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Kearney L, Brady S, Marsh N, Davies-Tuck M, Nugent R, Eley V. The effects of intravenous hydration regimens in nulliparous women undergoing induction of labor: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2024. [PMID: 38468190 DOI: 10.1111/aogs.14793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/27/2023] [Accepted: 01/07/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Labor is both a physiological and physical activity that requires energy expenditure by the woman. Despite this, women are often fasted in labor, with hydration requirements addressed predominantly by intravenous therapy. Little is known about how best to manage this in nulliparous women undergoing induction of labor, who can be prone to lengthy labors. Therefore, we undertook a systematic review and meta-analysis to determine the effects of intravenous hydration regimens on nulliparous women undergoing induction of labor. MATERIAL AND METHODS A systematic review and meta-analysis were conducted. Databases searched were PubMed, CINAHL, Embase, Cochrane, Scopus, and Web of Science using the search strategy combination of associated key concepts for intravenous therapy and nulliparous laboring women. The primary outcome was excessive neonatal weight loss. Meta-analyses for categorical outcomes included estimates of odds ratio (OR) and their 95% confidence intervals (CI) calculated; and for continuous outcomes the standardized mean difference, each with its 95% CI. Heterogeneity was assessed visually and by using the χ2 statistic and I2 with significance being set at p < 0.10. RESULTS A total of 1512 studies were located and following screening, three studies met the eligibility criteria. No studies reported excessive neonatal weight loss. Increased rates of intravenous therapy (250 mL/h vs. 125 mL/h) during labor were not found to reduce the overall length of labor (mean difference -0.07 h, 95% CI -0.27 to 0.13 h) or reduce cesarean sections (OR 0.74, 95% CI 0.45-1.23), when women were not routinely fasted. CONCLUSIONS Our review found no significant improvements for nulliparous women who received higher intravenous fluid volumes when undergoing induction of labor and were not routinely fasted. However, data are limited, and further research is needed.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Royal Brisbane and Women's Hospital, Metro North Health, Herston, Queensland, Australia
| | - Susannah Brady
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital, Metro North Health, Herston, Queensland, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Victoria Eley
- Royal Brisbane and Women's Hospital, Metro North Health, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
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Kearney L, Nugent R, Maher J, Shipstone R, Thompson JM, Boulton R, George K, Robins A, Bogossian F. Factors associated with spontaneous vaginal birth in nulliparous women: A descriptive systematic review. Women Birth 2024; 37:63-78. [PMID: 37704535 DOI: 10.1016/j.wombi.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
PROBLEM Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. BACKGROUND There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously. AIM To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy. METHODS Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded. FINDINGS Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%-99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal. DISCUSSION Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research. CONCLUSION Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, Australia; Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Health, Australia.
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Australia
| | - Jane Maher
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Australia
| | | | - John Md Thompson
- School of Health, University of the Sunshine Coast, Australia; Faculty of Medicine, University of Auckland, New Zealand
| | - Rachel Boulton
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Australia
| | - Kendall George
- Women's and Newborn Services, Townsville Hospital and Health Service, Australia
| | - Anna Robins
- School of Health, University of the Sunshine Coast, Australia
| | - Fiona Bogossian
- School of Health, University of the Sunshine Coast, Australia
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Kearney L, Craswell A, Dick N, Massey D, Nugent R. Evidence-based guidelines for intrapartum maternal hydration assessment and management: A scoping review. Birth 2023. [PMID: 37803945 DOI: 10.1111/birt.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/09/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023]
Abstract
PROBLEM Inconsistent practice relating to intrapartum hydration assessment and management is reported, and potential harm exists for laboring women and birthing persons. BACKGROUND Labor and birth are physically demanding, and adequate nutrition and hydration are essential for labor progress. A lack of clear consensus on intrapartum hydration assessment and management during labor and birth currently exists. In addition, there is an inconsistent approach to managing hydration, often including a mixture of intravenous and oral fluids that are poorly monitored. AIM The aim of this scoping review was to identify and collate evidence-based guidelines for intrapartum hydration assessment and management of maternal hydration during labor and birth. METHODS PubMed, Embase, and CINAHL databases were searched, in addition to professional college association websites. Inclusion criteria were intrapartum clinical guidelines in English, published in the last 10 years. FINDINGS Despite searching all appropriate databases in maternity care, we were unable to identify evidence-based guidelines specific to hydration assessment and management, therefore resulting in an "empty review." A subsequent review of general intrapartum care guidelines was undertaken. Our adapted review identified 12 guidelines, seven of which referenced the assessment and management of maternal hydration during labor and birth. Three guidelines recommend that "low-risk" women in spontaneous labor at term should hold determination over what they ingest in labor. No recommendations with respect to assessment and management of hydration for women undergoing induction of labor were found. DISCUSSION Despite the increasing use of intravenous fluid as an adjunct to oral intake to maintain maternal intrapartum hydration, there is limited evidence and, subsequently, guidelines to determine best practice in this area. How hydration is assessed was also largely absent from general intrapartum care guidelines, further perpetuating potential clinical variation in this area. CONCLUSION There is an absence of guidelines specific to the assessment and management of maternal hydration during labor and birth, despite its importance in ensuring labor progress and safe care.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Nellie Dick
- Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Debbie Massey
- Edith Cowan University, School of Nursing and Midwifery, Perth, Western Australia, Australia
| | - Rachael Nugent
- Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
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Nugent R, Wee A, Kearney L, de Costa C. The effectiveness of continuous positive airway pressure for treating obstructive sleep apnoea in pregnancy: A systematic review. Aust N Z J Obstet Gynaecol 2023; 63:290-300. [PMID: 36866618 DOI: 10.1111/ajo.13654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/20/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) occurs in 15-20% of pregnant women living with obesity. As global obesity prevalence increases, OSA in pregnancy is concurrently increasing, yet remains under-diagnosed. The effects of treating OSA in pregnancy are under-investigated. AIM A systematic review was conducted to determine whether treating pregnant women with OSA using continuous positive airway pressure (CPAP) will improve maternal or fetal outcomes, compared with no treatment or delayed treatment. MATERIALS AND METHODS Original studies in English published until May 2022 were included. Searches were conducted in Medline, PubMed, Scopus, the Cochrane Library and clinicaltrials.org. Maternal and neonatal outcome data were extracted, and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach (PROSPERO registration: CRD42019127754). RESULTS Seven trials met inclusion criteria. Use of CPAP in pregnancy appears to be well tolerated with reasonable adherence. Use of CPAP in pregnancy may be associated with both a reduction in blood pressure and pre-eclampsia. Birthweight may be increased by maternal CPAP treatment, and preterm birth may be reduced by treatment with CPAP in pregnancy. CONCLUSION Treatment of OSA with CPAP in pregnancy may reduce hypertension and, preterm birth, and may increase neonatal birthweight. However, more rigorous definitive trial evidence is required to adequately assess the indication, efficacy, and applications of CPAP treatment in pregnancy.
