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Item Metadata only 17-Hydroxyprogesterone caproate in triplet pregnancy: an individual patient data meta-analysis(Wiley-Blackwell, 2016) Combs, C.; Schuit, E.; Caritis, S.; Lim, A.; Garite, T.; Maurel, K.; Rouse, D.; Thom, E.; Tita, A.; Mol, B.Preterm birth complicates almost all triplet pregnancies and no preventive strategy has proven effective.To determine, using individual patient data (IPD) meta-analysis, whether the outcome of triplet pregnancy is affected by prophylactic administration of 17-hydroxyprogesterone caproate (17OHPc).We searched literature databases, trial registries and references in published articles.Randomised controlled trials (RCTs) of progestogens versus control that included women with triplet pregnancies.Investigators from identified RCTs collaborated on the protocol and contributed their IPD. The primary outcome was a composite measure of adverse perinatal outcome. The secondary outcome was the rate of birth before 32 weeks of gestation. Other pre-specified outcomes included randomisation-to-delivery interval and rates of birth at <24, <28 and <34 weeks of gestation.Three RCTs of 17OHPc versus placebo included 232 mothers with triplet pregnancies and their 696 offspring. Risk-of-bias scores and between-study heterogeneity were low. Baseline characteristics were comparable between 17OHPc and placebo groups. The rate of the composite adverse perinatal outcome was similar among those treated with 17OHPc and those treated with placebo (34 and 35%, respectively; risk ratio [RR] 0.98, 95% confidence interval [95% CI] 0.79-1.2). The rate of birth at <32 weeks was also similar in the two groups (35 and 38%, respectively; RR 0.92, 95% CI 0.55-1.56). There were no significant between-group differences in perinatal mortality rate, randomisation-to-delivery interval, or other specified outcomes.Prophylactic 17OHPc given to mothers with triplet pregnancies had no significant impact on perinatal outcome or pregnancy duration.17-Hydroxyprogesterone caproate had no significant impact on the outcome or duration of triplet pregnancy.Item Metadata only 2015 RANZCOG Arthur Wilson Memorial Oration 'From little things, big things grow: the importance of periconception medicine'(Wiley, 2015) Norman, R.The time of our conception is when we are most vulnerable to survival and growing as a healthy human being. Genetic and environmental effects on gametes and the developing embryo can be literally life-and-death events with regard to the successful outcome of pregnancy. In the past decade, we have also understood that environmental factors under which the gametes grow and the embryo develops have lifelong implications with regard to developmental origins of health and disease. We now know that parenting begins before conception in that a compromised egg or sperm from either parent can alter the trajectory of development even if the embryo and intrauterine environment is optimal. There are now a large number of factors known to impact on the gametes to adversely affect them, including obesity, nutrition, cigarette smoking and environmental pollutants. The increasing use of in vitro fertilisation across the world exposes developing embryos to less than optimal environmental conditions through altered culture media, gases and potential pollutants from plastics, air and water. Many of these environmental exposures have not undergone experimental investigation and yet widely implemented in thousands of laboratories across the world. There have been many attempts to set up periconception planning either through the health service, the print and electronic media or through government action. We as a profession, as well as our Colleges, could do much better job in this area of preventative medicine by developing better guidelines and education for professional colleagues, the health service and the community.Item Metadata only 4-Hydroxyglutamate is a novel predictor of preeclampsia(Elsevier, 2019) Sovio, U.; McBride, N.; Wood, A.M.; Cook, E.; Gaccioli, F.; Charnock-Jones, D.S.; Lawlor, D.A.; Smith, G.C.S.BACKGROUND:Pre-term pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. A multi-centre randomized-controlled trial has shown that first-trimester screening followed by treatment of high-risk women with aspirin reduces the risk of pre-term