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Biomedical subjects

C Dodds

Publications and source records attributed to C Dodds.

At least 19 recordsLinked to original sources
PubMed2006

Criminal prosecutions for HIV transmission: people living with HIV respond.

This paper presents an analysis of responses to the first criminal convictions for HIV transmission in England and Wales within a sample of people living with HIV. These findings represent an important contribution to the development of well-informed prosecution policy. The responses were collected during 20 focused group discussions with a community and web-recruited sample of heterosexual African men and women, and gay and bisexual men (n = 125) living with diagnosed HIV in London, Manchester and Brighton. The vast majority (90%) of comments made were critical of the implementation and impact of criminalization. In particular, respondents expressed concern about the way in which criminal convictions conflict with messages about shared responsibility for 'safer sex', and the extent to which such cases will exacerbate existing stigma and discrimination related to HIV. Most felt that the successes achieved by human rights approaches to HIV prevention, treatment, and care were placed under threat by the growing culture of blame encouraged by criminal prosecutions.

Criminal Law↗
PubMed2004

A comparison of three sub-Tenon's cannulae.

PURPOSE: To compare the quality of anaesthesia and complication rates between three sub-Tenon cannula of increasing length (anterior Greenbaum, mid Kumar-Dodds, and posterior Steven's sub-Tenon's cannulae). METHODS: A total of 150 patients undergoing cataract extraction were randomised to receive a sub-Tenon injection of 5 ml of 2% lidocaine with hyaluronidase with one of the three cannulae. The development of akinesia was assessed every 2 min over a 6-min period. Complications were also recorded. RESULTS: There was no difference in the onset of akinesia, with 46, 50, and 46 patients achieving adequate akinesia within 6 min for the anterior, mid, and posterior groups respectively (P>0.05). There was an increase in retained lid opening with anterior compared to mid and posterior cannulae (P=0.0001). There was significantly less retained lid closure with the posterior compared to the mid or anterior cannulae (P<00001). The mean (range, SD) scores for pain during injection were 0.4 (0-5, 0.83), 1.2 (0-9, 1.96), and 1.1 (0-6, 1.19) for the anterior, mid, and posterior groups, respectively. These were not significantly different between the anterior and mid groups, or the mid and posterior groups (P>0.05), but there was significantly more pain on injection with the posterior compared to the anterior groups (P<0.01). All patients scored intraoperative pain as zero. There was significantly more chemosis in the anterior group (76%) compared to the mid (20%) and posterior (32%) groups (P<0.0001). There were significantly (P=0.0004) more conjunctival haemorrhages in the anterior group (56%) than the mid (20%) or posterior (20%) groups. CONCLUSIONS: We have shown that all three cannulae provide high-quality anaesthesia with minor differences in retained muscle activity, chemosis, and haemorrhage rates.

Adult↗
PubMed2003

Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication after cardiac and major non-cardiac surgery with general anaesthesia in the elderly. We hypothesized that the incidence of POCD would be less with regional anaesthesia rather than general. METHODS: We included patients aged over 60 years undergoing major non-cardiac surgery. After giving written informed consent, patients were randomly allocated to general or regional anaesthesia. Cognitive function was assessed using four neuropsychological tests undertaken preoperatively and at 7 days and 3 months postoperatively. POCD was defined as a combined Z score >1.96 or a Z score >1.96 in two or more test parameters. RESULTS: At 7 days, POCD was found in 37/188 patients (19.7%, [14.3-26.1%]) after general anaesthesia and in 22/176 (12.5%, [8.0-18.3%]) after regional anaesthesia, P = 0.06. After 3 months, POCD was present in 25/175 patients (14.3%, [9.5-20.4%]) after general anaesthesia vs. 23/165 (13.9%, [9.0-20.2%]) after regional anaesthesia, P = 0.93. The incidence of POCD after 1 week was significantly greater after general anaesthesia when we excluded patients who did not receive the allocated anaesthetic: 33/156 (21.2%[15.0-28.4%]) vs. 20/158 (12.7%[7.9-18.9%]) (P = 0.04). Mortality was significantly greater after general anaesthesia (4/217 vs. 0/211 (P < 0.05)). CONCLUSION: No significant difference was found in the incidence of cognitive dysfunction 3 months after either general or regional anaesthesia in elderly patients. Thus, there seems to be no causative relationship between general anaesthesia and long-term POCD. Regional anaesthesia may decrease mortality and the incidence of POCD early after surgery.

