PubMed · 10310131
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J D Dempsey. 1983. Value analysis: a step beyond standardization.. https://pubmed.ncbi.nlm.nih.gov/10310131/
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OBJECTIVE: To determine whether there is an increased incidence of persistent pulmonary hypertension in neonates delivered by cesarean, with or without labor, compared with those delivered vaginally. METHODS: We did a computerized retrospective review of 29,669 consecutive deliveries over 7 years (1992-1999). The incidences of persistent pulmonary hypertension of the newborn, transient tachypnea of the newborn, and respiratory distress syndrome (RDS) were tabulated for each delivery mode. Cases of persistent pulmonary hypertension were reviewed individually to determine delivery method and whether labor had occurred. The three groups defined were all cesarean deliveries, all elective cesareans, and all vaginal deliveries. RESULTS: Among 4301 cesareans done, 17 neonates had persistent pulmonary hypertension (four per 1000 live births). Among 1889 elective cesarean deliveries, seven neonates had persistent pulmonary hypertension (3.7 per 1000 live births). Among 21,017 vaginal deliveries, 17 neonates had persistent pulmonary hypertension (0.8 per 1000 live births). chi2 analysis showed an odds ratio 4.6 and P <.001 for comparison of elective cesarean and vaginal delivery for that outcome. CONCLUSION: The incidence of persistent pulmonary hypertension of the newborn was approximately 0.37% among neonates delivered by elective cesarean, almost fivefold higher than those delivered vaginally. The findings have implications for informed consent before cesarean and increased surveillance of neonates after cesarean.
STUDY OBJECTIVE: To develop criteria for credentialing physicians in advanced gynecologic endoscopy. DESIGN: Descriptive study (Canadian Task Force classification III). SETTING: University-affiliated community hospital. Patients. None. INTERVENTION: Criteria for credentialing physicians were tested. MEASUREMENTS AND MAIN RESULTS: Physicians were granted universal privileges in advanced gynecologic laparoscopy or hysteroscopy when they were certified by the Accreditation Council for Gynecologic Endoscopy (ACGE). Alternatively, they received category-specific privileges in any one of six categories when they provided documentation of having satisfactorily performed 10 cases in four categories or 5 cases in the remaining two. Required cases included those performed during residency or with a proctor. Completion of an approved residency, board certification or eligibility, and good standing were other requirements. Proof of continuing medical education in endoscopy was also considered. Of 31 physicians in the department, 3 had ACGE certification: 1 in laparoscopy, 2 in laparoscopy and hysteroscopy. Three physicians gained privileges under the alternative system. One received category 1, one received categories 1 and 2, and the third received categories 1, 2, and 6 privileges. Twenty-five physicians were granted standard endoscopy privileges, including six who applied for advanced endoscopy privileges. These applications are pending case documentation and proctorship. CONCLUSION: A system for credentialing physicians in advanced gynecologic endoscopy, using two alternative pathways, was implemented.
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