pre-eclampsia. However, the biomarkers currently employed in risk prediction are only weakly associated with the outcome. METHODS:We conducted a case-cohort study within the Pregnancy Outcome Prediction study to analyse untargeted maternal serum metabolomics in samples from 12, 20, 28 and 36 weeks of gestational age (wkGA) in women with pre-eclampsia delivering at term (n = 165) and pre-term (n = 29), plus a random sample of the cohort (n = 325). We used longitudinal linear mixed models to identify candidate metabolites at 20/28 wkGA that differed by term pre-eclampsia status. Candidates were validated using measurements at 36 wkGA in the same women. We then tested the association between the 12-, 20- and 28-wkGA measurements and pre-term pre-eclampsia. We externally validated the association using 24- to 28-wkGA samples from the Born in Bradford study (25 cases and 953 controls). RESULTS:We identified 100 metabolites that differed most at 20/28 wkGA in term pre-eclampsia. Thirty-three of these were validated (P < 0.0005) at 36 wkGA. 4-Hydroxyglutamate and C-glycosyltryptophan were independently predictive at 36 wkGA of term pre-eclampsia. 4-Hydroxyglutamate was also predictive (area under the receiver operating characteristic curve, 95% confidence interval) of pre-term pre-eclampsia at 12 (0.673, 0.558-0.787), 20 (0.731, 0.657-0.806) and 28 wkGA (0.733, 0.627-0.839). The predictive ability of 4-hydroxyglutamate at 12 wkGA was stronger than two existing protein biomarkers, namely PAPP-A (0.567, 0.439-0.695) and placenta growth factor (0.589, 0.463-0.714). Finally, 4-hydroxyglutamate at 24-28 wkGA was positively associated with pre-eclampsia (term or pre-term) among women from the Born in Bradford study. CONCLUSIONS:4-hydroxyglutamate is a novel biochemical predictor of pre-eclampsia that provides better first-trimester prediction of pre-term disease than currently employed protein biomarkers.Item Metadata only [46-OR]: early and late onset preeclampsia versus small for gestational age risks in subsequent pregnancies(Elsevier, 2015) Bernardes, T.; Mol, B.; Ravelli, A.; van den Berg, P.; Stolk, R.; Groen, H.OBJECTIVES: Current literature suggests that early and late onset preeclampsia should be treated as distinct entities and that early onset preeclampsia shares pathophysiology aspects with intrauterine growth restriction. Our objective was to investigate whether 5th percentile small for gestational age (SGA) in a 1st pregnancy increases 2nd pregnancy risk of early and late onset preeclampsia, and vice versa. METHODS: We studied a cohort of 1st and 2nd singleton pregnancies of 262.934 women from the Dutch Perinatal Registry who gave birth between 2000 and 2007. We analyzed 2nd pregnancy risk of SGA, early and late onset preeclampsia using logistic regression considering in each case the absence of the outcome in the first pregnancy. Gestational age, maternal age, iatrogenic preterm birth, chronic hypertension, max diastolic pressure, diabetes, ethnicity and socioeconomic status were adjusted for. RESULTS: In women without 1st pregnancy preeclampsia, prevalences of early and late onset preeclampsia in the 2nd pregnancy were 0.05% and 0.6%, respectively. SGA in the 1st pregnancy increased these prevalences to 0.1% and 1.1%. After adjustment for confounders, 2nd pregnancy late onset preeclampsia risk was increased (aOR 1.3; 95% CI 1.1-1.6) due to SGA in the 1st pregnancy but early onset preeclampsia did not increase (aOR 1.3; 95% 0.7-2.3). In women that did not present SGA in the 1st pregnancy, SGA prevalence in term 2nd pregnancies was 3.3%. Prevalence was higher in women who presented 1st pregnancy late and early preeclampsia: 5.4% (aOR 1.6; 95% CI 1.4-1.9) and 10.2% (aOR 3.2; 95% CI 2.5-4.0), respectively. CONCLUSIONS: In the absence of preeclampsia in the 1st pregnancy, SGA increased late but not early onset 2nd pregnancy preeclampsia risks. Second pregnancy SGA risk was increased by preeclampsia in the 1st pregnancy, especially in early onset cases. DISCLOSURES: T.P. Bernardes: None. B.W. Mol: None. A.C. Ravelli: None. P.P. van den Berg: None. R.P. Stolk: None. H. Groen: None.Item Metadata only A 'no-fault' cerebral palsy pension scheme would benefit all Australians(Blackwell Publishing Asia, 2011) MacLennan, A.The Australian Federal Productivity Commission is proposing two new schemes