Activities of Daily Living↗
PubMed2003

The effect of sleep disruption on performance of anaesthetists--a pilot study.

Fatigue has been implicated in the occurrence of critical incidents. Using a driving simulator to assess vigilance, we investigated the effect of sleep disruption on the ability of anaesthetists to maintain vigilance after a night on-call. Following an undisturbed night of sleep, subjects demonstrated a significant improvement in their vigilance scores. Subjects failed to demonstrate this following a disturbed night. The timing of disturbance had a bearing on performance. Subjects' performance was worse if their sleep had been disturbed in the first third of the night. The effect of sleep disruption on vigilance has implications for patient safety during anaesthesia.

Anesthesia↗
PubMed2003

Cognitive dysfunction after minor surgery in the elderly.

BACKGROUND: Major surgery is frequently associated with postoperative cognitive dysfunction (POCD) in elderly patients. Type of surgery and hospitalization may be important prognostic factors. The aims of the study were to find the incidence and risk factors for POCD in elderly patients undergoing minor surgery. METHODS: We enrolled 372 patients aged greater than 60 years scheduled for minor surgery under general anesthesia. According to local practice, patients were allocated to either in- (199) or out-patient (173) care. Cognitive function was assessed using neuropsychological testing preoperatively and 7 days and 3 months postoperatively. Postoperative cognitive dysfunction was defined using Z-score analysis. RESULTS: At 7 days, the incidence (confidence interval) of POCD in patients undergoing minor surgery was 6.8% (4.3-10.1). At 3 months the incidence of POCD was 6.6% (4.1-10.0). Logistic regression analysis identified the following significant risk factors: age greater than 70 years (odds ratio [OR]: 3.8 [1.7-8.7], P = 0.01) and in- vs. out-patient surgery (OR: 2.8 [1.2-6.3], P = 0.04). CONCLUSIONS: Our finding of less cognitive dysfunction in the first postoperative week in elderly patients undergoing minor surgery on an out-patient basis supports a strategy of avoiding hospitalization of older patients when possible.

Aged↗
PubMed2002

Anaesthesia for treating distal radial fracture in adults.

BACKGROUND: Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. Anaesthesia is usually provided during manipulation of displaced fractures or during surgical treatment. OBJECTIVES: To examine the evidence for the relative effectiveness of the main methods of anaesthesia (haematoma block, intravenous regional anaesthesia (IVRA), regional nerve blocks, sedation and general anaesthesia) as well as associated physical techniques and drug adjuncts used during the management of distal radial fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002), the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2001), MEDLINE (1966 to October 2001), EMBASE (1988 to 2001 Week 48), Current Controlled Trials (December 2001) and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials evaluating relevant interventions for these injuries (see Objectives). We excluded pharmacological trials comparing drug dosages and, with one exception, different drugs in the same class. Also excluded were trials reporting only pharmacokinetic and/or physiological outcomes. DATA COLLECTION AND ANALYSIS: All trials meeting the selection criteria were independently assessed by the three reviewers for methodological quality. Data were extracted independently by two reviewers. Quantitative data are presented using relative risks or mean differences together with 95 per cent confidence limits. Only very limited pooling of results from comparable trials was possible. MAIN RESULTS: The 18 included studies involved at least 1200, mainly female and older, patients with fractures of the distal radius. All studies had serious methodological limitations, notably in the frequent failure to assess clinically important and longer-term outcomes. Five trials provided evidence that, when compared with haematoma block, IVRA provided better analgesia during fracture manipulation and enabled better and easier reduction of the fracture, with some indication of a reduced risk of later redislocation or need for re-reduction. In contrast, haematoma block was quicker and easier to perform and less resource intensive. There was inadequate evidence of relative effectiveness of different methods of anaesthesia only examined within single trials: nerve block versus haematoma block; intravenous sedation versus haematoma block; general anaesthesia versus haematoma block; general anaesthesia versus sedation; and general anaesthesia versus haematoma block and sedation. None of the three trials evaluating three different physical aspects of anaesthesia (injection site of, or extra tourniquet, for IVRA; and technique for brachial plexus block) provided conclusive evidence for the effectiveness and safety of the novel technique. Six trials examined the use of drug adjuncts. The addition of two different muscle relaxants and one analgesic was tested for IVRA; one sedative and hyaluronidase for haematoma block; and clonidine for brachial plexus block. All trials evaluating adjuncts failed to provide evidence on eventual clinical outcome. A seriously flawed study comparing bupivacaine with prilocaine for IVRA gave some insight on the potential confounding effects of treatment by different doctors on patient outcome. REVIEWER'S CONCLUSIONS: There was insufficient robust evidence from randomised trials to establish the relative effectiveness of different methods of anaesthesia, different associated physical techniques or the use of drug adjuncts in the treatment of distal radial fractures. There is, however, some indication that haematoma block provides poorer analgesia than IVRA, and can compromise reduction. Given the many unresolved questions over the management of these fractures, we suggest an integrated programme of research, which includes consideration of anaesthesia options, is the way forward.

