Correction: Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia between 34 and 37 weeks' gestation (HYPITAT-II): a multicentre, open-label randomised controlled trial

Kim Broekhuijsen, Josje Langenveld, Gert-Jan van Baaren, Mariëlle G van Pampus, Anton H van Kaam, Henk Groen, Martina Porath, Maureen TM Franssen, Ben W Mol, and HYPITAT-II study grou

Economic evaluations and clinical decision making in obstetrical care

Controlling the increase of healthcare costs is a continuing and growing concern, especially in times of economic crisis and persistent deficits in government budgets. In the last decade health care costs have been growing faster than the Dutch economy itself. In 2012 the health care costs were €93 billion. In 2012 the Netherlands spent 15.4% of its gross domestic product on health care and welfare Although pregnancy itself is generally not considered as a medical condition, pregnancy and delivery inevitably involve health care decisions, which affect maternal and neonatal outcomes, as well as costs. It is important, both for health care professionals and for policy makers, to have evidence on clinical effectiveness as well as costs of available diagnostic and treatment strategies. Although the quality of the economic evaluations has improved over the last decades, the relevance of economic evaluations in the field of obstetrics is not fully acknowledged. The number of publications concerning economic evaluations in obstetrics during the past decades has not significantly increased. Furthermore, translation of the results of (cost-)effectiveness studies into the guidelines seems to be problematic. The aim of the research reported in this thesis was to assess the effectiveness, costs and cost-effectiveness of a number of diagnostic and treatment strategies in obstetrical care. The resulting evidence can contribute to the development of clinical guidelines and evidence based policy making

Filling a missing link: the influence of portrayals of older characters in television commercials on the memory performance of older adults

The portrayal of older characters in television commercials has over time become more varied and positive. This study examines how different portrayals of older characters relate to self-stereotyping, a process through which older individuals apply their beliefs about older people in general to themselves and behave accordingly. The study thereby seeks to connect, as few have previously done, cultural studies and critiques of media portrayals with psychological studies of the effects of self-stereotyping. Sixty participants aged 65-75 years were primed with television commercials that portrayed older characters in different ways: 'warm and incompetent', 'warm and competent', and 'cold and competent'. It was hypothesised that priming with warm/incompetent portrayals would have a negative effect on memory performance because such representations match the dominant stereotype, and that the effect would occur only among older people who identify with their own age group. It was found that the participants who identified with their own age group did indeed show impaired memory performance after priming with warm/incompetent portrayals, but also that the same effect was found after priming with warm/competent portrayals. The findings are discussed in terms of resistance against stereotyping by older individuals themselves as well as by media producers

Imitation can reduce malnutrition in residents in assisted living facilites

Contains fulltext : 76959.pdf (publisher's version ) (Closed access)n.a.2 p

Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial)

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Child outcomes after induction of labour or expectant management in women with preterm prelabour rupture of membranes between 34 and 37 weeks of gestation: study protocol of the PPROMEXIL Follow-up trial. A long-term follow-up study of the randomised controlled trials PPROMEXIL and PPROMEXIL-2

Introduction Late preterm prelabour rupture of membranes (PROM between 34(+0) and 36(+6) weeks gestational age) is an important clinical dilemma. Previously, two large Dutch randomised controlled trials (RCTs) compared induction of labour (IoL) to expectant management (EM). Both trials showed that early delivery does not reduce the risk of neonatal sepsis as compared with EM, although prematurity-related risks might increase. An extensive, structured long-term follow-up of these children has never been performed. Methods and analysis The PPROMEXIL Follow-up trial (NL6623 (NTR6953)) aims to assess long-term childhood outcomes of the PPROMEXIL (ISRCTN29313500) and PPROMEXIL-2 trial (ISRCTN05689407), two multicentre RCTs using the same protocol, conducted between 2007 and 2010 evaluating IoL versus EM in women with late preterm PROM. The PPROMEXIL Follow-up will analyse children of mothers with a singleton pregnancy (PPROMEXIL trial n=520, PPROMEXIL-2 trial n=191, total IoL n=359; total EM n=352). At 10-12 years of age all surviving children will be invited for a neurodevelopmental assessment using the Wechsler Intelligence Scale for Children-V, Color-Word Interference Test and the Movement Assessment Battery for Children-2. Parents will be asked to fill out questionnaires assessing behaviour, motor function, sensory processing, respiratory problems, general health and need for healthcare services. Teachers will fill out the Teacher Report Form and answer questions regarding school attainment. For all tests means with SDs will be compared, as well as predefined cut-off scores for abnormal outcome. Sensitivity analyses consisting of different imputation techniques will be used to deal with lost to follow-up. Ethics and dissemination The study has been granted approval by the Medical Centre Amsterdam (MEC) of the AmsterdamUMC (MEC2016_217). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders. This protocol is published before analysis of the results

Cost-effectiveness of induction of labor at term with a Foley catheter compared to prostaglandin E2 gel (based on the PROBAAT trial; registration NTR 1646)

Obstetric

Delivery versus expectant monitoring for late preterm hypertensive disorders of pregnancy (HYPITAT-II): a multicenter, open label, randomized controlled trial

Research into fetal development and medicin

An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

Item does not contain fulltextOBJECTIVE: To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy. DESIGN: A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II). SETTING: Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands. POPULATION: Women diagnosed with non-severe hypertensive disorders of pregnancy between 340/7 and 370/7 weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring. METHODS: A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. MAIN OUTCOME MEASURES: Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge. RESULTS: The average costs of immediate delivery (n = 352) were euro10 245 versus euro9563 for expectant monitoring (n = 351), with an average difference of euro682 (95% confidence interval, 95% CI -euro618 to euro2126). This 7% difference predominantly originated from the neonatal admissions, which were euro5672 in the immediate delivery arm and euro3929 in the expectant monitoring arm. CONCLUSION: In women with mild hypertensive disorders between 340/7 and 370/7 weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications. TWEETABLE ABSTRACT: Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery