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Biomedical subjects

R Brand

Publications and source records attributed to R Brand.

At least 73 records · Page 4Linked to original sources
PubMed1998

Vascular morbidity and mortality during long-term follow-up in claudicants selected for peripheral bypass surgery.

OBJECTIVES: To identify claudicants at high risk (and low risk) of late vascular morbidity and mortality after peripheral bypass surgery. DESIGN: Prospective cohort study with mean follow-up of 8.6 years. PATIENTS: One-hundred and fifty-five claudicants selected for peripheral bypass surgery. Only three patients were lost to follow-up. End points were major vascular events, additional interventions, all-cause mortality, and functional outcome. RESULTS: Major vascular events occurred in 59 patients. Life-table analysis revealed an annual risk increase of 3.5%. Strong predictors were hypertension (hazard ratio (HR) 2.7; 95% confidence interval (CI) 1.5-4.8), diabetes (HR 2.4; 95% CI 1.0-5.4) and cardiac disease (HR 2.2; 95% CI 1.2-4.0). Sixty patients needed additional interventions with a highest incidence (17%) in the first year, and thereafter 2.8% each year. None of the known risk factors were associated with an altered incidence of interventions. Approximately 3.5% of patients died per year compared with 2% per year in the control group. Prominent high-risk factors for mortality were cardiac disease (HR 3.3; 95% CI 1.8-6.0) and diabetes (HR 3.0; 95% CI 1.5-7.1). CONCLUSION: Major vascular events and additional interventions are common and serious in claudicants. However, it is possible to select low-risk patients in which peripheral bypass surgery is justified.

Arteriovenous Shunt, Surgical↗
PubMed1998

Evaluation of copolymers of polyethylene oxide and polybutylene terephthalate (polyactive): mechanical behaviour.

Polyether-polyester segmented block copolymers (Polyactive) on the basis of polybutylene terephthalate (PBT) and polyethylene oxide (PEO) were mechanically tested. Tensile strength and modulus of elasticity in compressive and tensile deformation were recorded according to ASTM standards. These tests were done in vitro under dry and wet conditions, and after 3, 9 and 25 wk subcutaneous implantation of these materials in goats. Strength and modulus of elasticity were higher with increased contents of PBT in the copolymers. After water uptake, the polymer displayed a lower strength and stiffness. Disintegration of the materials with 70% PEO content and dumb-bell shape was noted at 3 wk. Disintegration of the cylinders of the same material was seen after 25 wk implantation. Of the materials with 60% PEO content, only four of the five dumb-bells had disintegrated after 25 wk implantation. The in vivo test results of all other implants did not show a clinically relevant decrease of strength and stiffness with time after implantation of the copolymers in the goats. Mechanical behavior of the various copolymers seemed mainly determined by the amount and integrity of the PBT phase.

Journal Article↗
PubMed1998

Bone marrow transplantation in children: consequences for renal function shortly after and 1 year post-BMT.

The aim of this study was to investigate the effect of a bone marrow transplantation (BMT) on renal function in children. In a 5-year period, 142 children received a BMT at the Department of Pediatrics of the University Hospital Leiden. The study was performed retrospectively using the estimated glomerular filtration rate before and 1 year after BMT, and weekly measurements of serum creatinine during the first 3 months after BMT for assessment of renal function. Patient characteristics (sex, age, diagnosis), conditioning regimen, type of BMT, major complications (sepsis, veno-occlusive disease and graft-versus-host disease (GVHD)) and the use of nephrotoxic medication were listed. In the first 3 months after BMT 17 (12%) patients died, 13 from transplant-related complications other than renal failure and four from relapse of the disease. Forty-eight children (34%) had a period with acute renal insufficiency. A high pre-BMT serum creatinine, transplantation with either a non-HLA-identical related or a matched unrelated donor were risk factors for acute renal insufficiency after BMT. Sepsis and the use of intravenous vancomycin were risk factors for acute renal insufficiency only for patients with a high pre-BMT serum creatinine. GVHD seemed to have a beneficial effect on renal function of BMT recipients. One year after BMT a total of 35 (25%) patients had died, 16 from transplant-related complications and 19 from relapse of the disease; another 17 patients could not be evaluated. Twenty-five of 90 evaluable children (28%) had chronic renal insufficiency. Chronic renal insufficiency 1 year after BMT was correlated with a high serum creatinine in the first 3 months after BMT. None of the children of this retrospective study on renal function after BMT needed dialysis.

Acute Kidney Injury↗
PubMed1998

Frequencies and types of exchange aberrations induced by X-rays and neutrons in Chinese hamster splenocytes detected by FISH using chromosome-specific DNA libraries.

PURPOSE: To estimate the frequencies of radiation- (low and high LET) induced chromosome aberrations in Chinese hamster splenocytes by two-colour fluorescence in situ hybridization using DNA painting probes specific for chromosomes 2, 3, 8, X and Y and to determine (1) the ratio of radiation-induced translocations and dicentrics; (2) the spectrum of exchange aberrations induced by X-rays and neutrons; and (3) the relative involvement of the different chromosomes in the formation of aberrations. MATERIALS AND METHODS: Isolated splenocytes from the Chinese hamster were irradiated in vitro with different doses of 200 kV X-rays (0.75, 1.5, 3.0 Gy) and 1 MeV fast neutrons (0.25, 0.5, 1.0 Gy). Conventional analysis of chromosome aberrations was carried out in Giemsa-stained preparations. Chromosome aberrations involving chromosomes 2, 3, 8, X and Y were analysed in first division metaphases using two-colour FISH. RESULTS: The results indicate that when all types of translocations are taken into account both X-rays and neutrons induce more translocations than dicentrics, the ratio between the two types of exchanges being 1.4 and 1.8 respectively. The ratio of 'apparently simple' reciprocal translocations and reciprocal complete dicentrics was close to 1 for both types of radiation. The RBE of neutrons for induction of exchanges was found to be between 5 and 8. Neutron irradiation was more efficient at inducing insertions. Among the chromosomes studied, an increased involvement was observed for chromosome 8 in dicentrics and translocations than that expected on the basis of its chromosome length. The high content of interstitial telomeric sequences in chromosome 8 may be responsible for the observed sensitivity of this chromosome. CONCLUSIONS: The results obtained in this study indicate that: (1) more translocations are found than dicentrics; (2) heterogeneity exists among Chinese hamster chromosomes for involvement in radiation-induced exchanges; (3) the spectrum and distribution of exchange aberrations are different between X-rays and neutrons; and (4) the relative frequencies of insertions could be used as a 'fingerprint' for exposure to high LET radiation.

Animals↗
PubMed1998

Outcome of very preterm small for gestational age infants: the first nine years of life.

OBJECTIVE: To determine the influence of intrauterine growth retardation of preterm infants on mortality and cognitive development. DESIGN: A nationwide study cohort of very preterm and/or small for gestational age infants (< 32 weeks and/or < 1500 g) born alive in 1983 in the Netherlands. Assessment on neuromotor and cognitive development at five years, and a parental questionnaire on school performance at nine years. Cognitive outcome is defined as handicap for mental and speech-language development, and need for special education. SAMPLE: 134 small for gestational age infants (< 10th centile) and 410 appropriate for gestational age infants (between 25th and 75th centile) of all infants between 25 and 32 weeks of gestational age were identified; infants with congenital malformations and not of caucasian race were excluded. MAIN OUTCOME MEASURES: Neonatal mortality, in-hospital and five years mortality; Cognitive outcome at five years; School performance at nine years. RESULTS: The mortality risk for small for gestational age compared with appropriate for gestational age infants was significantly higher, after adjustment for gestational age, sex, multiple pregnancy and mode of delivery (OR 2.56, 95% CI 1.26-5.26). Small for gestational age infants showed more often gross motor and minor neurological dysfunction, but less cerebral palsy than appropriate for gestational age infants. Cognitive outcome at five years in small for gestational age infants was significantly worse than appropriate for gestational age infants stratified for mode of delivery OR 2.44 (95% CI 1.05-5.55). At nine years of age significantly more small for gestational age infants (16.4%) needed special education than appropriate for gestational age infants (11.9%). CONCLUSION: Intrauterine growth retardation increases the risk of mortality and of cognitive disorders.

Child↗
PubMed1998

Effects of Helicobacter pylori on gastritis, pentagastrin-stimulated gastric acid secretion, and meal-stimulated plasma gastrin release in the absence of peptic ulcer disease.

