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K F Schulz

Publications and source records attributed to K F Schulz.

108 records · Page 6Linked to original sources
PubMed1980

Delayed abortion in an area of easy accessibility.

Abortions performed late in pregnancy are associated with higher death and complication rates, are more expensive, and are emotionally more taxing for patients and staff than abortions performed early in pregnancy. To examine potential correlates of late abortion, we studied 1,066 women having abortions at two Washington, DC, abortion facilities. We found the following variables to be statistically significantly related to the gestational stage of pregnancy at the time a woman seeks an abortion: history of irregular periods, level of education, type and number of pregnancy symptoms volunteered, moral feelings of the women about abortion, confided suspicion of pregnancy to another person, knowledge of the legality of abortion, contraceptive use, pregnancy symptoms elicited by professional personnel, and length of time the sexual partner was known. Yet, these variables are responsible for only a small percentage of the problem, since much variation in gestational age was unexplained by our analysis. This result and the finding that most of the important determinants of delay were individually oriented factors strongly imply that the problem of late abortions is one that will not be greatly influenced by public health interventions.

Abortion Applicants↗
PubMed1980

Oxytocin augmentation of second-trimester abortion: safe or hazardous?

The role of oxytocin in augmenting the uterine activity of second-trimester instillation abortions is controversial. To evaluate the efficacy and safety of oxytocin augmentation, we studied 10,013 women who underwent hypertonic saline instillation procedures and 1,241 women who underwent prostaglandin F2a (PGF2a) instillation procedures in the United States in the period 1971 through 1975. Data were obtained through the Joint Program for the Study of Abortion under the auspices of the Center for Disease Control, a multi-center, prospective, cohort study. We found that concurrent administration of oxytocin was associated with a significantly shorter instillation-to-abortion time for hypertonic saline, but with a significantly longer time for PGF2a. For hypertonic saline, use of concurrent oxytocin did not affect either the success rate or the major complication rate; however, it did not affect the specific type of complication that occurred. For PGF2a, use of concurrent oxytocin was associated with a lower success rate and a higher major complication rate than when PGF2a was used alone; however, the relatively small number of observations and limitations in our study design may have affected our results. When we compared the 2 main abortifacients, even when we controlled for concurrent oxytocin augmentation, unaugmented PGF2a had higher major complication rates than hypertonic saline.

Abortion, Induced↗
PubMed1979

Local versus general anesthesia: which is safer for performing suction curettage abortions?

The relative safety of suction curettage abortions performed with either local or general anesthesia has not been clearly established. To compare the safety of these two anesthetic techniques, we studied 36,430 women who received local anesthetics and 17,725 who received general anesthetics for this operation in the United States from 1971 through 1975. The aggregated major complication rates for the two groups were similar, but there were significant differences between local and general anesthesia for specific complications and treatments. Local anesthesia was associated with higher rates of febrile and convulsive morbidity; however, general anesthesia was associated with higher rates of hemorrhage, cervical injury, and uterine perforation. Both anesthetic techniques appear to be safe, with similar degrees of overall safety, although each is associated with a different spectrum of complications.

Abdomen↗
PubMed1978

World Health Organization studies of prostaglandins versus saline as abortifacients. A reappraisal.

The World Health Organization (WHO) Task Force on the Use of Prostaglandins for the Regulation of Fertility has sponsored a series of randomized clinical trials and case-series investigations to assess the effectiveness and safety of prostaglandins as abortifacients. Our reanalysis of the WHO studies found the prostaglandins to be faster and more hazardour than hypertonic saline as intraamniotic abortifacients. Moreover, studies by the Center for Disease Control imply that dilatation and evacuation (D&E) may be more effective, safe, convenient, and inexpensive than prostaglandins for abortions after 12 weeks' gestation, especially in the 13- to 16-week interval. For gestations of greater than or equal to 17 weeks, the occurrence of live births in prostaglandin-induced abortions has produced serious legal and ethical problems in the United States. Until the effectiveness and safety of other prostaglandins regimen approach that of D&E, we feel that D&E should be the index of comparison against which newer methods of inducing abortion are tested.

Abortion, Induced↗
PubMed1978

Measles vaccine efficacy: influence of age at vaccination vs. duration of time since vaccination.

To evaluate the recent decision of the Advisory Committee on Immunization Practice to increase the recommended age for initial measles vaccination from 12 to 15 months, we carried out a case control study of vaccine failure in a recent measles epidemic. Compared to children vaccinated at ages 15 months or older, we found an increased risk of vaccine failure among those vaccinated at 12 to 14 months (relative risk = 19.2, 95% confidence interval = 4.6 to 80.1). In order to sort out the influence of age at vaccination from elapsed time since vaccination, we subjected the data to discriminant analysis. Age at vaccination subsumed all of the effect of duration of time since vaccination. Thus, we find no evidence of waning immunity over time.

Age Factors↗
PubMed1977

Mid-trimester abortion by dilatation and evacuation: a safe and practical alternative.