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Affiliation(s)
- Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, James Cook University, Queensland, Birtinya, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Wee
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, James Cook University, Queensland, Birtinya, Australia
| | - Lauren Kearney
- The University of Queensland, Brisbane, Queensland, Australia
- Royal Brisbane and Womens Hospital, Queensland, Brisbane, Australia
| | - Caroline de Costa
- The Cairns Institute, James Cook University, Cairns, Queensland, Australia
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Foo XY, Nugent R. Implementation of a policy of universal cystoscopy at the time of hysterectomy for benign indications: A retrospective comparative study. Aust N Z J Obstet Gynaecol 2023; 63:99-104. [PMID: 35909245 DOI: 10.1111/ajo.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lower urinary tract injury (LUTI) is a serious complication of major gynaecologic surgery. Although intra-operative cystoscopy can facilitate timely diagnosis and treatment of LUTI, the optimal approach to cystoscopy at the time of benign hysterectomy remains debatable. AIMS To assess whether implementation of a policy of universal cystoscopy at the time of benign hysterectomy was associated with a difference in intra-operative detection and rates of LUTI. MATERIALS AND METHODS Retrospective cohort study at a large regional teaching hospital where a policy of universal cystoscopy at the time of benign hysterectomy was implemented on 30 September 2019. Hysterectomies performed from 1 November 2016 to 31 March 2021 were included and categorised into the 'pre-policy' and 'post-policy' groups. Primary outcomes included the intra-operative detection and overall rates of LUTI. Secondary outcome was the policy adherence rate. Multivariate analysis was used to examine the effect of this policy on the outcomes. RESULTS There were 584 hysterectomies identified, including 325 in the pre-policy group and 259 in the post-policy group. Cystoscopy was performed in 55.1% in the pre-policy group and 97.7% in the post-policy group (P < 0.01). Adjusted for age, indication and route of hysterectomy, there were no significant differences in the intra-operative cystoscopic detection of LUTI (42.9% vs 25.0%, P = 0.55) or the rate of LUTI (2.2% vs 1.5%, P = 0.25) after implementation of the policy. CONCLUSIONS The practice of universal cystoscopy at the time of benign hysterectomy has not been associated with a significant change in the intra-operative detection and rates of LUTI at our institution.
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Affiliation(s)
- Xin Yu Foo
- Women's and Families Services, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Rachael Nugent
- Women's and Families Services, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
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6
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Seed E, Kearney L, Weaver E, Ryan EG, Nugent R. A prospective cohort study comparing neonatal outcomes of waterbirth and land birth in an Australian tertiary maternity unit. Aust N Z J Obstet Gynaecol 2023; 63:59-65. [PMID: 35796252 DOI: 10.1111/ajo.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maternal preference for warm water immersion (WWI) and waterbirth is increasing, but adoption into obstetric guidelines and clinical practice remains limited. Concerns regarding safety and a paucity of evidence have been cited as reasons for the limited adoption and uptake. AIM The aim was to investigate maternal and neonatal outcomes after WWI and/or waterbirth compared with land birth. MATERIALS AND METHODS A prospective cohort study was conducted in an Australian public maternity hospital between 2019 and 2020. Maternal and neonatal outcomes for 1665 women who had a vaginal birth were studied. Primary outcome was admission to the neonatal unit (NNU). Secondary outcomes included neonatal antibiotic administration, maternal intrapartum fever, epidural use and perineal injury. Multivariate logistical regression analyses compared the outcomes between three groups: waterbirth, WWI only and land birth. RESULTS NNU admissions for a suspected infectious condition were significantly higher in the land birth group (P = 0.035). After accounting for labour duration, epidural use and previous birth mode, no significant difference was detected between groups in the odds of NNU admission (P = 0.167). No babies were admitted to NNU with water inhalation or drowning. Women birthing on land were more likely to be febrile (2 vs 0%; P = 0.007); obstetric anal sphincter injury and postpartum haemorrhage were similar between groups. Regional analgesia use was significantly lower in the WWI group compared to the land birth group (21.02 vs 38.58%; P = <0.001). There was one cord avulsion in the waterbirth group (0.41%). CONCLUSION Maternal and neonatal outcomes were similar between groups, with no increased risk evident in the waterbirth and WWI groups.
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Affiliation(s)
- Emma Seed
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Lauren Kearney
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia.,University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Elizabeth G Ryan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.,University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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7
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Wojcik N, Watkins L, Nugent R. Patient acceptability, continuation and complication rates with immediate postpartum levonorgestrel intrauterine device insertion at caesarean section and vaginal birth. Aust N Z J Obstet Gynaecol 2022; 62:773-778. [PMID: 35451065 PMCID: PMC9790316 DOI: 10.1111/ajo.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/05/2022] [Accepted: 04/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Immediate postpartum long-acting reversible contraception (LARC) has been shown to reduce unintended pregnancy but uptake of this type of contraception in Australia is low compared to European counterparts. AIMS To assess self-reported continuation rates, complications and satisfaction in patients having immediate postpartum hormonal intrauterine device (IUD) inserted at caesarean section (CS) or after vaginal birth (VB). MATERIALS AND METHODS Retrospective cohort study of all patients with immediate postpartum hormonal IUD insertion over three years at a tertiary maternity service. Primary outcomes were patient satisfaction, continuation and expulsion rates. Secondary outcomes were reason for discontinuation, patient-reported complications, attendance for postpartum check with a general practitioner (GP) and rate of unplanned pregnancy. Simple descriptive statistics were used to analyse the data. RESULTS One hundred and ninety-three women had a hormonal IUD inserted and 143 consented to involvement (CS n = 79; VB n = 64). Six and 12 months continuation rates for CS were 60.8% and 54.4%, and VB were 46.9% and 39.1%. The most common reasons for removal were: pain (34.5%), heavy or irregular bleeding (25.9%) and partial expulsion (24.1%). Expulsion was more likely after VB (34.1%) than CS (10.1%), (odds ratio 2.72; 95% CI 1.07-6.90; P = 0.036). There were 60.8% of women post-CS and 56.3% of women post-VB who were satisfied with their decision to have immediate postpartum insertion and most women attended routine postpartum follow-up with their GP (89.5%). CONCLUSION Immediate postpartum hormonal IUD insertion in this cohort is associated with higher rates of expulsion and lower satisfaction rates compared to those documented in the literature for delayed postpartum insertion cohorts.
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Affiliation(s)
- Natasha Wojcik
- Department of Obstetrics and GynaecologySunshine Coast University Hospital and Health ServiceSunshine CoastQueenslandAustralia
| | - Leah Watkins
- Department of Obstetrics and GynaecologySunshine Coast University Hospital and Health ServiceSunshine CoastQueenslandAustralia
| | - Rachael Nugent
- University of the Sunshine CoastSunshine CoastQueenslandAustralia
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Gaupp F, Ruggeri Laderchi C, Lotze-Campen H, DeClerck F, Bodirsky BL, Lowder S, Popp A, Kanbur R, Edenhofer O, Nugent R, Fanzo J, Dietz S, Nordhagen S, Fan S. Food system development pathways for healthy, nature-positive and inclusive food systems. Nat Food 2021; 2:928-934. [PMID: 37118243 DOI: 10.1038/s43016-021-00421-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/02/2021] [Indexed: 04/30/2023]
Abstract
Sustainable food systems require the integration of and alignment between recommendations for food and land use practices, as well as an understanding of the political economy context and identification of entry points for change. We propose a food systems transformation framework that takes these elements into account and links long-term goals with short-term measures and policies, ultimately guiding the decomposition of transformation pathways into concrete steps. Taking the transition to healthier and more sustainable diets as an example, we underscore the centrality of social inclusion to the food systems transformation debate.
