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To determine the effects of indomethacin suppositories in the relief of acute colic and prevention of recurrent colic, we instituted a prospective double-blind, placebo-controlled protocol. Patients were randomized to receive either 50 mg. indomethacin or placebo suppositories every 8 hours and all patients received prescriptions for supplemental narcotics to be used on an as needed basis. Relief of colic was assessed by counting the total number of supplemental narcotics used by each patient per 24 hours during the study period, which was defined as until passage of the calculus or 5 days. There were 41 patients entered into the study protocol and complete followup was available for 26. Mean calculus size was 3.4 mm. in the indomethacin group versus 3.1 mm. in the placebo group. All 13 patients in the control group had recurrent episodes of colic and 8 of these 13 had more than 1 recurrent episode. Five patients in the placebo group required admission to the hospital for control of pain. In contrast, only 4 of the 13 patients in the treatment group had colic and only 1 had more than 1 episode of colic. No patient in the active drug group required admission to the hospital for control of pain. Over-all the ratio of supplemental narcotic used by the placebo group versus the indomethacin group was 7.6:1 (p less than 0.005). The mean interval time to passage of the calculus was slightly lower in the indomethacin group (89 versus 82 hours) but this difference was not statistically significant (p greater than 0.10). Our data strongly support the use of indomethacin suppositories in the prevention of recurrent colic secondary to ureteral calculi.

Objective: To determine whether the institution of a structured board review program is associated with improved in-service examination scores by residents at an emergency medicine (EM) residency program. Methods: A retrospective, historical control analysis of the association of a board review program and inservice examination scores at one EM residency program was performed. A structured board review consisting of monthly reading assignments in "classic" EM textbooks followed by a graded multiple-choice written examination was instituted in 1987. Percentile scores on the American Board of Emergency Medicine (ABEM) in-service examination before (1985)(1986) and after (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994) initiation of the board review process were compared by resident level (EM-1, 2, or 3). Results: The EM-1 mean percentile score before board review was 50.7 and rose to 68.9 after the institution of the board review program (p = 0.039). Mean EM-2 scores (66.8 vs 65.4) and EM-3 scores (74.4 vs 67.4) decreased slightly; these decreases were not statistically significant. Due to the large increase in EM-1 scores, the mean scores for the total program increased slightly (63.4 vs 67.4; p = NS). Conclusion:In this study, EM-1 in-service scores improved in association with the institution of a structured board review program. This formalized didactic program may increase the knowledge base and test performance of EM-1 residents. A favorable effect on EM-2 and EM-3 resident scores was not seen.

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