Abortions by dilatation and evacuation after the 12th menstrual week of pregnancy are said to be both hazardous and impractical. To evaluate this hypothesis, we compared the safety and feasibility of 6213 abortions by this means and 8662 induced by intra-amniotic instillation of saline during the 13th to the 20th week of pregnancy. Abortions by dilatation and evacuation had a lower rate for major complica-tions (0.69 vs. 1.78 per cent; P is less than 0.001) and lower rates for treatment of complications, including antibiotic administration (2.22 vs. 5.65 per cent; P is less than 0.001), blood transfusion (0.19 vs. 0.91 per cent; P is less than 0.001), and curettage or manual evacuation of the uterus (0.98 vs. 34.10 per cent; P is less than 0.001). Such abortions also had a lower rate for failure of the method to produced abortion (0.11 vs. 2.52 per cent; P is less than 0.001). Although large, randomized trials are required to determine the appropriate role of mid-trimester abortion by this means, this method appears safe and practical through the 20th week of pregnancy.

Abortion, Induced↗
PubMed1977

Methods of midtrimester abortion: which is safest?

In the United States, the three principal methods of abortion for patients at 13 or more menstrual weeks' gestation are intraamniotic instillation of saline or prostaglandin F2alpha (PGF2alpha) and dilatation and evacuation (D&E). The relative safety of these methods, however, has not been established. This report compares the three methods using data on 17467 abortions collected by the Joint Program for the Study of Abortion under the auspices of the Center for Disease Control (JPSA/CDC). Abortion by D&E was found to be significantly safer than abortion by saline instillatin (p less than 0.001), and abortion by saline instillation was significantly safer than by PGF2alpha (p less than 0.01). Moreover, midtrimester D&E is both safe and practical; it is a direct and rapid procedure which can be performed on an outpatient basis. Although PGF2alpha accelerated the time required for abortion, it also significantly increased serious morbidity.

Abortifacient Agents↗
PubMed1977

Midtrimester abortion by intraamniotic prostaglandin F2alpha. Safer than saline?

Published reports disagree on the risks of intraamniotic prostaglandin F2alpha (PGF2alpha) for midtrimester abortion. To evaluate the safety and efficacy of intraamniotic PGF2alpha, we compared 1241 PGF2alpha and 10,013 saline abortions performed during the 13th to the 24th menstrual week. The results were reported in the Joint Program for the Study of Abortion/CDC, a multicenter prospective study. PGF2alpha abortions required less time (P less than .001) but had higher rates of major complications (P less than .01), antibiotic and operative treatment of complications (P less than .001), and readmission to a hospital (P less than .001). These findings challenge the current contention that PGF2alpha is safer than saline as an abortifacient.

Abortifacient Agents↗
PubMedDate not supplied

Reducing classification errors in cohort studies: the approach and a practical application.

Classification errors of dependent variables can distort the results of observational studies. To reduce misclassification from our multicentre observational study of abortion complications, we extended the methodology of Lawrence and Greenwald for use in situations of unequal sample sizes and implemented both an office review and a field review. We reabstracted 424 reported complications and a random sample of 364 reported non-serious cases from 12 institutions participating in our study. In total, 30 per cent of the reported serious complications turned out to be misclassified: the office review detected 74 per cent of the total number of misclassifications with the remainder found in the field review. Because, with our particular data base, we estimated expending only 15 per cent of the total resources with our office effort, this represented the most cost-efficient approach to reducing classification errors. By eliminating the false positives from our study, we forced the specificity to 1.00 which produced both an unbiased estimate of the relative risk and an increase of 4 per cent to 63 per cent in the power of our study.

Abortion, Spontaneous↗
PubMedDate not supplied

Abortion utilization: does travel distance matter?

The further a woman must travel in order to obtain an abortion, the less likely she is to get one. Distance is especially disadvantageous to blacks, and most so to black teenagers. Distance discourages use among rural as well as urban women. Opening new clinics increases abortion use in nearby communities.

Abortion, Legal↗
PubMedDate not supplied

[Improving the quality of reports on randomized controlled trials. Recommendations of the CONSORT Study Group].

This summary corresponds to the translation into Spanish of the Special Communication published in the Journal of the American Medical Association in August 1996, along with the editorial published in the same issue "How to report Randomized Controlled Trials. The Consort Statement". It describes the Consolidated Standards for Preparation of Controlled Clinical Trials, prepared by a work group made up of members of the SORT Group and of the Asilomar Work Group, along with the director of a magazine and the author of the report on a clinical trial. The work was carried out by means of a Delphi process and the result was a check list and a process diagram. The check list is made up of 21 items that mainly refer to methods, results and discussions on the report of a controlled clinical trial, identifying the necessary information in order to be able to evaluate the internal and external value of the report, judging the improvement to be positive for the patient, the editors and the reviewers of the magazines.

Delphi Technique↗