to better support those with major disability. The main National Disability Insurance Scheme (NDIS) will provide long-term care and support for the disabled. A smaller scheme, the National Injury Insurance Scheme (NIIS), will provide ‘no-fault ‘support for those following an accident or ‘medical injury’. It is proposed that cerebral palsy (CP) is part of the NIIS. While this brings quicker and more equitable benefits to CP families, the scheme labels CP as a ‘medical accident’ and infers preventability. Obstetricians will fund much of the system. Despite being labelled a ‘no-fault’ system, maternity staff can still be litigated for extensive ‘head of damages’, eg loss of earning capacity. An additional option is for federal/state legislation to introduce a true ‘no-fault’ lifetime pension specifically for all children on CP registers. This pension would be graded by degree of disability and dependent on waiving civil litigation. Savings in medico-legal costs and potentially a 7% reduction in caesarean delivery would cover the estimated annual cost of $50 000 per annum indexed life pension for severe CP cases and the total annual cost of AUD $93 million for Australia. This pension and the NDIS would help cover the needs of children with CP without recourse to prolonged litigation and without detriment to the maternity services of Australia, caused by defensive obstetrics and maternity hospital closure because of CP litigation.Item Metadata only A 41-year-old woman with premature menopause(Medicine Today Pty Ltd, 2006) MacLennan, A.Should this woman be encouraged to continue hormone therapy (HT) until the normal age of menopause? [Author's abstract]Item Metadata only A 5-year multicentre randomized controlled trial comparing personalized, frozen and fresh blastocyst transfer in IVF(Elsevier, 2020) Simón, C.; Gómez, C.; Cabanillas, S.; Vladimirov, I.; Castillón, G.; Giles, J.; Boynukalin, K.; Findikli, N.; Bahçeci, M.; Ortega, I.; Vidal, C.; Funabiki, M.; Izquierdo, A.; López, L.; Portela, S.; Frantz, N.; Kulmann, M.; Taguchi, S.; Labarta, E.; Colucci, F.; et al.RESEARCH QUESTION:Does clinical performance of personalized embryo transfer (PET) guided by endometrial receptivity analysis (ERA) differ from frozen embryo transfer (FET) or fresh embryo transfer in infertile patients undergoing IVF? DESIGN:Multicentre, open-label randomized controlled trial; 458 patients aged 37 years or younger undergoing IVF with blastocyst transfer at first appointment were randomized to PET guided by ERA, FET or fresh embryo transfer in 16 reproductive clinics. RESULTS:Clinical outcomes by intention-to-treat analysis were comparable, but cumulative pregnancy rate was significantly higher in the PET (93.6%) compared with FET (79.7%) (P = 0.0005) and fresh embryo transfer groups (80.7%) (P = 0.0013). Analysis per protocol demonstrates that live birth rates at first embryo transfer were 56.2% in PET versus 42.4% in FET (P = 0.09), and 45.7% in fresh embryo transfer groups (P = 0.17). Cumulative live birth rates after 12 months were 71.2% in PET versus 55.4% in FET (P = 0.04), and 48.9% in fresh embryo transfer (P = 0.003). Pregnancy rates at the first embryo transfer in PET, FET and fresh embryo transfer arms were 72.5% versus 54.3% (P = 0.01) and 58.5% (P = 0.05), respectively. Implantation rates at first embryo transfer were 57.3% versus 43.2% (P = 0.03), and 38.6% (P = 0.004), respectively. Obstetrical outcomes, type of delivery and neonatal outcomes were similar in all groups. CONCLUSIONS:Despite 50% of patients dropping out compared with 30% initially planned, per protocol analysis demonstrates statistically significant improvement in pregnancy, implantation and cumulative live birth rates in PET compared with FET and fresh embryo transfer arms, indicating the potential utility of PET guided by the ERA test at the first appointment.Item Metadata only A Biosensing System Based on Extracellular Potential recording of Ligand-Gated Ion Channel Function Overexpressed in Insect cells(Amer Chemical Soc, 2003) Haruyama, T.; Bongsebandhu-Phubhakdi, S.; Nakamura, I.; Mottershead, D.; Keinanen, K.; Kobatake, E.; Aizawa, M.We have used outer cell potential measurement to record agonist-dependent cellular responses in cells engineered to express ligand-gated ion channels and grown on a microelectrode surface. Application of