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Le Lann C, Drumez É, Ghesquiere L, Winer N, Dochez V, Misbert É. [Impact of the mode of follow-up of preterm premature rupture of membranes before 36 weeks of gestation on the latency period]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00209-5. [PMID: 38734234 DOI: 10.1016/j.gofs.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/25/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Preterm premature rupture of membranes (PPROM) is the main cause of premature delivery, complicating 1-3% of all pregnancies. Conventional hospitalization (CH) is the most frequent mode of follow-up, but homecare (HC) seems to be an alternative. OBJECTIVES Study of the impact of the monitoring mode on the duration of the latency period and on the latency ratio after PPROM, and analysis of the risk factors modifying this ratio. METHODS This was a bicentric retrospective cohort study here-abouts including patients who presented a PPROM between 24 and 36weeks of gestation from 2016 to 2018. Patients had a follow-up in HC at Lille University Hospital center (UHC) and in CH at Nantes UHC according to two different follow-up protocols. The latency ratio corresponded to the real latency period divided by the latency period to theoretical term. RESULTS We included 154 patients: 102 in HC and 52 in CH. The mean latency period was significantly higher in HC: 36.9±21.8 days, corresponding to an 85.5±23.7% latency ratio versus 20.2±12 days, corresponding to an 66.9±29.8% latency ratio in CH (P<0.001). The latency ratio in CH was correlated with term at PPROM (P=0.001). CONCLUSIONS The duration of the latency period seems prolonged for PPROM followed by HC management versus CH in selected populations. This study suggests a benefit to HC in stable patients.
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Affiliation(s)
- Charlotte Le Lann
- Faculté de médecine de Nantes, centre hospitalier universitaire de Nantes, Nantes, France.
| | - Élodie Drumez
- Département de biostatistiques, UDSL, université de Lille, CHRU de Lille, Lille, France
| | - Louise Ghesquiere
- Gynécologie-obstétrique, centre hospitalier universitaire de Lille, Lille, France
| | - Norbert Winer
- Gynécologie-obstétrique, centre hospitalier universitaire de Nantes, France
| | - Vincent Dochez
- Gynécologie-obstétrique, centre hospitalier universitaire de Nantes, France
| | - Émilie Misbert
- Gynécologie-obstétrique, centre hospitalier universitaire de Nantes, France
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Sreedhar S, Rathore S, Benjamin S, Gowri M, Mathews JE. Expectant versus immediate delivery in women with PPROM between 34 and 35 +6 weeks: A Retrospective cohort. J Family Med Prim Care 2020; 9:3225-3229. [PMID: 33102274 PMCID: PMC7567214 DOI: 10.4103/jfmpc.jfmpc_146_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/13/2020] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
Context: Studies comparing the efficacy of expectant management (EM) and immediate delivery (ID) in the management of women with preterm prelabor rupture of membranes (PPROM) between 34 and 35+6 weeks have not been done in a developing country. Although large multicentric studies show better outcomes with EM, the economic implications have not been studied. Aims: This study compared women with PPROM between 34 and 35 +6 weeks, managed expectantly with women who were delivered immediately. Settings and Design: Large tertiary center and retrospective cohort. Methods and Materials: Data of 206 women with PPROM between 34 and 35+6 weeks managed with immediate delivery in the years 2014 and 2015 were compared with seventy-five women with PPROM managed expectantly in the years 2016 and 2017. Statistical Analysis Used: Data was summarized using mean standard deviation (SD) or median interquartile range for continuous variables and frequency and percentage for categorical variables. Continuous variables were compared using independent t-test and categorical variables were compared using Chi-square statistics. Results: Neonatal sepsis was seen in 1/75 (1.3%) in the group managed expectantly and 12/206 (5.8%) in the ID group (P = 0.109). Respiratory distress was seen in 3/75 (4%) in the group managed expectantly and 22/206 (10.7%) with ID (P = 0.08). Chorioamnionitis was similar in both groups. Cesarean rate was 17.3% with expectant management and 28% with ID (P = 0.065). The mean hospital bill was ₹.33,494/- in the ED group and ₹.27,079/- in the ID group (P < 0.001). Conclusions: Expectant management was more expensive.
