Biomedical subjects
Publications and source records attributed to C Ayoub.
We describe a newly designed syringe pump which is electrically controlled by a dual foot switch pedal. The device enables the scrubbed anaesthetist performing the regional block to aspirate, as well as to inject, the local anaesthetic without the need for any additional personnel.
This newly designed peripheral nerve stimulator allows the scrubbed anaesthetist performing a nerve block to adjust the electrical current output needed for localisation of the target nerve without the need for an assistant.
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We describe a modification to the Guedel airway that improves suction and oxygenation during fibreoptic bronchoscopy. The entire roof of a Guedel airway was removed. Two 2.5-mm internal diameter tracheal tubes were inserted into the modified airway to allow continuous oxygen delivery and suction throughout fibreoptic bronchoscopy. It was tested as a single-use device in ten patients undergoing awake fibreoptic bronchoscopy under sedation and topical anasthesia. During the procedure there were no problems with either fogging of the lens or secretions in the pharynx. In addition, oxyhaemoglobin saturation, as monitored continuously by pulse oximetry, was >/= 97% in all patients.
BACKGROUND: Previously, effects of preoperative sedatives were assessed mainly with respect to preoperative outcomes such as anxiety and compliance. The purpose of this investigation was to evaluate the effects of preoperative sedatives on postoperative psychological and clinical recovery. METHODS: Patients undergoing general anesthesia and outpatient surgery were enrolled in a double-blind, randomized, placebo-controlled trial. Subjects (n = 55) were randomly assigned to receive either 5 mg intramuscular midazolam (n = 26) or a placebo injection (n = 29) at least 30 min before surgery. The anesthetic technique was controlled. Postoperative anxiety, pain, analgesic consumption, clinical recovery parameters, and global health (SF-36) were evaluated up to 1 month after surgery. RESULTS: Surgery length did not differ significantly between the treatment and placebo groups (118 +/- 45 min vs 129 +/- 53 min; P = NS). Throughout the first postoperative week, subjects in the treatment group reported a greater reduction in postoperative pain compared with subjects in the placebo group (F1,50= 3.5; P = 0.035). Moreover, at 1 week, ibuprofen use was reported by less subjects in the treatment group than in the placebo group (0% vs 17.2%; P = 0.026). Subjects in the treatment group also reported a greater reduction in postoperative anxiety throughout the follow-up period (F1,53 = 9.2; P = 0.04). However, global health indexes (SF-36) did not detect any significant differences between the two experimental groups (multivariate F1,45 = 0.44; P = 0.51). CONCLUSION: Subjects treated with midazolam preoperatively self-report improved postoperative psychological and pain recovery. However, the clinical significance of these findings is unclear at the present time.
BACKGROUND: Difficult intubation, often unexpected, remains a primary concern for the anesthesiologist. None of the bedside tests have proven to be efficacious and highly predictive. The prupose of this study was to correlate the full range of thyromental distance with both the Cormack grade and the Mallampati score. METHODS: One hundred and sixty patients undergoing general anesthesia were included in the study. Patients with abnormal atlanto-occipital extension, small chin size and mouth opening were excluded from the study. The thyromental distance, the Mallampati score, and the Cormack grade were determined in all patients. The correlation between the thyromental distance and each of the Cormack grade and the Mallampati score was determined, as well as the correlation between the Mallampati score and the Cormack grade. The cut-off value of the tyromental distance that discriminated best between patients with easy glottic visualization (Cormack grade 1,2) vs. difficult visualization (Cormack grade 3,4) was derived. RESULTS: A significant and high correlation was observed between the thyromental distance and the Cormack grade (r = -0.72). In contrast, a lower correlation was observed between the thyromental distance and the Mallampati score (r = -0.41) and the Mallampati score and the Cormack grade (r = 0.47). A cut-off value for the TMD of 4 cm was the best in discriminating between patients with difficult and easy glottic visualization. The combination of TMD < or = 4 cm and Mallampati score of 3,4 predicted the patients with the most difficult glottic visualization. CONCLUSION: Patients with a thyromental distance greater than 4 cm can be easily intubated. In contrast, when the TMD < or = 4 cm, tracheal intubation is difficult in 48% of patients if the Mallampati score is 1,2 and in 79% if the Mallampati score is 3 or 4.