glutamate, a natural agonist, induced a complex and robust potentiometric response in cells expressing homomeric GluR-D glutamate receptor, but not in nonexpressing control cells. The response consisted of an initial decrease in outer potential followed by a transient increase and was not obtained for other amino acids devoid of agonist activity at glutamate receptors. Furthermore, the pharmacological agonist of the GluR-D receptor, kainate, also produced the potentiometric response whereas 6-cyano-7-nitroquinoxaline-2,3-dione, a competitive antagonist, was not active in itself but attenuated the responses to glutamate. The time course of the measured changes was slow, which may be partially due to the ligand being applied by free diffusion but may also reflect a contribution by secondary changes in the behavior of the cells. This novel approach should be applicable to other ligand-gated ion channels and holds promise as a cell-based biosensor for high-throughput drug screening and other applications.Item Open Access A Blue-Enriched, Increased Intensity Light Intervention to Improve Alertness and Performance in Rotating Night Shift Workers in an Operational Setting(Dove Medical Press, 2021) Sletten, T.L.; Raman, B.; Magee, M.; Ferguson, S.A.; Kennaway, D.J.; Grunstein, R.R.; Lockley, S.W.; Rajaratnam, S.M.W.Purpose: This study examined the efficacy of a lighting intervention that increased both light intensity and short-wavelength (blue) light content to improve alertness, performance and mood in night shift workers in a chemical plant. Patients and Methods: During rostered night shifts, 28 workers (46.0±10.8 years; 27 male) were exposed to two light conditions each for two consecutive nights (~19:00-07:00 h) in a counterbalanced repeated measures design: traditional-spectrum lighting set at pre-study levels (43 lux, 4000 K) versus higher intensity, blue-enriched lighting (106 lux, 17,000 K), equating to a 4.5-fold increase in melanopic illuminance (24 to 108 melanopic illuminance). Participants completed the Karolinska Sleepiness Scale, subjective mood ratings, and the Psychomotor Vigilance Task (PVT) every 2-4 hours during the night shift. Results: A significant main effect of time indicated KSS, PVT mean reaction time, number of PVT lapses (reaction times > 500 ms) and subjective tension, misery and depression worsened over the course of the night shift (p<0.05). Percentage changes in KSS (p<0.05, partial η2=0.14) and PVT mean reaction time (p<0.05, partial η2=0.19) and lapses (p<0.05, partial η2=0.17) in the middle and end of night shift, expressed relative to start of shift, were significantly improved during the lighting intervention compared to the traditional lighting condition. Self-reported mood did not significantly differ between conditions (p>0.05). Conclusion: Our findings, showing improvements in alertness and performance with exposure to blue-enriched, increased intensity light, provide support for light to be used as a countermeasure for impaired alertness in night shift work settings.Item Metadata only A breastfeeding study in a rural population in South Australia(Deakin University, 2006) Stamp, G.; Casanova, H.Introduction: The benefits of breastfeeding for mothers and babies are well recognised; however, challenges to its establishment and maintenance exist in rural locations. Method: This study in a rural community aimed to: (1) collect rates of any breastfeeding at 6 weeks, 3 months and 6 months postpartum; and (2) seek women’s postnatal breastfeeding needs and discern how they were met. Fifty-eight women, most of whom had planned to birth at one of two rural hospitals with fewer than 50 births a year were interviewed face-to-face or by telephone. Questions included whether they were still breastfeeding, reasons for stopping, and their breastfeeding support needs in hospital and after discharge on eight domains: establishment; attachment; engorgement; sore nipples; cracked nipples; ongoing support; supply and mastitis. Results: The number breastfeeding at 3 months (55%) compared poorly with South Australia (62%) or nationally (63%). Midwives met most of the needs of the women in hospital while, at home, midwives and GPs remained the main sources of support. At home, small numbers contacted the Australian Breastfeeding Association, child and youth health service nurse; a