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Affiliation(s)
- Shruthi Sreedhar
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Swati Rathore
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Benjamin
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - M Gowri
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jiji E Mathews
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, Tamil Nadu, India
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Krishnan V, Makris A, Hennessy A, Hollis B, Lee G. Blood pressure assessments of pregnant women in a Day Assessment Unit - A prospective observational study. Obstet Med 2019; 14:26-30. [PMID: 33995569 DOI: 10.1177/1753495x19881848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/20/2019] [Indexed: 11/15/2022] Open
Abstract
Aim We investigated the optimum time and number of observations for assessing women in the Day Assessment Unit. Methods A single centre prospective observational study was undertaken. Women referred for blood pressure assessment in the Day Assessment Unit were recruited. Results The blood pressure of women who subsequently developed preeclampsia was noted to change differently over the time of observation compared to women with other hypertensive disorders, most notably in the first and third hour (p = 0.042), although the averages at each hour did not differ between these two groups. Conclusions Mean blood pressure measured over four hours did not significantly differ compared to blood pressure measured over one hour. Women who subsequently developed preeclampsia had a different pattern of blood pressure change whilst in the Day Assessment Unit.
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Affiliation(s)
- Vidhu Krishnan
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, Australia
| | - Angela Makris
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | | | - Brian Hollis
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, Australia
| | - Gaksoo Lee
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, Australia.,Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
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4
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Women's views and postpartum follow-up in the CHIPS Trial (Control of Hypertension in Pregnancy Study). Eur J Obstet Gynecol Reprod Biol 2016; 206:105-113. [DOI: 10.1016/j.ejogrb.2016.07.509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/11/2016] [Accepted: 07/26/2016] [Indexed: 11/19/2022]
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Bendix J, Hegaard HK, Langhoff-Roos J, Bergholt T. Changing prevalence and the risk factors for antenatal obstetric hospitalizations in Denmark 2003-2012. Clin Epidemiol 2016; 8:165-75. [PMID: 27354824 PMCID: PMC4910683 DOI: 10.2147/clep.s102029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Population-based studies evaluating the use and extent of antenatal obstetric hospitalizations (AOH) are sparse. The objective of the present study was to describe the prevalence, time trend, and risk factors for AOH in Denmark. Materials and methods A retrospective national register-based cohort study was conducted that included all pregnancies with delivery after 22 gestational weeks in Denmark from 2003 to 2012. The outcomes were AOH and the diagnoses leading to these hospitalizations. AOH was defined as an antenatal hospitalization for at least 1 day with at least one obstetric International Classification of Diseases-10 diagnosis and admission date more than 3 days before delivery. Results The study included 617,906 pregnancies; 48,366 (7.8%) pregnancies were associated with 64,072 AOH before delivery. The percentage of pregnancies with AOH decreased from 8.6% to 7.1%. The median length of stay decreased from 3 to 2 days, and admission for at least 7 days was almost halved. Threatened preterm delivery was the most frequent diagnostic category for AOH. A decline was seen in all diagnostic categories except maternal diseases. Significant risk factors for AOH were multiple pregnancies, low or high maternal age and body mass index, nulliparity, lower educational levels, unemployment or being outside the workforce, single partner status, and smoking. The relative risk of very preterm delivery before gestational age of 34 weeks was higher in pregnancies with AOH compared with pregnancies without AOH (relative risk 15.2; 95% confidence interval: 14.6–15.8). Conclusion This study shows a shift toward less use and shorter duration of antenatal hospitalization in Denmark. The most common indication used in pregnancies with AOH was threatened preterm delivery, and more than one-third resulted in very preterm deliveries.
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Affiliation(s)
- Jane Bendix
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital Hillerod, University of Copenhagen, Hillerod, Denmark
| | - Hanne Kristine Hegaard
- The Research Unit of Women's and Children's Health, The Juliane Marie Centre for Women, Children and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bergholt
- Department of Obstetrics, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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6
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Catt E, Chadha R, Tang S, Palmquist E, Lange I. Management of Preterm Premature Rupture of Membranes: A Comparison of Inpatient and Outpatient Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:433-40. [DOI: 10.1016/j.jogc.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/18/2015] [Indexed: 10/21/2022]
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Abstract
Pre-eclampsia affects 3-5% of pregnancies and is traditionally diagnosed by the combined presentation of high blood pressure and proteinuria. New definitions also include maternal organ dysfunction, such as renal insufficiency, liver involvement, neurological or haematological complications, uteroplacental dysfunction, or fetal growth restriction. When left untreated, pre-eclampsia can be lethal, and in low-resource settings, this disorder is one of the main causes of maternal and child mortality. In the absence of curative treatment, the management of pre-eclampsia involves stabilisation of the mother and fetus, followed by delivery at an optimal time. Although algorithms to predict pre-eclampsia are promising, they have yet to become validated. Simple preventive measures, such as low-dose aspirin, calcium, and diet and lifestyle interventions, show potential but small benefit. Because pre-eclampsia predisposes mothers to cardiovascular disease later in life, pregnancy is also a window for future health. A collaborative approach to discovery and assessment of the available treatments will hasten our understanding of pre-eclampsia and is an effort much needed by the women and babies affected by its complications.
