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Elizabeth Shaw

Publications and source records attributed to Elizabeth Shaw.

11 recordsLinked to original sources
PubMed2007

Nine novel COL4A3 and COL4A4 mutations and polymorphisms identified in inherited membrane diseases.

Both thin basement membrane nephropathy (TBMN) and autosomal recessive Alport syndrome result from mutations in the COL4A3 and COL4A4 genes, and this study documents further mutations and polymorphisms in these genes. Thirteen unrelated children with TBMN and five individuals with autosomal recessive Alport syndrome were examined for mutations in the 52 exons of COL4A3 and the 47 coding exons of COL4A4 using single-stranded conformation polymorphism (SSCP) analysis. Amplicons producing different electrophoretic patterns were sequenced, and mutations were defined as variants that changed an amino acid but were not present in 50 non-hematuric normals. Three further novel mutations were identified. These were IVS 22-5 T>A in the COL4A3 gene in a consanguineous family with autosomal recessive Alport syndrome, and R1677C and R1682Q in the COL4A4 gene. In addition, six novel polymorphisms (G455G, I462I, G736G and IVS 38-8 G>A in COL4A3, and L658L and A1577A in COL4A4) were demonstrated.Many different COL4A3 and COL4A4 mutations cause TBMN and autosomal recessive Alport syndrome. The identification of polymorphisms in these genes is particularly important to enable diagnostic laboratories to distinguish mutations from uncommon normal variants.

Adolescent↗
PubMed2006

Self-sampling for group B streptococcus in women 35 to 37 weeks pregnant is accurate and acceptable: a randomized cross-over trial.

OBJECTIVE: In Canada, screening for group B Streptococcus (GBS) in pregnant women is recommended at 35 to 37 weeks' gestation. Since there is normally no other indication for pelvic examination at this stage of pregnancy, women may be more comfortable performing the test themselves. We assessed the accuracy of self- sampling versus clinician sampling for GBS and women's preference for each collection method. METHODS: Consecutive patients presenting between October 2003 and April 2005 to a maternity centre in Hamilton for their 35- to 37-week prenatal visit were randomly allocated to having vaginal-rectal swabs self-collected, and then collected by a clinician, or to having the swabs clinician-collected, and then self-collected. The main outcomes were prevalence of infection and sensitivity of the two methods. Other analyses compared women who refused participation in the study with those who participated, and preference for sampling method before and after conducting the tests. RESULTS: Of the 386 women approached, 330 (85.5%) agreed to participate. The prevalence of GBS was 17.0% (56/330) and 18.8% (62/330) in the self-obtained and clinician-obtained specimens respectively (difference =1.8%; 95% confidence intervals [CI] -2.0-6.0). Sensitivity was 87.5% (95% CI 77.0-93.8) and 96.9% (95% CI 88.7-99.8) for the self-obtained and clinician-obtained specimens respectively. Women who declined to participate in self-sampling were significantly more likely not to have completed high school and to prefer clinician sampling. Prior to testing, 79% of women preferred self-sampling or had no preference. Preference was unchanged for approximately two-thirds of women after sampling. CONCLUSION: Self-sampling for GBS is an accurate and acceptable alternative for the majority of pregnant women. Less-educated women may be hesitant to self-sample, and clinician sampling should remain an option.

Adult↗
PubMed2006

Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health.

BACKGROUND: Postpartum support is recommended to prevent infant and maternal morbidity. This review examined the published evidence of the effectiveness of postpartum support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of life, and maternal physical health. METHODS: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999 and was enhanced in 2003 and 2005. Studies were categorized based on the the above outcomes. Data were extracted in a systematic manner, and the quality of each study was reviewed. RESULTS: In the 1999 search, 9 studies met the inclusion criteria. The 2003 and 2005 searches identified 13 additional trials for a total of 22 trials. Universal postpartum support to unselected women at low risk did not result in statistically significant improvements for any outcomes examined. Educational visits to a pediatrician showed statistically significant improvements in maternal-infant parenting skills in low-income primiparous women. In women at high risk for family dysfunction and child abuse, nurse home visits combined with case conferencing produced a statistically significant improvement in home environment quality using the HOME (Home Observation for Measurement of the Environment) program. Similarly, in women at high risk for either family dysfunction or postpartum depression, home visitation or peer support, respectively, produced a statistically significant reduction in Edinburgh Postnatal Depression Scale scores (difference - 2.23, 95% CI -3.72 to -0.74, p= 0.004; and 15.0% vs 52.4%, OR 6.23, 95% CI 1.40 to 27.84, p= 0.01, respectively). Educational programs reduced repeat unplanned pregnancies (12.0% vs 28.3%, p= 0.003) and increased effective contraceptive use (RR 1.35, 95% CI 1.09 to 1.68, p= 0.007). Maternal satisfaction was higher with home visitation programs. CONCLUSIONS: No randomized controlled trial evidence was found to endorse universal provision of postpartum support to improve parenting, maternal mental health, maternal quality of life, or maternal physical health. There is some evidence that high-risk populations may benefit from postpartum support.

Adult↗
PubMed2005

Family medicine obstetrics. Collaborative interdisciplinary program for a declining resource.

PROBLEM BEING ADDRESSED: A continuing decline in the number of family physicians in Canada providing obstetric, and particularly intrapartum, care. OBJECTIVE OF PROGRAM: The Maternity Centre of Hamilton in Ontario was a pilot project initiated to help family physicians provide full obstetric care through a collaborative interdisciplinary model and shared call. PROGRAM DESCRIPTION: Eleven family physicians provided care in collaboration with a nurse practitioner and other health professionals. Women came from the Maternity Centre's own practices, community physicians, or agencies, or through self-referral. More than a quarter of the women were considered psychosocially high-risk patients. Key features of the program included interdisciplinary collaboration and information technology that supported prenatal and birth documentation. CONCLUSION: The program has helped family physicians, and even recruited some, to practise full obstetric care and has provided high-quality, accessible services to pregnant women. Physicians experienced increased jab and personal satisfaction, and patients were highly satisfied with the service.

Cooperative Behavior↗
PubMed2004

Systematic review of the literature on postpartum care: methodology and literature search results.

BACKGROUND: The postpartum period is a time for multiple clinical interventions. To date, no critical review of these interventions exists. This systematic review examined evidence for the effectiveness of postpartum interventions that have been reported in the literature. METHODS: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women that were conducted in North America, Europe, Australia, or New Zealand. The initial literature search was done in 1999, using postpartum content search terms, and was enhanced in 2003. In both years, bibliographic databases were searched from their inception. Studies were categorized into key topic areas. Data extraction forms were developed and completed for each study, and the quality of each study was systematically reviewed. Groups of studies in a topic area were reviewed together, and clinically relevant questions emanating from the studies were identified to determine whether the studies, alone or together, provided evidence to support the clinical intervention. RESULTS: In the 1999 search, of 671 studies identified, 140 studies were randomized controlled trials that met the selection criteria: 41 studies related to breastfeeding, 33 to postpartum perineal pain management, and 63 to 11 other key topic areas (Papanicolaou test, rubella immunization, contraception, postpartum support, early discharge, postpartum depression and anxiety, postpartum medical disorders, smoking cessation, nutrition supplements other than breastfeeding, effects of pelvic floor exercise, and effects of early newborn contact). The results of the systematic review of each topic will be summarized in separate papers as they are completed. CONCLUSIONS: This systematic search has identified key topic areas in postpartum care for which randomized controlled trials have been conducted. Our ultimate goal is to provide evidence-based guidelines on the use of routine postpartum interventions.

Breast Feeding↗
PubMed2004

Systematic review of the literature on postpartum care: selected contraception methods, postpartum Papanicolaou test, and rubella immunization.

