bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency obstetric care in developing countries: impact of guidelines implementation in a community hospital in Senegal
Authors: Dumont Alexandre , Gaye Alioune , Mahé Patricia , Bouvier‐Colle Marie‐Hélène 
Published: August 2005

Objective  To evaluate, with volunteer professionals in a resource‐poor setting, an approach of audit and feedback to promote local implementation of emergency obstetric guidelines.Design  Triple cohort observational time series study.Setting  A 46‐bed obstetric unit in an academic‐affiliated community hospital in Senegal.Population  All pregnant women with haemorrhagic and hypertensive complications who were admitted to the maternity unit during the study periods.Methods  To assess the benefits of guidelines implementation, maternal outcomes during the intervention period were compared with those occurring in two one‐year periods when staff daily supervision was the main potentially effective action on clinical management.Main outcome measures  The intervention strategy was criteria‐based audits with regular feedback over a one‐year period. The clinical focus was haemorrhage and hypertension the most frequent causes of maternal death in the study population. Hospital charts were audited by external reviewers. The primary outcome was the case fatality rate (CFR) among patients with haemorrhage and hypertension.Results  There was an increase in morbidity diagnoses during the intervention period. In addition, there was a marked increase in obstetric interventions, especially for transfusions and caesarean deliveries. Patients characteristic‐adjusted case fatality decreased by 53% between baselines I and II and during the intervention period by 33% and 24%, compared with baseline periods I and II, respectively. Outcome improvements were different for haemorrhage and hypertension.Conclusion  While staff daily supervision may have improved maternal outcome before the intervention period, audit and feedback produced marked effects on emergency obstetric care, specially for complications requiring highly trained management (e.g. pre‐eclampsia). Audit and feedback are one of the potentially effective guidelines implementation strategies that should be considered for further studies in resource‐poor health facilities.
Personal accounts of ‘near‐miss’ maternal mortalities in Kampala, Uganda
Authors: Weeks Andrew , Lavender Tina , Nazziwa Enid , Mirembe Florence 
Published: August 2005

Objective  To explore the socio‐economic determinants of maternal mortality in Uganda through interviews with women who had ‘near‐misses’.Design  Observational study using qualitative research methods.Setting  The postnatal and gynaecology wards of a large government hospital in Kampala, Uganda.Sample  Thirty women who had narrowly avoided maternal deaths with diagnoses of obstructed labour (7), severe pre‐eclampsia/eclampsia (3), post caesarean infection (6), haemorrhage (5), ectopic pregnancy (5) and septic abortion (4).Methods  The semi‐structured interviews were conducted in the local language by a woman unconnected to the hospital, and were recorded before being translated and transcribed. Analysis was conducted in duplicate using commercial software.Results  The predominant theme was powerlessness, which occurred both within and outside the hospital. It was evident in the women's attempts to get both practical and financial help from those around them as well as in their failure to gain rapid access to care. Financial barriers and problems with transport primarily governed health‐seeking behaviour. Medical mistakes and delays in referral were evident in many interviews, especially in rural health centres. Women were appreciative of the care they received from the central government hospital, although there were reports of overcrowding, long delays, shortages and inhumane care. There were no reports of bribery.Conclusions  Women with near‐miss maternal mortalities experience institutional and social powerlessness: these factors may be a major contributor to maternal mortality.
Misoprostol and declining abortion‐related morbidity in Santo Domingo, Dominican Republic: a temporal association
Authors: Miller Suellen , Lehman Tara , Campbell Martha , Hemmerling Anke , Brito Anderson Sonia , Rodriguez Hector , Vargas Gonzalez Wilme , Cordero Milton , Calderon Victor 
Published: August 2005