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Affiliation(s)
- Ben W J Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia.
| | - Claire T Roberts
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Laura A Magee
- BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | | | - G Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, University of Fort Hare, and Eastern Cape Department of Health, East London, South Africa
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8
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McCarthy EA, Carins TA, Hannigan Y, Bardien N, Shub A, Walker SP. Effectiveness and safety of 1 vs 4 h blood pressure profile with clinical and laboratory assessment for the exclusion of gestational hypertension and pre-eclampsia: a retrospective study in a university affiliated maternity hospital. BMJ Open 2015; 5:e009492. [PMID: 26582404 PMCID: PMC4654395 DOI: 10.1136/bmjopen-2015-009492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/23/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE We asked whether 60 compared with 240 min observation is sufficiently informative and safe for pregnancy day assessment (PDAC) of suspected pre-eclampsia (PE). DESIGN A retrospective study of 209 pregnant women (475 PDAC assessments, 6 months) with routinely collected blood pressure (BP), symptom and laboratory information. We proposed a 60 min screening algorithm comprising: absence of symptoms, normal laboratory parameters and ≤1high-BP reading (systolic blood pressure, SBP 140 mm Hg or higher or diastolic blood pressure, DBP 90 mm Hg or higher). We also evaluated two less inclusive screening algorithms. We determined short-term outcomes (within 4 h): severe hypertension, proteinuric hypertension and pregnancy-induced hypertension, as well as long-term outcome: PE-related diagnoses up to the early puerperium. We assessed performance of alternate screening algorithms performance using 2×2 tables. RESULTS 1 in 3 women met all screen negative criteria at 1 h. Their risk of hypertension requiring treatment in the next 3 h was 1.8% and of failing to diagnose proteinuric hypertensive PE at 4 h was 5.1%. If BP triggers were 5 mm Hg lower, 1 in 6 women would be screen-negative of whom 1.1% subsequently develops treatment-requiring hypertension and 4.5% demonstrate short-term proteinuric hypertension. We present sensitivity, specificity, negative and positive likelihood ratios for alternate screening algorithms. CONCLUSIONS We endorse further research into the safest screening test where women are considered for discharge after 60 min. Safety, patient and staff satisfaction should be assessed prospectively. Any screening test should be used in conjunction with good clinical care to minimise maternal and perinatal hazards of PE.
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Affiliation(s)
- Elizabeth Anne McCarthy
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Thomas A Carins
- Department of Emergency, Austin Health, Heidelberg, Victoria, Australia
| | - Yolanda Hannigan
- Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Nadia Bardien
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Alexis Shub
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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9
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Lowe SA, Bowyer L, Lust K, McMahon LP, Morton M, North RA, Paech M, Said JM. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol 2015; 55:e1-29. [PMID: 26412014 DOI: 10.1111/ajo.12399] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
This guideline is an evidence based, practical clinical approach to the management of Hypertensive Disorders of Pregnancy. Since the previous SOMANZ guideline published in 2008, there has been significant international progress towards harmonisation of definitions in relation to both the diagnosis and management of preeclampsia and gestational hypertension. This reflects increasing knowledge of the pathophysiology of these conditions, as well as their clinical manifestations. In addition, the guideline includes the management of chronic hypertension in pregnancy, an approach to screening, advice regarding prevention of hypertensive disorders of pregnancy, and discussion of recurrence risks and long term risk to maternal health. The literature reviewed included the previous SOMANZ Hypertensive Disorders of Pregnancy guideline from 2008 and its reference list, plus all other published National and International Guidelines on this subject. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT), National Institute for Health and Care Excellence (NICE) Evidence Search, and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2007 and March, 2014.
