia compared to nine out of twenty in the other two drug groups. This difference was not significant. There were no reports of increased bleeding, bronchoconstriction, bleeding from the upper gastrointestinal tract, renal impairment or pain from the intra-muscular injection site in any of the groups. The administration of a non-steroidal anti-inflammatory drug to patients presenting for laparoscopic surgery reduces postoperative pain. There were no obvious differences between the agents used.

Effect of preanaesthetic medication on anaesthesia with ICI 35, 868.

The effect of three commonly used premedicants and a control on anaesthesia with ICI 35, 868 is described. Two randomized studies were performed--one a group study of induction characteristics at 2 mg kg-1 and the other a detailed study in patients undergoing minor gynaecological surgery with an induction dose of 1.5 mg kg-1 and maintenance with incremental doses plus 66% nitrous oxide in oxygen. Premedication had little effect on the already good induction characteristics. Only heavy opiate premedication produced reliable induction at 1.5 mg kg-1, but with an increase in side-effects. Diazepam appears to be the premedicant of choice, although the overall frequency of pain on injection has not been affected by premedication.

New method for obtaining uncontaminated urine from women.

Midstream sampling and colony counts have greatly improved precision in diagnosing urinary tract infections. In women, however, contamination by vaginal flora and cells still poses a diagnostic problem. We have devised an instrument for helping collect uncontaminated urine from women and have tested it in three sets of observations. Approximately 96% of 200 women were able to use the device successfully after minimal instruction. Bacterial colony counts and quantitative estimation of vaginal epithelial cells were performed on urine collected by 18 female volunteers using conventional clean-catch technics and on urine collected by the same 18 women using the Clean Streamer. The average bacterial colony count in conventionally collected urine was 8,100/ml while in Clean Streamer collected urine it was 1,722/ml. The average number of vaginal epithelial cells in conventionally collected urine was 22.4/ml while in Clean Streamer collected urine it was 14.1/ml. The difference in both comparisons is statistically significant (P = .01). We believe that use of the Clean Streamer greatly facilitates the ability of a woman to collect a urine sample uncontaminated by vaginal secretions and flora.