OBJECTIVE: There is strong evidence accumulating that chronic infection with Helicobacter pylori (H. pylori) interferes with inhibitory pathways of the regulation of acid secretion. The increase in maximum acid output (MAO), and the increase in the sensitivity of the parietal cell to gastrin commonly observed in patients suffering from duodenal ulcer disease (DU), however, remains largely unexplained. Insufficient evidence is available concerning how these parameters are influenced by H. pylori infection in patients not suffering from peptic ulcer disease (PUD) and how they are related to H. pylori-induced gastritis. The aim of this study was to compare basal gastric acid secretion (BAO), MAO, and the sensitivity of the parietal cell to gastrin in H. pylori-positive and H. pylori-negative patients not suffering from PUD, and to study the relationship with their individual postprandial gastrin release and the degree of gastric antral and corpus gastritis. METHODS: H. pylori status was assessed by CLO test and histology (two biopsies each from the antrum and the corpus) in 14 H. pylori-positive and 16 H. pylori-negative nonulcer patients of comparable age, weight and gender. Gastritis score was assessed by a pathologist, who was unaware of the acid secretory data. Following determination of BAO, the relation of pentagastrin and gastric acid secretion was established with a cumulative pentagastrin dose response curve for the dose range 0.03-6.0 microg/kg(-1) h(-1) and MAO (Vmax) and pentagastrin sensitivity (ED50) were determined. Basal and postprandial gastrin release was measured by radioimmunoassay. RESULTS: There was a significant higher gastritis score in the H. pylori-positive compared with the H. pylori-negative subjects. The dose response curves of the pentagastrin stimulated gastric acid secretion were not different between H. pylori-positive and H. pylori-negative groups. No correlation was seen between the gastritis score, basal acid output (BAO) peak acid output (PAO), maximum acid output (MAO), ED50 values and the plasma gastrin values. There was, however, a considerable larger variation of the PAO and MAO data of the H. pylori-infected subjects and >50% of the respective data was above or below the relatively low range of the respective values of the noninfected subjects. CONCLUSIONS: H. pylori-induced gastritis does not regularly enhance maximum acid output in nonulcer patients, nor does it modify the sensitivity of the parietal cell to gastrin. H. pylori infection is thus unlikely to be directly responsible for an increase of these parameters in DU disease. Our data support, however, the concept that chronic H. pylori infection can either enhance or attenuate maximum acid secretory capacity in certain subgroups of patients.

Adult↗
PubMed1998

A retrospective Dutch study comparing T cell-depleted allogeneic blood stem cell transplantation vs T cell-depleted allogeneic bone marrow transplantation.

Retrospectively, a cohort of 43 hematological patients receiving an allogeneic T cell-depleted (TCD)-PBSCT between 1994 and 1997, was compared to a cohort of 435 patients, who received an allogeneic TCD-BMT between 1990 and 1996. Both cohorts were comparable with respect to diagnosis, risk status, age and sex. PB grafts contained four to five times more hematopoietic progenitor cells and T cells as compared to BM grafts. T cell depletion was performed by either elutriation, CD34 selection, E-rosetting, or Campath serotherapy. Conditioning was cyclophosphamide/TBI in the majority of patients of both cohorts. All patients received cyclosporin A as GVHD prophylaxis until day 90 post-transplant. Engraftment was significantly faster in the PBPCT cohort with a median time to neutrophil recovery (>0.5 x 10(9)/l) of 16 vs 21 days in the BMT cohort (P = 0.0009). Platelet recovery to 50 x 10(9)/l was 16 vs 34 days for the PB and BM cohort respectively (P < 0.0001). A median percentage of 76% of BMT patients recovered to 50 within 100 days post-BMT vs 91% of patients receiving a PB graft. The incidence of acute GVHD grades II, III and IV was similar in both cohorts. In contrast, the probability of developing chronic GVHD was 21% in the BM cohort vs 37% in the PB cohort. Relapse incidence was reduced in the PB cohort (9 vs 29%), while treatment-related mortality was not different for both cohorts. These favorable results require confirmation by a prospective randomized trial, which is currently being performed by several European centers.

Adolescent↗
PubMed1997

Assessment of bioactivity for orthopedic coatings in a gap-healing model.