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Affiliation(s)
- Sandra A Lowe
- Department of Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Lucy Bowyer
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Karin Lust
- Department of Obstetric Medicine and Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Mark Morton
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | - Michael Paech
- Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Joanne M Said
- Sunshine Hospital and University of Melbourne, Melbourne, Victoria, Australia
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10
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Barber CC, Starkey NJ. Predictors of anxiety among pregnant New Zealand women hospitalised for complications and a community comparison group. Midwifery 2015; 31:888-96. [PMID: 25987104 DOI: 10.1016/j.midw.2015.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 04/21/2015] [Accepted: 04/26/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE to investigate predictors of anxiety for women experiencing hospitalisation during pregnancy and a comparison group of pregnant women (with or without medical complications) in the community. DESIGN correlational, cross-sectional observational questionnaire study. SETTING regional antenatal inpatient unit and community-based settings in New Zealand in 2009 and 2010. PARTICIPANTS 118 pregnant women in hospital and 114 pregnant women in community. MEASUREMENTS AND FINDINGS women in hospital and community groups completed a battery of questionnaires on pregnancy and health history, life events, anxiety, optimism, coping, and relationship factors. Midwives caring for the women provided ratings of health status and psychological distress. Both groups of women had scores on state anxiety significantly above local norms; women in the hospital were significantly higher than those in the community on state anxiety and worry about their pregnancy. The groups did not differ on factors such as life events, optimism, and coping self-efficacy. Ratings of health and distress made by women and their midwives showed poor agreement. Predictors of acute anxiety differed across the groups: for hospitalised women, anxiety was predicted by their rating of their health and their dispositional optimism; for women in the community, anxiety was predicted by stressful life events, dispositional optimism, and coping self-efficacy. KEY CONCLUSIONS many women hospitalised during pregnancy are extremely anxious, and those most vulnerable are those who are less optimistic and see their health as poor. Health care professionals may not be aware of how anxious women are, and women and their hospital caregivers had poor agreement on ratings of the woman׳s health status. IMPLICATIONS FOR RESEARCH AND PRACTICE women hospitalised during pregnancy are at risk for high levels of anxiety. Midwives are well placed to help women by recognising their distress, supporting informed optimism, and guiding women toward realistic coping strategies and using existing social support networks. Research is needed on strategies for implementation and effectiveness of brief interventions to support women to manage anxiety and stress during pregnancy both in hospital and in the community.
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Affiliation(s)
- Carol Cornsweet Barber
- School of Psychology, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand.
| | - Nicola J Starkey
- School of Psychology, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand
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11
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens 2014; 4:105-45. [PMID: 26104418 DOI: 10.1016/j.preghy.2014.01.003] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/17/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation and treatment of the hypertensive disorders of pregnancy (HDP). EVIDENCE The literature reviewed included the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines from 2008 and their reference lists, and an update from 2006. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT) and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2006 and March 2012. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care and GRADE.
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Affiliation(s)
| | - Anouk Pels
- Academic Medical Centre, Amsterdam, The Netherlands
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12
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Turnbull D, Adelson P, Oster C, Bryce R, Fereday J, Wilkinson C. Psychosocial outcomes of a randomized controlled trial of outpatient cervical priming for induction of labor. Birth 2013; 40:75-80. [PMID: 24635460 DOI: 10.1111/birt.12035] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Induction of labor, an increasingly common intervention, is often preceded by the application of an agent to "prime" or "ripen" the cervix. We conducted a randomized controlled trial to compare clinical, economic, and psychosocial outcomes of inpatient and outpatient cervical priming before induction of labor. In this paper we present the psychosocial outcomes. METHODS Women participating in a randomized controlled trial in two Australian metropolitan teaching hospitals completed questionnaires to measure anxiety and depression at enrollment, and to examine satisfaction, experiences, depression, and infant feeding 7 weeks after giving birth. Data analysis was by intention to treat and by having received the intervention as intended (approximately 50% in each group). RESULTS Of 1,004 eligible women, 85 percent consented (n = 407, outpatient; n = 414 inpatient). No statistically significant or clinically relevant differences were found in immediate anxiety, depression, or infant feeding. Small, statistically significant differences favoring outpatient priming were found in seven of the nine subscales in the 7-week postpartum questionnaire. The direction of the effect was maintained, mostly with a larger effect size in women who received the intervention. CONCLUSION Women allocated to outpatient priming were more satisfied with their priming experience than women allocated to inpatient priming. Being informed that they could go home after cervical priming did not increase women's anxiety.
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Affiliation(s)
- Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, South Australia
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Pericás JM, Aibar J, Soler N, López-Soto A, Sanclemente-Ansó C, Bosch X. Should alternatives to conventional hospitalisation be promoted in an era of financial constraint? Eur J Clin Invest 2013; 43:602-15. [PMID: 23590593 DOI: 10.1111/eci.12087] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 03/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Because the current economic crisis has led to austerity in health policies, with severe restrictions on public health care, avoiding unnecessary admissions and shortening hospital stays is rapidly becoming an urgent priority. Alternatives to hospitalisation replace or shorten hospital processes, including diagnosis, monitoring, treatment and follow-up. This review aims to present the available evidence on alternatives to conventional hospitalisation for medical disorders; options for surgery, psychiatry and palliative care are largely excluded. MATERIALS AND METHODS Narrative review. RESULTS The main alternatives to conventional hospitalisation include day centres (DC), quick diagnosis units (QDU), hospital at home (HaH) and, in some circumstances, telemonitoring. DC increase patient comfort, reduce costs and can improve efficiency. In generally healthy patients with suspected severe disease, QDU may be a good alternative to hospitalisation for diagnostic procedures. However, their cost-effectiveness remains to be clearly proven. Randomised controlled trials have shown that hospital-at-home (HaH) can lead to earlier hospital discharges, improve outcomes and reduce costs in patients with prevalent chronic diseases. Although telemonitoring seems to be promising and its use is increasing, methodologically sounder studies with a higher level of evidence are needed to assess its clinical effectiveness. CONCLUSIONS Factors such as ageing, the need for an earlier diagnosis of suspected severe disease, the increasing complexity of medical care and the increasing costs of hospitalisation mean that, whenever possible, giving priority to less expensive alternatives to hospital admission, such as QDU, DC, HaH and telemedicine, is an urgent task in the current economic crisis.
