Circumcision, Male

Morris, Brian J.; Green, Edward C.

doi:10.1002/9781118410868.wbehibs191

Cited by 2 publications

(2 citation statements)

References 27 publications

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“…We defined head trauma as any non-penetrating head injury above the neck irrespective of mechanism 28. Patients experiencing multisystem trauma were included in the study.…”

Section: Methodsmentioning

confidence: 99%

AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury

et al. 2017

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ObjectivesManagement of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome.DesignMulticentre, observational study using routine patient records.Setting33 emergency departments in England and Scotland.Participants3566 adults (aged ≥16 years) who had suffered blunt head injury and were currently taking warfarin.Main outcome measuresPrimary outcome measure was rate of adverse outcome defined as death or neurosurgery following initial injury, clinically significant CT scan finding or reattendance with related complication within 10 weeks of initial hospital attendance. Secondary objectives included identifying risk factors for adverse outcome using univariable and multivariable analyses.ResultsClinical data available for 3534/3566 patients (99.1%), median age 79 years; mean initial international normalised ratio (INR) 2.67 (SD 1.34); 81.2% Glasgow Coma Scale (GCS) 15: 59.8% received a CT scan with significant head injury-related finding in 5.4% (n=208); 0.5% underwent neurosurgery; 1.2% patients suffered a head injury-related death. Overall adverse outcome rate was 5.9% (95% CI 5.2% to 6.7%). Patients with GCS=15 and no associated symptoms had lowest risk of adverse outcome (risk 2.7%; 95% CI 2.1 to 3.6). Patients with GCS=15 multivariable analysis (using imputation) found risk of adverse outcome to increase when reporting at least one associated symptom: vomiting (relative risk (RR) 1.8; 95% CI 1.0 to 3.4), amnesia (RR 3.5; 95% CI 2.1 to 5.7), headache (RR 1.3; 95% CI 0.8 to 2.2), loss of consciousness (RR 1.75; 95% CI 1.0 to 3.0). INR measurement did not predict adverse outcome in patients with GCS=15 (RR 1.1; 95% CI 1.0 to 1.2).ConclusionsIn alert warfarinised patients following head injury, the presence of symptoms is associated with greater risk of adverse outcome. Those with GCS=15 and no symptoms are a substantial group and have a low risk of adverse outcome.Trial registration numberNCT02461498.

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“…We defined head trauma as any non-penetrating head injury above the neck irrespective of mechanism 28. Patients experiencing multisystem trauma were included in the study.…”

Section: Methodsmentioning

confidence: 99%

AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury

et al. 2017

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“…A further concern – again – has to do with the interpretation of risk. According to even proponents of circumcision, such as Brian Morris ( 63 ), the absolute likelihood of clinically significant, non-resolvable surgical complications associated with the surgery is low, regardless of the age at which it is performed. Thus, even if one were to grant that there is a relative-risk reduction in the incidence of adverse events – over and above the loss of erogenous tissue – this consideration would not be morally decisive.…”

Section: Timingmentioning

confidence: 99%

Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines

Earp

2015

Front. Pediatr.

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The Centers for Disease Control and Prevention (CDC) have announced a set of provisional guidelines concerning male circumcision, in which they suggest that the benefits of the surgery outweigh the risks. I offer a critique of the CDC position. Among other concerns, I suggest that the CDC relies more heavily than is warranted on studies from Sub-Saharan Africa that neither translate well to North American populations nor to circumcisions performed before an age of sexual debut; that it employs an inadequate conception of risk in its benefit vs. risk analysis; that it fails to consider the anatomy and functions of the penile prepuce (i.e., the part of the penis that is removed by circumcision); that it underestimates the adverse consequences associated with circumcision by focusing on short-term surgical complications rather than long-term harms; that it portrays both the risks and benefits of circumcision in a misleading manner, thereby undermining the possibility of obtaining informed consent; that it evinces a superficial and selective analysis of the literature on sexual outcomes associated with circumcision; and that it gives less attention than is desirable to ethical issues surrounding autonomy and bodily integrity. I conclude that circumcision before an age of consent is not an appropriate health-promotion strategy.

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Circumcision, Male

Cited by 2 publications

References 27 publications

AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury

AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury

Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines

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