bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating measurement variability in clinical investigations: the case of ultrasonic estimation of urinary bladder volume
Authors: Khan Khalid S. , Chien Patrick F. W. , Honest Matthew R. , Norman Geoffrey R. 
Published: August 2005

Objective
To evaluate the quality of studies seeking to establish measurement properties (reliability and validity) of ultrasonic estimation of urinary bladder volume.Design
Online searching of the MEDLINE database between 1966 and 1995, and scanning of bibliography of known studies on ultrasonic bladder volume estimation. Study selection and study quality assessment were performed independently by two reviewers. Each article was evaluated for suitability of the reference standard, adequacy of reported blinding of the observers and appropriateness of the statistical index of concordance. The last two of these guidelines were applied to reliability studies (evaluating the relation among observed ultrasonic estimations), and all three guidelines were applied to validity studies (evaluating the relation of ultrasonic estimation with a definitive measurement).Population
One hundred and twenty‐five participants enrolled in the five reliability studies and 769 participants in the 27 validity studies selected for appraisal of their quality.Main outcome measure
Rate of study compliance with preset criteria for high quality.Results
None of the studies complied with all of the criteria for high methodologic quality. In the five reliability studies, investigators did not report adequate blinding of observers in three (60%) and an appropriate index of reliability was not used in any. Among the 27 validity studies, there was a lack of a suitable reference standard in 6 (22%), an inadequate blinding in 25 (93%), and an inappropriate index of validity in all (100%).Conclusion
Based on our guidelines for quality assessment, a large proportion of studies on measurement properties was found to have inadequate methods, raising concern about the credibility of the reliability and validity estimates reported. These deficiencies highlight the lack of rigour employed in the design, conduct and analysis of reliability and validity studies, which has the potential for leading to patient mismanagement due to biases in the assessment of measurement variability in clinical investigations.
Sex ratios: are there natural variations within the human population?
Authors: Maconochie Noreen , Roman Eve 
Published: August 2005

Objective
To investigate on a population basis the suggestion that certain factors naturally alter the odds of having a boy or a girl, and that some women are predisposed towards having children of one particular gender.Design
Routine data analysis.Population
Routinely collected data on singleton infants born in Scotland from 1975 to 1988, linked so that births (live and still) to the same mother could be identified. The analyses relate to 549,048 first to fifth order births occurring to 330,088 women whose records were complete from the first delivery onwards.Main outcome measures
Gender of infant.Results
Of 549,048 births, 51.4% were male. Apart from random variation, the sex ratio of 1.06 remained constant at all birth orders (P= 0.18). The probability of a male infant appeared unrelated to the genders of the preceding siblings (P > 0.20 in second to fifth deliveries), and there was no evidence of variation with maternal age (P= 0.31), maternal height (P= 0.69), paternal social class (P= 0.12), maternal social class (P= 0.57), year of delivery (P= 0.84) or season of birth (P= 0.41). Whilst mothers whose children were all the same gender were more likely to continue childbearing than those with children of different genders, there was no evidence that those with daughters were more likely to continue than those with sons.Conclusions
The suggestion that some women have a natural predisposition towards having children of a particular gender is not supported by these data. On a population basis there is no evidence to suggest that gender determination is anything other than a chance process.
Is a rising caesarean section rate inevitable?
Authors: Wilkinson Chris , McIllwaine Gillian , Boulton‐Jones Clare , Cole Susan 
Published: August 2005