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Affiliation(s)
- Juan M Pericás
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Magee LA, Lowe S, Douglas MJ, Kathirgamanathan A. Therapeutics and anaesthesia. Best Pract Res Clin Obstet Gynaecol 2011; 25:477-90. [PMID: 21478058 DOI: 10.1016/j.bpobgyn.2011.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
Many aspects of hypertension care outside pregnancy may be applied in pregnancy, but little information is available on which to base decision-making. It would seem reasonable to continue previous dietary salt restriction and physical activity in women with pre-existing (and controlled) hypertension, encourage a heart-healthy diet in all women with a hypertension disorder of pregnancy, and take patient preference into account when deciding on place of care. Although bed rest has become a key part of obstetric practice and for care of women with a hypertension disorder of pregnancy, in particular, the evidence is lacking to support this practice. This may also increase thromboembolic risk. Antihypertensive treatment is strongly advised for women with severe hypertension. The most common agents are parenteral labetalol, hydralazine, or oral nifedipine capsules. Clinicians should familiarise themselves with multiple agents. Until the role of antihypertensive treatment for non-severe hypertension in pregnancy is clarified by ongoing research, clinicians should explicitly state an individual patient's blood pressure goal, which could reasonably be anywhere between 130/80 and 155/105 mmHg. Labetalol and methyldopa are used most commonly. Breastfeeding should be encouraged. Many risk factors for hypertension (e.g. obesity), as well as hospitalisation and pre-eclampsia, all increase the thromboembolic risk for pregnant women, and care providers should consider thromboprophylaxis in the appropriate setting. Finally, anaesthetists play a critical role in the management of women with a hypertension disorder of pregnancy, and should be involved earlier rather than later in the course of their care.
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Affiliation(s)
- Laura A Magee
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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15
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Maloni JA. Antepartum bed rest for pregnancy complications: efficacy and safety for preventing preterm birth. Biol Res Nurs 2010; 12:106-24. [PMID: 20798159 DOI: 10.1177/1099800410375978] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Preterm birth is the major maternal-child health issue across developed nations and the leading cause of perinatal mortality and morbidity. Of all deaths of infants <1 year of age in the United States in 2005, 68.6% occurred in infants born prior to term. Although the preterm birth rate in European countries is 5-7%, the U.S. preterm birth rate is 12.7%, representing an increase of 9% since 2000. Antepartum bed rest/activity restriction (ABR/AR) has been a mainstay of treatment to prevent preterm birth for the past 30 years prescribed for nearly 1 million women in the United States annually, despite a lack of evidence for its effectiveness. In fact, there is increasing evidence that ABR causes several adverse physiologic and psychological side effects among women and their infants. Unfortunately, these findings have had little impact on clinical practice. This integrative review of literature provides a comprehensive analysis of the evidence for the practice of prescribing ABR and its physiologic, behavioral, and experiential side effects. It also presents a model to guide continuing research about the effects of maternal bed rest as well as evidence supporting the use of home care with bed rest, a different, safe, and feasible model of prenatal care for treating women with pregnancy complications used particularly in other countries. Finally, suggestions to improve the health of high-risk pregnant and postpartum women and their infants are provided.