BACKGROUND: The postpartum period is a time when many routine interventions are provided to mothers. This review examined the published evidence for the effectiveness of selected contraceptive methods, Papanicolaou (Pap) tests, and rubella immunization. METHODS: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999, and was enhanced in 2003. Studies were categorized and reviewed by topic areas. Data were extracted in a systematic method, and the quality of each study was reviewed. RESULTS: In the 1999 search, 140 studies were randomized controlled trials that met the selection criteria: 5 related to postpartum contraception, 1 to timing of the postpartum Pap test, and 2 to postpartum rubella immunization. In the 2003 searches, 1 additional study related to postpartum contraception was identified. From the published literature on selected contraceptive methods, the intrauterine devices examined were effective in preventing pregnancy and had comparable side effect profiles. No clear recommendation can be made because insertion timing was not randomized in the included trials. Although delaying the postpartum Pap smear until 8 weeks reduces the proportion of inflammatory smears, it is uncertain whether a Pap smear is of benefit to postpartum women. The RA 27/3 postpartum rubella vaccine appears to be more effective than the Cendehill vaccine, but a small proportion of women may develop acute and chronic joint manifestations. CONCLUSIONS: Some evidence is available to support selected postpartum contraceptive methods and the postpartum rubella vaccine, but data are lacking on the effectiveness and optimal timing of the postpartum Pap smear.

Contraception↗
PubMed2003

Prospective evaluation of colposcopic features in predicting cervical intraepithelial neoplasia: degree of acetowhite change most important.

OBJECTIVE.: To prospectively evaluate the contribution of three colposcopic features-degree of acetowhite change, blood vessel pattern, and lesion margin-to the diagnosis of cervical intraepithelial neoplasia. MATERIALS AND METHODS.: A total of 301 women, who participated in two randomized controlled trials and a cross-sectional study of human papillomavirus testing and who were referred to a regional colposcopy center, were studied. Women were examined by colposcopists, who prospectively scored all abnormal transformation zones using three features. The site with the highest score (the most abnormal site) was biopsied and histology reviewed by two pathologists. RESULTS.: In multivariate analysis, degree of acetowhite change was the only feature significantly associated with cervical intraepithelial neoplasia. CONCLUSIONS.: Grading lesion severity using degree of acetowhite change alone gave comparable results to grading using the three combined features.

Journal Article↗
PubMedDate not supplied

Pharmacoeconomic modeling of prior-authorization intervention for COX-2 specific inhibitors in a 3-tier copay plan.

OBJECTIVE: To determine from a health plan perspective the cost-effectiveness of cyclooxygenase-2 (COX-2) specific inhibitors, with and without a prior-authorization (PA) process. METHODS: A modeling exercise was employed, based on prescription drug claims for a managed care organization with 3.8 million health maintenance organization (HMO) and preferred provider organization (PPO) members. Drug claims revealed 96154 members (2.9% of the 3.3 million members with a pharmacy benefit) who received either one or more prescriptions for a COX-2 drug or a nonspecific nonsteroidal anti-inflammatory drug (NSAID). These patients were stratified into 2 groups for further analysis, those having a concurrent proton pump inhibitor (PPI) and those without a concurrent PPI. Decision analysis was used to estimate the cost-effectiveness of COX-2 therapy. Actual health plan drug claims data were used to determine utilization and prescribing patterns of nonspecific NSAIDs, COX-2 specific inhibitors, and PPIs. Results from the literature from 8 clinical trials were employed to determine the probability of a serious gastrointestinal (GI) event. Cost-effectiveness analysis (CEA) was used to determine the cost of each therapy, including the predicted cost to treat a serious GI event in a drug benefit design with PA versus a benefit design without PA. RESULTS: Cost-effectiveness analysis (CEA) showed that the cost per success no serious GI event) for Cox-2 specific inhibitors with PA was US dollars 278 versus US dollars 422 without PA. CONCLUSIONS: The one-year model predicted that costs associated with an increase in COX-2 utilization after removal of PA would exceed the costs to administer PA and treat NSAID-related serious GI events in the managed care population. Based upon this CEA, PA appears to be an effective tool to manage COX-2 pharmacy costs. Further examination of the medical claims would be useful to validate the assumed GI event rates with or without PA and to further demonstrate more definitively the value of a PA program for COX-2 drugs.

Anti-Inflammatory Agents, Non-Steroidal↗