Objective  To validate anecdotal reports that abortion‐related complications decreased in the Dominican Republic after the introduction of misoprostol into the country.Design  Retrospective records reviews and cross‐sectional surveys, interviews and focus groups.Setting  Family planning clinics, pharmacies, door‐to‐door canvassing and a tertiary care maternity hospital in Santo Domingo, Dominican Republic.Population  Women of reproductive age in Santo Domingo, Dominican Republic.Methods  Qualitative and quantitative methods were used. Individual interviews and focus groups of reproductive health professionals, non‐governmental organisation leaders and women's group leaders (n= 50) were conducted to discover the role of misoprostol in the Dominican Republic. Local women (n= 157) were surveyed to determine their knowledge of misoprostol as an abortifacient and mystery client visits were made to 80 pharmacies in order to purchase misoprostol without a prescription. Sales data were obtained that documented when misoprostol was introduced to the Dominican Republic pharmacies. Hospital admissions for abortions from the prior eight years were reviewed and hospital emergency room consultation ledgers of 31,190 visits for the period 1994–2001 were reviewed for abortion complications.Main outcome measures  Frequencies of maternal morbidities and knowledge of misoprostol.Results  Mystery clients purchased misoprostol without a prescription in nearly 64% of pharmacies; staff provided little additional information or counselling. Reliable sales data documented the introduction of misoprostol in 1986. Abortion complications decreased from 11.7% of abortions in 1986 to 1.7% in 2001. The majority of professionals interviewed felt that knowledge of these findings should be made public.Conclusions  The data were of too poor quality to validate the verbal reports reliably, but misoprostol appears to have been widely used over a period when abortion‐related morbidity fell. It remains plausible that the use of misoprostol contributed to the reduction.
Routines in facility‐based maternity care: evidence from the Arab World
Authors:   Choices and Challenges in Changing Childbirth Research Network
Published: August 2005

Objectives  To document facility‐based practices for normal labour and delivery in Egypt, Lebanon, the West Bank (part of the Occupied Palestinian Territory) and Syria and to categorise common findings according to evidence‐based obstetrics.Design  Three studies (Lebanon, West Bank and Syria) interviewed a key informant (providers) in maternity facilities. The study in Egypt directly observed individual labouring women.Setting  Maternity wards.Sample  Nationally representative sample of hospitals drawn in Lebanon and Syria. In the West Bank, a convenience sample of hospitals was used. In Egypt, the largest teaching hospital's maternity ward was observed.Methods  Shared practices were categorised by adapting the World Health Organization's (WHO) 2004 classification of practices for normal birth into the following: practices known to be beneficial, practices likely to be beneficial, practices unlikely to be beneficial and practices likely to be ineffective or harmful.Main outcome measures  Routine hospital practices for normal labor and delivery.Results  There was infrequent use of beneficial practices that should be encouraged and an unexpectedly high level of harmful practices that should be eliminated. Some beneficial practices were applied inappropriately and practices of unproven benefit were also documented. Some documented childbirth practices are potentially harmful to mothers and their babies.Conclusion  Facility practices for normal labour were largely not in accordance with the WHO evidence‐based classification of practices for normal birth. The findings are worrying given the increasing proportion of facility‐based births in the region and the improved but relatively high maternal and neonatal mortality ratios in these countries. Obstacles to following evidence‐based protocols for normal labour require examination.
Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial
Authors: Walraven Gijs , Blum Jennifer , Dampha Yusupha , Sowe Maimuna , Morison Linda , Winikoff Beverly , Sloan Nancy 
Published: August 2005

Objective  To assess the effectiveness of 600 μg oral misoprostol on postpartum haemorrhage (PPH) and postpartum anaemia in a low income country home birth situation.Design  Double blind randomised controlled trial.Setting  Twenty‐six villages in rural Gambia with 52 traditional birth attendants (TBAs).Sample  One thousand, two hundred and twenty‐nine women delivering at home under the guidance of a trained TBA.Methods  Active management of the third stage of labour using three 200‐μg misoprostol tablets and placebo or four 0.5‐mg ergometrine tablets (standard treatment) and placebo. Tablets were taken orally immediately after delivery.Main outcome measures  Measured blood loss, postpartum haemoglobin (Hb), difference between Hb at the last antenatal care visit and three to five days postpartum.Results  The misoprostol group experienced lower incidence of measured blood loss ≥500 mL and postpartum Hb <8 g/dL, but the differences were not statistically significant. The reduction in postpartum (compared with pre‐delivery) Hb ≥ 2 g/dL was 16.4% with misoprostol and 21.2% with ergometrine [relative risk 0.77; 95% confidence interval (CI) 0.60–0.98; P= 0.02]. Shivering was significantly more common with misoprostol, while vomiting was more common with ergometrine. Only transient side effects were observed.Conclusions  Six hundred micrograms of oral misoprostol is a promising drug to prevent life‐threatening PPH in this setting.
SYSTEMATIC REVIEW: WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture
Authors: Justus Hofmeyr G. , Say Lale , Metin Gülmezoglu A. 
Published: August 2005