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Affiliation(s)
- Judith A Maloni
- Case Western Reserve University, Frances Payne BoltonSchool of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
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16
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Dowswell T, Middleton P, Weeks A. Antenatal day care units versus hospital admission for women with complicated pregnancy. Cochrane Database Syst Rev 2009; 2009:CD001803. [PMID: 19821282 PMCID: PMC4171387 DOI: 10.1002/14651858.cd001803.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Antenatal day care units have been widely used as an alternative to inpatient care for women with pregnancy complications including mild and moderate hypertension, and preterm prelabour rupture of the membranes. OBJECTIVES The objective of this review is to compare day care units with routine care or hospital admission for women with pregnancy complications in terms of maternal and perinatal outcomes, length of hospital stay, acceptability, and costs to women and health services providers. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2009). SELECTION CRITERIA Randomised controlled trials comparing day care with inpatient or routine care for women with complicated pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently carried out data extraction and assessed studies for risk of bias. MAIN RESULTS Three trials with a total of 504 women were included. For most outcomes it was not possible to pool results from trials in meta-analyses as outcomes were measured in different ways.Compared with women in the ward/routine care group, women attending day care units were less likely to be admitted to hospital overnight (risk ratio 0.46, 95% confidence interval 0.34 to 0.62). The average length of antenatal admission was shorter for women attending for day care, although outpatient attendances were increased for this group. There was evidence from one study that women attending for day care were significantly less likely to undergo induction of labour, but mode of birth was similar for women in both groups. For other outcomes there were no significant differences between groups.The evidence regarding the costs of different types of care was mixed; while the length of antenatal hospital stays were reduced, this did not necessarily translate into reduced health service costs.While most women tended to be satisfied with whatever care they received, women preferred day care compared with hospital admission. AUTHORS' CONCLUSIONS Small studies suggest that there are no major differences in clinical outcomes for mothers or babies between antenatal day units or hospital admission, but women may prefer day care.
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Affiliation(s)
- Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive MedicineFirst Floor, Liverpool Women's NHS Foundation TrustLiverpoolUKL8 7SS
| | - Philippa Middleton
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Andrew Weeks
- The University of LiverpoolSchool of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive MedicineFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Magee LA, von Dadelszen P, Chan S, Gafni A, Gruslin A, Helewa M, Hewson S, Kavuma E, Lee SK, Logan AG, McKay D, Moutquin JM, Ohlsson A, Rey E, Ross S, Singer J, Willan AR, Hannah ME. Women's Views of Their Experiences in the CHIPS (Control of Hypertension in Pregnancy Study) Pilot Trial. Hypertens Pregnancy 2009; 26:371-87. [DOI: 10.1080/10641950701547549] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Reference. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008. [DOI: 10.1016/s1701-2163(16)32783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Stainton MC, Lohan M, Fethney J, Woodhart L, Islam S. Women's responses to two models of antepartum high-risk care: Day stay and hospital stay. Women Birth 2006; 19:89-95. [PMID: 16965946 DOI: 10.1016/j.wombi.2006.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2006] [Indexed: 11/30/2022]
Abstract
AIM To replicate and extend previous research by examining women's responses to two current models of high-risk antenatal care that replaced the traditional bed rest model. PARTICIPANTS A sample of 61 women assigned to high-risk antenatal care: 29 in the Antenatal Hospital Unit (ANHU) and 32 in the Pregnancy Day Stay Unit (PDSU). METHODS A longitudinal study with data collected by a range of validated tools were used to assess mood, family functioning, stress and physical symptoms every 2 weeks from admission into antenatal high-risk care to birthing and at 3- and 6-weeks postpartum. Data were analysed for similarities and differences and change over time between the two groups of women. FINDINGS Stress from emotions was the highest antenatal stressor for both groups and highest for those in hospital. Stress about health increased over time for those in the PDSU and varied for those in ANHU. Anxiety was significantly different between the groups over time (p<0.01), being highest for the ANHU group and decreasing from admission to 6-weeks postnatal for both groups. Sensation Seeking (sensory deprivation) showed significant differences (p<0.05) with the highest scores in the ANHU group and increasing over time for both groups. Family relationships were most disrupted for those in ANHU. Both groups were satisfied with support from spouse, family and friends and those in ANHU acknowledged the support received from midwifery staff. CONCLUSIONS AND IMPLICATIONS The responses of both the woman and her family differ between the two models of care and vary with time. Midwives can use the patterns of response identified of these findings to address needs for assistance with family relationships, sensory stimulation, information and support and management of anxiety when care is required for complications of pregnancy.
