Loading...
Please wait, while we are loading the content...
Similar Documents
Overview of Teaching / learning strategies to enhance nurses ’ knowledge and skills in EB patient decision support
| Content Provider | Semantic Scholar |
|---|---|
| Author | Stacey, Dawn Connor, Annette M. O’ |
| Copyright Year | 2013 |
| Abstract | Untimely old, circumcision has elicited more controversy and war of words than any surgical procedure in history. Although previous claims of benefits like curing masturbation, gout, epilepsy, and even insanity were no doubt absurd, important research has shed light on real medical benefits of circumcision. In particular, the procedure has consistently shown to result in the decreased risk of debilitating and costly diseases such as HIV, cervical cancer, and infantile urinary tract infection. Because of advances in the understanding of the anatomy of the foreskin and pain conditioning in infants, prevailing attitudes have changed about anesthesia and analgesia during the procedure. This article objectively summarizes the bulk of significant medical literature over the last century to provide an accurate statement about what we know and what we do not know about neonatal circumcision, including its history, epidemiology, medical benefits, complications, contraindications, techniques, management for pain, and current controversies. Demirseren, M., & Gokrem, S. (2004). Circumcision in unqualified hands: A A significant risk of complication [Electronic version]. The Journal of the American Society of Plastic Surgeons, 113(3): 1090 -1092. No Abstract available Healthwise. (2012). Circumcision: Should I keep my son's penis natural? Retrieved 2013-Nov-7 from http://decisionaid.ohri.ca/AZsumm.php?ID=1035 Learman, L. (1999). Neonatal circumcision: A dispassionate analysis [Electronic version]. Clinical Obstetrics and Gynecology, 42(4): 849-859. Abstract: This review provides a dispassionate analysis of the evidence on the benefits and risks of neonatal circumcision. The evidence is considered within a clinically relevant framework in which decision-making relies on three interrelated factors: 1) clinical experience, 2) scientific evidence, and 3) patient preference. The roles of patient preference and clinical experience are outlined; then health benefits, risks, and economic costs of circumcision are explored. The most commonly proposed benefits of circumcision are prevention of penile inflammatory disorders, urinary tract infections, penile cancer, and sexually transmitted diseases. Meanwhile, the short-term risks of circumcision include surgical complications and the infliction of pain and distress on the neonate. A potential long-term consequence of the procedure is sexual dysfunction. In considering the cost-effectiveness of circumcision, the following areas are taken into account: 1) economic data on the direct and indirect cost of the procedure and subsequent care, 2) valid estimates of the probability of events prevented and events cause by the intervention, and 3) an accurate estimate of the circumcision's impact on health status. Evidence of the technical aspects of circumcision, namely, the surgical and anesthetic techniques, are also reviewed. This review provides a dispassionate analysis of the evidence on the benefits and risks of neonatal circumcision. The evidence is considered within a clinically relevant framework in which decision-making relies on three interrelated factors: 1) clinical experience, 2) scientific evidence, and 3) patient preference. The roles of patient preference and clinical experience are outlined; then health benefits, risks, and economic costs of circumcision are explored. The most commonly proposed benefits of circumcision are prevention of penile inflammatory disorders, urinary tract infections, penile cancer, and sexually transmitted diseases. Meanwhile, the short-term risks of circumcision include surgical complications and the infliction of pain and distress on the neonate. A potential long-term consequence of the procedure is sexual dysfunction. In considering the cost-effectiveness of circumcision, the following areas are taken into account: 1) economic data on the direct and indirect cost of the procedure and subsequent care, 2) valid estimates of the probability of events prevented and events cause by the intervention, and 3) an accurate estimate of the circumcision's impact on health status. Evidence of the technical aspects of circumcision, namely, the surgical and anesthetic techniques, are also reviewed. Little, D. C., Cooney, D. R., & Custer. (2002). Pediatric circumcision and release of phimosis Operative Techniques in General Surgery, 4(3), 251-259. Abstract: Neonatal circumcision remains a common, yet controversial surgical procedure. On the one hand, existing scientific evidence demonstrates some potential medical benefits of newborn circumcision. On the other hand, the scientific studies and data to date have not demonstrated a clear risk: benefit ratio resulting in a consensus sufficient to recommend routine neonatal circumcision. Parental wishes should be respected and usually determine what