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Affiliation(s)
- F Gaupp
- EAT, Oslo, Norway.
- Potsdam Institute for Climate Impact Research, Potsdam, Germany.
| | | | - H Lotze-Campen
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Humboldt-Universität zu Berlin, Berlin, Germany
| | - F DeClerck
- EAT, Oslo, Norway
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - B L Bodirsky
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - S Lowder
- Food and Land Use Coalition, London, UK
- SYSTEMIQ, London, UK
| | - A Popp
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - R Kanbur
- Cornell University, Ithaca, NY, USA
| | - O Edenhofer
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - R Nugent
- RTI International, Seattle, WA, USA
| | - J Fanzo
- Johns Hopkins University, Baltimore, MD, USA
| | - S Dietz
- London School of Economics, London, UK
| | | | - S Fan
- China Agricultural University, Beijing, China
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Jenkinson B, Kearney L, Kynn M, Reed R, Nugent R, Toohill J, Bogossian F. Validating a scale to measure respectful maternity care in Australia: Challenges and recommendations. Midwifery 2021; 103:103090. [PMID: 34332313 DOI: 10.1016/j.midw.2021.103090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/27/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Respectful maternity care is a pervasive human rights issue, but little is known about its realisation in Australia. Two scales, developed in North America, measure key aspects of respectful maternity care: the Mothers on Respect Index and Mothers Autonomy in Decision Making scale. This study aimed to validate these two scales in Queensland, Australia, and to determine the extent to which women currently experience respectful maternity care and autonomy in decision making. DESIGN A sequential two-phase study. A focus group reviewed the scales, made adaptations to scale items and completed a Content Validation Survey. The Respectful Maternity Care in Queensland survey, comprising the validated Australian scales and demographic questions was distributed online in early 2020. SETTING Queensland, Australia. PARTICIPANTS Focus group involved women (n=10) who were aged over 18, English-speaking, and had given birth during the preceding two years. All women who had birthed in Queensland between September 2019 and February 2020, were eligible to participate in the cross-sectional survey. 161 women participated in the survey. MEASUREMENTS AND FINDINGS Item content validity (>0.78) was established for all but one item. Scale content validity was established for both scales (0.92 and 0.99 respectively). Survey participants (n= 161) were mostly married/partnered (95%), heterosexual (93%), tertiary educated (47%), Caucasian (88%), and had experienced a range of maternity models of care. Median scores on each scale (74 and 26 respectively) indicated that participants felt well respected and highly autonomous. Free-text comments highlighted the importance of relationship-based care. KEY CONCLUSIONS Both scales appear valid for use in Australia. Although most participants reported high levels of respect and autonomy, the proportion of participants who had experienced continuity of midwifery care was also high. IMPLICATIONS FOR PRACTICE Both scales could be routinely deployed as patient reported experience measures in Australia, broadening the data that informs maternity service planning and delivery.
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Affiliation(s)
- Bec Jenkinson
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia; The University of Queensland, Australia
| | - Lauren Kearney
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia; Sunshine Coast Health Institute, Australia.
| | - Mary Kynn
- University of Aberdeen, United Kingdom
| | - Rachel Reed
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Rachael Nugent
- Sunshine Coast Health Institute, Australia; The Sunshine Coast University Hospital, Queensland, Australia
| | - Jocelyn Toohill
- Office of the Chief Nursing and Midwifery Officer, Department of Health, Queensland, Australia
| | - Fiona Bogossian
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia; The University of Queensland, Australia; Sunshine Coast Health Institute, Australia
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Kearney L, Craswell A, Massey D, Marsh N, Nugent R, Alexander C, Smitheram C, McLoughlin A, Ullman A. Peripheral intravenous catheter management in childbirth (PICMIC): A multi-centre, prospective cohort study. J Adv Nurs 2021; 77:4451-4458. [PMID: 34118163 DOI: 10.1111/jan.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/06/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter; however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision-making during insertion and perceptions of women. METHODS This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non-participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time. RESULTS Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18-gauge catheter was considered more painful than a 16-gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18-gauge catheters mostly in hand or wrist (66%). Decision-making about site, catheter gauge, dressing and attempts varied. Thirty-four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non-dominant arm as key reasons for the location of PIVC. CONCLUSIONS Regular use of a large-gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia.,Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Debbie Massey
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Nicole Marsh
- Royal Brisbane Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Rachael Nugent
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Catherine Alexander
- Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, QLD, Australia
| | - Carmel Smitheram
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Anthea McLoughlin
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, QLD, Australia.,Children's Health Queensland, Brisbane, QLD, Australia
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Nelson P, Nugent R. The association between sonographic fetal head circumference, obstetric anal sphincter injury and mode of delivery: A retrospective cohort study. Aust N Z J Obstet Gynaecol 2021; 61:722-727. [PMID: 33783831 DOI: 10.1111/ajo.13342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 02/28/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is no consensus to the implications of an increased sonographic fetal head circumference (HC) and its impact on delivery. AIM To examine if there is any association between sonographic fetal HC, obstetric anal sphincter injury (OASIS) and mode of delivery. MATERIALS AND METHODS A retrospective cohort study of term, singleton births between April 2017 and March 2019 at a large regional hospital in Australia with a third trimester ultrasound. Logistic regressions were performed investigating sonographic fetal HC and additional risk factors for OASIS. Further multinomial logistic regressions assessed the relationship between the sonographic HC and mode of delivery. Odds ratios and their 95% CIs were reported. RESULTS Of 667 eligible women, 487 (73%) had vaginal births, with 32 (6.6%) sustaining an OASIS and 180 (27%) had caesarean sections (CS). The sonographic fetal HC did not show an association with OASIS (odds ratio 1.005; CI 0.99-1.01, P = 0.447). A statistically significant association (P < 0.05) with OASIS was found with Asian ethnicity (4.38; 1.5-11.32), prolonged second stage (≥2 h) (4.26; 1.57-10.49) and occiput posterior position (4.01; 1.08-11.92). For women with a sonographic fetal HC ≥ 90th percentile, the odds of having CS compared to a spontaneous vaginal birth are 2.77 (95% CI: 1.36, 5.62; P = 0.005) times higher than those who have a HC < 90th percentile. CONCLUSION This study does not support the use of sonographic fetal HC in assessing a woman's risk of sustaining an OASIS. Sonographic fetal HC is associated with mode of delivery.