In order to study bone growth conducting capacities of new biomaterials under standardized conditions, a goat model was developed based on a canine model by Soballe. Titanium alloy implants with and without a hydroxyapatite coating were used as positive and negative controls, and these were implanted with a circumferential gap of one millimeter in the spongious bone of the knee condyles of two groups of four goats. These goats were sacrificed at 6 and 25 weeks. A second experiment was done on two groups of four goats with the same type of titanium alloy and hydroxyapatite-coated implants as controls and with Polyactive 55-45 coated titanium alloy implants for testing. These goats were sacrificed at 9 and 25 weeks, respectively. Qualitative and quantitative differences in gap healing were evaluated through light microscopy, and initiation and direction of bone apposition were determined with fluorescence microscopy. Apposition of bone was seen directly on all hydroxyapatite surfaces and on some of the noncoated titanium alloy surfaces. The difference between the percentage of bone growth on the titanium alloy implants and the hydroxyapatite-coated implants appeared to be divergent in time: the bone growth on the noncoated implants declined after 9 weeks in contrast to the steady increase of bone growth on the hydroxyapatite-coated implants towards the 25 week follow-up time (p = 0.02). No significant difference was found between the first and the second experiment: apposition of bone on the implants differed only 6.6% on a scale of 0% to 100%. Only scarce bone growth was seen on the polyactive-coated implants in this model. The newly tested Polyactive 55-45 coating apparently needs initial bone contact for bone-bonding and therefore showed hardly any direct bone formation on its surface. The clear differences in the reaction of bone to the coated and noncoated implants in this goat study and the reproducibility of these reactions of bone to the different controls indicate the sensitivity of the currently used animal model and its suitability for use as a bioactivity assay.

Animals↗
PubMed1997

Analysis of the synovial cell infiltrate in early rheumatoid synovial tissue in relation to local disease activity.

OBJECTIVE: To define variations in the cellular infiltrate and in the expression of monokines in synovial tissue (ST) from rheumatoid arthritis (RA) patients with different durations of disease and different levels of disease activity. METHODS: The immunohistologic features of synovial biopsy specimens from 31 patients with early RA (< 1 year) and 35 patients with longstanding RA (> 5 years) were compared. The possible associations between these features and local disease activity, as measured by the score for pain in the biopsied knee joint were also evaluated. RESULTS: The immunohistologic features were not dependent on disease duration. We found a positive correlation between the scores for knee pain and the semiquantitative scores for the number of macrophages, as well as the expression of interleukin-6 and tumor necrosis factor alpha, whereas the correlation with the scores for CD4+ T cells was negative. Multivariate analysis showed that these correlations were highly statistically significant (P < 0.003). CONCLUSION: The results do not support the view that inflammatory mechanisms in the synovial tissues of RA patients differ between early and late stages of the disease. The findings presented here are consistent with the concept that early RA is the result of a synovitis process of longer duration and that macrophage-derived cytokines play an important role in maintaining the clinical signs of inflammation.

Adult↗
PubMed1997

Association of cancer prevention-related nutrition knowledge, beliefs, and attitudes to cancer prevention dietary behavior.

OBJECTIVE: To examine the relationship of cancer prevention-related nutrition knowledge, beliefs, and attitudes to cancer prevention dietary behavior. SUBJECTS/SETTING: Noninstitutionalized US adults aged 18 years and older. METHODS: Data collected in the 1992 National Health Interview Survey Cancer Epidemiology Supplement were analyzed. The supplement included questions to ascertain knowledge, beliefs, and attitudes and a food frequency questionnaire to ascertain nutrient intake. STATISTICS: Multivariate linear regression modeling was conducted to assess the hypothesized relationships. RESULTS: After adjustment for relevant covariates (age, sex, education, total energy, perceived barriers to eating a more healthful diet), knowledge and belief constructs were predictive of dietary behavior. Specifically, fat, fiber, and fruit and vegetable intakes more closely approximated dietary recommendations for persons with more cancer-prevention knowledge. The strength of the associations between these constructs and dietary behavior varied in some cases according to level of education and perceived barriers to eating a healthful diet. Of the perceived barriers to eating a healthful diet, perceived ease of eating a healthful diet was most strongly and consistently predictive of intake. CONCLUSIONS: Research findings challenge dietetics practitioners to design diet- and health-promotion programs and activities that not only educate the public about the importance of diet to health, but also address barriers to dietary change.

Adult↗
PubMed1997

Outcome for children treated with fetal intravascular transfusions because of severe blood group antagonism.

