20 research outputs found
Justifications for coercive care in child and adolescent psychiatry, a content analysis of medical documentation in Sweden
Upper secondary school students’ compliance with two Internet-based self-help programmes: a randomised controlled trial
Behavioural and physiological responses to pharmaceutical exposure in macroalgae and grazers from a Baltic Sea littoral community
Early versus delayed oxytocin augmentation in nulliparous women with prolonged labour--a randomised controlled trial.
OBJECTIVE: To study the effects of early versus delayed oxytocin augmentation on the obstetrical and neonatal outcome in nulliparous women with spontaneous but prolonged labour. DESIGN: Randomised controlled study. SETTING: Two delivery units in Sweden. POPULATION: Healthy nulliparous women with normal pregnancies, spontaneous onset of active labour, a cervical dilatation of 4-9 cm and no progress in cervical dilatation for 2 hours and for an additional hour if amniotomy was performed due to slow progress. METHODS: Women (n = 630) were randomly allocated either to labour augmentation by oxytocin infusion (early oxytocin group) or to postponement of oxytocin augmentation for another 3 hours (expectant group). MAIN OUTCOME MEASURE: Mode of delivery (spontaneous vaginal or instrumental vaginal delivery or caesarean section) and time from randomisation to delivery. RESULTS: The caesarean section rate was 29 of 314 (9%) in the early oxytocin group and 34 of 316 (11%) in the expectant group (OR 0.8, 95% CI 0.5-1.4), and instrumental vaginal delivery 54 of 314 (17%) in the early oxytocin versus 38 of 316 (12%) in the expectant group (OR 1.5, 95% CI 0.97-2.4). Early initiation of oxytocin resulted in a mean decrease of 85 minutes in the randomisation to delivery interval. CONCLUSION: Early administration of oxytocin did not change the rate of caesarean section or instrumental vaginal delivery but shortened labour duration significantly in women with a 2-hour arrest in cervical dilatation. No other clear benefits or harms were seen between early and delayed administration of oxytocin
Women's experiences after early versus postponed oxytocin treatment of slow progress in first childbirth--a randomized controlled trial.
OBJECTIVE: The aim was to compare the childbirth experiences of primiparous women with slow labour progress who had received early versus postponed oxytocin augmentation. METHODS: The population included healthy primiparous women with slow labour progress after a normal pregnancy and spontaneous onset of active labour at term who had taken part in a randomized controlled trial at two delivery units in Sweden comparing early versus postponed oxytocin augmentation. A total of 536 women were sent the Childbirth Experience Questionnaire (CEQ) one month postpartum. The 22-item questionnaire assesses four domains of the childbirth experience. Main outcomes were the four domains of the CEQ: Own capacity, Professional support, Perceived safety and Participation. RESULTS: There were no significant differences between the women in the early and expectant oxytocin treatment groups in any of the four domains; however, operative births were associated with significantly worse childbirth experiences. Almost every third woman in both groups had negative and depressing memories from the childbirth process. CONCLUSIONS: Early oxytocin augmentation for slow labour progress does not appear to be more beneficial than expectant management regarding women's perceptions of childbirth one month postpartum. Given the risks for the foetus associated with oxytocin treatment, prudent expectant management seems to be a safe and viable alternative
Focal neurological deficits secondary to intraoperative CSF drainage: successful resolution with an epidural blood patch
Ticagrelor versus clopidogrel in patients with acute coronary syndromes.
Background
Ticagrelor is an oral, reversible, direct-acting inhibitor of the adenosine diphosphate
receptor P2Y12 that has a more rapid onset and more pronounced platelet
inhibition than clopidogrel.
Methods
In this multicenter, double-blind, randomized trial, we compared ticagrelor (180-mg
loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to-600-mg loading
dose, 75 mg daily thereafter) for the prevention of cardiovascular events in 18,624
patients admitted to the hospital with an acute coronary syndrome, with or without
ST-segment elevation.
Results
At 12 months, the primary end point — a composite of death from vascular causes,
myocardial infarction, or stroke — had occurred in 9.8% of patients receiving ticagrelor
as compared with 11.7% of those receiving clopidogrel (hazard ratio, 0.84;
95% confidence interval [CI], 0.77 to 0.92; P<0.001). Predefined hierarchical testing
of secondary end points showed significant differences in the rates of other composite
end points, as well as myocardial infarction alone (5.8% in the ticagrelor
group vs. 6.9% in the clopidogrel group, P = 0.005) and death from vascular causes
(4.0% vs. 5.1%, P = 0.001) but not stroke alone (1.5% vs. 1.3%, P = 0.22). The rate of
death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopidogrel;
P<0.001). No significant difference in the rates of major bleeding was found
between the ticagrelor and clopidogrel groups (11.6% and 11.2%, respectively;
P = 0.43), but ticagrelor was associated with a higher rate of major bleeding not related
to coronary-artery bypass grafting (4.5% vs. 3.8%, P = 0.03), including more
instances of fatal intracranial bleeding and fewer of fatal bleeding of other types.
Conclusions
In patients who have an acute coronary syndrome with or without ST-segment elevation,
treatment with ticagrelor as compared with clopidogrel significantly reduced
the rate of death from vascular causes, myocardial infarction, or stroke without an
increase in the rate of overall major bleeding but with an increase in the rate of non–
procedure-related bleeding