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BACKGROUND: To determine whether music influences intraoperative sedative and analgesic requirements, two randomized controlled trials were performed. METHODS: In phase 1, 35 adults undergoing urologic procedures with spinal anesthesia and patient-controlled intravenous propofol sedation were randomly assigned to hear favorable intraoperative music via headset or to have no music. In phase 2, 43 adults undergoing lithotripsy treatment of renal or ureteral calculi and receiving patient-controlled intravenous opioid analgesia were randomly assigned to either a music or no-music group. The effect of music on sedatives and analgesics requirements, recovery room duration, and adverse outcomes was assessed. RESULTS: In phase 1, patients in the music group required significantly less propofol for sedation than patients in the control group (0 [0-150] mg vs. 90 [0-240] mg, median[range]; P < 0.001). These findings persisted after adjusting for duration of surgery (0.3+/-0.1 mg/min vs. 1.6+/-0.4 mg/min; P < 0.001). Similarly, in phase 2, patients who listened to music had a significant reduction in alfentanil requirements (1,600 [0-4,250] microg vs. 3,900 [0-7,200] microg; P = 0.005). This persisted after adjusting for duration of surgery (52+/-9 microg/min vs. 119 +/-16 microg/min, mean +/- SD, P < 0.001). Duration of stay in the postanesthesia care unit and the rate of adverse events was similar in both groups (P = NS). CONCLUSIONS: Use of intraoperative music in awake patients decreases patient-controlled sedative and analgesic requirements. It should be noted, however, that patients in the no-music group did not use a headset during operation. Thus, the decrease in sedative and analgesic requirements could be caused by elimination of ambient operating room noise and not by the effects of music.
Contrary to the standard assumption that psychopathology stems from developmental immaturity (retardation, fixation, regression), people diagnosed with psychopathology typically develop along distinctive pathways in which they build complex, advanced skills. These pathways are based on adaptation to trauma, such as maltreatment, or to problems in affective-cognitive regulation, such as those in autism. They do not fit normative developmental frameworks. Research has characterized several types of distinctive pathways, especially those arising from maltreatment; they are marked by normal developmental complexity but distinctive affective-cognitive organization. In one study sexually abused depressed adolescent girls admitted for treatment in a mental hospital described themselves-in-relationships with age-appropriate, complex developmental levels equal to those of both nonabused depressed girls and other adolescents. At the same time, they showed a powerful negativity bias contrasting with the positivity biases of other girls. Many of them produced dramatic switches in affective-cognitive organization across assessments contrasting with the similar organization showed by other girls. In another study toddlers from maltreating families showed a consistent negativity bias in play and representations of interactions. We show how to portray these distinctive developmental pathways through the example of Hidden Family Violence, in which people dissociate their private violent world from their public, good-citizen world.
The purpose of this study was to examine the rates of posttraumatic stress disorder (PTSD) among a sample of severely maltreated children and their mothers, and to investigate the age of onset of documented maltreatment in these children. The sample consisted of 109 pairs of women and their children who were before a juvenile/family court due to maltreatment of sufficient severity to warrant removal of the child from parental custody. Children were examined using the PTSD Section of the Diagnostic Interview for Children and Adolescents, Revised 6th Version (DICA-6-R). The PTSD Module of the Structured Clinical Interview for DSM-III-R (SCID) was administered to all mothers. Clinical psychiatric interviews were also administered to all children and mothers. From the sample of 109 cases, 15.6% of the mothers met SCID criteria for a current presentation of PTSD, while 36.7% had a past history of PTSD. Of the 109 evaluated children, 35.8% met current DICA criteria for PTSD. Posttraumatic stress disorder is significantly overrepresented in the children of mothers diagnosed with PTSD (p = .001). The average age of maltreatment onset was 46.4 months among the children diagnosed as PTSD, and was 61.3 months in the group of seriously maltreated children who did not develop PTSD (p = .038). The onset of maltreatment is significantly earlier among children whose mothers meet PTSD criteria than among other maltreated children (p = .025). Intergenerational transmission of violence and developmental effects of traumatic experiences upon the young child are discussed.
