bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sweeping of the membranes to prevent post‐term pregnancy and to induce labour: a systematic review
Authors: Boulvain Michel , Irion Olivier , Marcoux Sylvie , Fraser William 
Published: August 2005

Objective
To evaluate the effectiveness of sweeping of the membranes to prevent post‐term pregnancy and to induce labour.Design
A systematic review of randomised controlled trials.Methods
Potentially eligible trials were identified in Medline and in the Cochrane Controlled Trials Register. Inclusion of studies and data extraction were performed by two reviewers working independently. Summary estimates of the effect of the intervention were computed as relative risks, risk differences and weighted mean differences.Main outcome measures
Use of formal methods of labour induction, delay before spontaneous onset of labour, prevention of post‐term pregnancy, side effects, maternal and perinaial morbidity.Results
Sixteen reports were identified. Thirteen were included in the review, with a total of 1992 women. Sweeping of the membranes, when performed at term, reduced the duration of pregnancy and the proportion of women continuing pregnancy beyond 41 and 42 weeks. When sweeping of the membranes was performed, a reduction in the use of formal methods for labour induction was observed (RR = 0.48; 95% CI 0.28485). There was no difference between groups in the mode of delivery or in the risk of infection. Discomfort during vaginal examination and other side effects (e.g. bleeding, irregular contractions) were more frequently reported by women allocated to sweeping.Conclusions
While sweeping of the membranes reduces the interval to spontaneous onset of labour, there is no evidence of a reduction in maternal or neonatal morbidity. When used as a means of induction of labour, the reduction in the use of formal methods must be balanced against women's discomfort and other side effects attributable to the procedure.
Prophylactic administration of clindamycin 2 % vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: a randomised placebo‐controlled double‐blind trial
Authors: Vermeulen Gustaaf M. , Bruinse Hein W. 
Published: August 2005

Objective
To test the hypothesis that prophylactic administration of clindamycin 2% vaginal cream can reduce the incidence of preterm birth in a high risk population.Design
A multi‐centre, randomised, double‐blind, placebo‐controlled trial.Setting
Twelve city hospitals in The Netherlands.Participants
One hundred and sixty‐eight women with a singleton pregnancy and a history of a spontaneous preterm delivery in the preceding pregnancy.Interventions
Clindamycin 2% vaginal cream, or placebo cream, administered daily for seven days at 26 and 32 weeks of gestation.Main outcome measures
Spontaneous preterm birth at c 37 weeks, admission for threatened preterm labour, neonatal infectious morbidity.Results
In the intention‐to‐treat analysis no difference was found in overall preterm birth between clindamycin and placebo (23% vs 18%, respectively). In the subgroup who completed the trial and administered all medication, more women delivered before 34 weeks in the clindamycin group (1.4% in the placebo vs 9.0% in the clindamycin group; P < 0.05). The length of admissions for threatened preterm labour did not differ. More infectious neonatal morbidity was seen in the clindamycin group 5/83 vs 0/85; P < 0.05).Conclusion
Clindamycin 2% vaginal cream given prophylactically to women with a spontaneous preterm birth in the preceding pregnancy did not prevent preterm delivery or reduce the number of admissions for threatened preterm labour. The neonatal infectious morbidity in the group treated with clindamycin was significantly higher and a major concern.
National Confidential Enquiry into counselling for genetic disorders by non‐geneticists: general recommendations and specific standards for improving care
Authors: Harris Rodney , Lane Beverley , Harris Hilary , Williamson Paula , Dodge John , Modell Bernadette , Ponder Bruce , Rodeck Charles , Alberman Eva 
Published: August 2005

