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Biomedical subjects

A Reid

Publications and source records attributed to A Reid.

203 records · Page 12Linked to original sources
PubMedDate not supplied

Local anesthesia for circumcision: which technique is most effective?

BACKGROUND AND OBJECTIVES: Circumcision is the most commonly performed surgical procedure in the United States, and it is painful. Several investigators have independently documented the reliability and safety of local anesthesia in eliminating the pain associated with circumcision. Investigations have not, however, been conducted to determine which technique is most effective in reducing the pain of the procedure. This study compares the techniques of local anesthesia for circumcision to determine which technique most safely and reliably reduces pain. METHODS: Fifty-six infants being circumcised were randomly assigned to one of three groups according to anesthesia technique: (1) distal branch block, (2) root block, and (3) subpubic block. Change in heart rate and oxygen saturation, as well as cry response, were recorded. Heart rate and oxygen saturation differences were analyzed utilizing Student's t test, whereas cry response was analyzed using the chi-square test. RESULTS: We discontinued using the distal branch block technique during the study because we were concerned about possible untoward outcomes. As a result, only data from the circumcisions of the 42 infants who were assigned to the root block and subpubic block groups were analyzed. The dorsal penile nerve root block more reliably reduced the pain of circumcision than did the subpubic technique (P = 0.05). There were no serious complications with any of the techniques in this study. CONCLUSIONS: Compared with distal branch block and subpubic block techniques, nerve block at the penile root most reliably and safely eliminated the pain of circumcision.

Anesthesia, Local↗
PubMedDate not supplied

Community action for health promotion: a review of methods and outcomes 1990-1995.

OBJECTIVE: Our objective was to explore the effectiveness of community action as a strategy for health promotion, through a critical review of five years of community action evaluation literature. METHODS: Community action was defined as a health promotion, program that involved the community in implementation and control of the process of the program. Criteria for scientific evaluation of programs were proposed for sampling and control procedures, reliability and validity of instruments, analysis techniques, and specification of details of the intervention. A critical review of the literature, located by an on-line and related reference search, was undertaken for community action aimed at reducing cancer and cardiovascular disease, between January 1990 and May 1995. RESULTS: None of seven community action studies (17 articles) that examined cancer risk factors fulfilled all the criteria for rigorous scientific evaluation. The most methodologically adequate cancer study, the COMMIT intervention, had only a moderate degree of success in reducing community smoking rates. Similarly, none of the six studies (25 articles) on cardiovascular disease fulfilled all the criteria. The results for the most methodologically adequate study, the Minnesota Heart Health Program, were disappointing, with strong secular trends preventing adequate assessment of the intervention effect. CONCLUSIONS: The finding that none of the reviewed studies met all evaluation criteria was due to several factors, including political considerations, feasibility, and the continued evolution of the science of evaluation in health promotion. Some important questions are posed for researchers by the failure of methodologically superior projects, such as COMMIT, to show major gains in reducing health risk behaviors.

Cardiovascular Diseases↗
PubMedDate not supplied

Psychosocial risk factors in near-fatal asthma and in asthma deaths.

BACKGROUND: A description of near-fatal asthma (NFA) and comparison with patients who died of asthma in an English health district between 1988 and 1995. METHODS: The hospital case notes of patients aged under 65 years with NFA, identified from the intensive therapy unit register, were reviewed using forms based on those of the East Anglian confidential asthma death enquiry. Details were compared with patients dying from asthma in the same population during the same period. RESULTS: Between 1988 and 1995, 19 patients suffered 23 episodes of NFA and 44 died from asthma. Those with NFA were significantly younger. There were more women in both groups. Two patients with NFA subsequently died of asthma. Significantly more patients with NFA had had a previous NFA episode than those who died. Five had a cardio-respiratory arrest. Thirteen required intermittent positive pressure ventilation (IPPV). PaCO2 ranged from 6.1 to 17.8 kPa; nine had PaCO2 > or = 10 kPa and three recovered without IPPV. Adverse psychological and social factors were similar in both groups. Denial was the commonest psychological factor and domestic, financial or employment stress, smoking or passive smoking the commonest adverse social factors; only two with NFA and seven who died had no recorded adverse psychological or social factors. CONCLUSIONS: NFA and deaths from asthma occur in asthmatics who have many psychosocial risk factors in common. Special attention needs to be directed at patients with these adverse psychosocial factors, emphasising that they need continued follow-up with support to help them manage their asthma according to currently recommended practice.

Acute Disease↗