Safety Considerations in the Use of Ketorolac for Postoperative Pain.

BACKGROUND: Ketorolac use has significantly expanded for postoperative pain management since it first became available in the United States, primarily due to well established effects on patient pain scores and its ability to reduce perioperative opioid requirements. As an inhibitor of cyclooxygenase, ketorolac use has raised clinical concern including particular controversy regarding its potential effects on bone healing, postoperative kidney function and perioperative bleeding. OBJECTIVE: To review the supporting data from clinical studies addressing the safety of ketorolac use for postoperative pain. METHOD: This review highlights the most up-to-date research from clinical trials as well as from retrospective studies and meta-analyses regarding the effects of perioperative use of ketorolac on bone healing, kidney function and blood loss. RESULTS: Based on the most up-to-date literature, ketorolac in normal doses has been demonstrated to be safe with respect to bone healing. In patients with normal kidney function, numerous studies have established the safety of Ketorolac; however other studies have raised safety concerns in patients with comorbid kidney, heart and liver disease. While there is evidence that ketorolac may cause prolonged bleeding time and may be associated with increased postoperative blood loss after tonsillectomy, large scale prospective randomized controlled trials and subsequent meta-analyses have failed to establish an association of ketorolac use and perioperative blood loss. CONCLUSION: Perioperative administration of ketorolac has been demonstrated to be safe and effective in healthy patients and is particularly beneficial as an opioid-sparing agent in vulnerable patient groups. However, in certain surgical and medical contexts, proper patient selection based on the multidisciplinary collaboration between perioperative clinician specialists will optimize patient safety and pain management outcomes.

Telemedicine and face-to-face care for pediatric obesity.

The University of California Davis Medical Center (Sacramento, CA) has pioneered the use of telemedicine in its approach to childhood obesity to cover more than 20 rural clinics in California. In our study, we compared the outcomes of the Telemedicine Weight Management Clinic (TM) with those of its face-to-face (FTF) Weight Management Clinic counterpart over the last 5 years, predicting the results to be equivalent or in favor of TM. All children seen in the TM from June 2006 to June 2011 were included (n=121), and encounter notes in medical records were reviewed. For comparison, an equivalent sample of FTF patients was selected from that time frame (n=122). Data that were also abstracted from the medical record included age at first visit, gender, race, referral site, and comorbid diagnoses. Forty-two percent of TM patients compared with 52% of FTF patients received a change in diagnosis. Thirty-nine percent of TM patients received a change in diagnostic evaluation compared with 67% of patients in FTF. When comparing patients who received more than one visit with either form of consultation, the TM group demonstrated substantially more improvement than the FTF group in improving nutrition (88% versus 65%), increasing activity (76% versus 49%), and decreasing screen time (33% versus 8%). Substantially more TM patients were successful with a combined outcome of any one of the weight parameters that included weight loss, weight maintenance, or slowing of weight gain (69% TM versus 44% FTF). Our study suggests that telemedicine can serve as a feasible strategy to increase access to medical care for childhood obesity in rural communities and promote changes in lifestyle with the goal of maintaining a healthy weight.

In their words: connecting on-line weblogs to developmental processes.

This paper seeks to connect adolescents' communication within on-line weblogs or blogs to developmental processes. A total of 195 English language blogs written by self-identified 14- to 18-year-olds were selected; three entries from each blog were analysed, resulting in a sample of 585 entries. Blogger demographics, self-presentation, and blog entries (format, style, content, and tone) were coded. The blog authors in our sample were overwhelmingly female and lived within the US; the majority were between 15- and 16-years of age. Bloggers utilized usernames and userpictures for self-presentation and in addition to gender, frequently presented information about their age and location. The majority of the entries used text, were narrative and reflective in style, and contained themes related to their authors' peers and everyday life. Emotional tone was present and entries with romantic, identity, and future-related themes often contained emotional tone. Blog authors seemed to be using blogs to create narratives and to reflect about the people and events in their lives. Our results show that adolescent bloggers project off-line themes to their blogs, suggesting that their on-line and off-line contexts are psychologically connected.