Objectives
To assess genetic counselling by non‐geneticists and to improve clinical practice.Design
National retrospective review of casenotes.Setting
Antenatal, paediatric, medical, and surgical units.Sample
1293 genetic events were identified, involving potentially avoidable cases of Down's syndrome, neural tube defect, cystic fibrosis, beta thalassaemia major and late onset medullary carcinoma of the thyroid (multiple endocrine neoplasia). Notes were available for review in 888 (69%) of these cases.Outcomes
Documented counselling, offers of relevant genetic screening and prenatal diagnosis.Results
Clinical audit was frustrated by poor quality hospital records lacking evidence of counselling. Non‐geneticist clinicians concentrate on the management of disease, and may overlook the need for counselling and recording data which patients will later need for decisions about reproduction or disease prevention. Counselling, screening and prenatal diagnosis were sometimes impossible because of late booking in pregnancy, or because of delayed diagnosis of an earlier affected child with cystic fibrosis. There are marked regional inequalities of access to genetic services, particularly for minority ethnic groups with increased risks of thalassaemia. Although patients were selected for this enquiry because they had known high risks of genetic disorders, on average less than half were referred to medical geneticists. General recommendations relevant for improvement of care for patients and families with medical genetic needs and those specific for each disorder are given.Conclusions
Assessment of the quality of genetic care becomes increasingly important as genetic counselling spreads beyond the narrow confines of specialist genetic services. Even though the events studied in this enquiry largely occurred between 1991 and 1995, there is little reason to believe that clinicians in general have become markedly better trained in medical genetics. The General Medical Council and Medical Royal Colleges should urgently consider the need for a national policy for improving undergraduate and postgraduate medical, nursing and midwifery education in genetics. Commissioners of clinical services should require that genetic management be at least as well‐documented as surgical operations, drug records and informed consent, perhaps by using a nationally agreed pro‐forma for prenatal diagnosis. Regular audit of counselling provided by non‐geneticists is necessary to confirm that clinical improvements are occurring and standards are being met. The Confidential Enquiry provides data for a systematic approach to clinical governance of genetics in all specialities. This sets the scene for multi‐speciality NHS genetic services capable of giving patients greater consistency both in access and in quality.
Evaluation of a definition of pre‐eclampsia
Authors: North Robyn A. , Taylor Rennae S. , Schellenberg Jean‐Claude 
Published: August 2005

Objectives
To determine: 1. whether an alternative definition of gestational hypertension and pre‐eclampsia stratifies women according to their risk of maternal and fetal complications; 2. whether pregnancy outcome in women with gestational hypertension differs in the presence or absence of ‘+’ proteinuria; and 3. whether a blood pressure rise of ≥ 30/15 mmHg during pregnancy is associated with adverse outcome in women who remain normotensive.Design
Prospective, nested case–control study.Setting
Community based.Population
Healthy, nulliparous women (n= 1496).Methods
Women recruited into a study investigating serum markers predictive of pre‐eclampsia were classified as having gestational hypertension (systolic blood pressure ≥ 140 mmHg with a rise of ≥ 30 mmHg and/or diastolic blood pressure ≥ 90 mmHg with a rise of ≥ 15 mmHg) or pre‐eclampsia (gestational hypertension plus proteinuria ≥ 2+on dipstick or > 0.3 g/24 h). Maternal and fetal complications in gestational hypertension or pre‐eclampsia were compared with a control group of 223 randomly selected normotensive women. The main outcome measures were severe maternal disease, preterm birth and small for gestational age infant.Results
A stepwise increase in adverse maternal and fetal outcomes occurred in gestational hypertension (n= 117, 743%) and pre‐eclampsia (n= 71, 4.8%). Severe maternal disease developed in 26.5% (21.4% severe hypertension alone, 5.1% multisystem disease) of women with gestational hypertension and 63.4% (21.1% severe hypertension alone, 42.3% multisystem disease) of women with pre‐eclampsia (OR 4.8; 95% CI 2.4–9.5). Preterm birth and small for gestational age infants were more frequent in gestational hypertension (OR 1.7; 95% CI 0.5–5.4, and OR 2.0; 95% CI 1.0–3.7, respectively) and pre‐eclampsia (OR 14.6; 95% CI 5.8–37.8, and OR 2.6; 95% CI 1.2–5.3) than in the normotensive group. Among women with gestational hypertension severe maternal disease was more common in women with ‘+’ proteinuria (41.7%) than in those with no proteinuria (15.9%): OR 3–8; 95% CI 1.5–9.8. Pregnancies were uncomplicated in the 27% of normotensive women who had a rise of ≥ 30 mmHg systolic blood pressure and/or ≥ 15 mmHg rise in diastolic blood pressure.Conclusions
In the nulliparous population studied our definition of gestational hypertension and pre‐eclampsia identified women at increasing risk of maternal and fetal complications. In gestational hypertension, the presence of proteinuria ‘+’ was associated with a 3.8‐fold increase in severe maternal disease. Normotensive women who have a rise in blood pressure ≥ 30/15 mmHg had uncomplicated pregnancies.
Two trials of antenatal thyrotrophin‐releasing hormone for fetal maturation: stopping before the due date
Authors: Alfirevic Z. , Boer K. , Brocklehurst P. , Buimer M. , Elbourne D. , Kok J. , Tansey S. ,   on behalf of the Antenatal TRH Trial and the Thyroneth Trial Groups
Published: August 2005