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Affiliation(s)
- Philippa Nelson
- Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
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Baxter H, Carter E, Marris K, Nugent R, Weaver E. Effect of surgeon volume on long-term quality of life outcomes following tension-free vaginal tape surgery. Int Urogynecol J 2021; 33:2099-2106. [PMID: 33760990 DOI: 10.1007/s00192-021-04714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/31/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The role of the general obstetrician/gynaecologist completing routine urogynaecology procedures is controversial, and some research has suggested that these patients should be referred to high-volume subspecialists. In response to recent public and regulatory scrutiny of vaginal mesh procedures, credentialling guidelines have been released in Australia requiring surgeons to demonstrate a minimum caseload prior to performing tension-free vaginal tape (TVT) surgery for incontinence. Hence, a retrospective cohort study was conducted to evaluate the long-term quality of life outcomes of TVT procedures for high- and low-volume surgeons. METHODS One hundred seventy patients who had undergone TVT surgery between 1 May 2011 and 1 May 2016 in the Sunshine Coast health district were invited to complete the UDI-6 (Urinary Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) surveys. Perioperative information was accessed from available health records. Mean UDI-6 and IIQ-7 scores were compared for high- and low-volume groups, and the groups were assessed for confounding factors. RESULTS Of the 170 patients eligible, 83 completed the surveys (47.2%). No differences in UDI-6 or IIQ-7 scores were found between high- and low-volume surgeons (p > 0.05). High-volume surgeons completed more concomitant procedures amongst survey respondents (p < 0.05), though this was not reproduced when considering all 170 patients eligible for the study. There were no significant differences in age, ASA (American Society of Anaesthesiologists) score or complication rate amongst survey respondents. CONCLUSIONS Amongst the patients surveyed, high- and low-volume surgeons had similar long-term quality of life outcomes for TVT surgery, without any significant difference in complication rate.
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Affiliation(s)
- Harold Baxter
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
| | - Edward Carter
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Kelsi Marris
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
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Watkins L, Kearney L, Kynn M, Hodgman C, Nugent R. Implementation of a guideline of early administration of tranexamic acid for severe primary postpartum haemorrhage: a retrospective comparative study. Aust N Z J Obstet Gynaecol 2020; 61:354-359. [PMID: 33350456 DOI: 10.1111/ajo.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since the WOMAN trial, intravenous tranexamic acid (TXA) has been increasingly used in severe postpartum haemorrhage (PPH) but research evaluating use in high-income settings is limited. AIMS To assess whether implementation of a new guideline involving early administration of 1 g intravenous TXA in active PPH with blood loss ≥ 1000 mL, was associated with a change in maternal morbidity. MATERIALS AND METHODS Retrospective study of all singleton, term, vaginal births from November 2016 to June 2019 with a PPH of ≥1000 mL, before and after hospital adoption of a guideline recommending early (within three hours of birth) administration of TXA for women with active PPH ≥ 1000 mL. Univariate analysis assessed the impact of this guideline implementation on a primary outcome of maternal morbidity, defined as one or more of haemoglobin < 90 g/L, administration of blood products, hysterectomy or intensive care admission. Secondary outcomes were adverse events related to administration of TXA, use of an intrauterine balloon or postpartum iron infusion. RESULTS There was no difference in morbidity (odds ratio (OR) 0.86, 95% CI 0.57-1.29, P = 0.46) or postpartum iron infusion (OR 1.44, 95% CI 0.92-2.27, P = 0.11), but there was a reduction in the use of intrauterine balloon tamponade after the implementation of the TXA guideline (OR 0.33, 95% CI 0.16-0.67, P < 0.01). CONCLUSIONS This retrospective analysis showed a reduced use of intrauterine balloon but failed to show a benefit in maternal morbidity with early administration of TXA for severe postpartum haemorrhage in a high-income setting.
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Affiliation(s)
- Leah Watkins
- Queensland Health, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Lauren Kearney
- Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Mary Kynn
- University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Caitlin Hodgman
- Queensland Health, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Rachael Nugent
- Queensland Health, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
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Little J, Nugent R, Vangaveti V. Influence of maternal obesity on Bishop Score and failed induction of labour: A retrospective cohort study in a regional tertiary centre. Aust N Z J Obstet Gynaecol 2018; 59:243-250. [PMID: 29797415 DOI: 10.1111/ajo.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/24/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maternal obesity is a growing health concern that has previously been associated with increased need for induction of labour (IOL) and caesarean section (CS) rates. Currently, limited evidence explores the influence of maternal body mass index (BMI) on Bishop Score (BS) and outcome of IOL. This study hypothesises that maternal obesity will lead to a lower BS at presentation, higher rates of failed IOL, and increased CS rates. AIMS To explore the influence of maternal obesity on BS and likelihood of failed IOL. METHODS A retrospective cohort analysis was conducted of all live, term, singleton, cephalic deliveries initiated with IOL across normal BMI (18.00-24.99), overweight BMI (25.00-29.99), and obese BMI (>30.00) at the Townsville Hospital and Health Service (THHS) between July 2011 to June 2016. Student's t-test, χ2 test, and binary logistic regression were used for statistical analysis. BS and failed IOL, defined as CS with cervical dilatation <3 cm, were the primary outcome measures. Delivery mode was the secondary outcome measure. RESULTS A total of 1543 women were included, 678 with normal BMI, 370 with overweight BMI, and 495 with obese BMI. Obese women are more likely to have a low BS (<5) at presentation (unadjusted odds ratio (OR) 1.5 (1.1-2.0), P < 0.05), an increased rate of failed IOL (adjusted OR (aOR) 1.6 (1.0-2.5), P < 0.05) and increased CS rate (aOR 1.1 (1.0-1.9), P < 0.05), compared to normal weight women. CONCLUSIONS Maternal obesity is associated with a lower BS, more difficult IOL process, and increased risk of failed IOL and CS.
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Affiliation(s)
- Jessica Little
- Department of Obstetrics & Gynaecology, Logan Hospital, Meadowbrook, Queensland, Australia.,Department of Obstetrics & Gynaecology, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Rachael Nugent
- Department of Obstetrics & Gynaecology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,Department of Obstetrics & Gynaecology, The Townsville Hospital, Douglas, Queensland, Australia
| | - Venkat Vangaveti
- School of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
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15
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Nugent R, de Costa C, Vangaveti V. Caesarean risk in obese women at term: A retrospective cohort analysis. Aust N Z J Obstet Gynaecol 2017; 57:440-445. [PMID: 28338231 DOI: 10.1111/ajo.12616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity in pregnancy is a growing health problem conferring higher risk to both the woman and her infant. Internationally, peak bodies offer little guidance regarding the method and timing of delivery in these patients. Our hypothesis is that induction of labour (IOL) at term will not increase the caesarean section (CS) rate when compared to expectant management. AIMS To compare perinatal outcomes between IOL and expectant management in obese women at term. METHODS A retrospective cohort study of all term, singleton, vertex deliveries at the Townsville Hospital and Health Service from January 2011 to June 2015 in women with a body mass index (BMI) ≥ 35. Women undergoing IOL at 37 weeks were compared with women expectantly managed at that gestational age. Similar comparisons were made at 38, 39 and 40 weeks. χ2 tests and binary logistic regression were used for statistical comparison. The primary outcome measure was mode of delivery, with secondary measures of perinatal morbidity also considered. RESULTS There was no difference in outcome of CS, or other maternal secondary outcomes. There was no difference in rates of neonatal nursery admission. Expectant management at 38 weeks was associated with lower odds of post-partum haemorrhage (odds ratio 0.371; 95% confidence interval 0.163-0.845). CONCLUSIONS In women with a BMI ≥ 35, IOL does not affect the CS rate, or the risk of neonatal adverse events, but may increase the rate of postpartum haemorrhage when compared with expectant management.