Objective
To determine the indications for singleton caesarean sections in Scotland in 1994.Design
Prospective survey of singleton caesarean sections using information provided by clinicians entering data onto a computer in labour wards.Setting
Twenty‐three consultant‐led obstetric units in Scotland.Population
Women undergoing caesarean section in participating Scottish maternity units during 1994.Results
Using routinely collected data it was found that the caesarean section rate varied by maternal age, parity, gestation, history of previous section and hospital of delivery, but there was no difference by area of deprivation. 87.4% (8369/9573) of Scottish caesarean sections were included in the survey of which 8098 were in women with singleton pregnancies. Most singleton caesarean sections were undertaken in primiparae (50.5%), 31.2% were in women with a history of previous section and 18.3% were in multiparous women who had not had a previous section; 38.9% of the operations were elective, 13.9% were emergencies before labour and 47.2% were emergencies during labour. Four main indications—elective section for breech presentation (10.7% of all sections); emergency Caesarean section before labour because of fetal problems (2.8%); emergency caesarean section during labour for fetal distress and/or failure to progress (30.3%); repeat section for reasons other than above (16.2%) accounted for 60% of all Caesarean sections in women with no other recorded complications. 7.7% of all singleton caesarean sections (19.8% of elective operations) were associated with maternal request for the operation.Discussion
The survey has identified why caesarean sections are performed by Scottish obstetricians and highlighted some areas where there would be scope to increase the vaginal delivery rate. Before this can be attempted, agreement must be reached by clinicians about effective management of particular problems. Women also need to have ready access to evidenced‐based information about caesarean section.
Effect of spinal anaesthesia on the lower urinary tract in continent women
Authors: Haeusler Guenther , Sam Christine , Chiari Astrid , Tempfer Clemens , Hanzal Engelbert , Koelbl Heinz 
Published: August 2005

Objective
To evaluate the effect of spinal anaesthesia on the bladder neck position and the urethral closure function in the resting state and during clinical stress test in healthy, continent women.Design
Controlled clinical trial.Setting
Department of Gynaecology and Obstetrics, Vienna University Medical School.Participants
Fourteen continent women, of which seven were nulliparous and seven parous, underwent minor gynaecological procedures under spinal anaesthesia. Urodynamics and ultrasound investigations were performed before and during spinal anaesthesia.Main outcome measures
Changes in the bladder neck position and the urethral closure function before and during spinal anaesthesia.Results
Bladder neck position was found to be lower and more posterior during spinal anaesthesia as compared with pre‐operative assessment. The posterior urethrovesical angle increased significantly both at rest and during maximum straining. We observed a significant increase in bladder compliance, and all parameters of the urethral pressure profile decreased significantly. While none of the nulliparous women had a positive clinical stress test during spinal anaesthesia, 4/7 parous women demonstrated leakage (Fisher's exact test, P= 0.03).Conclusions
Blockage of nerve supply to the pelvic floor muscles in continent women is associated with a significant loss of support of the bladder neck region confirming the theory of an active mechanism of muscular elements providing continence.
Is there an incremental rise in the risk of obstetric intervention with increasing maternal age?
Authors: Rosenthal Adam N. , Paterson‐Brown Sara 
Published: August 2005

Objective
To determine whether increasing maternal age increases the risk of operative delivery and to investigate whether such a trend is due to fetal or maternal factors.Design
Analysis of prospectively collected data on a maternity unit database.Setting
A postgraduate teaching hospital.Population
6410 nulliparous women with singleton cephalic pregnancies delivering at term (37–42) weeks of gestation) between 1 January 92 and 31 December 95.Main outcome measures
Mode of delivery, rates of prelabour caesarean section, induction of labour and epidural usage.Results
There was a positive, highly significant association between increasing maternal age and obstetric intervention. Prelabour (P < 0.001) and emergency (P < 0.001) caesarean section, instrumental vaginal delivery (spontaneous labour P < 0.001; induced labour P= 0.001), induction of labour (P < 0.001) and epidural usage in spontaneous labour (P = 0.005) all increased with increasing age. In the second stage of labour fetal distress and failure to advance, requiring instrumental delivery, were both more likely with increasing maternal age (in both P < 0.001). Epidural usage in induced labour and the incidence of small for gestational age newborns did not increase with increasing maternal age (P = 0.68 and P = 0.50, respectively).Conclusions
This study demonstrates that increasing maternal age is associated with an incremental increase in obstetric intervention. Previous studies have demonstrated a significant effect in women older than 35 years of age, but these data show changes on a continuum from teenage years. This finding may reflect a progressive, age‐related deterioration in myometrial function.
Intra‐umbilical vein injection and retained placenta: evidence from a collaborative large randomised controlled trial
Authors: Carroli Guillermo , Belizan José M. , Grant Adrian , Gonzalez Laura , Campodonico Liana , Bergel Eduardo ,   on behalf of the Grupo Argentino de Estudio de Placenta Retenida
Published: August 2005

