Search PubMed⌕ Search

Biomedical subjects

F Reynolds

Publications and source records attributed to F Reynolds.

At least 37 records · Page 2Linked to original sources
PubMed2000

Relationships between catastrophic thoughts, perceived control and distress during menopausal hot flushes: exploring the correlates of a questionnaire measure.

OBJECTIVES: Many studies have established that highly negative or catastrophic thoughts about chronic health problems such as pain are associated with greater distress, lower self-efficacy for dealing with the problem and depressed mood. This study examined whether highly negative (or 'catastrophic') appraisals of hot flush experiences were associated with greater distress and lower perceived control regarding this menopausal problem. DESIGN: A postal survey was carried out, with a follow-up 12 months later. METHODS: Two questionnaires were initially completed by a volunteer sample of 61 women currently experiencing hot flushes. A mixture of qualitative and quantitative data were collected, including a Catastrophic Thoughts Questionnaire (CTQ) measure of catastrophic thoughts, based in part on Rosenstiel AK and Keefe FJ. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 1983;17:33-44. Thirty nine women who continued to report hot flushes were followed up 12 months later. RESULTS: Ratings to each item of the CTQ were highly intercorrelated. Women reporting more catastrophic thoughts tended to be lower in perceived control over flushes. Respondents' reported distress during hot flushes was more closely related to their frequency of negative thoughts about the problem, than to perceived control, flush chronicity or daily frequency of flushes. Over 12 months, respondents showed a highly stable pattern of catastrophic thoughts, and continued links with levels of distress during flush episodes. CONCLUSIONS: Cognitive appraisal processes that undermine coping with other chronic health problems seem also relevant to understanding the distress triggered by intermittent, unpredictable flush episodes. The findings imply that women may develop improved tolerance for menopausal flushing through challenging negative interpretations of the experience.

Adaptation, Psychological↗
PubMed2000

Effect of epidural blockade on indicators of splanchnic perfusion and gut function in critically ill patients with peritonitis: a randomised comparison of epidural bupivacaine with systemic morphine.

OBJECTIVES: (a) To measure gastric tonometry values in critically ill patients with peritonitis and to assess the impact of epidural analgesia on these values. (b) To assess the impact of epidural analgesia on gastro-intestinal motility by abdominal ultrasound and paracetamol absorption. (c) To observe any change in clinical outcome that may result from the use of epidural analgesia in such patients. DESIGN: A double-blinded, prospective, randomised and controlled study of general intensive therapy unit (ITU) patients. PATIENTS: Twenty-one patients admitted with peritonitis and adynamic small bowel following abdominal surgery were randomly allocated to receive either intravenous morphine or epidural bupivacaine for analgesia. MEASUREMENTS AND RESULTS: Gastric intramucosal pH (pHig) and the mucosal:arterial PCO2 gradient (Pg-PaCO2) were measured at admission and after 24 h of analgesia. Analysis of mean changes in tonometry values showed a rise in Pg-PaCO2 and a fall in pHig in the morphine group and a significant difference between groups in the Pg-PaCO2 trends (p = 0.024). Significant improvements in the ultrasound appearance of the small bowel were observed in the epidural group (p = 0.0037, Mann-Whitney U test of median changes in a locally developed scoring system). There were no significant differences between the groups in any of the variables derived from the paracetamol absorption test (n = 10); both groups showed persistently delayed gastric outflow throughout the study period. CONCLUSIONS: Epidural analgesia resulted in improvements in gastric mucosal perfusion and the ultrasound appearance of the small bowel, indicating potential clinical benefit in a group of patients in whom epidural catheterisation is traditionally contraindicated.

Analgesia, Epidural↗
PubMed2000

Chemical stability of bupivacaine, lidocaine and epinephrine in pH-adjusted solutions.

Epinephrine and sodium bicarbonate may be added to local anaesthetic solutions in order to reduce the onset time and enhance the quality of epidural anaesthesia for Caesarean section. Such mixtures are sometimes prepared several hours in advance for subsequent use in emergency Caesarean section through a pre-existing epidural catheter. To evaluate this practice, we studied the chemical stability in solution over 24 h of nine epidural mixtures consisting of different combinations of bupivacaine, lidocaine, epinephrine and sodium bicarbonate. In mixtures alkalinised with sodium bicarbonate, epinephrine concentrations decreased significantly over 24 h (p<0.0001), whereas those in nonalkalinised mixtures did not change with time. Bupivacaine and lidocaine concentrations in all mixtures did not decrease over time regardless of alkalinisation. We do not recommend adding epinephrine to alkalinised epidural solutions that are to be stored for a prolonged period before clinical use.

Anesthesia, Epidural↗
PubMed2000

Paraesthesiae and nerve damage following combined spinal epidural and spinal anaesthesia: a pilot survey.

Concern has been expressed that recent changes in techniques of spinal blockade may have resulted in an increase in frequency of neurological sequelae. In order to make preliminary enquiries about anaesthetists' recent experiences of neurological sequelae following spinal and combined spinal-epidural anaesthesia, a questionnaire, covering numbers of procedures, needles used and any neurological problems that had been encountered, was sent to the anaesthetist in charge of each obstetric centre on the Royal College of Obstetricians and Gynaecologists' United Kingdom list. Replies were received from 222 of the 259 units, of whom 40 reported a total of 56 cases involving prolonged neurological sequelae, of which nine were probable obstetric palsies, 18 could be attributed to the regional procedure (one instance of conus damage and the rest largely sensory disturbances) and 29 were of uncertain origin, including a second conus damage. There was no obvious difference in incidence of problems associated with combined spinal-epidural vs. the single-shot spinal technique (odds ratio 1.14, confidence interval 0.53 to 2.46), or Sprotte vs. Whitacre atraumatic needle (odds ratio 1.40, confidence interval 0.64 to 3.08). A prospective survey, or better still, randomisation would be needed to verify these findings.