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Affiliation(s)
- Rachael Nugent
- Department of Obstetrics and Gynaecology, The Townsville Hospital, Douglas, Queensland, Australia
| | - Caroline de Costa
- Department of Obstetrics and Gynaecology, James Cook University, College of Medicine, Cairns Clinical School, Cairns Hospital, Cairns City, Queensland, Australia
| | - Venkat Vangaveti
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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16
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Mofenson LM, Harris DR, Moye J, Bethel J, Korelitz J, Read JS, Nugent R, Meyer W. Alternatives to HIV-1 RNA concentration and CD4 count to predict mortality in HIV-1-infected children in resource-poor settings. Lancet 2003; 362:1625-7. [PMID: 14630444 DOI: 10.1016/s0140-6736(03)14825-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cheaper, simpler alternatives to CD4 lymphocyte count and HIV-1 RNA detection for assessing the prognosis of HIV-1 infection are needed for resource-poor settings. However, little is known about the predictive value of alternative assays, in particular in children. We assessed the prognostic value of total lymphocyte count, immune complex-dissociated p24 antigen, white blood cell count, packed-cell volume (haematocrit), and serum albumin for mortality in 376 HIV-1-infected, mainly African-American or Hispanic children enrolled during March, 1988 to January, 1991. In a Cox proportional hazards model, including all assay-alternatives to CD4 and RNA, total lymphocyte count (p<0.0001) and serum albumin (p=0.0107) independently predicted mortality. Further assessment of these markers is warranted in resource-poor settings.
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Boulevard, Rockville, MD 20852, USA.
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17
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Ulshafer P, Pandow M, Nugent R. Communications - Rauwolfia Alkaloids. XXVIII. The Isolation of Raujemidine, An Isomer of Reserpine, from R. canescens. J Org Chem 2002. [DOI: 10.1021/jo01114a024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Tse V, Lising J, Khadra M, Chiam Q, Nugent R, Yeaman L, Mulcahy M. Radiation exposure during fluoroscopy: should we be protecting our thyroids? Aust N Z J Surg 1999; 69:847-8. [PMID: 10613281 DOI: 10.1046/j.1440-1622.1999.01715.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent reports on thyroid cancer among Australian orthopaedic surgeons prompted the present study which sought to evaluate the effectiveness of lead shielding in reducing radiation exposure (RE) to the thyroid region during endo-urological procedures. METHODS Radiation exposure to the thyroid region of the surgeon and scrubbed nurse was monitored for 20 consecutive operations over a 6-week period by thermoluminescent dosimeters (TLD). A TLD was placed over and underneath a thyroid shield of 0.5 min lead equivalent thickness to monitor the effect of shielding. RESULTS Eight percutaneous nephrolithotomies, seven retrograde pyelograms and ureteric stentings and five ureteroscopies for calculous disease were monitored. Total exposure time was 63.1 min. For the surgeon, the total cumulative RE over and under the lead shield was 0.46 and 0.02 mSv, respectively, equating to a 23-times reduction in RE if shielding was used. This effectively reduced RE to almost background levels, which was represented by the control TLD exposure (0.01 mSv). CONCLUSION Although RE without thyroid shields did not exceed current standards set by radiation safety authorities, no threshold level has been set below which thyroid carcinogenesis is unlikely to occur. Because lead shields are easy to wear and can effectively reduce RE to the thyroid region to near-background levels, they should be made easily available and used by all surgeons to avoid the harmful effects of radiation on the thyroid.
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Affiliation(s)
- V Tse
- Department of Urology, Canberra Hospital, Garran, Australian Capital Territories, Australia.
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19
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Stiehm ER, Lambert JS, Mofenson LM, Bethel J, Whitehouse J, Nugent R, Moye J, Glenn Fowler M, Mathieson BJ, Reichelderfer P, Nemo GJ, Korelitz J, Meyer WA, Sapan CV, Jimenez E, Gandia J, Scott G, O'Sullivan MJ, Kovacs A, Stek A, Shearer WT, Hammill H. Efficacy of zidovudine and human immunodeficiency virus (HIV) hyperimmune immunoglobulin for reducing perinatal HIV transmission from HIV-infected women with advanced disease: results of Pediatric AIDS Clinical Trials Group protocol 185. J Infect Dis 1999; 179:567-75. [PMID: 9952362 DOI: 10.1086/314637] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pediatric AIDS Clinical Trials Group protocol 185 evaluated whether zidovudine combined with human immunodeficiency virus (HIV) hyperimmune immunoglobulin (HIVIG) infusions administered monthly during pregnancy and to the neonate at birth would significantly lower perinatal HIV transmission compared with treatment with zidovudine and intravenous immunoglobulin (IVIG) without HIV antibody. Subjects had baseline CD4 cell counts </=500/microL (22% had counts <200/microL) and required zidovudine for maternal health (24% received zidovudine before pregnancy). Transmission was associated with lower maternal baseline CD4 cell count (odds ratio, 1.58 per 100-cell decrement; P=.005; 10.0% vs. 3.6% transmission for count <200 vs. >/=200/microL) but not with time of zidovudine initiation (5.6% vs. 4.8% if started before vs. during pregnancy; P=. 75). The Kaplan-Meier transmission rate for HIVIG recipients was 4. 1% (95% confidence interval, 1.5%-6.7%) and for IVIG recipients was 6.0% (2.8%-9.1%) (P=.36). The unexpectedly low transmission confirmed that zidovudine prophylaxis is highly effective, even for women with advanced HIV disease and prior zidovudine therapy, although it limited the study's ability to address whether passive immunization diminishes perinatal transmission.
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Affiliation(s)
- E R Stiehm
- Department of Pediatrics, University of California at Los Angeles Medical Center, Los Angeles, CA 90095-1752, USA.
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20
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Mofenson LM, Yogev R, Korelitz J, Bethel J, Krasinski K, Moye J, Nugent R, Rigau-Perez JG. Characteristics of acute pneumonia in human immunodeficiency virus-infected children and association with long term mortality risk. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. Pediatr Infect Dis J 1998; 17:872-80. [PMID: 9802627 DOI: 10.1097/00006454-199810000-00005] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the epidemiologic, clinical, radiologic, laboratory and treatment characteristics of acute pneumonia and its association with mortality in HIV-infected children. METHODS Data were collected during a trial of intravenous immunoglobulin (IVIG) for infection prophylaxis (1988 to 1991); CD4+ percentage was measured and HIV RNA was assessed on stored sera collected at baseline and every 3 months. Mortality was recorded during the trial and updated through 1996. All reported physician-diagnosed pneumonia episodes underwent blinded review for trial endpoint classification as acute (new radiologic findings and presence of clinical symptoms) or nonacute. RESULTS On blinded clinical trial endpoint review of all reported pneumonia episodes (n = 281), only 47% were classified as acute. One hundred thirty-one episodes of acute pneumonia were reported in 93 children (47 in 31 IVIG and 84 in 62 placebo patients, P < 0.01). The incidence of acute pneumonia was 24 episodes per 100 patient years. Findings associated with an acute bacterial process were uncommon (leukocytosis > or =15000/mm3 in 21% and fever > or =103 degrees F in 32% of episodes). Multiple acute episodes occurred in 34% of the children and were associated with increased risk of mortality in a univariate analysis (risk ratio, 2.1; 95% confidence interval, 1.3 to 3.4, P = 0.002), but in a multivariate model only baseline HIV RNA copy number and CD4+ percentage remained independently associated with mortality (relative risk, 2.0 and 1.4, respectively, P < 0.001). CONCLUSION Acute pneumonia was a common occurrence in HIV-infected children and was associated with long term mortality risk. Multiple episodes of acute pneumonia likely represent a marker of progressive disease and immunologic dysfunction rather than being causally associated with increased long term mortality.