Objective  To determine the prevalence of uterine rupture worldwide.Design  Systematic review of all available data since 1990.Setting  Community‐based and facility‐based reports from urban and rural studies worldwide.Sample  Eighty‐three reports of uterine rupture rates are included in the systematic review. Most are facility based using cross‐sectional study designs.Methods  Following a pre‐defined protocol an extensive search was conducted of 10 electronic databases as well as other sources. Articles were evaluated according to specified inclusion criteria. Uterine rupture data were collected along with information on the quality of reporting including definitions and identification of cases. Data were entered into a database and tabulated using SAS software.Main outcome measures  Prevalence of uterine rupture by country, period, study design, setting, participants, facility type and data source.Results  Prevalence figures for uterine rupture were available for 86 groups of women. For unselected pregnant women, the prevalence of uterine rupture reported was considerably lower for community‐based (median 0.053, range 0.016–0.30%) than for facility‐based studies (0.31, 0.012–2.9%). The prevalence tended to be lower for countries defined by the United Nations as developed than the less or least developed countries. For women with previous caesarean section, the prevalence of uterine rupture reported was in the region of 1%. Only one report gave a prevalence for women without previous caesarean section, from a developed country, and this was extremely low (0.006%).Conclusion  In less and least developed countries, uterine rupture is more prevalent than in developed countries. In developed countries most uterine ruptures follow caesarean section. Future research on the prevalence of uterine rupture should differentiate between uterine rupture with and without previous caesarean section.
Role of the Fastigial Nucleus in Generalized Seizures as Demonstrated by GABA Agonist Microinjections
Authors: Miller John W. , Gray Beverly C. , Turner Glenna M. 
Published: August 2005

Summary:The cerebellum is electrically and metaboli cally active during seizures. Numerous studies have also shown that cerebellar electrical stimulation and lesions of the cerebellar cortex or nuclei influence seizure thresh old, but there are significant contradictions, with different effects observed even in investigations using the same species and similar seizure types and experimental ma nipulations. Discrete intracerebral microinjection of neu roactive agents has been used to characterize the way in which other brain regions control seizures, but has not been applied to the cerebellar systems. This approach has advantages because effects are restricted to specific re ceptors and spare passing axons; experimental variables also can be simply specified and reproduced. We used this method to characterize the role of the cerebellar nu clei in seizures and to determine if observed effects could be reproduced with different agents at different doses. Effects of bilateral control microinjections in the fastigial (medial) cerebellar nucleus were compared with different doses of the GABAA agonist piperidine‐4‐sulfonic acid and the GABAB agonist (−)baclofen (Bf). Soon after in jection, the animals were ataxic. After 4 min, seizures were induced by timed continuous intravenous (i.v.) bicu culline (BIC) infusion. Both GABA agonists produced significant reductions in myoclonic, clonic, and tonic sei zure thresholds. Injections just dorsal or anterior to this nucleus and bilateral dentate (lateral) nucleus injections had little effect on seizures. These results demonstrate that the cerebellar system does control seizures, but does not provide support for the early concept that cerebellar stimulation and systemic phenytoin block seizures through inhibition of cerebellar nuclei secondary to Pur kinje cell activation.
Phosphate Energy Metabolism During Domoic Acid‐Induced Seizures
Authors: Sutherland Garnette R. , Ross Brian D. , Lesiuk Howard , Peeling James , Pillay Neelan , Pinsky Carl 
Published: August 2005