Journal Article↗
PubMed1999

Some relationships between perceived control and women's reported coping strategies for menopausal hot flushes.

OBJECTIVES: This questionnaire study compared the patterns of reported coping strategies of women high and low in perceived control over hot flushes. METHOD: A volunteer sample of 38 women fully completed a postal questionnaire. Perceived control was measured by a standardised scale (Reynolds F. Maturitas 1997a;27:215-221) and respondents provided qualitative accounts of coping. RESULTS: Consonant with previous findings that higher perceived control is associated with lower distress, the data indicated that women high in self-rated perceived control tended to describe more numerous coping strategies to manage both the physical and socio-emotional discomfort of flush episodes. Preventive strategies were infrequently adopted in both groups. However, the links between distress, control and coping were complex and subject to several influences. Those feeling low in control tended to report rather more numerous flushes (although the differences did not quite reach significance). Also, qualitative analysis of coping strategies suggested that it is not always coping behaviour per se that differentiates more and less distressed women, but attitudes towards these behaviours. A coping strategy (such as wearing cotton fabrics) that seems satisfactory to one women may fundamentally challenge the body-image of another, increasing distress by making her feel drab and different from her pre-menopausal self. Also, women often make reference to situational influences on their coping choices. CONCLUSION: The data support further enquiries into the role of psychological interventions to enhance strategies for coping with hot flushes. Some relationships occur between perceived control and women's reported coping strategies for menopausal hot flushes.

Adaptation, Psychological↗
PubMed1998

Accidental dural puncture rates in UK obstetric practice.

Headache following epidural analgesia is a common cause of complaint, but accidental dural puncture rates vary among hospitals and with techniques. We were therefore interested to discover the extent of audit of dural puncture, the dural puncture rates in those UK centres that kept reliable records, and the techniques they used for detecting the epidural space. Consultants in charge of anaesthetic services to all 257 obstetric units in the UK were sent a questionnaire requesting numbers of obstetric epidurals, techniques used to detect the epidural space and the numbers of accidental dural punctures in the years 1991-1995. Replies were received from 191 respondents (74%) of whom 104 were able to provide some information about dural puncture rates. Dural puncture rate was inversely related to the number of epidurals performed; the highest recorded rate was 3.6% in a unit with < 300 epidurals annually, and the lowest 0.19% in a unit with > 1000. Most respondents did not record the loss of resistance technique used but among those who did, the dural puncture rate using mainly saline was 0.69% and using mainly air was 1.11% (P<0.001). Since accurate patient information is crucial for informed consent, audit needs to be improved in many centres. Though the accidental dural puncture rate may be under-reported in this survey, our data are in agreement with other findings that loss of resistance to saline is safer than loss of resistance to air.

Journal Article↗
PubMed1998

Effect of epidural fentanyl on neonatal respiration.

BACKGROUND: The addition of opioids to epidural infusions for laboring mothers may reintroduce the problem of neonatal depression seen with systemic opioids. The authors studied neonatal respiration and neurobehavior in newborns of mothers randomized to receive epidural analgesia with or without fentanyl. METHODS: One hundred thirty-eight women in labor received loading doses of plain bupivacaine. When pain-free, they received an infusion of either 0.125% bupivacaine alone or 0.0625% bupivacaine with 2.5 microg/ml fentanyl. After delivery, transcutaneous oxygen tension and carbon dioxide tension were recorded in the newborns every 10 s until 90 min after delivery using a transcutaneous oxygen-carbon dioxide monitor. Umbilical venous and arterial acid-base status, Apgar scores, and Neurologic and Adaptive Capacity Scores 2 h and 24 h after delivery were measured. The umbilical venous plasma fentanyl concentration was correlated with indices of neonatal respiration and welfare in the fentanyl group. RESULTS: One hundred fourteen newborns delivered vaginally were studied. In the fentanyl group, the mean (range) maternal dose of fentanyl was 184 microg (range, 53-400), and the umbilical venous fentanyl concentration was 0.077 ng/ml (range, <0.021 to 0.244). There were no significant differences between the groups for any indices of neonatal respiration or neonatal welfare, and the plasma fentanyl concentration did not correlate with any of these indices. CONCLUSIONS: The results suggest that fentanyl added to epidural bupivacaine infusions during labor does not depress neonatal respiration or adversely affect neurobehavioral scores and other indices of neonatal welfare.

Adult↗
PubMed1998

Patch tests versus use tests in skin irritation risk assessment.

In the risk assessment of the ability of a substance or preparation to cause skin irritation, a patch test involving human volunteers is often seen as providing definitive information. However, the skin exposure conditions found in an occluded patch may be far removed from those in a particular use situation, not least for such reasons as the high dose per unit area, the duration of exposure and the maceration of the skin. Whilst these factors may enhance sensitivity in the identification of intrinsic hazard, they may do little to ensure accurate safety evaluation for real use. In this paper, we report data from a series of studies with an unmarketed facial skin cosmetic product. Whilst the product was unexpectedly highly irritating in a standard patch test in 30 volunteers, subsequent use tests, including a 6x daily open application to the elbow for 3 weeks and 2x daily application in a half-face test lasting 3 to 4 weeks and involving 52 volunteers failed to show any evidence of skin irritation. It is concluded that the most meaningful results for skin irritation risk assessment are likely to come from studies which involve relevant patterns of exposure.

Adult↗