midwife employed by a pharmacist and family members such as mothers and mothers-in-law for support. Overall, 25% of women who had an identified need did not seek help. Of those who did, 36% had the need met well and 28% poorly. After discharge, 52 (90%) would have welcomed a visit from a community midwife had it been available. In the regional town, facilities to breastfeed and change babies’ nappies were rated poor or non-existent. Conclusion: Since this study, a part-time community midwife has been employed and a new project initiated that educates and assists older women volunteers to support and promote breastfeeding for isolated new mothers.Item Metadata only A checklist for assessing the methodological quality of studies using transcranial magnetic stimulation to study the motor system: An international consensus study(Elsevier Sci Ireland Ltd, 2012) Chipchase, L.; Schabrun, S.; Cohen, L.; Hodges, P.; Ridding, M.; Rothwell, J.; Taylor, J.; Ziemann, U.In the last decade transcranial magnetic stimulation (TMS) has been the subject of more than 20,000 original research articles. Despite this popularity, TMS responses are known to be highly variable and this variability can impact on interpretation of research findings. There are no guidelines regarding the factors that should be reported and/or controlled in TMS studies. This study aimed to develop a checklist to be recommended to evaluate the methodology and reporting of studies that use single or paired pulse TMS to study the motor system. A two round international web-based Delphi study was conducted. Panellists rated the importance of a number of subject, methodological and analytical factors to be reported and/or controlled in studies that use single or paired pulse TMS to study the motor system. Twenty-seven items for single pulse studies and 30 items for paired pulse studies were included in the final checklist. Eight items related to subjects (e.g. age, gender), 21 to methodology (e.g. coil type, stimulus intensity) and two to analysis (e.g. size of the unconditioned motor evoked potential). The checklist is recommended for inclusion when submitting manuscripts for publication to ensure transparency of reporting and could also be used to critically appraise previously published work. It is envisaged that factors could be added and deleted from the checklist on the basis of future research. Use of the TMS methodological checklist should improve the quality of data collection and reporting in TMS studies of the motor system.Item Metadata only A clinical prediction model to assess the risk of operative delivery(Wiley, 2012) Schuit, E.; Kwee, A.; Westerhuis, M.; van Dessel, H.; Graziosi, G.; van Lith, J.; Nijhuis, J.; Oei, S.; Oosterbaan, H.; Schuitemaker, N.; Wouters, M.; Visser, G.; Mol, B.; Moons, K.; Groenwold, R.Objective: To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress. Design: Secondary analysis of a randomised trial. Setting: Three academic and six non-academic teaching hospitals in the Netherlands. Population: 5667 labouring women with a singleton term pregnancy in cephalic presentation. Methods: We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy-to-use nomograms were developed. Main outcome measures: Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference). Results: 375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin augmentation, intrapartum fever, prolonged rupture of membranes, meconium stained amniotic fluid, epidural anaesthesia, and use of ST-analysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70–0.78 and 0.73–0.81, respectively. Conclusion: In Dutch women with a singleton term pregnancy in cephalic presentation, antepartum and intrapartum characteristics can assist in the prediction of the need for an instrumental vaginal delivery or caesarean section for fetal distress or failure to progress.Item Metadata only A clinically relevant criterion for grip strength: relationship with falling in a sample of older adults(Dietitians Association of Australia, 2003) Miller, M.; Giles, L.; Crotty, M.; Harrison, J.; Andrews, G.Objective: To develop a clinically relevant criterion for assessment of grip strength in older adults. Design: Longitudinal cohort study. Subjects: 1251 persons aged [greater than or equal to] 70 years who had grip strength measured as part of the Australian Longitudinal