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Eltorki M, Busse JW, Freedman SB, Thompson G, Beattie K, Serbanescu C, Carciumaru R, Thabane L, Ali S. Intravenous ketorolac versus morphine in children presenting with suspected appendicitis: a pilot single-centre non-inferiority randomised controlled trial. BMJ Open 2022; 12:e056499. [PMID: 35383071 PMCID: PMC8984007 DOI: 10.1136/bmjopen-2021-056499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Despite a lack of evidence demonstrating superiority to non-steroidal anti-inflammatory drugs, like ketorolac, that are associated with lower risk of harms, opioids remain the most prescribed analgesic for acute abdominal pain. In this pilot trial, we will assess the feasibility of a definitive trial comparing ketorolac with morphine in children with suspected appendicitis. We hypothesise that our study will be feasible based on a 40% consent rate. METHODS AND ANALYSIS A single-centre, non-inferiority, blinded (participant, clinician, investigators and outcome assessors), double-dummy randomised controlled trial of children aged 6-17 years presenting to a paediatric emergency department with ≤5 days of moderate to severe abdominal pain (≥5 on a Verbal Numerical Rating Scale) and are investigated for appendicitis. We will use variable randomised blocks of 4-6 and allocate participants in 1:1 ratio to receive either intravenous (IV) ketorolac 0.5 mg/kg+IV morphine placebo or IV morphine 0.1 mg/kg+IV ketorolac placebo. Analgesic co-intervention will be limited to acetaminophen (commonly used as first-line therapy). Participants in both groups will be allowed rescue therapy (morphine 0.5 mg/kg) within 60 min of our intervention. Our primary feasibility outcome is the proportion of eligible patients approached who provide informed consent and are enrolled in our trial. Our threshold for feasibility will be to achieve a ≥40% consent rate, and we will enrol 100 participants into our pilot trial. ETHICS AND DISSEMINATION Our study has received full approval by the Hamilton integrated Research Ethics Board. We will disseminate our study findings at national and international paediatric research conferences to garner interest and engage sites for a future multicentre definitive trial. TRIAL REGISTRATION NCT04528563, Pre-results.
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Affiliation(s)
- Mohamed Eltorki
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence & Impact, McMaster, Hamilton, Ontario, Canada
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | | | - Graham Thompson
- Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Karen Beattie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Redjana Carciumaru
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Research Institute, St Joseph's Health Care, Hamilton, Ontario, Canada
| | - Samina Ali
- Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
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Fourmaux S, Serbanescu C, Lecherbourg L, Payeur S, Martin F, Kieffer JC. Investigation of the thermally induced laser beam distortion associated with vacuum compressor gratings in high energy and high average power femtosecond laser systems. Opt Express 2009; 17:178-84. [PMID: 19129886 PMCID: PMC2838188 DOI: 10.1364/oe.17.000178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We report successful compensation of the thermally induced laser beam distortion associated with high energy 110 mJ and high average power femtosecond laser system of 11 Watts operated with vacuum compressor gratings. To enhance laser-based light source brightness requires development of laser systems with higher energy and higher average power. Managing the high thermal loading on vacuum optical components is a key issue in the implementation of this approach. To our knowledge this is the first time that such thermal induced distortions on the vacuum compressor gratings are characterized and compensated.
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Affiliation(s)
- S Fourmaux
- INRS-EMT, Université du Québec, Varennes, Québec, Canada.
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Fourmaux S, Serbanescu C, Kincaid RE, Krol A, Kieffer JC. K(alpha) x-ray emission characterization of 100 Hz, 15 mJ femtosecond laser system with high contrast ratio. Appl Phys B 2008; 94:569-575. [PMID: 20052295 PMCID: PMC2801139 DOI: 10.1007/s00340-008-3342-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report K(alpha) x-ray production with a high energy (110 mJ per pulse at 800 nm before compression/15 mJ at 400 nm after compression), high repetition rate (100 Hz), and high pulse contrast (better than 10(-9) at 400 nm) laser system. To develop laser-based x-ray sources for biomedical imaging requires to use high-energy and high-power ultra-fast laser system where compression is achieved under vacuum. Using this type of laser system, we demonstrate long-term stability of the x-ray yield, conversion efficiency higher than 1.5 x 10(-5) with a Mo target, and the x-ray spot size close to the optical focal spot. This high-repetition K(alpha) x-ray source can be very useful for x-ray phase-contrast imaging.
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Affiliation(s)
- S Fourmaux
- INRS-EMT, Université du Québec, Varennes, J3X 1S2, Canada,
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Fourmaux S, Payeur S, Alexandrov A, Serbanescu C, Martin F, Ozaki T, Kudryashov A, Kieffer JC. Laser beam wavefront correction for ultra high intensities with the 200 TW laser system at the advanced laser light source. Opt Express 2008; 16:11987-11994. [PMID: 18679471 DOI: 10.1364/oe.16.011987] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We successfully implemented laser beam wavefront correction on the 200 TW laser system at the Advanced Laser Light Source. Ultra high intensities in excess of 10(20) W/cm(2) have been demonstrated. This system is, to our knowledge, the first 100 TW class laser to combine simultaneously ultra high intensity, 10(9) laser pulse contrast ratio and 10 Hz high repetition rate.
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Affiliation(s)
- S Fourmaux
- INRS-EMT, Université du Québec, 1650 Lionel Boulet, Varennes J3X1S2, Québec, Canada.
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