Serotonin reuptake inhibitors in pregnancy and the risk of major malformations: a systematic review

Objective To review studies conducted to establish the risk of major congenital malformations in women exposed to serotonin reuptake inhibitors (SRIs) during the first trimester of pregnancy. Methods A literature research was conducted within PsychoINFO, EMBASE, MEDLINE and Cochrane databases from 1966 to October 2006, to identify studies assessing the risk of major malformations in infants whose mother was taking SRIs (SSRIs and SNRIs) during the first trimester of pregnancy. Results Fifteen studies were selected for the analysis: seven adopted a prospective cohort design and seven a retrospective design, of these one was a case-control study. Data Synthesis and Conclusions The reviewed studies suggest that exposure to fluoxetine, sertraline, citalopram and venlafaxine in early pregnancy is not associated with an increased risk of major congenital malformations. For paroxetine, recent data call for caution in prescribing such a drug in early pregnancy. For the other SRIs, the risk remains substantially undetermined, as data are so far scanty. Given this background, large prospective cohort studies are urgently needed to better assess the risk/benefit ratio of SRIs-treatment during pregnancy. Copyright # 2007 John Wiley & Sons, Ltd. key words—antidepressants; selective serotonin inhibitors (SRIs); pregnancy; major malformations

Knowledgde Organization design:A Diagnostic tool

The design of a Knowledge Organization has to exhibit congruence between the human and the technological dimensions. In this paper we propose a methodology that diagnoses the failures found within an organizational design of a Knowledge Organization due to an absence of equilibrium between these different dimensions. We argue that this disequilibrium stems from the absence of knowledge intensive relations linking the agents of an organization. For this reason we have investigated the minimal set of conditions necessary for the existence of knowledge intensive organizational relations, that is for the existence of a Knowledge Organization. In order to illustrate the features and the implications of the proposed methodology we apply it to the diagnosis of two cases

Serotonin reuptake inhibitors in pregnancy and the risk of major malformations: a systematic review

Objective To review studies conducted to establish the risk of major congenital malformations in women exposed to serotonin reuptake inhibitors (SRIs) during the first trimester of pregnancy. Methods A literature research was conducted within PsychoINFO, EMBASE, MEDLINE and Cochrane databases from 1966 to October 2006, to identify studies assessing the risk of major malformations in infants whose mother was taking SRIs (SSRIs and SNRIs) during the first trimester of pregnancy. Results Fifteen studies were selected for the analysis: seven adopted a prospective cohort design and seven a retrospective design, of these one was a case-control study. Data Synthesis and Conclusions The reviewed studies suggest that exposure to fluoxetine, sertraline, citalopram and venlafaxine in early pregnancy is not associated with an increased risk of major congenital malformations. For paroxetine, recent data call for caution in prescribing such a drug in early pregnancy. For the other SRIs, the risk remains substantially undetermined, as data are so far scanty. Given this background, large prospective cohort studies are urgently needed to better assess the risk/benefit ratio of SRIs-treatment during pregnancy. Copyright # 2007 John Wiley & Sons, Ltd. key words—antidepressants; selective serotonin inhibitors (SRIs); pregnancy; major malformations

Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations

Postoperative pulmonary complications (PPCs) occur frequently and are associated with substantial morbidity and mortality. Evidence suggests that reduction of PPCs can be accomplished by using lung-protective ventilation strategies intraoperatively, but a consensus on perioperative management has not been established. We sought to determine recommendations for lung protection for the surgical patient at an international consensus development conference. Seven experts produced 24 questions concerning preoperative assessment and intraoperative mechanical ventilation for patients at risk of developing PPCs. Six researchers assessed the literature using questions as a framework for their review. The modified Delphi method was utilised by a team of experts to produce recommendations and statements from study questions. An expert consensus was reached for 22 recommendations and four statements. The following are the highlights: (i) a dedicated score should be used for preoperative pulmonary risk evaluation; and (ii) an individualised mechanical ventilation may improve the mechanics of breathing and respiratory function, and prevent PPCs. The ventilator should initially be set to a tidal volume of 6-8 ml kg-1 predicted body weight and positive end-expiratory pressure (PEEP) 5 cm H2O. PEEP should be individualised thereafter. When recruitment manoeuvres are performed, the lowest effective pressure and shortest effective time or fewest number of breaths should be used