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA.
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21
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Cooper ER, Hanson C, Diaz C, Mendez H, Abboud R, Nugent R, Pitt J, Rich K, Rodriguez EM, Smeriglio V. Encephalopathy and progression of human immunodeficiency virus disease in a cohort of children with perinatally acquired human immunodeficiency virus infection. Women and Infants Transmission Study Group. J Pediatr 1998; 132:808-12. [PMID: 9602190 DOI: 10.1016/s0022-3476(98)70308-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the incidence, predictors, and survival of children with human immunodeficiency virus (HIV) encephalopathy followed in the Women and Infants Transmission Study cohort. STUDY DESIGN Retrospective review of clinical and immunologic staging of perinatally HIV-infected infants, based on the 1994 Centers for Disease Control and Prevention Classification System. RESULTS Data were available for 128 HIV-infected children, with a median follow-up of 24 months. HIV encephalopathy was diagnosed in 27 (21%) of children. Median survival after diagnosis was 14 months. Of children with encephalopathy, 74% had at least moderate immunosuppression by the time of diagnosis. Encephalopathy represented the first acquired immunodeficiency syndrome-defining condition in 67%, and the only one in 26% of children. Hepatosplenomegaly or lymphadenopathy during the first 3 months of life was diagnosed in 63%, in contrast to 29% of those without encephalopathy (p value = 0.001). Cardiomyopathy was present in 30% of the children with encephalopathy versus 2% of those without encephalopathy. High viral load in infancy was associated with increased risk of encephalopathy but was not predictive of age at onset. CONCLUSIONS Encephalopathy in children with HIV is common and is associated with high viral load, immunodeficiency, and shortened survival. Encephalopathy was more likely to develop in infants with early signs and symptoms of HIV, although age at onset could not be predicted.
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Affiliation(s)
- E R Cooper
- Boston University School of Medicine, Massachusetts, USA
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22
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Mofenson LM, Korelitz J, Meyer WA, Bethel J, Rich K, Pahwa S, Moye J, Nugent R, Read J. The relationship between serum human immunodeficiency virus type 1 (HIV-1) RNA level, CD4 lymphocyte percent, and long-term mortality risk in HIV-1-infected children. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. J Infect Dis 1997; 175:1029-38. [PMID: 9129063 DOI: 10.1086/516441] [Citation(s) in RCA: 155] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Association of human immunodeficiency virus type 1 (HIV-1) RNA level, CD4 cell percent, and mortality was examined in stored sera from 254 infected children in an intravenous immunoglobulin infection prophylaxis trial. Ninety-two children (36.2%) died (41 during the study, 51 during long-term follow-up). The geometric mean baseline HIV-1 RNA level was 104,626 copies/mL, and the mean CD4 cell percent was 25%. Relative risk of death (RR) was 2.1 if the baseline RNA level was >100,000 copies/mL (95% confidence interval [CI], 1.4-3.0) and was 3.0 if the baseline CD4 cell percent was <15% (95% CI, 2.2-4.0). If RNA levels increased after baseline, the RR was 1.8 (95% CI, 1.3-2.6), and if the CD4 cell percent dropped to <15%, the RR was 2.8 (95% CI, 1.6-4.9). In a multivariate model, both baseline RNA level and CD4 cell percent were independently associated with mortality risk. In a time-dependent model, the RR per log10 increase in HIV-1 RNA copy numbers was 2.8 (95% CI, 2.1-3.6) and per 5 percentage point decrement in CD4 cell percent was 1.3 (95% CI, 1.2-1.5). Both variables should be considered for in decision-making regarding therapy and evaluation of antiretroviral response.
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA
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23
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Goldenberg RL, Klebanoff MA, Nugent R, Krohn MA, Hillier S, Andrews WW. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol 1996; 174:1618-21. [PMID: 9065140 DOI: 10.1016/s0002-9378(96)70617-8] [Citation(s) in RCA: 165] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our purpose was determine whether there are ethnic differences in vaginal colonization with organisms reputed to be associated with preterm delivery. STUDY DESIGN In seven urban medical centers in the United States from 1984 to 1989, 13,747 predominantly low-socioeconomic-status women at 23 to 26 weeks' gestation were grouped according to ethnic origin. Each had a vaginal culture for multiple organisms and Gram's stain and pH test to diagnose bacterial vaginosis. Multivariate analyses with adjustment for maternal age, insurance status, marital status, smoking history, education level, age at first sexual intercourse, and number of male partners in the past year were also performed to determine the odds ratio for a black woman versus a white woman having a positive test result. RESULTS For nearly every organism studied, Asian-Pacific Islander and white women had the lowest percentages of positive test results whereas black women had the highest. When black and white women are compared, black women were more likely to be colonized with Chlamydia trachomatis, 16% versus 5%; Neisseria gonorrhoeae, 2.5% versus 0.4%; Bacteroides sp., 25% versus 14%; bacterial vaginosis, 23% versus 9%; and the four other organisms evaluated. Adjustment for potential confounders including certain health behaviors did not markedly change the risk of a black woman having a positive test result, with the odds ratios for colonization with each organism ranging from 1.8 to 6.4. CONCLUSIONS Highly significant differences exist in vaginal colonization patterns among women of different ethnic groups, with the highest rates of potentially pathogenic organisms observed in black women and the lowest in Asian-Pacific Islander women. Differences in health behaviors do not explain the variation in colonization rates.
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Affiliation(s)
- R L Goldenberg
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA
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24
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Mofenson LM, Korelitz J, Pelton S, Moye J, Nugent R, Bethel J. Sinusitis in children infected with human immunodeficiency virus: clinical characteristics, risk factors, and prophylaxis. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. Clin Infect Dis 1995; 21:1175-81. [PMID: 8589139 DOI: 10.1093/clinids/21.5.1175] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The clinical presentation, radiological and laboratory evaluation, treatment, and risk factors of sinusitis in a cohort of 376 human immunodeficiency virus (HIV)-infected children from a placebo-controlled clinical trial of intravenous immunoglobulin (IVIG) as prophylaxis for infections were examined. Ninety-five episodes of sinusitis were described in 60 patients; one-third of the patients had two or more episodes. Sinusitis episodes were commonly associated with nonspecific, chronic symptoms (67.4%, persistent nasal discharge; 54.7%, nocturnal or persistent cough), whereas symptoms more specific to acute sinusitis were less frequent (17.9%, headache or facial pain; 9.5%, periorbital swelling; 25.3%, temperature of > or = 102 degrees F; 9%, total white blood cell count of > or = 15,000/mm3). The sinuses primarily involved were the maxillary sinus (85.9%) and the ethmoidal sinus (42.3%); 36% of episodes involved two or more sinuses. Preceding respiratory infections did not appear to increase the risk of sinusitis, and CD4+ lymphocyte counts in children with and without sinusitis did not differ. Neither monthly IVIG prophylaxis nor three times weekly trimethoprimsulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia decreased the risk of sinusitis. Sinusitis in HIV-infected children is most often subacute and recurrent. Evaluations of new modalities for prophylaxis for sinusitis are needed.