Study of Ageing (1992) and survived to a second interview 12 months later. Setting: Randomly selected sample of community-dwelling older adults residing in the Adelaide (South Australia) Statistical Division as defined by the Australian Bureau of Statistics. Main outcome measures: Participants were asked if they had any falls in the previous 12 months and the same question was repeated in the second interview. Statistical analyses: Logistic regression analyses were performed with faller status at 12 months as the dependent variable, grip strength [greater than or equal to] 25th percentile as the reference category and controlling for age, gender, fuller status, BMI, exercise status and chronic disease. Results: For both genders the percentage fullers was highest for those with grip strength < 25th percentile (< 28kg males, < 15.5kg females). After controlling for potential confounders, grip strength < 25th percentile independently predicted falls 12 months later (OR = 1.41, 95% CI=1.03-1.94, P = 0.034). Conclusion: In previous studies grip strength has been shown to be positively correlated with measures of nutritional health and in this study we have shown that it is an important determinant of future falls. This knowledge could be used to help prevent falls in the elderly, in the future. Further research is warranted to determine whether nutritional support interventions can (1) improve or maintain grip strength among older adults and (2) aid in the prevention of subsequent accidental fails.Item Metadata only A cluster of vulvar cancer and vulvar intraepithelial neoplasia in young Australian Indigenous women(Kluwer Academic Publ, 2009) Condon, J.; Rumbold, A.; Thorn, J.; O'Brien, M.; Davy, M.; Zardawi, I.Objective: To describe the epidemiological features of a possible disease cluster of vulvar cancer and pre-cancers in Australian Indigenous women living in the Northern Territory (NT) of Australia. Methods: We identified NT-resident women with a confirmed histological diagnosis of vulvar cancer or high-grade vulvar intraepithelial neoplasia (VIN) between 1 January 1996 and 31 December 2005. Results: Seventy-one women were identified; 32 diagnosed with vulvar cancer and 39 with high-grade VIN. Most women diagnosed were Indigenous, aged less than 50 years and living in remote communities in the East Arnhem (EA) district, on the north-east coast of the NT. The age-adjusted incidence rate of vulvar cancer in EA Indigenous women aged 0–49 years was 31.1 per 100,000 (95% CI 13.1–49.1), over 50 times higher than the national Australian rate (0.4 per 100,000, 95% CI 0.4–0.5) for the same age-group. In the age-group of 0–49 years, the age-adjusted incidence rate of VIN for EA Indigenous women was 34.7 per 100,000 (95% CI 15.2–54.3), compared with 6.7 per 100,000 (95% CI 2.0–11.4) for Indigenous women living elsewhere in the Top End of the NT. Conclusion: These data provide evidence of a geographic cluster of vulvar cancer in remote Indigenous communities in northern Australia.Item Metadata only A comparative randomized trial to assess the impact of oral contraceptive pretreatment on follicular growth and hormone profiles in GnRH antagonist-treated patients(Oxford Univ Press, 2006) Rombauts, L.; Healy, D.; Norman, R.BACKGROUND: This randomized controlled trial was designed to assess the impact of oral contraceptive (OC) scheduling with a GnRH antagonist (ganirelix) regimen on the ovarian response of women undergoing recombinant FSH (rFSH) stimulation for IVF, compared with a non-scheduled ganirelix regimen and a long GnRH agonist (nafarelin) protocol. METHODS: A total of 110 women was treated with an OC and ganirelix, 111 with ganirelix alone and 111 with nafarelin. The OC (containing 30 µg ethinylestradiol/150 µg desogestrel) was taken for 14–28 days and stopped 2 days prior to the start of rFSH treatment. Primary efficiency parameters were the number of cumulus-oocyte complexes (per attempt) and the number of grade 1 or 2 embryos (per attempt). RESULTS: In terms of follicular growth and hormone profiles, the OC-scheduled antagonist regimen mimicked the agonist regimen rather than the (non-scheduled) GnRH antagonist regimen. In the OC-scheduled GnRH antagonist group and the nafarelin group (versus the non-scheduled antagonist group), pituitary suppression was more profound at the start of