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We give you many useful information about health

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Tampilkan postingan dengan label guidelines. Tampilkan semua postingan
Tampilkan postingan dengan label guidelines. Tampilkan semua postingan

Jumat, 14 Oktober 2011

Guidelines of the ultrasound can diagnose wrongly miscarriage

As if anxiety about potential error were not quite stressful for newly pregnant women, research published Friday shows that the current guidelines for using ultrasound to determine that a pregnancy is completed can not always be accurate.

Four new studies looked at ultrasound U.K. specifications, but when the results are extrapolated to the guidelines of the U.S., researchers suggest that 1 in 23 women diagnosed with error could still have a viable pregnancy.

That could mean for the future of such incorrectly doomed pregnancies is not known. Researchers analyzed not if women in the studies that have been informed that their pregnancies had ended then has to have surgery to remove their uterus.

But just the possibility that a pregnant woman unintentionally would end a pregnancy viable is intolerable, said Tom Bourne, Professor of Gynecology at Imperial College London and principal author of three related studies published in the journal ultrasound in obstetrics and Gynecology. "We are concerned that the current guidelines can lead to a misdiagnosis," said Bourne. "The current thresholds for error are not appropriate."

More: Women Grieve error for years, even after having a healthy baby

Ultrasound is the gold standard used to determine the error. It is assumed - at least by pregnant women - exceptionally precise. Yet, studies, who analysed the existence or the size of the gestational sac, concluded that the presence or absence of a gestational sac, as well as its size, were not infallible indicators of spontaneous abortion.

The researchers followed 1,060 women who complained of slight bleeding or pain - the two potential signs that a pregnancy is distressed - between five and eight weeks of pregnancy and had an initial ultrasound. As is practical, they returned seven to ten days later for a further analysis measure the growth of the bag. Those who were still pregnant were followed again between 11 and 14 weeks.

Generally, an embryo enjoyed 6 mm with no increase in the size of the gestational sac between detectable scans or without a heartbeart is supposed to indicate the spontaneous abortion, but Bourne concluded that it is possible that a pregnancy may not grow measurable in a week. In fact, half a percentage point for women in the study - or 1 in 183 - still could be pregnant even if scanning guidelines technically would have classified their pregnancies in the end.

To the United Kingdom, ultrasounds which reveal an empty gestational sac over 20 mm in size lead to a diagnosis of spontaneous abortion. In the United States, the standard established by the American College of Radiology is 16 mm. based on the findings of researchers, 8 in 183 U.S. women - or 1 to 23 - would have a miscarriage diagnosed incorrectly.

More: The common use Painkiller may be linked to the risk of miscarriage

Another study concluded that a gestational sac can vary up to 20% according to the who made the measure; different clinicians obtain different results. Imagine, for example, that a Sonographer overstates size of CCS, and then a second ultrasound later underestimates it. The confusion which could lead to a women being falsely that she had failed.

To increase the precision, Bourne recommends ultrasound guidelines be updated and increased standards for the determination of miscarriage.

Jonathan Schaffir, Associate Professor of obstetrics and Gynecology at the Ohio State University, who was not involved in the research, said that the British studies are important, even if it is likely that most of the doctors who suspect miscarriage at early stages of pregnancy would adopt a wait-and-see approach. "It is important of Miss not even a viable pregnancy, but it is rather unusual to determine the error based on an analysis of these measures at the beginning, at the beginning," he said. "From a practical point of view, the results of these studies will not change clinical practice."

Bonnie Rochman is a journalist in time. Find him on Twitter at @ brochman. You can also continue the discussion on the time Facebook page and Twitter time @.



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Senin, 19 September 2011

Ob-gyn guidelines often based on opinion, weak data

AppId is over the quota
AppId is over the quota
A nurse feeds a baby in the neonatal intensive care unit at the Virtua Health facility in Vorhees, New Jersey, November 19, 2009. REUTERS/Tim Shaffer

A nurse feeds a baby in the neonatal intensive care unit at the Virtua Health facility in Vorhees, New Jersey, November 19, 2009.

Credit: Reuters/Tim Shaffer

By Frederik Joelving

NEW YORK | Fri Sep 16, 2011 5:31pm EDT

NEW YORK (Reuters Health) - Solid evidence is often missing from the practice guidelines used by obstetrician-gynecologists across the U.S., a new study shows.

Less than a third of the recommendations from the American College of Obstetricians and Gynecologists (ACOG) are based on gold-standard scientific experiments, researchers found.

The rest are based on anecdotal evidence or expert opinion, which is subject to personal biases, they reported.

"That is often the fall-back when there is no data," said Dr. Andrew D. Auerbach, a professor of medicine at the University of California, San Francisco, who was not part of the study.

He said expert opinion is helpful in pointing out what we don't know, but might not always translate into what's best for patients.

"Many, many times we have the best intentions and the best wishes and yet things don't work out the way we would have liked," Auerbach told Reuters Health.

Guidelines help doctors keep up with the latest developments in their fields and are widely perceived as a recipe for good patient care.

But there is often surprisingly little hard data behind them. Earlier this year, for instance, a group of researchers found that only one in seven treatment recommendations from the Infectious Diseases Society of America was based on high-quality data from clinical trials.