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-7510, USA
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Shinotoh H, Snow BJ, Hewitt KA, Pate BD, Doudet D, Nugent R, Perl DP, Olanow W, Calne DB. MRI and PET studies of manganese-intoxicated monkeys. Neurology 1995; 45:1199-204. [PMID: 7783889 DOI: 10.1212/wnl.45.6.1199] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Using MRI and PET, we investigated the consequences of manganese intoxication in a primate model of parkinsonism and dystonia. Three rhesus monkeys were injected intravenously with doses of 10 to 14 mg/kg of MnCl2 on seven occasions, each a week apart. Two animals became hypoactive with abnormal extended posturing in the hind limbs. These motor disturbances did not improve with administration of levodopa. In all three monkeys, T1-weighted MRI demonstrated high signal intensities in the regions of the striatum, globus pallidus, and substantia nigra. No significant changes were found on [18F]6-fluoro-L-dopa, [11C]raclopride, or [18F]fluorodeoxyglucose PET. These results are consistent with the pathologic findings, which were primarily confined to the globus pallidus, and indicate that manganese intoxication is associated with preservation of the nigrostriatal dopaminergic pathway, despite clinical evidence of parkinsonian deficits. Chronic manganese intoxication may cause parkinsonism by damaging output pathways downstream to the nigrostriatal dopaminergic pathway. This is consistent with the demonstrated lack of therapeutic response to levodopa.
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Affiliation(s)
- H Shinotoh
- Neurodegenerative Disorders Centre, University of British Columbia, Vancouver, Canada
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Mofenson LM, Moye J, Korelitz J, Bethel J, Hirschhorn R, Nugent R. Crossover of placebo patients to intravenous immunoglobulin confirms efficacy for prophylaxis of bacterial infections and reduction of hospitalizations in human immunodeficiency virus-infected children. The National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. Pediatr Infect Dis J 1994; 13:477-84. [PMID: 8078734 DOI: 10.1097/00006454-199406000-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
After completion of a placebo-controlled trial of intravenous immunoglobulin (IVIG) infection prophylaxis, patients were offered open label IVIG and optional participation in a follow-up study. The purpose of the follow-up study was to evaluate the IVIG effect in original placebo recipients and longevity of IVIG benefit in original IVIG recipients. Of 212 human immunodeficiency virus-infected children on study at trial closure, 148 (67 of 98 (68%) placebo and 81 of 114 (71%) IVIG patients) received open label IVIG for a mean of 16 months. When open label IVIG was begun, 45% were receiving trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia (43% of placebo and 47% of IVIG patients) and 54% were receiving zidovudine (55% of placebo and 53% of IVIG patients). In patients who received placebo during the original study, the rate of serious bacterial infections was significantly lower after change to open label IVIG (estimated 15.8 fewer episodes/100 patient years; 95% confidence interval, 3.2 to 28.5; P = 0.014). Similar findings were observed for minor bacterial infections (estimated 61.2 fewer/100 patient years; 95% confidence interval, 29.2 to 93.3; P < 0.001) and hospitalizations (estimated 43.7 fewer/100 patient years; 95% confidence interval, 27.7 to 59.6; P < 0.001). Decreases were observed whether or not trimethoprim-sulfamethoxazole prophylaxis was being given at the time open label IVIG was begun. In patients who received IVIG during the original study, no significant difference was seen in infections or hospitalizations after change to open label IVIG.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852
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Mofenson LM, Bethel J, Moye J, Flyer P, Nugent R. Effect of intravenous immunoglobulin (IVIG) on CD4+ lymphocyte decline in HIV-infected children in a clinical trial of IVIG infection prophylaxis. The National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. J Acquir Immune Defic Syndr (1988) 1993; 6:1103-13. [PMID: 8105072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Our objective was to evaluate the effect of intravenous immunoglobulin (IVIG) on absolute CD4+ lymphocyte count (CD4+ count) trends in human immunodeficiency virus- (HIV) infected children enrolled in a trial of IVIG for infection prophylaxis. To that end, we conducted a randomized, double-blind, outpatient trial comparing subjects treated with 400 mg per kilogram of IVIG every 28 days with those given 0.1% albumin placebo. CD4+ counts were measured at entry and every 12 weeks. Twenty-eight clinical centers in mainland United States and Puerto Rico participated. Previous reports showed IVIG efficacy for infection prophylaxis in 313 patients with entry CD4+ counts of > or = 0.20 x 10(9)/L (> or = 200/mm3). Two hundred and seventy-seven (89%) of these 313 children had three or more CD4+ counts measured during the trial and were included in evaluation of CD4+ count trends. Rates of CD4+ count decline, as measured by regression slopes, were compared between IVIG and placebo groups using generalized linear models, comparing unadjusted, age-adjusted, and standardized age-adjusted data. Potential covariate effects were assessed by modeling change in CD4+ count in terms of log change between successive measurements. Age-adjusted slope analysis showed slowing of CD4+ count decline by 13.5 cells/mm3 per month in IVIG compared with placebo recipients (95% confidence interval, 3.1-23.9, p = 0.012). Modeling log change between measurements documented a beneficial effect of IVIG that was cumulative over time and independent of other therapies. Occurrence of serious bacterial infection in the interval before CD4+ count measurement or death was independently associated with more rapid CD4+ count decline (p = 0.01 and p = 0.008, respectively). Zidovudine therapy was associated with a transient increase in CD4+ count. Benefits of IVIG include slowing of CD4+ count decline as well as previously reported reductions in serious and minor bacterial and viral infections in subjects with entry CD4+ counts of > or = 0.20 x 10(9)/L. This finding provides corroboration for the hypothesis that immunologic mechanisms contribute to the pathogenesis of CD4+ decline in HIV infection.
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Affiliation(s)
- L M Mofenson
- Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892
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Mofenson LM, Moye J, Bethel J, Hirschhorn R, Jordan C, Nugent R. Prophylactic intravenous immunoglobulin in HIV-infected children with CD4+ counts of 0.20 x 10(9)/L or more. Effect on viral, opportunistic, and bacterial infections. The National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. JAMA 1992; 268:483-8. [PMID: 1352363 DOI: 10.1001/jama.268.4.483] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the efficacy of intravenous immunoglobulin (IVIG) for prevention of viral, opportunistic, and minor bacterial infections in children infected with human immunodeficiency virus (HIV). DESIGN Randomized, double-blind, placebo-controlled, outpatient clinical trial comparing subjects treated with 400 mg of IVIG per kilogram of body weight every 28 days with those given albumin placebo. SETTING Twenty-eight clinical centers in mainland United States and Puerto Rico. PATIENTS Three hundred seventy-six children infected with human immunodeficiency virus with clinical or immunologic evidence of HIV disease, 313 of whom had entry CD4+ counts of at least 0.20 x 10(9)/L (greater than or equal to 200/mm3). MAIN OUTCOME MEASURES The incidence of laboratory-proven and clinically diagnosed viral, opportunistic, and bacterial infections. MAIN RESULTS Viral infections and minor bacterial infections contributed more frequently to morbidity in children with entry CD4+ counts of at least 0.20 x 10(9)/L (together over five times as frequent) than did serious bacterial infection, the primary outcome measure of the trial. Opportunistic infections occurred at a similar rate as laboratory-proven serious bacterial infections. In this group of children, IVIG was significantly associated with a decrease in the rate of viral infections and minor bacterial infections per 100 patient-years (36.0 vs 54.0 episodes of viral infection per 100 patient-years, IVIG vs placebo, P = .01; and 115.1 vs 159.7 episodes of minor bacterial infection per 100 patient-years, IVIG vs placebo, P = .02), as well as a decrease in the rate of serious bacterial infections per 100 patient-years (26.4 vs 48.2 episodes per 100 patient-years; P = .002). There was no apparent difference in the rate of opportunistic infections between treatment arms. CONCLUSIONS Beneficial effect of IVIG was seen across multiple infectious outcome measures, with reductions in serious and minor viral and bacterial infections observed in children with entry CD4+ counts of at least 0.20 x 10(9)/L.