Summary:The effect of domoic acid‐induced seizure activity on energy metabolism and on brain pH in mice was studied by continuous EEC recording and in vivo 31P nuclear magnetic resonance (NMR) spectroscopy. Mice were divided into ventilated (n = 6) and nonventilated (n = 7) groups. Baseline EEG was 0.1‐mV amplitude with frequence of >30‐Hz and of 4–5 Hz. After intraperitoneal (i.p.) administration of domoic acid (6 mg/kg), electro graphic spikes appeared at increasing frequency, pro gressing to high‐amplitude (0.1‐0.8 mV) continuous sei zure activity (status epilepticus). In ventilated mice, the [31P]NMR spectra showed that high‐energy phosphate levels and tissue pH did not change after domoic acid administration or during the intervals of spiking or status epilepticus. Nonventilated mice showed periods of EEG suppression accompanied by decreases in the levels of high‐energy phosphate metabolites and in pH, corresponding to episodic respiratory suppression during the spiking interval. In all animals, status epilepticus was fol lowed by a marked decrease in EEG amplitude that pro gressed rapidly to isoelectric silence. [31P]NMR spectra obtained after this were indicative of total energy failure and tissue acidosis. In a separate group of ventilated mice (n = 4), domoic acid‐induced status epilepticus was ac companied initially by an increase in mean arterial blood pressure (MAP) that slowly returned to baseline level. Isoelectric silence was accompanied by a decrease in MAP to 75 ± 8 mm Hg. These experiments suggest that domoic acid‐induced seizures are not accompanied by an increase in substrate demand that exceeds supply.
Knowledge, Attitude, and Practice Toward Epilepsy Among Rural Tanzanian Residents
Authors: Rwiza H. T. , Matuja W. B. P. , Kilonzo G. P. , Haule J. , Mbena P. , Mwang'ombola R. , Jilek‐Aall L. 
Published: August 2005

Summary:Before a health education program can be established, one must first know what the target population believes and does with respect to the disease in question. Therefore, we performed a study among Tanzanian rural inhabitants to identify their knowledge, attitude, and practice (KAP) toward epilepsy: 3,256 heads of households (mean age 40.2 years, range 15–90 years; M/F ratio 1:1) were interviewed. Of the respondents, 32.9% said they had never seen a seizure; 67.7% said they did not know the cause of epilepsy; 33.3% mentioned various causes including heredity, witchcraft, infection of the spinal cord, hernia; 40.6% believed epilepsy was infectious through physical contact, flatus, breath, excretions, sharing food; 36.8% believed epilepsy could not be cured and 17.1% believed it could not even be controlled; 45.3% believed epilepsy could be treated by traditional healers, and only 50.8% believed hospital drugs were of any use; and 62.7% of the respondents would not allow an epileptic child to go to school for various reasons, including mental subnormality (54.0%), fear of the child falling while alone (65.9%), and fear that the epileptic child would infect other children (11.2%). Concerning what is to be done when a seizure occurs, 33.5% of the respondents would keep away and not touch the person; 16.5% would take some potentially harmful measure such as forcing a mouth gag or forcing a drink such as water (1 even mentioned urine); 5.2% would take unnecessary measures such as rushing the patient to a hospital. Only 35.7% of respondents would perform at least some of the currently recommended first‐aid measures. Therefore, there is a need for health education on epilepsy in Tanzania, and these results are forming the base for design and execution of a health education and a primary health care program in epilepsy control.
Prevalence of Epilepsy in Kelibia, Tunisia
Authors: Attia‐Romdhane N. , Mrabet A. , Hamida M. Ben 
Published: August 2005