is in the best interest of each individual child. To make an informed choice, parents should be given accurate and unbiased information as well as reassurance about the procedure's safety. It is legitimate for parents and physicians to take into account the cultural, religious, and ethnic traditions of the family in addition to the medical factors. Analgesia is safe and effective in reducing the procedural pain in children and should be used. Circumcision done in the newborn period should be performed only in healthy infants with no obvious genital abnormalities. When properly performed by qualified, well-informed practitioners, circumcision should be a safe procedure with a low risk (<1%) of complications. Neonatal circumcision remains a common, yet controversial surgical procedure. On the one hand, existing scientific evidence demonstrates some potential medical benefits of newborn circumcision. On the other hand, the scientific studies and data to date have not demonstrated a clear risk: benefit ratio resulting in a consensus sufficient to recommend routine neonatal circumcision. Parental wishes should be respected and usually determine what is in the best interest of each individual child. To make an informed choice, parents should be given accurate and unbiased information as well as reassurance about the procedure's safety. It is legitimate for parents and physicians to take into account the cultural, religious, and ethnic traditions of the family in addition to the medical factors. Analgesia is safe and effective in reducing the procedural pain in children and should be used. Circumcision done in the newborn period should be performed only in healthy infants with no obvious genital abnormalities. When properly performed by qualified, well-informed practitioners, circumcision should be a safe procedure with a low risk (<1%) of complications. Integrating Evidence-based Patient Decision Support in Nursing Curriculum D Stacey, et al. Integrating Evidence-based Patient Decision Support in Nursing Curriculum. © 2006 [updated links 2013]. 31 Available from www.ohri.ca/decisionaid. Nelson, C., Dunn, R., Wan, J., & Wei, J. (2005). The increasing incidence of newborn circumcision: Data from the nationwide inpatient sample [Electronic version]. The Journal of Urology, 173(3), 978-981. No abstract available Olds, S., London, M., Ladewig, P., & Davidson, M. (2004). Maternal-Newborn Nursing & Women’s Health Care (7 th ed.). New Jersey: Pearson Education. Ottawa decisional support framework. (2005). Retrieved 02/05, 2006 from http://decisionaid.ohri.ca/odsf.html. Rideout, E. (2001). Transforming nursing education through Problem-Based Learning. Mississauga, ON: Jones and Bartlett. Van Howe, R. S. (2004). A cost-utility analysis of neonatal circumcision. Medical Decision Making, 24(6), 584-601. Abstract: A cost-utility analysis, based on published data from multiple observational studies, comparing boys circumcised at birth and those not circumcised was undertaken using the Quality of Well-being Scale, a Markov analysis, the standard reference case, and a societal perspective. Neonatal circumcision increased incremental costs by $828.42 per patient and resulted in an incremental 15.30 well-years lost per 1000 males. If neonatal circumcision was cost-free, pain-free, and had no immediate complications, it was still more costly than not circumcising. Using sensitivity analysis, it was impossible to arrange a scenario that made neonatal circumcision cost-effective. Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically. A cost-utility analysis, based on published data from multiple observational studies, comparing boys circumcised at birth and those not circumcised was undertaken using the Quality of Well-being Scale, a Markov analysis, the standard reference case, and a societal perspective. Neonatal circumcision increased incremental costs by $828.42 per patient and resulted in an incremental 15.30 well-years lost per 1000 males. If neonatal circumcision was cost-free, pain-free, and had no immediate complications, it was still more costly than not circumcising. Using sensitivity analysis, it was impossible to arrange a scenario that made neonatal circumcision cost-effective. Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically. Integrating Evidence-based Patient Decision Support in Nursing Curriculum D Stacey, et al. Integrating Evidence-based Patient Decision Support in Nursing Curriculum. © 2006 [updated links 2013]. 32 Available from www.ohri.ca/decisionaid. Case Scenario 2.1c: Infant feeding Faculty Resources American Association of Pediatrics (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496-506, Retrieved February 5, 2006, from the American Association of Pediatrics website: www.aap.org/advocacy/releases/feb05breastfeeding.htm. Chuang, C. K., Lin, S. P., Lee, H. C., Wang, T. J., Shih, Y. S., Huang, F. Y. et al. (2005). Free amino acids in full-term and pre-term human milk and infant formula |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://decisionaid.ohri.ca/docs/implement/PtDS_Curriculum.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