Objectives
To determine whether the addition of antenatal thyrotrophin‐releasing hormone (TRH) to corticosteroids, given to women at risk of preterm delivery, would decrease the risk of death and severe morbidity associated with prematurity.Design
Two concurrent multicentre, double blind, randomised, placebo‐controlled trials were designed with a common core dataset to be analysed as a single large pragmatic trial.Setting
Hospital maternity units.Populations
Pregnant women at risk of preterm delivery who had been prescribed a course of corticosteroids to enhance fetal maturation.Interventions
Antenatal administration of TRH 400 μg every eight hours for four doses versus matching placebo.Main outcome measures
Primary: death of the baby or chronic lung disease (defined as oxygen dependency at 28 days after birth). Secondary: other measures of respiratory morbidity, in particular respiratory distress syndrome. Other measures of short term neonatal morbidity including intraventricular haemorrhage and necrotising enterocolitis. Measures of maternal side effects.Results
The antenatal TRH trial was halted early on the basis of external evidence. Overall a total of 225 women were recruited who delivered 275 babies. The primary outcome of death or chronic lung disease occurred in 33 babies in the TRH group and 43 babies in the placebo group (RR 0.8, 95% CI 0.5–1.2). There were no other differences between the two groups. Stratified analysis did not reveal any differences between the two groups depending on how long before the time of delivery the mother had received the TRH or placebo.Conclusions
These trials are too small to provide convincing evidence of the effect of antenatal TRH on neonatal outcome. When added to the existing systematic review and meta‐analysis, however, these data should provide evidence on which subsequent practice can be based. The process by which the trials were monitored and stopped is of relevance to future trials.
The value of sonography in early pregnancy for the detection of fetal abnormalities in an unselected population
Authors: Whitlow B. J. , Chatzipapas I. K. , Lazanakis M. L. , Kadir R. A. , Economides D. L. 
Published: August 2005

Objective
To determine the value of early pregnancy sonography in detecting fetal abnormalities in an unselected obstetric population.Design
Prospective cross‐sectional study. All women initially underwent transabdominal sonography and when the anatomical survey was considered to be incomplete, transvaginal sonography was also performed (20.1 %). Nuchal translucency was measured and karyotyping was performed as appropriate.Setting
University Department of Obstetrics and Gynaecology.Participants
6634 sequential unselected women (mean maternal age 29–9 years, range 13–50; mean gestational age 12+4 weeks, range 11+0‐14+6), carrying 6443 live fetuses participated in this study.Main outcome measure
Detection rate of fetal anomalies and the associated cost per case detected in early pregnancy.Results
The incidence of anomalous fetuses was 1.4% (926443) including 43 chromosomal abnormalities. The detection rate for structural abnormalities was 59.0% (37/63, 95% CI 46.5–72.4) and the specificity was 99.9% in early pregnancy. When the first and second trimester scans were combined, the detection for structural abnormalities was 8 1.0% (5 1/63, 95% CI 67.7–89.2). Seventy‐eight percent (31/40) of chromosomal abnormalities (excluding three cases of XXY) were diagnosed at 11–14 weeks, either because of a nuchal translucency greater than or equal to the 99th centile for gestational age (43%; 17/40,95% CI 27‐4–60.4), or due to the presence of structural abnormalities (35%; 14/40, 95% CI 21.2–52.8). Sixty‐five percent (15/23) of cases of trisomy 21 were also diagnosed either because of having a nuchal translucency greater than or equal to the 99th centile (57.0%; 13/23) or due to the presence of a structural abnormality (9.0%; 2/23). Overall, the detection rate of structurally abnormal fetuses was 59% (37/63) in early pregnancy and 81% in combination with the second trimester scan. The cost per abnormality diagnosed in early pregnancy is estimated to be f6258 per structurally abnormal fetus, £7470 per chromosomal abnormality and f4453 per anomalous fetus.Conclusion
The majority of fetal structural and chromosomal abnormalities can be detected by sonographic screening at 11–14 weeks, but the second trimester scan should not be abandoned.
Trends in births at and beyond term: evidence of a change?
Authors: Roberts Christine L. , Taylor Lee , Henderson‐Smart David 
Published: August 2005