stimulation (P # 0.001), there was a slower start of follicular growth (P # 0.001), longer stimulation was required (11.7 and 10.3 days respectively versus 9.4; P # 0.001), and more rFSH was used (2667 and 2222 IU versus 1966 IU; P # 0.001). In the three groups, the number of oocytes was similar (13.1, 12.9 and 11.5 respectively; not significant) as well as the number of good quality embryos (5.1, 5.7 and 5.0 respectively; not significant). CONCLUSION: OC treatment prior to the rFSH/ganirelix regimen can be successfully applied to schedule patients, although more days of stimulation and more rFSH are required than with a non-scheduled GnRH antagonist regimen.Item Metadata only A comparison of cognitive restructuring and cognitive defusion as strategies for resisting a craved food(Harwood Acad Publ GMBH, 2012) Moffitt, R.; Brinkworth, G.; Noakes, M.; Mohr, P.The present study investigated the effectiveness of two cognitive strategies for resisting a craved food. One-hundred-and-ten self-identified chocolate cravers were randomised to a waiting list control condition or to receive a 60-minute standardised group intervention on cognitive restructuring (CR) or cognitive defusion (CD). All participants were provided with a bag of chocolates which they were instructed to carry with them for seven days and try to resist eating; uneaten chocolates were returned at the end of the study period. Measures included chocolate consumption and other behavioural, cognitive and evaluative self-reported outcomes. Overall, the odds of abstinence from chocolate were 3.26 times higher for participants in the CD than the CR condition. The effect of the interventions depended on baseline cognitive distress levels; for individuals at high levels of cognitive distress the CD condition led to significantly more restraint from chocolate than both the CR and control conditions. In addition, CD led to greater self-reported improvements in eating behaviours during the study period and was rated significantly easier to use and apply than CR. CD is discussed as a simple and efficient approach to manage food cravings and, potentially, other behavioural contributors to obesity.Item Open Access A comparison of complications between open abdominal sacrocolpopexy and laparoscopic sacrocolpopexy for the treatment of vault prolapse(Hindawi Publishing Corporation, 2013) Coolen, A.; van Oudheusden, A.; van Eijndhoven, H.; van der Heijden, T.; Stokmans, R.; Mol, B.; Bongers, M.Introduction. Sacrocolpopexy is a generally applied treatment for vault prolapse which can be performed laparoscopically or by open laparotomy. Methods. Between October 2007 and December 2012, we performed a multicenter prospective cohort study in 2 university and 4 teaching hospitals in the Netherlands. We included patients with symptomatic posthysterectomy vaginal vault prolapse requiring surgical treatment, who either had abdominal or laparoscopic sacrocolpopexy. We studied surgery related morbidity, which was divided in pre-, peri-, and postoperative characteristics. Results. We studied 85 patients, of whom 42 had open abdominal and 43 laparoscopic sacrocolpopexy. In the laparoscopic sacrocolpopexy group, estimated blood loss was significantly less compared to the abdominal group: 192 mL (±126) versus 77 mL (±182), respectively (P ≤ .001). Furthermore, hospital stay was significantly shorter in the laparoscopic group (4.2 days) as compared to the abdominal group (2.4 days) (P ≤ .001). The overall complication rate was not significantly different (P = .121). However there was a significant difference in favor of the laparoscopic group in peri- and postoperative complications requiring complementary (conservative) treatment and/or extended admittance (RR 0.24 (95%-CI 0.07-0.80), P = .009). Conclusion. Laparoscopic sacrocolpopexy reduces blood loss and hospital stay as compared to abdominal sacrocolpopexy and generates less procedure related morbidity.Item Metadata only A comparison of emergence delirium scales following general anesthesia in children(Blackwell Publishing Ltd, 2010) Bajwa, S.; Costi, D.; Cyna, A.Background
Emergence delirium (ED) is of increasing interest since the introduction of short-acting volatiles such as sevoflurane.Methods
