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Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures

OBJECTIVES:

To test the hypotheses that minority children with long-bone fractures are less likely to (1) receive analgesics, (2) receive opioid analgesics, and (3) achieve pain reduction.

METHODS:

We performed a 3-year retrospective cross-sectional study of children <18 years old with long-bone fractures using the Pediatric Emergency Care Applied Research Network Registry (7 emergency departments). We performed bivariable and multivariable logistic regression to measure the association between patient race and ethnicity and (1) any analgesic, (2) opioid analgesic, (3) ≥2-point pain score reduction, and (4) optimal pain reduction (ie, to mild or no pain).

RESULTS:

In 21 069 visits with moderate-to-severe pain, 86.1% received an analgesic and 45.4% received opioids. Of 8533 patients with reassessment of pain, 89.2% experienced ≥2-point reduction in pain score and 62.2% experienced optimal pain reduction. In multivariable analyses, minority children, compared with non-Hispanic (NH) white children, were more likely to receive any analgesics (NH African American: adjusted odds ratio [aOR] 1.72 [95% confidence interval 1.51–1.95]; Hispanic: 1.32 [1.16–1.51]) and achieve ≥2-point reduction in pain (NH African American: 1.42 [1.14–1.76]; Hispanic: 1.38 [1.04–1.83]) but were less likely to receive opioids (NH African American: aOR 0.86 [0.77–0.95]; Hispanic: aOR 0.86 [0.76–0.96]) or achieve optimal pain reduction (NH African American: aOR 0.78 [0.67–0.90]; Hispanic: aOR 0.80 [0.67–0.95]).

CONCLUSIONS:

There are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve ≥2-point reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.




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Ronald Koeman: Netherlands boss undergoes heart procedure after suffering chest pains

Former Southampton and Everton boss and current Netherlands coach Ronald Koeman has been admitted to hospital in Amsterdam with heart problems.




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It pains me to say this, but when it comes to the virus app Barnaby Joyce has a point

A model favoured by the Europeans would better protect privacy.




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It pains me to say this, but when it comes to the virus app Barnaby Joyce has a point

A model favoured by the Europeans would better protect privacy.




t pain

It pains me to say this, but when it comes to the virus app Barnaby Joyce has a point

A model favoured by the Europeans would better protect privacy.




t pain

Owner of Pavement Painting Business Pleads Guilty in Alaska to Illegally Disposing Hazardous Waste

William Duran Vizzerra Jr. pleaded guilty today to illegally disposing of hazardous waste, a felony criminal offense, at a storage lot in Anchorage, Alaska.



  • OPA Press Releases

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Owner of Pavement Painting Business Sentenced in Alaska for Illegally Disposing Hazardous Waste

The former owner of a road and parking lot painting and striping business in Anchorage, Alaska, was sentenced today for illegally disposing of more than 200,000 pounds of highly flammable hazardous waste in Anchorage.



  • OPA Press Releases

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Owner of Colorado Aircraft Painting Company Pleads Guilty to Unlawfully Treating Hazardous Waste

Norman Teltow, owner of Gold Metal Paint Co. LLC (GMP), pleaded guilty late yesterday in Denver to a criminal information charging him with illegally treating hazardous waste at the company’s facility.



  • OPA Press Releases

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chest pains




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The most effective tattoos machines kits while using the greatest painters of the planet

A very few century in the past seamen were the first person to possess celeb wrist tats. Several mariners were superstitious as well as sea-loving movie star for their hand showed its northern border superstar which was intended to...




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Apple is addressing the biggest pain-point of iPhone users during COVID-19

Apple is soon going to roll out a new software that addresses the pain-point of iPhone users in wake of COVID-19 pandemic.




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Elle Fanning reveals she went paintballing with an 'aggressive' Angelina Jolie

'She and I were not on the same team. I was so bad. I hit their security guard in the neck, and he was on my team! [laughs] Angelina's really good,' she said.




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Simon Cowell 'storms out of BGT auditions' after contestant painted with his penis

According to The Sun , Tim Patch, 70, from Australia arrived to audition before the judges in a pink thong, chaps and cowboy hat and painted Simon and David Walliams with his manhood.




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Indonesian man left in constant pain after facial 'birthmark' grew into enormous tumour

Andriadi Putra, 34, from Medan in North Sumatra, Indonesia, has trouble eating and talking because of the 'trunk' like tumour weighing around 88lbs. Putra suffers from Neurofibromatosis.




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Oscar Pistorius rushed to hospital with 'chest pains'

There were initial fears that shamed athlete Oscar Pistorious had suffered a heart attack at Atteridgeville Prison in South Africa.




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ASK DR ELLIE: How can I relieve the shooting hot pain in my leg?

DR ELLIE CANNON: Symptoms that disturb sleep can be traumatising. Not only do you have to cope with the pain or discomfort, but the exhaustion that comes with broken sleep too.




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Rashford shares his workout pain as England players receive motivational Zoom call from Southgate

The Three Lions boss admitted he and his players couldn't wait to unite the nation at the European Championships this summer but said they now have to come together in a different way.




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Last Paintings at the Gagosian reveals Howard Hodgkin's reputation is soaring says Philip Hensher

After the death of a great artist, their professional life continues for some time. So, a year after the great English painter Sir Howard Hodgkin died in March 2017, new work continues to emerge.




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FA at pains to shrug off David Beckham's manager who had a longstanding deal

CHARLES SALE - SPORTS AGENDA: One of the longest contracts in sport is complicating the FA’s plan to bring the England players’ commercial operation in-house.




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Cancer: That Painful and Lingering Disorder

Options for cancer detection and treatment were few in the 18th century. Medical Historian Sharon Cotner lays out some of the common practices in this week’s show.




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A Woman in Her 20s With Chest Pain and Arm Claudication

This case report describes bilateral calcified coronary aneurysms with a significant proximal left anterior descending and right coronary artery stenoses immediately distal to the aneurysms.





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Ruling Out Acute Coronary Syndrome in Patients With Chest Pain

ACS is a common and potentially lethal problem. However, only about 10% of patients who present to an emergency department with chest pain actually have ACS. In this JAMA Clinical Reviews podcast, we discuss which signs, symptoms and tests used to make the diagnosis of ACS are reliable.

Edward H. Livingston MD, speaks with Alexander Fanaroff, MD, author of Does This Patient With Chest Pain Have Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review as well as a patient who was diagnosed with myocardial infarction.




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Scott Paine




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The Artist Painting the Entombment




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The Artist Painting the Entombment (detail)




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Buffalo Bill at Painted Rock, or, After the human buzzards




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Great Egret Painting




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Robert Bruce Horsfall Snowy Egret Painting




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Cancer: That Painful and Lingering Disorder

Options for cancer detection and treatment were few in the 18th century. Medical Historian Sharon Cotner lays out some of the common practices in this week’s show.




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Here’s how you can manage joint pain