PubMed · 14623721
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
Roger N Rosenberg. 2003. Pain 2003.. https://doi.org/10.1001/archneur.60.11.1520
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
The parallel gatekeeping strategy proposed by Dmitrienko et al. (Statist. Med. 2003; 22:2387-2400) provides a flexible framework for the pursuit of strong control on study wise type I error rate. This paper further explores the application of the weighted Simes parallel gatekeeping procedure recommended by Dmitrienko et al. and proposes some modifications to it to better incorporate the interrelationships of different hypotheses in actual clinical trials and to achieve better power performance. We first propose a simple method to quantitatively control the impact of secondary tests on the testing of primary hypotheses. We then introduce a matched gatekeeping procedure to exemplify how to address special relationships between individual primary and secondary tests following the parallel gatekeeping framework. Our simulation study demonstrates that the enhanced gatekeeping procedures generally result in more powerful tests than the parallel gatekeeping procedure in Dmitrienko et al. whenever applicable.
Intramuscular injections are still part of routine care in the treatment of children. Vaccines, premedications and analgesics are administered by this route. The pain associated with an intramuscular injection is severe, the risk of complications is increased, and pharmacodynamics and pharmacokinetics are unpredictable. In many cases, equivalent alternatives of rectal, oral or intranasal routes of administering pharmacologic agents exist. Intramuscular injection of analgesics and premedications to children are-except in case of emergencies-obsolete. This demand corresponds to the guidelines of the World Health Organization (WHO) and the International Association for the Study of Pain (IASP).
We are reporting on the case of an 11-year old girl with a malignant tumour. The extreme pain throughout the body could not be treated by conventional methods. By intravenous application of a morphine and s-ketamine mixture we were able to achieve a very effective analgesic result. Apart from the opiate effect of the morphine the decisive factor was the NMDA-antagonism of the s-ketamine. The latter suppresses central sensitisation and chronic pain and reduces or even prevents the development of opioid tolerance. It was possible to use smaller opiate doses more effectively, thus reducing the side effects of the pain therapy. Under associated whole-body thermochemotherapy the girl experienced general pain relief and we were able to return to conventional therapy with a fentanyl plaster.