Objective
To examine trends in the distribution of births at and beyond term in New South Wales and in particular, to determine whether any changes are associated with changes in the obstetric practices of induction and elective caesarean section.Design
Cross‐sectional analytic study.Setting
New South Wales, Australia.Population
All 540,162 women delivering a singleton cephalic‐presenting infant of gestational age ≥ 37 weeks from 1 January 1990 to 31 December 1996.Methods
Data were obtained from the New South Wales midwives data collection, a population‐based surveillance system covering all births in New South Wales. The data were analysed to examine changes over time and associations between gestational age, maternal factors and onset of labour.Main outcome measures
Induction of labour and elective caesarean section rates.Results
From 1990 to 1996 there was a significant decrease in births reported as 40 weeks of gestation, from 35,670 (46.3%) to 30,651 (40.3%). These declines were offset by significant increases in births at 38 and 39 weeks. Births ≥ 42 weeks declined from 3321 (4.6%) to 2132 (2.8%). The decline in prolonged pregnancies was associated with increasing induction rates at 41 weeks. The re‐distribution of some births from 40 to 38–39 weeks was associated with increasing rates of elective caesarean sections and induction at 38 and 39 weeks, and increasing maternal age.Conclusions
Clinicians appear to be implementing the recommendations of randomised controlled trials to offer induction after 41 weeks of gestation. However the trend of performing elective caesarean sections at earlier gestational ages may be unnecessarily putting some infants at increased risk of respiratory morbidity.
Gastrostomy tubes in patients with recurrent gynaecological cancer and intestinal obstruction
Authors: Tsahalina Efthalia , Woolas Robert P. , Carter Paul G. , Chan Felix , Gore Martin E. , Blake Peter M. , Shepherd John H. , Barton Desmond P. J. 
Published: August 2005

Objective
Women with recurrent gynaecological cancers who are not suitable for exenterative surgery commonly present with gastrointestinal dysfunction. This paper is a retrospective review of the use of gastrostomy tubes in such women.Methods
We performed a chart review of women with recurrent gynaecological cancer who had a gastrostomy tube placed between January 1991 and April 1998.Results
Thirty‐nine women (mean age 53.2 years, range 17–82) had a gastrostomy tube placed. Twenty‐eight (72%) had ovarian cancer, eight (21%) had cervical cancer, two had endometrial cancer and one had vaginal cancer. In 14 women a gastrostomy tube was placed as the sole procedure for palliation (11 elective, 3 emergency). In the remaining 25 women, who underwent major surgery, a gastrostomy tube was placed in anticipation of, or in the presence of, significant intestinal distension and expected prolonged post‐operative ileus. eleven women (28%) died without leaving hospital after their operation (median 11 days, range 2–36). All but one of the 28 women who left hospital had satisfactory oral intake. Twenty‐one women (54%) died with the gastrostomy tube in place (median 28 days, range 2–157) and 18 (46%) had the gastrostomy tube removed (median 14.5 days, range 9–180), 13 of whom (33%) have since died (median 167 days, range 77 days–7 years). Five women (13%) are alive (median 2.2 years, range 10 months–4.5 years). There were no problems which required the gastrostomy tube to be removed.Conclusion
Gastrostomy tubes have an important role in the treatment of women with recurrent gynaecological cancer, allowing gastric drainage and decompression without the disadvantages of nasogastric tubes.
Association Between Mind‐Body and Cardiovascular Exercises and Memory in Older Adults
Authors: Chan Agnes S. , Ho Yim‐chi , Cheung Mei‐chun , Albert Marilyn S. , Chiu Helen F. K. , Lam Linda C. W. 
Published: August 2005

