Comparison of codeine phosphate and morphine sulphate in infants undergoing cleft palate repair.

OBJECTIVE: To ascertain the quality of analgesia provided by morphine in comparison to codeine. DESIGN: The study is a prospective, randomized, double-blind trial of analgesic effect employing validated pain scores. PATIENTS: Infants having primary cleft palate repair with informed parental consent to enter the study. INTERVENTIONS: Infants received one of two analgesics intraoperatively for immediate postoperative pain relief. Morphine was given by intravenous injection and codeine by the intramuscular route. MAIN OUTCOME MEASURE: Pain scores in the immediate postoperative period for 2 hours following surgery; this outcome measure was decided prior to data collection. RESULTS: The pain score and other outcome measures were all blinded. Measurements are all evident from the nature of the results. CONCLUSIONS: There was no clinically significant difference observed in the analgesic effect of either drug on the two groups studied.

Disruption of cleft palate repair following the use of the laryngeal mask airway.

A 55-year-old man was admitted for routine examination of ears with insertion of grommets under general anaesthesia. At 2 years of age he had undergone successful repair of cleft lip and palate. A reinforced laryngeal mask airway was employed to maintain the airway. Postoperatively, it was evident he had suffered complete disruption of the soft palate repair, leading to velopharyngeal insufficiency with nasal regurgitation of fluids. We discuss the possible aetiology, having found no such reported injury pattern documented in the literature.

Work problems and accommodations reported by persons who are postpolio or have a spinal cord injury.

A number of studies have documented early functional declines in persons with a disability. The purpose of this study was to document (1) whether employees who are aging with their disability have experienced new work problems as a consequence of functional declines and (2) whether their work problems are being accommodated adequately. Ninety-six individuals with a disability (50 who are postpolio and 46 who had a spinal cord injury) were interviewed by phone. Each had worked at least 5 years postonset and was either currently working or unemployed for less than 5 years at the time of the interview. Forty-nine of the 50 persons who are postpolio reported they had experienced functional declines in recent years, and 41 of the 50 rated the severity of their disability greater than it was when they first began working. As a result of the functional declines they had experienced, most (90.9%) of their work problems were new and would not have been significant problems for them when they first began working. The situation was very different for the group with spinal cord injuries. Only a few members of that group had experienced functional declines that were causing new problems at work. A total of 480 work problems were reported by study participants. Three out of every eight problems did not have an accommodation satisfactory to the employee. The primary reason why a satisfactory solution was not provided was that no accommodation had been identified. Employers were generally supportive of the employee's need for accommodation; they paid for 59.1% of the accommodations that had a cost and refused to provide an accommodation for only 18 of the 480 problems.

Project threshold.

Project Threshold is a program which uses an interdisciplinary approach to assist persons with physical disabilities in solving their functional problems at home or at work. The program originated to provide rehabilitation engineering services to those persons in the community whose needs were not being met through more traditional services. As the program evolved, it was evident that an interdisciplinary team was needed to fully develop the potential of this service delivery program. Occupational therapists were identified as important members of this team because of their expertise in functional assessment, analysis of activity and teaching such activities. Pivotal to the project's success is the adherence to a thorough and sequential service delivery process. This process is illustrated by the presentation of two cases; one involving an independent living evaluation, and the other a worksite assessment.