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PubMed1998

Do vascular registers affect decision-making? Finnvasc Study Group.

Treatment activity of vascular diseases varies depending on population, preference of doctors and the availability of vascular surgical services. Vascular registry offers an opportunity to review practice, to compare outcome with a standard, and to implement change to improve practice. Prospective data collection of all reconstructive vascular procedures has been performed in Finland for seven years. According to a review of the first five years, combined vascular and endovascular activity has increased nation-wide from 3508 procedures done in 1991 to 5200 in 1995. There are marked regional differences in the frequency and selection of various treatment modalities, which can not be explained only by epidemiological data but as well by skewed vascular care delivery. This data can be used for decision-making and should be used for planning of the vascular surgical services in Finland.

Data Collection↗
PubMed2002

Twin delivery.

The incidence of twin pregnancy has increased worldwide over the past 10 years largely as a consequence of the assisted reproductive technologies. Issues such as intrapartum monitoring and operative interventions, especially with regard to the second twin, provide a unique challenge in labour and delivery. Epidemiological data suggest that the term twin has a threefold higher mortality rate than the singleton. It is the authors' view that many aspects of twin delivery deserve as much import as those features of twin gestations such as pre-term birth and intrauterine growth restriction that, to date, have received much of the research and clinical interest in this area. Indications for elective Caesarean section are presented, incorporating new data derived from the delivery of the term singleton breech, and implications on the timing thereof are discussed. Vaginal delivery of both twins presenting by the vertex is recommended as safe as long as guidelines for the conduct of such delivery are followed. The recommended time interval between twins as well as the use of epidural, fetal monitoring and ultrasound in the delivery room are discussed. The second twin presenting as a non-vertex presents an urgent dilemma for accoucheurs. Data suggest that internal version and breech extractions are safer than external cephalic version provided that the appropriate techniques are applied. It is revealed, however, that the use of elective Caesarean section in this group of babies has not been subject to randomized controlled studies of sufficient power to determine the best method of delivery of the second twin - particularly in the low-birth-weight baby.

Breech Presentation↗
PubMed1998

Implementation of early discharges after uncomplicated vaginal deliveries: maternal and infant complications.

BACKGROUND: Short-stay obstetric stays have been the recent focus of many social and medical debates. We did a retrospective study of a large community teaching hospital's experience in making a safe transition to short-stay obstetrics. METHODS: Over a 10-month period, a multidisciplinary committee developed an intrapartum and postpartum education program to allow short hospital stays after uncomplicated vaginal deliveries. Computerized data were then retrieved on all uncomplicated spontaneous vaginal deliveries (DRG 373) from January 1994 to March 1995. RESULTS: During the study period, 554 women were discharged on the first postpartum day, resulting in three maternal readmissions and nine pediatric readmissions (combined readmission rate of 2.2%). This low readmission rate compared favorably with our experience with 2,563 uncomplicated vaginal deliveries from January 1991 to December 1993, immediately before the institution of the short-stay obstetrics program (combined readmission rate of 3.9%). The average hospital cost for a 1-day stay was $1,714 compared with $2,477 for a 2- to 3-day stay, representing a saving of only 31%. CONCLUSIONS: Early obstetric discharges after an uncomplicated spontaneous vaginal delivery can be safe and effective with appropriate patient selection and support.

Cost Savings↗
PubMed1994

Implications of council regulation 793/93 on the evaluation and control of existing substances.

The European Union (EU) programme on existing substances makes provision for the delivery by industry of data on substances produced or imported above certain quantities which will be used by the Commission to facilitate selection of priority lists of substances for which risk assessments will be carried out. The substances comprise three subsets of the existing substances listed in the European Inventory of Existing Commercial Chemical Substances (EINECS) according to the respective deadlines for delivery of the data. The risk assessments are performed by the member states according to a commission regulation 1488/94 supported by guidance documents, may require further data delivery or performance of tests by industry and must conclude that the substance is either of no concern, of concern and risk reduction measures are appropriate, or require further data or testing to arrive at one of the other conclusions. The EU programme on existing chemicals is coordinated with the related OECD programme which will allow chemicals evaluated under regulation 793/93 to constitute an EU contribution to OECD and to largely allow the community to avoid investing unnecessary resources in substances being evaluated by non-EC countries.

Europe↗
PubMed1999

Effects of obstetrician characteristics on cesarean delivery rates. A community hospital experience.