Objectives: To compare the memory function of older adults who regularly practiced mind‐body (MB) or cardiovascular (CV) exercises with that of those who did not engage in regular exercise. Older adults who engaged in both types of exercise were also included to examine the combined effects.Design: Cross‐sectional study between 2002 and 2003.Setting: Older adults from a local community in Hong Kong.Participants: One hundred forty adults aged 56 and older.Measurements: The Hong Kong List Learning Test was used to assess the memory of all participants. It is a clinically validated Chinese verbal‐memory test that measures various aspects of memory processing, including learning, retention, and retrieval abilities. MB and CV exercises were defined using three dimensions: motion speed, emphasis on relaxing the mind, and conscious control of movement.Results: Older adults who practiced MB or CV exercises demonstrated a similar level of memory function, and their learning and memory was better than that of individuals who did not exercise regularly. Those who practiced both types of exercises outperformed all other groups, even after corrected for the total hours of exercise. Although memory change across age was found in older adults who did not exercise, this trend was not observed in individuals who practiced MB exercises.Conclusion: Practicing both MB and CV exercises appears to have a combined effect that might help to preserve memory in older adults. In addition, MB exercises may be considered as an alternative training for older adults who cannot practice strenuous physical exercise.
A Community‐Based Fitness and Mobility Exercise Program for Older Adults with Chronic Stroke: A Randomized, Controlled Trial
Authors: Pang Marco Y. C. , Eng Janice J. , Dawson Andrew S. , McKay Heather A. , Harris Jocelyn E. 
Published: August 2005

Objectives: To examine the effects of a community‐based group exercise program for older individuals with chronic stroke.Design: Prospective, single‐blind, randomized, controlled intervention trial.Setting: Intervention was community‐based. Data collection was performed in a research laboratory located in a rehabilitation hospital.Participants: Sixty‐three older individuals (aged≥50) with chronic stroke (poststroke duration≥1 year) who were living in the community.Intervention: Participants were randomized into intervention group (n=32) or control group (n=31). The intervention group underwent a fitness and mobility exercise (FAME) program designed to improve cardiorespiratory fitness, mobility, leg muscle strength, balance, and hip bone mineral density (BMD) (1‐hour sessions, three sessions/week, for 19 weeks). The control group underwent a seated upper extremity program.Measurements: Cardiorespiratory fitness (maximal oxygen consumption), mobility (6‐minute walk test), leg muscle strength (isometric knee extension), balance (Berg Balance Scale), activity and participation (Physical Activity Scale for Individuals with Physical Disabilities), and femoral neck BMD (using dual‐energy x‐ray absorptiometry).Results: The intervention group had significantly more gains in cardiorespiratory fitness, mobility, and paretic leg muscle strength than controls. Femoral neck BMD of the paretic leg was maintained in the intervention group, whereas a significant decline of the same occurred in controls. There was no significant time‐by‐group interaction for balance, activity and participation, nonparetic leg muscle strength, or nonparetic femoral neck BMD.Conclusion: The FAME program is feasible and beneficial for improving some of the secondary complications resulting from physical inactivity in older adults living with stroke. It may serve as a good model of a community‐based fitness program for preventing secondary diseases in older adults living with chronic conditions.
Prevalence of subjects with progressive bone loss at implants
Authors: Fransson Christer , Lekholm Ulf , Jemt Torsten , Berglundh Tord 
Published: August 2005

AbstractAim: The aim of the present study was to assess the prevalence of subjects with progressive bone loss at implants with a function time of at least 5 years.Material and methods: Radiographs of 1346 patients who had attended annual follow‐up visits at the Brånemark Clinic, Public Dental Services, Gothenburg, Sweden were retrieved. Six hundred and sixty‐two subjects fulfilled the inclusion criteria. Thus, they all had been provided with implant‐supported (Brånemark System® Nobel BioCare, Gothenburg, Sweden) fixed partial or complete dentures or single‐tooth replacements with a documented function time in radiographs of at least 5 years. Implants that demonstrated progressive bone loss to a level of ≥3 threads of an implant were detected. The number of subjects who exhibited one or more implants with progressive bone loss to the threshold level was recorded.Results: Twenty‐eight percent of 662 included subjects had one or more implants with progressive bone loss. A logistic regression analysis revealed that the individuals in this group carried a significantly larger number of implants than the subjects in whom no implants with progressive loss were detected (6 vs. 4.8). Furthermore, >30% of the subjects in the group with progressive bone loss had ≥3 identified implants and that about 33% of all such implants in this group exhibited extensive bone loss. Out of the total 3413 implants included in the study, 423 implants (12.4%) demonstrated progressive bone loss.Conclusion: It is suggested that the prevalence of progressive bone loss at implants assessed from subject‐based data is higher than that evaluated from implant‐based data.