During the initial resuscitation of patients with severely injured during the weekdays, IH significantly reduced the cost, and elapsed time to diagnostic testing, therapeutic intervention, and to the operating room, respectively. IH reduced fatalities compared with CB.

ABSTRACT. Objective. The current study sought to investigate parental attitudes about circumcision and their satisfaction with the decision.Methodology. Parents of boys (6 months to 36 months old) in 3 different practices filled out a questionnaire while waiting for their child's well-child examination.Results. A total of 149 families were surveyed. Families (68) who did not have their sons circumcised were less satisfied with their decision. Compared with families (81) of circumcised children, parents of uncircumcised boys were less likely to have been asked by their physician about whether they wanted their child circumcised, believed that they did not receive adequate information about the procedure, felt less respected by their medical provider, and were more likely to reconsider their decision.Conclusion. The importance of adequate information and discussion is highlighted by this study. The policy represents a well thought out, reasoned approach to the highly charged issue of circumcision. The policy stresses the importance of accurate and impartial information provided to the family for discussion with their physician. Routine circumcision is not recommended but the authors cite new medical evidence in support of circumcision. This new information, notably studies relating a higher incidence of urinary infection in the uncircumcised, 2 led to a reassessment of the policy. This differs from the AAP policy in 1971, 3 which indicated that circumcision is not medically indicated.Wiswell et al 4 reported an increase in postneonatal circumcision from 1985 to 1993. No data were presented as to why this was occurring. At our institution in the primary care practice, it was also noted that an increasing number of parents were requesting late circumcision. Discussions with the families suggested dissatisfaction with the original decision regarding circumcision. This study was undertaken to document the degree of satisfaction that parents have with their initial decision, and how they perceive physician involvement in the decision process. METHODS ParticipantsParents of male children under 3 years of age were recruited from 3 clinical practices in the Los Angeles area (La Canada, Inglewood, and Childrens Hospital Los Angeles [CHLA]), while they are waiting for their children's routine appointments. The survey was conducted from February to April 1999. The practice sites were picked because of the diverse population served by the physicians. The practice in La Canada is in a suburban highincome community; the practice in Inglewood is an inner-city practice serving the black community, and the primary care practice at CHLA serves a low income, ethnically mixed, but predominantly Hispanic population. InstrumentThe Parental Attitudes on Circumcision Questionnaire, a questionnaire designed by the authors of this study, consisted of a 25-item scale (see "Appendix"). Items consisted of demographic information, circumcision status of child, reasons that influenced decision, information received about circumcision, and satis...

Background and Purpose-Studies have demonstrated the importance of early stroke treatment. If a neuroprotective agent (NA) clinical trial is successful, the greatest benefit might be attained with early prehospital administration. This study determined the potential reduction in time to treatment of stroke patients when NAs were administered in the prehospital setting. Methods-Twenty-three urban emergency medical services (EMS) agencies participated in this study. Prehospital personnel completed a stroke assessment checklist on any potential stroke victim. The checklist collected clinical inclusion/exclusion criteria for NA administration and event/decision times. Patients meeting the hypothetical clinical inclusion criteria were enrolled into this study. Time data included scene arrival/departure, emergency department (ED) arrival, and estimated time of theoretical NA administration. The reduction in time to stroke treatment was calculated as the difference between the time of ED arrival and the reported time of NA administration. The t test and simple linear regression were used to probe for differences in treatment time reduction between selected subgroups. EMS personnel's ability to obtain informed consent for theoretical NA administration was calculated. Results-Two hundred twenty-two patients were enrolled in this study; of these, 75 were deemed eligible for hypothetical NA administration and had complete time data.