Summary:A door‐to‐door survey was made in Kelibia, Tunisia to determine the prevalence of major neurologic disorders, including epilepsy. The survey was made according to a World Health Organization (WHO) protocol (1981). All individuals responding positively to the screening tool were examined by a neurologic team using well‐defined diagnostic criteria. One hundred forty‐one individuals, alive on prevalence day (July 1, 1985), were identified as having active epilepsy, giving a crude prevalence ratio of 4.04 per 1,000 and an age‐adjusted (on WHO population) prevalence ratio of 3.64 per 1,000. Prevalence ratios increase with age (in children and young adults with the highest prevalence ratio at ∼20 years) and decrease after 40 years. The most frequently identified type was generalized convulsive seizures (93%). The most frequently associated conditions were cerebral palsy and mental retardation.
Prototype Antiepileptic Drug Clinical Development Plan
Authors: Kramer Lynn D. , Pledger Gordon W. , Kamin Marc 
Published: August 2005

Summary:Antiepileptic drug (AED) development has been generally difficult owing to many factors: regulatory requirements for demonstration of efficacy and safety, subject availability, traditional trial designs, and physicians' beliefs about epilepsy and its treatment. The U.S. Food and Drug Administration (FDA) regulations require a new drug to be shown safe and effective for its intended use before it can be marketed. The unambiguous proof required is a formidable hurdle for AED development. We report a recent clinical development plan highlighting innovations in clinical trial design that have addressed these requirements, discuss alternative endpoints, and compare the results of various trial designs at various stages of development. This model clinical development plan includes trials relevant to all three clinically relevant contexts in which an AED might be used: as an adjunct to an existing regimen, as a substitution for much of an existing AED regimen, and as monotherapy.
Profile of Anticonvulsant Activity and Minimal Toxicity of Methyl 4‐[(p‐Chlorophenyl)amino]‐6‐Methyl‐2‐Oxo‐Cyclohex‐3‐En‐l‐Oate and Some Prototype Antiepileptic Drugs in Mice and Rats
Authors: Mulzac Dianna , Scott Kenneth R. 
Published: August 2005

Summary:The anticonvulsant and toxic properties of methyl 4‐[(p‐chlorophenyl)amino]‐6‐methyl‐2‐oxo‐cyclohex‐3‐en‐l‐oate (ADD 196022), were compared with those of phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA). These compounds were evaluated in mice and rats using well‐standardized anticonvulsant testing procedures. Results indicate that ADD 196022 is a very potent anticonvulsant in the maximal electroshock seizure (MES) model. The compound was effective in nontoxic doses after intraperitoneal (i.p.) administration in mice and oral administration in rats. In mice, i.p. administration of ADD 196022 resulted in an ED50 value of 26.2 mg/kg as compared with a value of 6.48 mg/kg for PHT in the same assay. ADD 196022 was more potent that PHT in the oral rat model, having an ED50 value of 5.79 mg/kg as compared to 23.2 mg/kg for PHT. ADD 196022 was ineffective in nontoxic doses against all other seizure models evaluated and thus has a pharmacologic profile similar to that of PHT.
Outcomes After Seizure Recurrence in People with Well‐Controlled Epilepsy and the Factors That Influence It
Authors: Chadwick David , Taylor Joan , Johnson Tony 
Published: August 2005

Summary: Purpose: To determine the risk of further seizures and probability of further remission after a first seizure recurrence in patients in remission of their epilepsy, and to examine the prognostic factors influencing this risk. Methods: Continued follow‐up of a cohort of 409 patients with a recurrence of seizures after randomization to the Medical Research Council (MRC) Antiepileptic Drug Withdrawal Study. Results: By 3 years after a seizure, 95% of patients have experienced a further 1‐year remission of their epilepsy and by 5 years 90% of patients have experienced a further 2‐year remission. The most important factors contributing to the risk of further seizures after a first seizure after randomization were the previous seizure‐free interval, having partial seizures at recurrence, and having previously experienced seizures while receiving treatment. There was no evidence that the group of patients who had discontinued or reduced treatment before the occurrence of their first seizure after randomization had a different outcome from those patients who continued treatment. Conclusion: Our results provide no evidence that discontinuation of antiepileptic drugs (AEDs) modifies the long‐term prognosis of a person's epilepsy, although it does increase the risk of seizures in the 1‐ to 2‐year period after discontinuation.