ABSTRACT
We aimed to develop an in-depth understanding about factors that influence cardiac medication adherence among South Asian, Chinese, and European White cardiac patients. Sixty-four patients were purposively sampled from an ongoing study cohort. Interviews were audio-recorded and transcribed for analyses. Physicians' culturally sensitive communication and patients' motivation to live a symptom-free and longer life enhanced adherence. European Whites were motivated to enhance personal well-being and enjoy family life. South Asians' medication adherence was influenced by the desire to fulfill the will of God and family responsibilities. The Chinese were motivated to avoid pain, illness, and death, and to obey a health care provider. The South Asians and Chinese wanted to ultimately reduce medication use. Previous positive experiences, family support, and establishing a routine also influenced medication adherence. Deterrents to adherence were essentially the reverse of the motivators/facilitators. This analysis represents an essential first step forward in developing ethno-culturally tailored interventions to optimize adherence.
Subject(s)
Cultural Characteristics , Heart Diseases , Medication Adherence/ethnology , Motivation , Aged , Asian People/psychology , Communication , Family/ethnology , Family/psychology , Female , Heart Diseases/drug therapy , Humans , Male , Middle Aged , Physician-Patient Relations , Qualitative Research , White People/psychologyABSTRACT
BACKGROUND: Sub-Tenon's local anaesthesia (STLA) is growing in popularity for ophthalmic surgery, and is widely regarded as safer than the alternative sharp needle techniques. Although safe, STLA is not devoid of risk. Therefore, the effectiveness of a plastic i.v. cannula was compared with the traditional metal Stevens' cannula for delivering STLA. METHODS: In a randomized, controlled trial, the efficacy of STLA administered by either a Stevens' sub-Tenon's metal cannula or a standard 20 G Optiva i.v. plastic cannula was compared; 120 patients, undergoing cataract surgery, were randomly allocated to one of the two groups. After STLA, the primary outcome measure, kinesia of the globe, was recorded at 5 and 10 min. RESULTS: There was no significant difference in the mean total ocular movement scores after STLA performed by either the 20 G i.v. cannula or standard 19 G sub-Tenon's cannula (P = 0.10). There was also no significant difference in any of the secondary outcome measures. CONCLUSIONS: A 20 G Optiva i.v. cannula and the Stevens' sub-Tenon's cannula were equally effective at providing STLA.
Subject(s)
Cataract Extraction , Nerve Block/instrumentation , Aged , Aged, 80 and over , Anesthetics, Local/administration & dosage , Equipment Design , Eye Movements/drug effects , Female , Humans , Lidocaine/administration & dosage , Male , Metals , Nerve Block/adverse effects , Nerve Block/methods , Pain Measurement , PlasticsABSTRACT
PURPOSE: To describe three cases of rectus muscle trauma in patients undergoing phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia via the inferonasal quadrant. METHODS: Retrospective review was carried out of 3 cases from 1080 patients who underwent phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia in our unit over a 3 year period up to April 2000. RESULTS: Two patients complained postoperatively of vertical diplopia and were shown to have restriction of elevation of the eye, which was found at surgical exploration to be due to inferior rectus muscle restriction. One patient had post-operative horizontal diplopia due restriction of abduction and exploration of the medial rectus muscle was planned. CONCLUSION: Rectus muscle trauma is proposed as a complication of sub-Tenon's local anaesthesia and caution is advised to operators to clearly identify the sub-Tenon's space for injection of local anaesthetic.
Subject(s)
Anesthesia, Local/adverse effects , Oculomotor Muscles/injuries , Phacoemulsification/methods , Strabismus/etiology , Aged , Aged, 80 and over , Anesthesia, Local/methods , Diplopia/etiology , Female , Humans , Lens Implantation, Intraocular/adverse effects , Retrospective StudiesABSTRACT
This review discusses the inadequacies of postoperative pain management in the UK and recommendations to improve its quality. Advanced pain-relieving techniques are available; in this article we discuss the practical considerations of delivering these successfully to patients through the introduction of acute pain teams, and especially through extension of the nurses' role.
Subject(s)
Analgesia, Patient-Controlled/methods , Analgesia, Patient-Controlled/standards , Pain, Postoperative/therapy , Patient Care Team/organization & administration , Quality Assurance, Health Care , Acute Disease , Analgesia, Patient-Controlled/economics , Cost Control , Humans , Research , Safety , United KingdomABSTRACT
One percent of children have appreciably and consistently raised arterial blood pressure. A 7-year-old girl admitted for routine tonsillectomy, had unrecognised hypertension which put her at increased risk. Should anaesthetic practice take more note of paediatric blood pressures?