We compared the Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales for assessing the presence of ED in 117 of 118 consecutive children <18 years recovering from general anesthesia. The primary measure was the worst score for ED as assessed on each scale and for each patient during their PACU stay. An experienced anesthetist observer also made a subjective assessment of the presence of ED.Results
A PAED score of > or =10 detected ED in 37 children (32%), while the Watcha detected 30 (26%) and Cravero 41 (35%). Twenty-five patients (21%) fulfilled criteria for ED in all three scales as did all eight patients assessed by the experienced pediatric anesthetist observer. Median PAED scores (interquartile ranges) for patients assessed as having ED or not respectively were for Watcha, 12 (11,14), 7 (4,8); for Cravero, 11 (9,13), 7 (4,8); and for the experienced anesthetist observer, 14.5 (13.5,16.5), 7 (6,10).Conclusions
All three scales correlated reasonably well with each other but have individual limitations in their potential to assess whether ED is present. In the absence of developing an improved research tool to assess ED, a PAED score >12 appears to provide greater sensitivity and specificity than a PAED score > or =10. However, the Watcha scale is a simpler tool to use in clinical practice and may have a higher overall sensitivity and specificity than the other scales.Item Metadata only A comparison of epidural and cerebronspinal fluid glucose in parturients at term: an observational study(Churchill Livingstone, 2012) Fah, A.; Sutton, J.; Cohen, V.; Dowling, K.; Cyna, A.Background
Detecting inadvertent dural puncture during labour epidural insertion can be difficult when using a loss of resistance to saline technique. Testing fluid for glucose that leaks from a Tuohy needle may confirm the presence of cerebrospinal fluid and infer inadvertent dural puncture. This study compared the glucose content of intrathecal fluid obtained during spinal anaesthesia for elective caesarean delivery with that of fluid from a Tuohy needle or epidural catheter when establishing epidural analgesia for labour.Methods
Women aged ≥18 years undergoing elective caesarean delivery and labouring parturients who requested epidural analgesia were recruited prospectively in a tertiary referral centre over a three-month period. Fluid was collected into a sterile container either during spinal anaesthesia or from a labour epidural needle. Glucose content was evaluated using a bedside blood glucometer and laboratory colorimetric analyzer.Results
Of the 118 women approached, 115 participated. All 40 women having spinal anaesthesia and 2/75 (2.7%) women having epidural analgesia, in whom inadvertent dural puncture was subsequently confirmed, had fluid samples testing positive for glucose. Median [range] laboratory glucose readings were 2.9 [1.3-5.1] mmol/L for cerebrospinal fluid and <0.3 mmol/L in fluid that leaked from a Tuohy needle (P=0.0001).Conclusion
When using a loss of resistance to saline technique for epidural catheter placement, bedside glucometer testing of fluid leaking from the epidural needle may be of value in the early detection of inadvertent dural puncture.Item Metadata only A comparison of long-term outcome between Manchester Fothergill and vaginal hysterectomy as treatment for uterine descent(Springer-Verlag, 2011) Thys, S.; Coolen, A.; Martens, I.; Oosterbaan, H.; Roovers, J.; Mol, B.; Bongers, M.Introduction and hypothesis: The objective of this study was to compare the Manchester Fothergill (MF) procedure with vaginal hysterectomy (VH) as surgical treatment of uterine descent. Methods: Consecutive patients who underwent MF were matched for prolapse grade, age and parity to consecutive patients treated with VH. Evaluated outcomes included functional outcome, morbidity, recurrence of pelvic organ prolapse (POP) and sexual function. Follow-up was performed using validated questionnaires. Results: We included 196 patients (98 patients per group). The response rate after a follow-up of 4–9 years was 80%. We found no differences in functional outcome and recurrence rates of POP between groups. Blood loss was significantly less and operating time was significantly shorter in the MF group. However, incomplete emptying of the bladder was more common in the MF group. Conclusions: The MF procedure is equally effective to the VH and should be considered as a surgical option that allows preservation of the uterus.