OBJECTIVE: Despite a decrease in the overall cesarean delivery rate at Ravenswood Hospital Medical Center in Chicago, a wide range of variation existed among individual obstetricians' rates. This study evaluated obstetricians' characteristics to determine whether they affected cesarean delivery rates. STUDY DESIGN: In 1994 members of my department adopted strategies to decrease the cesarean delivery rate. Data on women who were delivered at the obstetric unit from 1994-1997 and data on their neonates were studied. Certain characteristics of obstetricians were also analyzed. The data were grouped according to personal characteristics and obstetricians' cesarean delivery rates: group 1 had a low rate (</=15%) and group 2 had a high rate (>15%). Pearson chi2 analysis was used to evaluate the differences between the proportions. P <.05 was considered significant. RESULTS: The departmental cesarean delivery rate decreased from 20.5% in 1994 to 15.5% in 1997 (P <.0001), whereas individual obstetricians' rates varied from 0% to 44.4%. Obstetricians in group 1 (average rate 12.2%) and group 2 (average rate 20.8%, P <.0001) served similar populations with similar outcomes. Compared with obstetricians in group 2, those in group 1 (low rate) performed more vaginal deliveries after cesarean birth and used epidural analgesia and the vacuum extractor more frequently. Young age of physician, graduation from a domestic medical school, group practice, and smaller volume of births were all significantly linked to lower cesarean delivery rates. CONCLUSIONS: Cesarean delivery rates can safely be reduced. Certain individual obstetrician characteristics influence cesarean delivery rates. Obstetricians' commitment facilitates lowering of cesarean delivery rates.

Adult↗
PubMed2004

Microparticles for the delivery of DNA vaccines.

DNA vaccines have demonstrated a lack of adequate potency in humans, which has necessitated the exploration of various adjunct technologies. Inefficient delivery of DNA vaccines, particularly to antigen-presenting cells, may be contributing to this lack of potency. One effective means of facilitating delivery of DNA vaccines to APCs is through the use of microparticles. In this article, we review the background and rationale for microparticles as a vaccine delivery system, data demonstrating their utility and mode of action for DNA delivery, and the prospects for their development.

Adjuvants, Immunologic↗
PubMedDate not supplied

Pharmacokinetics of antibiotics in pregnancy and labour.

Few of the articles published on antibiotics and pregnancy are concerned with pharmacokinetics. It is particularly difficult to evaluate possible alterations in pharmacokinetic parameters that may be due to pregnancy. Most data available have been obtained in connection with abortion or delivery. Such data may not be representative for pregnancy as such. Marked changes in most organ systems, particularly in renal function, but in composition and amounts of body fluids as well, make it likely that several pharmacokinetic parameters change, possibly gradually as pregnancy progresses. Accumulated data for several beta-lactam antibiotics, and also for aminoglycosides indicate that antibiotics eliminated mainly by renal excretion will produce lower levels in serum or plasma in pregnant women than in other individuals. Also, the half-life of certain antibiotics in serum is shorter during pregnancy. Transplacental passage occurs for all antibiotics according to the physicochemical properties of the drug. Bolus injections to a pregnant woman are more efficient than continuous infusion in producing high levels of antibiotic in fetal serum and amniotic fluid. Fetal tissue levels are higher following multiple doses than after a single dose. Lower serum levels of antibiotics in pregnant women than in other individuals following the same dosage will be unsatisfactory as micr-organisms are less likely to be affected.

Aminoglycosides↗
PubMedDate not supplied

Breech presentations in a sample of Colombian hospitals.

All the breech presentations that occurred in a large sample of data on obstetric deliveries from a random sample of urban hospitals in Colombia are examined. The 463 breeches are analyzed by age and parity of the mother, type of breech presentation (frank or footling) and type of delivery (vaginal or abdominal). The data suggest that abdominal delivery reduces perinatal mortality although cell values are too small to adequately control for birth weight.

Adolescent↗
PubMedDate not supplied

[Delivery with vacuum extraction--indications, technique and complications].

This study is a retrospective analysis of data on deliveries which ended up in vacuum extraction at the Clinic of Gynecology and Obstetrics in Novi Sad during two periods: 1983-85, and 1993-95. The aim of this study was to analyze indications, technique and complications of deliveries which ended up in vacuum extraction. Out of the total number of deliveries-17,110 in the period 1983-85, 4.86% ended up in vacuum extraction. The perinatal morbidity was 10.82%, the perinatal mortality 15.13/1000. In the period 1993-95, there were 18,599 deliveries, whereas 2.65% ended up in vacuum extraction. The perinatal morbidity was 8.93%, while perinatal mortality 11.12/1000. The risk of morbidity occurring in surgical procedures can be decreased if prompt vacuum extraction is performed.

Adult↗
PubMed2002

Parenteral and mucosal delivery of a novel multi-epitope M protein-based group A streptococcal vaccine construct: investigation of immunogenicity in mice.

Primary vaccine strategies against group A streptococci (GAS) have focused on the M protein--the target of opsonic antibodies important for protective immunity. We have previously reported protection of mice against GAS infection following parenteral delivery of a multi-epitope vaccine construct, referred to as a heteropolymer. This current report has assessed mucosal (intranasal (i.n.) and oral) delivery of the heteropolymer in mice with regard to the induction and specificity of mucosal and systemic antibody responses, and compared this to parenteral delivery. GAS-specific IgA responses were detected in saliva and gut upon i.n. and oral delivery of the heteropolymer co-administered with cholera toxin B subunit, respectively. High titre serum IgG responses were elicited to the heteropolymer following all routes of delivery when administered with adjuvant. Moreover, as with parenteral delivery, serum IgG antibodies were detected to the individual heteropolymer peptides following i.n. but not oral delivery. These data support the potential of the i.n. route in the mucosal delivery of a GAS vaccine.

