Robert Emmett Farr (1875-1932): A pioneer of pediatric regional anesthesia.

Surgeons influence the introduction and development of anesthesia in many ways. Robert Emmett Farr is frequently cited as the first to describe the use of brachial plexus anesthesia in children. A surgeon based in Minneapolis, Minnesota, he passionately believed that regional anesthesia was superior to general anesthesia for many surgical procedures. He wrote extensively promoting other regional techniques, including local infiltration of local anesthetics for pyloromyotomy and harelip repairs, as well as caudal blocks for lower abdominal procedures. Anesthesia texts from the early 1900's suggest that regional anesthesia was not popular as a reliable alternative to general anesthesia. Undeterred, Farr continued promoting his view that regional anesthesia was the future of surgery. We examine how Farr promoted regional anesthesia in children and adults, in a way changing surgical practice and improving clinical care. We also hope to highlight the other contributions to medicine made by this pioneer.

Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS.

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.