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Administered the Child Abuse Potential (CAP) Inventory to 99 parents assessed as "At Risk" of parenting problems by the At Risk Parent-Child Program, Inc., Tulsa, Oklahoma. The study was designed to determine the number and extent of elevated abuse scores in an "At Risk" group compared to a norm group and to discover whether present "At Risk" parents were more seriously "At Risk" than past clients in the same program. During a 3-year period participants were offered the CAP-Inventory as part of the routine evaluation process. Results indicated the "At Risk" group scored significantly above a norm group, with 58% and 52% of the "At Risk" parents scoring above the 95th and 99th percentiles of the norm group, respectively. Comparison of the present results with data from a previous study in the same program (Milner & Ayoub, 1980) showed that the present "At Risk" group earned a significantly higher mean abuse score and had significantly more individual scores above the 95th and 99th percentiles of the norm group than did previous "At Risk" parents. The data indicated the Program is currently more effective in the selection of parents in need of its services. However, because the clients are in greater need, other findings (Thomasson, Berkovitz, Minor, Cassle, McCord, & Milner, 1981) suggest that the Program may now find itself having a more difficult time demonstrating program effectiveness because participants may be more resistant to treatment.
The At Risk Parent Child Program is a multidisciplinary network agency designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. This model system of service delivery emphasizes (1) the coordination of existing community resources to access a target population of families at risk of parenting problems, (2) the provision of multiple special services in a neutral location (ambulatory pediatric clinic), and (3) the importance of intensive individual contact with a clinical professional who serves as primary therapist, social advocate and service coordinator for client families. Identification and assessment of families is best done during prenatal and perinatal periods. Both formal and informal procedures for screening for risk factors are described, and a simple set of at risk criteria for use by hospital nursing staff is provided. Preventive intervention strategies include special medical, psychological, social and developmental services, offered in an inpatient; outpatient, or in-home setting. Matching family needs to modality and setting of treatment is a major program concern. All direct services to at risk families are supplied by professionals employed within existing local agencies (hospital, public health department, state guidance center, and medical school pediatric clinic). Multiple agency involvement allows a broad-based screening capacity which allows thousands of families routine access to program services. The administrative center of the network stands as an independent, community-funded core which coordinates and monitors direct clinical services, and provides local political advocacy for families at risk of parenting problems.
Sixty families assessed to be at risk of poor parenting were the subject of this study. These families were participants in a model multidisciplinary program designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. The model program consists of special medical, psychological, social and developmental services to families on an inpatient, outpatient, and in-home basis. Demographic information on these 60 families was tabulated. Each family was given a monthly rating on a simple measure of family function. Ratings over time were observed, and families were characterized in terms of a family rating vector (up, up-plateau, plateau, fluctuating, and down). Families were also described in terms of the constellation of problems brought to the therapy situation. Problem lists for each family were subjected to factor analysis. Five factor constructs which made clinical sense emerged from the analysis. Each factor could be labeled as a "family type." These types were: (I) Abusive Family, (II) Neglectful or Antisocial Family. (III) Family with an Emotionally Unstable Parent, (IV) Family with Cultural or Intellectual Limitation, and (V) Family with Child-Rearing Difficulties. Approximately 20% of these families did not fit the typology. Families were then divided into two groups--those who were relatively long-term, ongoing recipients of services, and those who left the program in the observation interval. Families were categorized according to family function rating vector and "family type." It was noted among long-term families, measured improvement in family function was most evident in families with transient situational crisis (who did not fit the typology) and those with intellectual and cultural deficits (Type IV). Among the families who dropped from the program, 15% were no longer at risk. Sixty-three percent of the remaining families were not improving. These techniques may be useful in determining which at risk families are more successful candidates for prevention efforts.
Investigated the ability of the Child Abuse Potential (CAP)--Inventory to distinguish "At Risk" individuals. During a 2-year period the CAP-Inventory was given of 67 "At Risk" parents who were participating in an "At Risk Parent-Child Program." Ss were judged as "At Risk" when they met one or more of the "At Risk" criteria that had been developed by the Program. Sixty-four of the Ss completed the CAP-Inventory. Results indicated that the "At Risk" sample scored significantly higher on the Inventory than a norm group. More specifically, 45% of the "At Risk" sample had Inventory scores above the 95th percentile of the norm group. Strengths and weaknesses involved in the labeling of Ss as "At Risk" using the "At Risk" criteria and the CAP-Inventory are discussed.
A multidisciplinary child abuse team investigated children with burns admitted to a general hospital in Tulsa, Okla. Of the 26 burn cases investigated, 14 were found to be accidental, seven accidental with extreme degrees of neglect, and five nonaccidental burns. There are correlations between physical findings and social characteristics, which may aid in the identification and disposition of children with burns. A multiplicity of injuries suggests that nonaccidental burns are not spontaneous abuse, but a planned form of aggression. The high mortality of the abused group indicates the seriousness and severity of nonaccidental injuries. This experience has also shown that nonaccidental burns in children demand a thorough investigation of medical, social, and emotional factors.
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