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Affiliation(s)
- M Colleen Stainton
- Centre for Women's Health Nursing, Royal Hospital for Women, Randwick, NSW 2031, Australia
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Turnbull DA, Wilkinson C, Griffith EC, Kruzins G, Gerard K, Shanahan M, Stamp GE. The psychosocial outcomes of antenatal day care for three medical complications of pregnancy: A randomised controlled trial of 395 women. Aust N Z J Obstet Gynaecol 2006; 46:510-6. [PMID: 17116056 DOI: 10.1111/j.1479-828x.2006.00651.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although antenatal day care is becoming increasingly common, there is little evidence as to the psychosocial efficacy of this model of care. AIM We aimed to assess the broader psychosocial impact of antenatal day care compared with admission to hospital. METHODS We carried out a randomised trial of 395 women, randomly assigned in a 2 : 1 ratio between day care and antenatal ward, stratified for major diagnostic categories (proteinuric hypertension, non-proteinuric hypertension and preterm premature rupture of membranes). Main outcome measures--self-report questionnaires (response rates ranging from 80 to 90%) were sent to women's homes four days after randomisation and seven weeks after delivery. RESULTS Overall, there were statistically significant differences favouring day care in 12 of 28 items at four days post-randomisation, with no differences in the two groups for the other 16 items. At seven weeks postdelivery, we found differences in eight of 28 items favouring day care, with no differences in the two groups for the other 20 items. The types of items indicating a sustained difference covered a range of aspects of care and included satisfaction with staff, continuity of carer, information transfer, and social support. There were no differences in relation to infant feeding and relationship with the baby. CONCLUSIONS Day care has an effect on women's satisfaction with care but does not produce broader psychosocial outcomes.
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Affiliation(s)
- Deborah A Turnbull
- School of Psychology, University of Adelaide, and Women's and Children's Hospital, South Australia, Australia.
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Liu S, Heaman M, Sauve R, Liston R, Reyes F, Bartholomew S, Young D, Kramer MS. An Analysis of Antenatal Hospitalization in Canada, 1991–2003. Matern Child Health J 2006; 11:181-7. [PMID: 17089198 DOI: 10.1007/s10995-006-0154-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 09/22/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the incidence and temporal trends of hospitalization during pregnancy, and provide additional information on maternal morbidity among Canadian women. METHODS A population-based cohort study was conducted using the Canadian Institute for Health Information's Discharge Abstract Database between fiscal year 1991/92 and 2002/03. This database included antenatal hospitalizations for all hospital deliveries (N=3,103,365) in Canada except for those occurring in Manitoba and Quebec. Temporal trends, and variations in the non-delivery antenatal hospitalization ratio (per 100 deliveries) by maternal age and province or territory were quantified. Primary causes for antenatal hospitalization, the lengths of in-hospital stay, and changing pattern by maternal age and time period were compared. RESULTS The overall antenatal hospitalization ratio declined by 43%, from 24.0 per 100 deliveries in 1991/92 to 13.6 in 2002/03. Younger women tended to be hospitalized more frequently than older women: 27.1 per 100 deliveries for women aged less than 20 years and 21.5 per 100 deliveries for 20-24 years, respectively, compared to 11.5 per 100 for women aged 35-39 years. The antenatal hospitalization ratio varied greatly by province/territory--from 12.2 per 100 deliveries in Ontario to 30.7 in the Yukon. Threatened preterm labour, antenatal hemorrhage, hypertensive disorders, severe vomiting and diabetes remained the five most common causes for antenatal hospitalization, although the trends for the first four declined dramatically from 1991/92 to 2002/03. Younger women were more likely to be admitted for threatened preterm labour and severe vomiting, while older women were more likely to be admitted for antenatal hemorrhage and hypertensive disorders. CONCLUSIONS The decline in antenatal hospitalization may reflect changes in management of pregnancy complications, e.g., transition from in-hospital care to out-of-hospital care, and introduction of antepartum home care programs. Information on interprovincial/territorial variations in antenatal hospitalization may be helpful in directing future maternal health care.
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Affiliation(s)
- Shiliang Liu
- Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of Canada, Tunney's Pasture, Ottawa, Ontario, Canada.
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Adamson J, Cockayne S, Puffer S, Torgerson DJ. Review of randomised trials using the post-randomised consent (Zelen's) design. Contemp Clin Trials 2006; 27:305-19. [PMID: 16455306 DOI: 10.1016/j.cct.2005.11.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Revised: 11/10/2005] [Accepted: 11/14/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 1979, Zelen described a trial method of randomising participants before acquiring consent in order to enhance recruitment to clinical trials. The method has been criticised ethically due to lack of consent and scientifically due to high crossover rates. This paper reviews recent published trials using this method and describes the reasons authors gave for using the method, examines the crossover rates, and looks at the quality of identified trials. METHODS Literature review searching for all citations to the relevant Zelen's papers of trials published since 1990 plus inclusion of trials from personal knowledge. RESULTS We identified 58 relevant trials. The most common justification for the use of Zelen method was to avoid the introduction of bias (e.g., to avoid the Hawthorne effect). Few trialists had explicitly used the design to enhance participant recruitment. Most trials (n=41) experienced some crossover from one group to the other (median crossover=8.9%, mean=13.8%, IQR 2.6% to 15%) although this was usually within acceptable limits. CONCLUSION The most important reason stated by authors for using Zelen's method was to limit bias. Zelen's method, if carefully used, can avoid 'resentful demoralisation' and the Hawthorne effect biasing a trial. Unlike a previous review, we found that crossover was not a problem for most trials.