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Affiliation(s)
- L M Mofenson
- Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md 20892
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Mofenson LM, Shearer WT, Moye J, Nugent R, Willoughby A. Manipulating the immune system with immune globulin. The National Institute of Child Health and Human Development. Intravenous Immunoglobulin Study Group. N Engl J Med 1992; 326:1636-7; author reply 1637-8. [PMID: 1584276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Affiliation(s)
- J T Mackie
- Department of Agriculture, Regional Veterinary Laboratory, Benalla, Victoria
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Repke JT, Berlin L, Spence M, Horn J, Niebyl J, Kanchanaraksa S, MacKenzie E, Nugent R, Polk BF. Reproducibility of the diagnosis of cervicitis in pregnancy. Am J Perinatol 1988; 5:242-6. [PMID: 3382483 DOI: 10.1055/s-2007-999695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cervicitis has been associated with several infections of the female genital tract. Criteria have been established for making the diagnosis of cervicitis in gynecologic populations but there are no well-established criteria for diagnosing cervicitis in obstetrical populations. Because of the association of the cervicitis and sexually transmitted diseases, and because of the association of sexually transmitted diseases and adverse pregnancy outcome, the present study was undertaken in an attempt to establish criteria for the diagnosis of cervicitis in pregnancy. We also attempted to determine the reproducibility of that diagnosis with respect to intra- and interobserver variability. We concluded that intraobserver variability is improved after specific training has been completed and that interobserver variability may be reduced to an acceptable level. On a public health scale, this may allow for identification of a population at high risk for adverse pregnancy outcome when sophisticated microbiologic techniques are unavailable.
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Affiliation(s)
- J T Repke
- Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Prior JC, Cox TA, Fairholm D, Kostashuk E, Nugent R. Testosterone-related exacerbation of a prolactin-producing macroadenoma: possible role for estrogen. J Clin Endocrinol Metab 1987; 64:391-4. [PMID: 3793856 DOI: 10.1210/jcem-64-2-391] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Men with PRL-producing macroadenomas often present with hypogonadism and impotence. This report documents exacerbation of a PRL-secreting tumor after two separate 200-mg testosterone enanthate (T) injections despite continued bromocriptine (BRC) therapy. A 37-yr-old man with a 60-mm invasive tumor and a serum PRL level of 13,969 +/- 332 ng/ml (mean +/- SD) responded to BRC therapy with rapid disappearance of visual field defect, headache, and facial pain as well as decrease in serum PRL to 5,103 +/- 1,446 ng/ml. T injection was followed by severe headache, facial pain, and increase in PRL to 13,471 ng/ml. Visual field deterioration and increased tumor size (height, 40-43 mm) by computed tomography were documented. A relationship between T injection and exacerbation of the prolactinoma was not recognized until after a second T injection 3 months later. After that therapy, baseline PRL increased from 6,900 to 12,995 ng/ml. The hypothesis that T was aromatized to estradiol, directly stimulating lactotrophs, was supported by an increase in serum estradiol from 24 to 51 pg/ml after the second T injection. Although T treatment is accepted as appropriate therapy for hypogonadism in men with prolactinomas, it may not only interfere with the response of the tumor to BRC therapy, but even stimulate tumor growth and secretion.
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Rootman J, Patel S, Berry K, Nugent R. Pathological and clinical study of Müller's muscle in Graves' ophthalmopathy. Can J Ophthalmol 1987; 22:32-6. [PMID: 3815153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Specimens of Müller's muscle from patients with Graves' disease were examined for evidence of morphologic, histochemical, immunohistochemical and electron microscopic changes. No scarring, significant inflammation or shared antigenicity between Müller's muscle and thyroglobulin-related antigens was found. There were moderate numbers of mast cells in 48 of 66 specimens. Computed tomography in 16 patients with Graves' ophthalmopathy showed enlargement of the superior rectus-levator complex in 17 of 28 orbits with lid retraction. However, no correlation was found between the amount of lid retraction and the degree of enlargement of the muscle complex.
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Nugent R. Non-clinical staff enhance patient care. Health Care (Don Mills) 1983; 25:12-4. [PMID: 10267360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
The clinical presentation, investigative findings, classification, and management of 17 acute pseudotumors based on patterns of orbital involvement is presented. Acute pseudotumors developed over days to weeks and were dominated by pain, neuropraxia, and inflammatory clinical features. Five patterns of acute inflammatory pseudotumor were seen. Anterior and diffuse acute pseudotumors were characterized by manifestations of inflammation of the globe and orbit including pain, lid swelling, ptosis, diplopia, uveitis, papillitis, optic neuropathy, and exudative retinal detachment. Anterior or diffuse orbital infiltration was noted on computerized tomography (CT) and ultrasound. Lacrimal involvement was characterized by local pain, tenderness, lid swelling and inflammation, with CT and ultrasound confirming an anterior inflammatory mass. Posterior or apical involvement led to an early optic neuropathy, and myositic lesions were characterized by features of muscle infiltration. Management with steroids was effective and could be followed by serial CT studies.
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Siegel E, Gillings D, Guild P, Nugent R. Planning and evaluation of regionalized perinatal care: a rural example. Semin Perinatol 1977; 1:283-301. [PMID: 618133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Mongrel cats with experimental cryogenic brain lesions were treated with the carotenoid compound crocetin. It has been shown that crocetin increases the diffusion speed of oxygen through plasma, and should provide a net increase in available oxygen to the capillary endothelial cell. The treated group of animals showed a significant reduction in edema as compared to a comparable control group. It is suggested that oxygen availability is an important factor in vasogenic edema.
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Nugent R. Protective equipment in amateur sport. Can Fam Physician 1974; 20:73-76. [PMID: 20469059 PMCID: PMC2274142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Injuries in amateur sports can be markedly reduced if athletes can be persuaded to wear the proper equipment. Four major sports are reviewed, and an outline given of protective equipment for each, with a description of the commonest injuries for each sport. Fit and maintenance of equipment are stressed.
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Nugent R. Case of Chyluria Treated with Gallic Acid and Thymol. Ind Med Gaz 1891; 26:366. [PMID: 29000759 PMCID: PMC5150621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Nugent R. Case of Laryngismus Stridulus. Ind Med Gaz 1889; 24:142-143. [PMID: 29000193 PMCID: PMC5141780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- R. Nugent
- Assistant to the 1st Resident-Surgeon, Presidency General Hospital
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