Objective
To determine whether intra‐umbilical vein injection with saline solution, with or without oxytocin, reduces the need for manual removal of placenta compared with expectant management.Design
Multicentre, randomised controlled trial.Setting
Eleven hospitals in four cities of Argentina: Buenos Aires, Corrientes, Rosario, and Salta.Participants
Two hundred and ninety‐one women showing no evidence of placental separation thirty minutes after vaginal delivery.Interventions
Three different management strategies: 1. intra‐umbilical vein injection of saline solution plus oxytocin; 2. intra‐umbilical vein injection of saline solution alone; and 3. expectant management.Main outcome measures
Primary: manual removal of the placenta. Secondary: blood loss after trial entry, haemoglobin level at 24 to 48 hours and at 40 to 45 days after delivery, blood transfusion, curettage, infection, and days of hospital stay.Results
Rates of subsequent manual removal were similar: intra‐umbilical vein injection of saline solution plus oxytocin (58%; RR 0.92; 95% CI 0.73–1.15), or saline alone (63%; RR 1.00; 95% CI 0.80–1.24), compared with expectant management (63%). There were also no detectable effects of the active managements on any of the secondary measures of outcome.Conclusions
Based on evidence available from randomised controlled trials, including this trial, it is unlikely that intra‐umbilical injection with or without oxytocin, is clinically useful. We recommend that this intervention should not be used in third stage management of labour.
Mandatory prenatal screening for the human immunodeficiency virus: the experience in south‐eastern France of a national policy, 1992–1994
Authors: Rey Dominique , Carrieri Maria‐Patrizia , Obadia Yolande , Pradier Christian , Moatti Jean‐Paul 
Published: August 2005

Objective
To evaluate the impact of the 1993 French National Policy which made it mandatory to offer screening for the presence of human immunodeficiency virus (HIV) to all pregnant women who planned to give birth, although women remained free to refuse the test.Design
Successive surveys in April 1992 and May 1994 in south‐eastern France. Logistic regressions were performed to identify factors which affected access to HIV testing for women who gave birth and those who terminated their pregnancy, and for each year of study.Main outcome measures
Attitudes and access to HIV testing among pregnant women, irrespective of pregnancy outcome.Setting
All obstetrics and gynaecology departments and abortion clinics in the region.Population 3497 women in 1992 (2775 who were delivered and 722 who chose termination) and 3407 in 1994 (2701 who were delivered and 766 who chose termination). The response rates were 82% and 88%, respectively.Results
In 1994 of women who were delivered, 73% had an HIV test, compared with 63% in 1992 (P < 0.001); however of women who terminated their pregnancy, only 28% had an HIV test, compared with 245% in 1992 (P not significant), although they were more at risk for HIV infection. Socioeconomic differences affecting access to testing were reduced between 1992 and 1994, but only among women who gave birth.Conclusion
Introduction of a policy which makes it mandatory to offer HIV screening to all women who intended to have their baby improved access to screening but did not improve the rate of preventative counselling. A mandatory requirement to offer HIV screening should be extended to women who request termination of pregnancy.
The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa
Authors: Hofmeyr G. J. , Gülmezoğlu A. M. , Buchmann E. , Howarth G. R. , Shaw A. , Nikodem V. C. , Cronje H. , de Jager M. , Mahomed K. 
Published: August 2005

