Latest Articles
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External cephalic version (ECV) for breech presentation at term substantially reduces the incidence of breech birth and cesarean section. Appropriate counseling and surveillance is important to ensure an acceptably low complication rate and reduce potential for litigation. Even a high success rate for ECV only minimally reduces the overall cesarean section rate.
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Critical care medicine · Apr 1996
Meta AnalysisAdult respiratory distress syndrome: a systemic overview of incidence and risk factors.
To determine the published incidence of adult respiratory distress syndrome (ARDS) as well as the clinical evidence supporting a casual association between ARDS and its major risk factors. ⋯ The significant variation in the incidence of ARDS is attributed to differences in the type and strength of study designs, as well as definitions or ARDS. While a substantial body of evidence exists concerning a casual role of ARDS risk factors, such as sepsis, aspiration, and trauma, > 60% of clinical studies employed weak designs. The lack of reproducible definitions for ARDS or its potential risk factors in 49% of studies raises concerns about the validity of the conclusions of these studies regarding the association between ARDS and the supposed risk factors.
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Meta Analysis
Bleeding risk of combined oral anticoagulant and antiplatelet therapy in cardiovascular disease.
In controlled clinical trials with patients with cardiovascular disease, both antiplatelet and oral anticoagulant therapy have proved effective in reducing thrombotic and thromboembolic complications. The combination of both therapeutic strategies has been evaluated in several cardiovascular conditions. ⋯ The safety of combined oral anticoagulant and antiplatelet therapy is probably acceptable, provided the antiplatelet therapy is given in a low dose. These results warrant an efficacy and safety evaluation of combined oral anticoagulant and low-dose antiplatelet therapy in large clinical trials.
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Meta Analysis
Antenatal psychosocial risk factors associated with adverse postpartum family outcomes.
To determine the strength of the association between antenatal psychosocial risk factors and adverse postpartum outcomes in the family, such as assault of women by their partner, child abuse, postpartum depression, marital dysfunction and physical illness. ⋯ Psychosocial risk factors during the antenatal period may herald postpartum morbidity. Research is required to determine whether detection of these risk factors may lead to interventions that improve postpartum family outcomes.
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Intravenous heparin is routinely given after thrombolytic therapy for patients with acute myocardial infarction in the United States and in some, but by no means all, other countries. Several trials have documented improved infarct-artery patency in patients treated with heparin; however, none was large enough individually to assess the effect of heparin on clinical outcomes. We performed a systematic overview of the 6 randomized controlled trials (1,735 patients) to summarize the available data concerning the risks and benefits of intravenous heparin versus no heparin after thrombolytic therapy. ⋯ The findings of this overview demonstrate that insufficient clinical outcome data are available to support or to refute the routine use of intravenous heparin therapy after thrombolysis. It is not known if these findings are due to lack of statistical power, inappropriate levels of anticoagulation, or lack of benefit of intravenous heparin. Large randomized studies of heparin (and of new antithrombotic regimens) are needed to establish the role of such therapy.