Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association

OBJECTIVES: Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established. METHODS: Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations. RESULTS: A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use. CONCLUSIONS: In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks

Settlement pattern of tortoises translocated into the wild: a key to evaluate population reinforcement success

peer reviewe

Current and Future Land Use around a Nationwide Protected Area Network

Land-use change around protected areas can reduce their effective size and limit their ability to conserve biodiversity because land-use change alters ecological processes and the ability of organisms to move freely among protected areas. The goal of our analysis was to inform conservation planning efforts for a nationwide network of protected lands by predicting future land use change. We evaluated the relative effect of three economic policy scenarios on land use surrounding the U.S. Fish and Wildlife Service's National Wildlife Refuges. We predicted changes for three land-use classes (forest/range, crop/pasture, and urban) by 2051. Our results showed an increase in forest/range lands (by 1.9% to 4.7% depending on the scenario), a decrease in crop/pasture between 15.2% and 23.1%, and a substantial increase in urban land use between 28.5% and 57.0%. The magnitude of land-use change differed strongly among different USFWS administrative regions, with the most change in the Upper Midwestern US (approximately 30%), and the Southeastern and Northeastern US (25%), and the rest of the U.S. between 15 and 20%. Among our scenarios, changes in land use were similar, with the exception of our “restricted-urban-growth” scenario, which resulted in noticeably different rates of change. This demonstrates that it will likely be difficult to influence land-use change patterns with national policies and that understanding regional land-use dynamics is critical for effective management and planning of protected lands throughout the U.S