Objective
To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labout.Design
Multicentre randomised controlled trial.Setting
Four urban academic hospitals in South Africa. Obstetric surveillance included the use of electronic fetal heart rate monitoring in most cases.Participants
Women in labour at term with moderate or thick meconium staining of the amniotic fluid.Interventions
Transcervical amnioinfusion of 800 mL saline at 15 mL per minute, followed by a maintenance infusion at 3 mL per minute. The control group received routine care. Blinding of the intervention was not possible.Main outcome measures
Caesarean section, meconium aspiration syndrome and perinatal mortality.Results
Caesarean section rates were similar (amnioinfusion group 70/167 vs control group 68/159; RR 0.98, 95% CI 0.76–1.26). The incidence of meconium aspiration syndrome was lower than expected on the basis of previous studies (4/162 vs 6/163; RR 0.67, 95% CI 0.19–2.33). There were no perinatal deaths. There were no significant differences between any of the subsidiary outcomes.Conclusions
This study concurred with three previous trials which found no effect of amnioinfusion for meconium stained amniotic fluid on caesarean section rate, though the pooled data from all identified trials to date show a significant reduction. The findings with respect to meconium aspiration syndrome were inconclusive in this study alone because of the small number of babies affected, but the point estimate of the relative risk was consistent with the finding of a significant reduction in previous studies and with the Zimbabwe arm (CRAMP 2) of this study. Pooled data clearly support the use of amnioinfusion for meconium stained amniotic fluid to reduce the incidence of meconium aspiration syndrome.
The value of screening for Down's syndrome in a socioeconomically deprived area with a high ethnic population
Authors: Ford C. , Moore A. J. , Jordan P. A. , Bartlett W. A. , Wyldes M. P. , Jones A. F. , MacKenne W. E. 
Published: August 2005

Objective
To assess the utility of biochemical antenatal screening for Down's syndrome in a socioeconomically deprived area with a high proportion of Asian women from the Indian Subcontinent.Design
Audit of Down's syndrome biochemical screening service over a four‐year period.Setting
Teaching hospital and community antenatal clinic in inner city Birmingham.Population
Women booked between October 1992 and December 1996.Methods
Blood for screening was collected between 14 and 21 weeks gestation, alpha‐fetoprotein and intact human chorionic gonadotrophin were measured in serum and the risk of Down's syndrome was calculated.Main outcome measures
Uptakes of screening and amniocentesis, screen positive rate, odds of being affected given a positive result, miscarriages associated with amniocentesis offered following a high risk result, detection rate, number of Down's cases prevented and a cost analysis. Outcome measures were compared between Asians and Caucasians.Results
Overall 11,974 women (71%) accepted serum screening. The screen positive rate was 8.3% in Asians and 5.0% in Caucasians. The uptake of amniocentesis in women following a high risk result was 54% overall (35% Asian, 67% Caucasian). Nineteen cases of Down's syndrome were identified, of which 13 occurred in women who opted for biochemical screening. The detection rate of the biochemical screening programme was 85% (11/13). Of these 11 cases, six (none of whom were Asian) elected to have an amniocentesis, of whom four thereafter had a termination.Conclusion
In this study the public health benefits of screening for Down's syndrome in a socioeconomically deprived area with a high Asian population, were small.
A double‐blind, randomised trial comparing the effects of tibolone and continuous combined hormone replacement therapy in postmenopausal women with menopausal symptoms
Authors: Hammar M. , Christau S. , Nathorst‐Böös J. , Rud T. , Garre K. 
Published: August 2005

Objective
To compare the effects of two postmenopausal regimens on menopausal symptoms, bleeding episodes, side effects and acceptability.Design
Double‐blind, randomised controlled trial.Setting
Twenty‐nine sites in Denmark, nine in Norway and six in Sweden.Participants
Four hundred and thirty‐seven postmenopausal women with menopausal complaints. None of these women had had a hysterectomy.Interventions
Daily treatment with tibolone 2.5 mg (n = 218) or 17β‐oestradiol 2 mg plus norethisterone acetate 1 mg (E2/NETA) (n = 219).Main outcome measures
Hot flushes, sweating episodes, vaginal dryness, assessment of sexual life and bleeding patterns; at baseline and after 4,12,24 and 48 weeks.Results
Treatment with either preparation significantly reduced mean scores for hot flushes, sweating episodes and vaginal dryness. The overall discontinuation rate was 28% (tibolone 25%, E2/NETA 31%; P = 0.14), mostly during the first six months. There was a markedly lower cumulative incidence of bleeding or spotting episodes with tibolone compared with E2/NETA (P < 0.0001), mainly during the first six treatment cycles.Conclusions
Both tibolone and E2/NETA effectively alleviate menopausal symptoms. However, tibolone caused significantly fewer bleeding or spotting episodes, which were reflected by lower overall rates of bleeding, as well as lower drop‐out rates due to bleeding.
An open study of the bladder neck support prosthesis in genuine stress incontinence
Authors: Moore Kate H. , Foote Andrew , Burton Gil , King Janet 
Published: August 2005