OBJECTIVE: To describe the outcome for 92 fetuses treated between May 1987 and January of 1993 with intrauterine (intravascular) transfusions for severe hemolytic disease in comparison with a high-risk and a healthy control group. STUDY DESIGN: Information on the perinatal period was obtained from the patient records. The children regularly attended the outpatient clinic, and a general pediatric examination was performed on each visit. The psychometer development of the child until age 4 1/2 years was assessed according to Gesell. At the age of 5 years, the adaptation part of the Denver Developmental Screening Test and a Dutch-language test were used. A neurologic examination was performed according to Touwen. RESULTS: In our study, 77 (83.7%) of 92 fetuses were born alive after intravascular transfusions. The overall survival rate was 79.3%. The follow-up group included 69 infants, with an age range of 6 months to 6 years. Correlation between antenatal and perinatal features showed a significant negative relationship between the number of intrauterine transfusions and the duration of phototherapy (p = 0.002). The probability that neurologic abnormalities would occur was significantly greater when perinatal asphyxia had been present (p < 0.05) and with a lower cord hemoglobin level at birth (p = 0.03). The total number of children with disabilities was 10.1% (7/69). CONCLUSIONS: The neurodevelopmental outcome for the group of survivors compared favorably with a group of high-risk, very low birth weight infants (10.1% to 18%), and less favorably with a healthy control group (10.1% to 6%).

Blood Transfusion, Intrauterine↗
PubMed1997

The distribution of cataract surgery services in a public health eye care program in Nepal.

The cost-effectiveness of public health cataract programs in low-income countries has been well documented. Equity, another important dimension of program quality which has received less attention is analyzed here by comparisons of surgical coverage rates for major sub-groups within the intended beneficiary population of the Nepal blindness program (NBP). Substantial differences in surgical coverage were found between males and females and between different age groups of the same gender. Among the cataract blind, the surgical coverage of males was 70% higher than that of females. For both genders, the cataract blind over 55 received proportionately fewer services than younger people blind from cataract. Blind males aged 45-54 had a 500% higher rate of surgical coverage than blind males over 65. Blind females aged 35-44 had nearly a 600% higher rate of surgical coverage than blind females over 65. There was wide variation in overall surgical coverage between geographic zones, but little variation by terrain type, an indicator of the logistical difficulties in delivery of services. Members of the two highest caste groupings had somewhat lower surgical coverage than members of lower castes. Program managers should consider developing methods to increase services to women and to those over 65. Reaching these populations will become increasingly important as those most readily served receive surgery and members of the under-served groups form a growing portion of the remaining cataract backlog.

Adult↗
PubMed1997

Vessel wall and flow characteristics after carotid endarterectomy: eversion endarterectomy compared with Dacron patch plasty.

OBJECTIVES: Experimental studies have demonstrated that decreases in vessel wall compliance and increases in turbulence may contribute to (re)stenosis. We studied vessel wall and flow characteristics after endarterectomy with Dacron patch plasty and after eversion endarterectomy, and compared those findings with the characteristics of non-stenotic, unoperated carotid arteries (controls). METHODS: Seventy-four patients who underwent 84 carotid endarterectomies were studied postoperatively by ultrasonography (2-24 months) Recorded variables included the diameter of the bulb, strain, elastic modulus (stiffness), and presence of turbulent flow. RESULTS: The vessel wall and flow characteristics of the two groups differed significantly. The diameter was higher and the strain lower in Dacron patch plasty than in controls; eversion endarterectomy did not differ from controls. The elastic modulus was higher (stiffer) in Dacron patch plasty than in eversion endarterectomy; neither Dacron patch plasty nor eversion endarterectomy differed significantly from controls. The stiffness index was not significantly different between the groups. Turbulence was present in Dacron patch plasty and eversion endarterectomy when compared with controls. CONCLUSION: In diameter, strain and stiffness, the operated carotid artery resembles the non-stenotic, unoperated artery more closely after eversion endarterectomy than after Dacron patch plasty.

Aged↗
PubMed1997

A phase I trial of weekly gemcitabine administered as a prolonged infusion in patients with pancreatic cancer and other solid tumors.