Administration, Intranasal↗
PubMedDate not supplied

Pharmacists' liability into the year 2000.

OBJECTIVE: To educate the pharmacy community regarding areas of potential liability arising from the pharmacist's role in the changing health care delivery system. DATA SOURCES: Published cases (LEXIS and Westlaw), literature (NEXIS and Westlaw), and abstracts available through July 1998. CASE SELECTION AND DATA ABSTRACTION: Selected on the basis of the authors' objectives and the usefulness of the information for practicing pharmacists. DATA SYNTHESIS: As the pharmacist's role in the health care delivery system continues to change, so too does the pharmacist's exposure to liability. Although historically a pharmacist had no common law "duty to warn," new laws requiring a pharmacist to counsel patients, along with increased scrutiny by the media, have increased the pharmacist's potential for liability. An evaluation of recent case law indicates that state courts are increasingly willing to extend a pharmacist's duty to warn where the pharmacist has special knowledge of the patient or the patient's condition, contraindicated drug usage, where a prescription substantially exceeds the maximum safe dosage, or where a pharmacist fills or refills a prescription without physician authorization. A recent issue that may add to the list of potential liability concerns is the substitution of generically equivalent narrow therapeutic index drug products. CONCLUSION: The pharmacist's role in the ever changing health care delivery system, along with the public's increased scrutiny of pharmacists' dispensing practices, may inevitably extend a pharmacist's duty to warn a patient of potential problems related to prescription drug products. This trend is expected to continue into the new millennium.

Forecasting↗
PubMed2004

A prospective study to investigate the relationship between periodontal disease and adverse pregnancy outcome.

OBJECTIVE: This study aimed to investigate a relationship between maternal periodontal disease and preterm birth, low birth weight and late miscarriage. DESIGN: Prospective study in a single centre. SETTING: Guy's and St Thomas' Hospital Trust, London, UK between August 1998 and July 2001. SUBJECTS AND METHODS: Pregnant women were recruited on attending an ultrasound scan at approximately 12 weeks of pregnancy. Subjects completed a questionnaire and underwent periodontal examination. MAIN OUTCOME MEASURES: Plaque and bleeding scores, pocket probing depth and loss of attachment. Pregnancy outcome data was collected retrospectively, including gestational age and birth weight at delivery. RESULTS: Data were collected for 3,738 subjects. Regression analysis indicated that there were no significant relationships between the severity of periodontal disease and either preterm birth (PTB) or low birth weight (LBW). In contrast, there did appear to be a correlation between poorer periodontal health and those that experienced a late miscarriage. CONCLUSIONS: There was no association between either preterm birth or low birth weight and periodontal disease in this population. There is evidence of a correlation between markers of poorer periodontal health and late miscarriage.

Abortion, Spontaneous↗
PubMed2006

Long-term breast-feeding in women with type 1 diabetes.

OBJECTIVE: Breast-feeding may be more difficult in women with diabetes because of neonatal morbidity and fluctuating maternal blood glucose values. The frequency of long-term breast-feeding and the possible predictors for successful breast-feeding were investigated. RESEARCH DESIGN AND METHODS: One hundred two consecutive women with type 1 diabetes were interviewed about breast-feeding using a semistructured questionnaire 5 days and 4 months after delivery. Clinical data were collected from the medical records. RESULTS: Five days after delivery, 86% of the women were breast-feeding. Four months after delivery, 55 (54%) women were exclusively, 14 (14%) were partly, and 33 (32%) were not breast-feeding compared with 50, 26, and 24% in the background population (NS). Mothers exclusively breast-feeding at 4 months were characterized by previous experience with breast-feeding, a higher educational level, and vaginal delivery and included a high proportion of nonsmokers, whereas there were no associations with diabetes-related parameters such as white classes, duration of diabetes, HbA(1c), and insulin dose at conception. Breast-fed offspring had a significantly higher birth weight and gestational age and were less often receiving glucose intravenously compared with the remaining offspring. Independent predictors of exclusive breast-feeding at 4 months were previous experience with breast-feeding (odds ratio 6.3 [95% CI 2.4-17]) and higher educational level (7.1 [2.4-21]). Cessation of breast-feeding was mainly due to common nursing problems, such as perceived milk supply, and not related to maternal diabetes status. CONCLUSIONS: The majority of the women with type 1 diabetes initiated breast-feeding, and the prevalence of breast-feeding at 4 months was comparable to that in the background population. Independent predictors of exclusive breast-feeding at 4 months were previous experience with breast-feeding and higher educational level.

Adult↗