Objective
To determine the proportion of unselected women with genuine stress incontinence in whom a bladder neck support prosthesis could be fitted successfully by three gynaecologists with no prior knowledge of the device, and to measure efficacy of the device.Design
Prospective interventional study.Setting
Two metropolitan urodynamic units.Sample
Eighty women with genuine stress incontinence.Main outcome measures
Average number of leaks per day on a frequency volume chart, average number of pads worn per day, urine loss on a one‐hour pad test, and urine flow rate.Results
Of the 80 recruits, 11 had exclusion criteria and four could not be fitted at the first visit. Of 65 participants, 39 (58%) withdrew from the study before week four. In 20 of 39 women (51%) post‐surgical scarring made fitting difficult, and six (15%) withdrew for unrelated personal or medical reasons. In five women (13%) the device was never effective; six withdrew because of adverse events and two required devices that were larger or smaller than those presently available. Thus 38 of 65 participants (58%) could be fitted by the three gynaecologists. Of 26 women who wore the device for four weeks, median leaks per day fell from 2.5 (interquartile range (IQR) 1.9–4.6) to 1.0 (IQR 0–2); median number of pads per day fell from 1.5 (IQR 0.5–3) to 0 (IQR 0–1); and median pad test loss fell from 19 g/h (IQR 8–49) to 2 g/h (IQR 0–8). Sixteen of these 26 patients (62%) achieved objective success, six (23%) were socially continent, one failed to respond and three declined to complete all outcome measures. Urine flow rates revealed no evidence of outflow obstruction. At the sixth month, 18 of 26 patients (69%) were wearing the device successfully; 15 of these women continued to the 12th month, and all but one were objectively dry.Conclusions
The bladder neck support prosthesis is a useful addition to the range of treatments available for the management of genuine stress incontinence, but may be difficult to fit in women who are oestrogen‐deprived or have undergone multiple surgical procedures. The demands of the trial protocol were found to be onerous by frail elderly women.
A study of the follow up patterns of women treated for CIN 2 and 3 before and after the introduction of the 1992 Guidelines
Authors: Mann C. H. , Kehoe S. , Brown A. , Luesley D. M. 
Published: August 2005

Objective
To analyse the five year cytology follow up data after discharge on women treated for histologically proven cervical intraepithelial neoplasia (CIN) 2 and 3. To assess whether the introduction of the 1992 Guidelines for Clinical Practice and Programme Management affected follow up patterns. To identify who was lost to follow up and for what reasons.Design
A retrospective cohort study of cervical cytological follow up data from 186 women treated for CIN 2 and 3.Setting
Primary care services, West Midlands, United Kingdom.Population
One hundred and eighty‐six women with CIN 2 or 3 treated with large loop excision of the transformation zone at the City Hospital, Birmingham, in whom the first follow up smear at six months was normal. The women were divided into two groups: Group 1 consisted of women treated before the introduction of the Guidelines (1988–1990), and Group 2 consisted of women treated at the time of the introduction of the Guidelines in 1992.Intervention
Introduction of the 1992 Guidelines for Clinical Practice and Programme Management.Main outcome measures
To determine the number of follow up smears each woman had over a five year period, to determine the number of women who had the recommended number of follow up smears, and to identify the number of women lost to follow up.Results
The median (interquartile range) number of smears in Group 1 was five (four to six) and in Group 2 was four (four to five). A similar proportion of women in both groups subsequently had abnormal smears (15% and 13.6%). Only one woman required further treatment. 22% of women in Group 1 and 10.2% of women in Group 2 had the correct number of smears to fulfil the 1992 Guidelines. There were 21 women (11.3%) who only had one smear following discharge from the clinic in the five year follow up period.Conclusions
The data from both cohorts shows follow up to be poor, and the introduction of the 1992 Guidelines has yet to result in an improvement in follow up patterns. The absence of a national cervical cytology database means that surveys of cytology follow up data will continue to be difficult due to the problems of data collection from numerous health authorities and the mobility of women in this age group.