Aged↗
PubMed2001

Vertical dimension. Part 1: comparison of clinical freeway space.

This study was conducted in order to compare the clinical freeway space measurements using three simple methods commonly used by dentists in their practices. The study was performed in 15 young healthy subjects with natural dentition and bilateral molar support. Artificial landmarks (adhesive tape) were placed on the more prominent parts of the nose and chin of each subject. Vertical dimension of occlusion (VDO) was measured in the intercuspal position. Postural vertical dimension (PVD) was measured in the following functional conditions: after swallowing saliva, after pronouncing the word "Mississippi", and in a relaxed postural mandibular position (RPMP). Then, the clinical freeway space value in each functional condition was obtained by subtracting VDO from PVD value. Significant differences among clinical freeway space values using three different methods were observed (ANOVA). A significantly higher clinical freeway space value was found using phonetics method than after swallowing and with the mandible in a relaxed postural position (Bonferroni multiple comparison test). No significant differences between swallowing and relaxed methods were found. These results seem to suggest that the measures of clinical freeway space depend upon the method used.

Adult↗
PubMed2001

Evaluation of the Greenbaum sub-Tenon's block.

A prospective, randomized blind study was conducted in 40 patients undergoing phacoemulsification and posterior chamber intraocular lens implantation. They received anaesthetic infiltration of 2% lidocaine with 1:200,000 epinephrine and hyaluronidase 150 U ml(-1) in a volume of 2, 3, 4 or 5 ml into the sub-Tenon's fascial space through a Greenbaum cannula after a conjunctival incision. Reduction of ocular movements, anaesthesia, pain on injection and any incidental complications were recorded. Akinesia and anaesthesia occurred within 5 min with 4 and 5 ml of local anaesthetic, and no supplementary injections were required. There were marked reductions in the frequency of forced eyelid movements with these volumes. Chemosis and conjunctival haemorrhage were noted in the majority of patients but caused no intraoperative problems. Approximately 10-15% of patients reported slight discomfort at the time of injection. Four to 5 ml of 2% lidocaine with 1:200,000 epinephrine and 150 U ml(-1) of hyaluronidase is the optimum volume to achieve adequate akinesia, anaesthesia and reduction of lid movements during the Greenbaum sub-Tenon's block.

Anesthesia, Local↗
PubMed1999

General anaesthesia: practical recommendations and recent advances.

General anaesthesia has become, thanks to recently developed drugs, monitoring devices and delivery systems, a very well tolerated method of making the great surgical opportunities of the last few years available to all ages of patient. With a balanced and rational use of drug profiles, general anaesthesia allows even frail and very ill patients a margin of tolerability inconceivable just a few years ago. For the vast majority of patients, the risk from the general anaesthetic technique is so small it can be considered negligible. However, the majority of general anaesthetic drugs are both highly potent and very toxic, with many of the volatile agents still having a therapeutic ratio of about 4:1. The anaesthetic staff have to continually upgrade their skills and knowledge to ensure that harm does not result. It is, however, reasonable to offer some practical guidelines from the current literature on when to choose a general anaesthetic technique, either alone or with a regional local anaesthetic method, and when to avoid loss of consciousness. The complications expected from the use of general anaesthesia are reviewed, and the basis for these complications investigated. The currently available drugs and their place in anaesthetic practice are also assessed. Recent developments in the area of total intravenous anaesthesia and monitoring for potential awareness using bispectral analysis suggest that this technique should now be included in the choice of anaesthetic. Recommendations are made on both the selection of the technique, and the appropriate agents for a given group of patients.

Age Factors↗