PURPOSE: Pharmacological studies of gemcitabine (2',2'-difluorodeoxycytidine) have shown that increased levels of the active triphosphate metabolite are achieved by prolonging infusion time while holding the dose rate constant. The primary aim of this study was to determine the maximum tolerated dose (MTD) of gemcitabine administered as a fixed rate infusion (10 mg/m2/min) on a weekly schedule in patients with untreated non-hematologic malignancies. PATIENTS AND METHODS: Twenty-seven patients (21 pancreatic adenocarcinoma, 3 hepatoma, 1 neuroendocrine tumor, and 2 adenocarcinoma of unknown primary) were enrolled in this open-label, non-randomized study. Three different entry dose levels (1200 mg/m2, 1500 mg/m2 and 1800 mg/m2) were evaluated for gemcitabine administered on days 1, 8, and 15 of a 28-day cycle. RESULTS: The MTD was defined as 1500 mg/m2 with granulocytopenia and thrombocytopenia being dose-limiting. There were no non-hematological dose limiting toxicities. The maximum WHO grade 3 or 4 toxicities for hemoglobin, leukocytes, neutrophils, and platelets for all doses of gemcitabine administered were 11.5%, 30.8%, 57.7%, and 26.9%, respectively. Non-hematologic toxicities included nausea, vomiting and fever. Four patients were withdrawn from the study for non-hematological toxicities: pneumonitis, ascites, disabling fatigue, and an acute myocardial infarction. Two of these events were severe (pneumonitis and myocardial infarction) but these may not be related to drug administration. CONCLUSION: Gemcitabine administered at a rate of 10 mg/m2/min was tolerated up to 1500 mg/m2 in patients with previously untreated non-hematologic malignancies. Myelosuppression seen in this study is more severe than anticipated based on previous reports of bolus administration of similar doses of gemcitabine. This supports earlier studies suggesting that prolonged duration of infusion increases the intracellular accumulation of active metabolites of gemcitabine.

Adenocarcinoma↗
PubMed1997

Contamination of bone allografts: analysis of incidence and predisposing factors.

We analysed the bacterial contamination of 1999 bone allografts retrieved from 200 cadaver donors under sterile operating conditions. The effect of various factors on the relative risk of contamination was estimated using a multiple logistic regression model. Organisms of low pathogenicity were cultured from 50% of the grafts and of high pathogenicity from 3%. The risk of contamination with low pathogenic organisms (mainly skin commensals) increased by a factor of 1.6 for each member added to the procurement team. The risk of contamination with high pathogenic organisms (mainly contaminants from the gastrointestinal tract) was 3.4 times higher in donors with a traumatic cause of death and 5.2 times higher in those with a positive blood culture. Preceding organ procurement did not significantly influence the risk of contamination. Rinsing the graft with an antibiotic solution was not an effective decontamination method. The major source of contamination is exogenous and is strongly influenced by the procurement team. Contamination from endogenous sources can be controlled by donor selection. We discuss methods that can be used to decrease contamination and the rate of discarding of bone allografts.

Anti-Bacterial Agents↗
PubMed1997

Mortality, severe respiratory distress syndrome, and chronic lung disease of the newborn are reduced more after prophylactic than after therapeutic administration of the surfactant Curosurf.

OBJECTIVE: To test the hypothesis that prophylactic treatment with the surfactant Curosurf (Chiesi Farmaceutici SPA, Parma, Italy) improves survival and respiratory problems more than rescue treatment. DESIGN: Meta-analysis of three prophylaxis versus rescue treatment trials, conducted in four countries. METHODS: A meta-analysis was performed with the original, individual data of mortality, severe respiratory distress syndrome, and chronic lung disease of 671 newborns as outcomes. The random-effects logistic model (accounting for the trial-within-country structure) was applied and adjusted for imbalances in covariates. RESULTS: The probability of each outcome differed between the countries, but the actual treatment effect itself did not. The adjusted odds ratios (ORs) and confidence intervals (CIs) for prophylaxis versus rescue were as follows: mortality: OR, .47; 95% CI, .30 to .73; severe RDS: OR, .50; 95% CI, .33 to .74; and chronic lung disease of the newborn in the survivors at day 28 after birth: OR, .54; 95% CI, .34 to .86. Gender, birth weight, gestational age, and prenatal administration of glucocorticosteroids were significant confounding covariates. CONCLUSION: The analysis shows that for the porcine surfactant Curosurf, prophylactic administration of surfactant has significant advantages over rescue therapy.

Biological Products↗
PubMed1996

Large differences in obstetrical intervention rates among Dutch hospitals, even after adjustment for population differences.

Within the framework of the 'Obstetric Peer Review' project (Verloskundige Onderlinge Kwaliteitsspiegeling, VOKS) statistical models have been developed to predict department specific intervention rates, based on the distribution of risk factors in each department. Subsequently the difference between the expected number of interventions (labour inductions, caesarean sections and vaginal operative deliveries) and the actual numbers were calculated for each year and subpopulation defined by the level of prematurity. Data used were available from the Perinatal Database of the Netherlands (Landelijke Verloskunde Registratie, LVR) concerning the years 1988-1992. Even after adjusting for many clinical risk factors the interdepartmental differences of intervention rates are both clinically relevant and statistically significant. It was also obvious, especially for the term population, that departments showed a consistent pattern with respect to the difference between their expected and observed intervention rates over these 5 years.

Cesarean Section↗