One such recommendation urged doctors to treat pneumonia with antibiotics right away. It ended up fueling overtreatment with no apparent benefits, possibly breeding resistant bacteria and exposing patients to side effects. (See Reuters Health story of January 10, 2011).

In the new study, Dr. Jason D. Wright of Columbia University in New York and colleagues went through 717 practice recommendations from ACOG, the nation's leading group of ob-gyns.

They found 30 percent of those were based on top-notch evidence, so-called randomized controlled trials. About 38 percent came from observational studies, whose value is limited, and 32 percent were purely expert opinion.

"It is disappointing, but I don't think it reflects their process," said Auerbach, who was recently part of an Institute of Medicine committee to develop standards for better guidelines. "It is really a call for better evidence."

In an editorial published along with the new study in ACOG's journal Obstetrics and Gynecology, Editor-in-Chief Dr. James R. Scott said the group's guidelines compared favorably with those in other areas of medicine.

He added that the guidelines panels conduct extensive reviews of the medical literature to find all relevant evidence and also take care to exclude experts with financial conflicts of interest.

According to Dr. Sheldon Greenfield, who chaired the Institute of Medicine guideline committee, those are two key elements in creating good guidelines.

A third component is to ensure that guideline panels represent all stakeholders -- including doctors from other specialties and patients, he told Reuters Health.

If those requirements are fulfilled, he added, there is room for opinion.

"For many of the recommendations there simply is not enough data, or it is disputed," said Greenfield, a professor of medicine at the University of California, Irvine. "So there has to be a role for expert opinion."

So far, however, few if any guideline panels meet all three requirements.

"It's about as common as peace in the Middle East," Greenfield said. "People are struggling with it."

SOURCE: bit.ly/pkPZu4 Obstetrics and Gynecology, September 2011.



View the original article here



Peliculas Online

Minggu, 18 September 2011

Ob-gyn guidelines often based on opinion, weak data

AppId is over the quota
AppId is over the quota
A nurse feeds a baby in the neonatal intensive care unit at the Virtua Health facility in Vorhees, New Jersey, November 19, 2009. REUTERS/Tim Shaffer

A nurse feeds a baby in the neonatal intensive care unit at the Virtua Health facility in Vorhees, New Jersey, November 19, 2009.

Credit: Reuters/Tim Shaffer

By Frederik Joelving

NEW YORK | Fri Sep 16, 2011 5:31pm EDT

NEW YORK (Reuters Health) - Solid evidence is often missing from the practice guidelines used by obstetrician-gynecologists across the U.S., a new study shows.

Less than a third of the recommendations from the American College of Obstetricians and Gynecologists (ACOG) are based on gold-standard scientific experiments, researchers found.

The rest are based on anecdotal evidence or expert opinion, which is subject to personal biases, they reported.

"That is often the fall-back when there is no data," said Dr. Andrew D. Auerbach, a professor of medicine at the University of California, San Francisco, who was not part of the study.

He said expert opinion is helpful in pointing out what we don't know, but might not always translate into what's best for patients.

"Many, many times we have the best intentions and the best wishes and yet things don't work out the way we would have liked," Auerbach told Reuters Health.

Guidelines help doctors keep up with the latest developments in their fields and are widely perceived as a recipe for good patient care.

But there is often surprisingly little hard data behind them. Earlier this year, for instance, a group of researchers found that only one in seven treatment recommendations from the Infectious Diseases Society of America was based on high-quality data from clinical trials.

One such recommendation urged doctors to treat pneumonia with antibiotics right away. It ended up fueling overtreatment with no apparent benefits, possibly breeding resistant bacteria and exposing patients to side effects. (See Reuters Health story of January 10, 2011).

In the new study, Dr. Jason D. Wright of Columbia University in New York and colleagues went through 717 practice recommendations from ACOG, the nation's leading group of ob-gyns.

They found 30 percent of those were based on top-notch evidence, so-called randomized controlled trials. About 38 percent came from observational studies, whose value is limited, and 32 percent were purely expert opinion.

"It is disappointing, but I don't think it reflects their process," said Auerbach, who was recently part of an Institute of Medicine committee to develop standards for better guidelines. "It is really a call for better evidence."

In an editorial published along with the new study in ACOG's journal Obstetrics and Gynecology, Editor-in-Chief Dr. James R. Scott said the group's guidelines compared favorably with those in other areas of medicine.

He added that the guidelines panels conduct extensive reviews of the medical literature to find all relevant evidence and also take care to exclude experts with financial conflicts of interest.

According to Dr. Sheldon Greenfield, who chaired the Institute of Medicine guideline committee, those are two key elements in creating good guidelines.

A third component is to ensure that guideline panels represent all stakeholders -- including doctors from other specialties and patients, he told Reuters Health.

If those requirements are fulfilled, he added, there is room for opinion.

"For many of the recommendations there simply is not enough data, or it is disputed," said Greenfield, a professor of medicine at the University of California, Irvine. "So there has to be a role for expert opinion."

So far, however, few if any guideline panels meet all three requirements.

"It's about as common as peace in the Middle East," Greenfield said. "People are struggling with it."

SOURCE: bit.ly/pkPZu4 Obstetrics and Gynecology, September 2011.



View the original article here



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