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Affiliation(s)
- Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
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Gregory KD, Johnson CT, Johnson TRB, Entman SS. The content of prenatal care. Womens Health Issues 2006; 16:198-215. [PMID: 16920524 DOI: 10.1016/j.whi.2006.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The Content of Prenatal Care report of the US Preventative Health Service (USPHS) Expert Panel established an important benchmark when published in 1989, but has not been significantly updated since that time. METHODS The literature since 1989 is reviewed to assess which recommendations have been validated and/or implemented. Additionally, new findings that support the recommendations put forth or expand the scope of prenatal care outlined in the 1989 report are examined and discussed. RESULTS The USPHS recommendation of a reduced prenatal visit schedule has support, and new content for the preconception visit has been identified, although this preconception visit has not been validated or widely implemented. CONCLUSIONS We identified new opportunities and initiatives for the content of prenatal care, particularly improvement in the electronic medical record, attention to multidisciplinary approaches to patient education and improved patient literacy, and an extended maternal life span approach, including postgestation visits.
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Affiliation(s)
- Kimberly D Gregory
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California, USA
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Affiliation(s)
- Lelia Duley
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU.
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Dumville JC, Hahn S, Miles JNV, Torgerson DJ. The use of unequal randomisation ratios in clinical trials: a review. Contemp Clin Trials 2005; 27:1-12. [PMID: 16236557 DOI: 10.1016/j.cct.2005.08.003] [Citation(s) in RCA: 230] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 05/05/2005] [Accepted: 08/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine reasons given for the use of unequal randomisation in randomised controlled trials (RCTs). MAIN MEASURES Setting of the trial; intervention being tested; randomisation ratio; sample size calculation; reason given for randomisation. METHODS Review of trials using unequal randomisation. DATABASES AND SOURCES: Cochrane library, Medline, Pub Med and Science Citation Index. RESULTS A total of 65 trials were identified; 56 were two-armed trials and nine trials had more than two arms. Of the two-arm trials, 50 trials recruited patients in favour of the experimental group. Various reasons for the use of unequal randomisation were given. Six studies stated that they used unequal randomisation to reduce the cost of the trial, with one screening trial limited by the availability of the intervention. Other reasons for using unequal allocation were: avoiding loss of power from drop-out or cross-over, ethics and the gaining of additional information on the treatment. Thirty seven trials papers (57%) did not state why they had used unequal randomisation and only 14 trials (22%) appeared to have taken the unequal randomisation into account in their sample size calculation. CONCLUSION Although unequal randomisation offers a number of advantages to trials the method is rarely used and is especially under-utilised to reduce trial costs. Unequal randomisation should be considered more in trial design especially where there are large differences between treatment costs.
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Affiliation(s)
- J C Dumville
- Area 4, York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom.
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Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C. Postcards from the EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ 2005; 331:805. [PMID: 16183654 PMCID: PMC1246077 DOI: 10.1136/bmj.38579.455266.e0] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2005] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine whether an intervention using postcards (postcards from the EDge project) reduces repetitions of hospital treated deliberate self poisoning. DESIGN Randomised controlled trial. SETTING Regional referral service for general hospital treated deliberate self poisoning in Newcastle, Australia. PARTICIPANTS 772 patients aged over 16 years with deliberate self poisoning. INTERVENTION Non-obligatory intervention using eight postcards over 12 months along with standard treatment compared with standard treatment alone. MAIN OUTCOME MEASURES Proportion of patients with one or more repeat episodes of deliberate self poisoning and the number of repeat episodes for deliberate self poisoning per person in 12 months. RESULTS The proportion of repeaters with deliberate self poisoning in the intervention group did not differ significantly from that in the control group (57/378, 15.1%, 95% confidence interval 11.5% to 18.7% v 68/394, 17.3%, 13.5% to 21.0%: difference between groups -2%, -7% to 3%). In unadjusted analysis the number of repetitions were significantly reduced (incidence risk ratio 0.55, 0.35 to 0.87). CONCLUSION A postcard intervention reduced repetitions of deliberate self poisoning, although it did not significantly reduce the proportion of individual repeaters.
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Affiliation(s)
- Gregory L Carter
- Suicide Prevention Research Unit, Centre for Mental Health Studies, Faculty of Health, University of Newcastle, Newcastle, Australia.
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Stainton MC, Lohan M, Woodhart L. Women's experiences of being in high-risk antenatal care day stay and hospital admission. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1448-8272(05)80014-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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