Sustainability of an HIV PEP Program for Sexual Assault Survivors: "Lessons Learned" from Health Care Providers.

This study explored challenges to continuing an HIV post-exposure prophylaxis (PEP) program of care provided to sexual assault survivors in the province of Ontario, Canada. Data were collected as part of an implementation and evaluation of a universal offering of HIV PEP (known as the HIV PEP Program) at 24 of 34 provincial hospital-based sexual assault treatment centres. Experienced health care providers were surveyed (n = 132) and interviewed in four focus groups (n = 26) about their perceptions of what, if any, factors threatened their ability to maintain the HIV PEP Program.

HIV postexposure prophylaxis use among Ontario female adolescent sexual assault victims: a prospective analysis.

Background: This study examined the use of HIV postexposure prophylaxis (PEP) among sexually assaulted adolescent females.

Methods: We analyzed data from the HIV PEP Project, an implementation and evaluation of a program of universal offering of PEP to sexual assault victims of all ages. Baseline and follow-up data were collected prospectively from consecutive clients seen at 18 hospital-based sexual assault treatment centers in Ontario, Canada from September 2003 to January 2005.

Prospective cohort study of HIV post-exposure prophylaxis for sexual assault survivors.

Background: There is a lack of standardized programs for HIV counselling and post-exposure prophylaxis (PEP) in the setting of sexual assault.

Methods: We conducted an 18-month prospective cohort study assessing universal HIV counselling for all sexual assault survivors presenting to 18 Ontario Sexual Assault Treatment Centres. HIV PEP was universally offered to those at risk of HIV infection (high risk or unknown risk) presenting < or =72 h after the assault, using Combivir one pill and Kaletra three capsules twice a day for 28 days.

Gender differences in quality of life and extent of rotator cuff pathology.

Purpose: The purpose of this study was to investigate the effect of age and gender on functional and emotional status and extent of rotator cuff and associated pathology in patients undergoing arthroscopic surgery.

Type Of Study: Historical cohort study.

Methods: This study involved 279 patients who underwent rotator cuff decompression or rotator cuff repair and for whom scores for the 5 domains of a preoperative rotator cuff outcome measure were available.

Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.

Context: North American cesarean delivery rates have risen dramatically since the 1960s, without concomitant improvements in perinatal or maternal health. A Cochrane Review concluded that continuous caregiver support during labor has many benefits, including reduced likelihood of cesarean delivery.

Objective: To evaluate the effectiveness of nurses as providers of labor support in North American hospitals.

Sexual assault forensic medical examination: is evidence related to successful prosecution?

Study Objective: We describe the medical-legal findings in a population of adult sexual assault cases assessed in an emergency department setting and reported to the police, document the law enforcement and legal disposition of cases seen over the study period, and determine whether medical-legal findings are associated with filing of charges and conviction after adjusting for demographic factors and assault characteristics.

Methods: This was a retrospective chart review of all police-reported cases seen from January 1993 to December 1997 at the British Columbia Women's Sexual Assault Service, a 24-hour hospital-based emergency service. Information on patient demographics, assault characteristics, and medical-legal findings was merged with data extracted from police and court files on the cases' legal outcomes and sperm-semen test results of collected forensic evidence.

Endometrial evaluation with transvaginal US and hysterosonography in asymptomatic postmenopausal women with breast cancer receiving tamoxifen.

Purpose: To determine performance characteristics of transvaginal ultrasonography (US) and hysterosonography for diagnosing endometrial abnormality in asymptomatic postmenopausal women with breast cancer receiving tamoxifen.

Materials And Methods: The authors prospectively examined 138 women receiving tamoxifen by using transvaginal US, hysterosonography, and office hysteroscopy. The combined hysteroscopic-histopathologic diagnosis was the reference standard.

Abuse: a risk factor for low birth weight? A systematic review and meta-analysis.

Background: Abuse during pregnancy is considered to be a potentially modifiable risk factor for low birth weight (LBW). We conducted a systematic review and meta-analysis to determine the strength of association between physical, sexual or emotional abuse during pregnancy and LBW.

Methods: We selected papers for review from an electronic search of MEDLINE (1966-1999), CINAHL (1982-1997) and the Cochrane Library.

Hospital selection for unit cost estimates in multicentre economic evaluations. Does the choice of hospitals make a difference?

Objective: The objectives of this study were (i) to develop a conceptual framework for selecting hospitals for unit cost estimates in national and international multicentre trials and (ii) to test the impact of alternative hospital selection on the cost results.

Design And Setting: Within the conceptual framework, the following considerations which can be used when selecting a sample of hospitals for unit cost estimates in multicentre trials were identified: the number of hospitals; the sampling method; and the desired level of geographical subanalysis. Results from a recently completed international multicentre trial were used to explore changes in cost results obtained by using alternative methods of selecting and stratifying hospitals for unit cost estimates.

A patent ductus arteriosus is associated with reduced middle cerebral artery blood flow velocity.

Unlabelled: The study objective was to determine the effect of a patent ductus arteriosus (PDA) on cerebral blood flow velocity in ventilated, very low birth weight neonates, in the first 5 days of life. Sonography of the right middle cerebral artery and ductus arteriosus was performed using a colour Doppler technique. Statistical analysis was by stepwise regression.

Antenatal steroids to prevent respiratory distress syndrome: multiple gestation as an effect modifier.

Background: To determine the effect of antenatal steroids on the incidence of respiratory distress syndrome and the need for surfactant in low-birth-weight infants (501-1500 grams).

Methods: A 6 year cohort of 946 infants (396 received complete steroids and 550 received no steroids) was studied for the occurrence of respiratory distress syndrome and the need for surfactant following antenatal steroid therapy. A stratified analysis identified confounding baseline characteristics or effect modifiers.

International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature Rupture of the Membranes.

Objective: Our objective was to determine significant predictors for the development of neonatal infection in infants born to patients with premature rupture of membranes at term.

Study Design: Multivariate analysis was used to determine the significant predictors of neonatal infection in infants born to women with premature rupture of the membranes who were enrolled in the Term PROM Study. In a randomized, controlled trial, the Term PROM Study recently compared induction of labor with expectant management for premature rupture of membranes at term.

Women's evaluations of induction of labor versus expectant management for prelabor rupture of the membranes at term. TermPROM Study Group.

Background: Induction of labor has become common practice in many Western countries, but few studies have assessed women's views.

Methods: A randomized, controlled trial was conducted at 72 hospitals in six countries. Five thousand forty-one women meeting eligibility criteria, with no contraindications for induction of labor or expectant management, were randomly assigned to four groups: induction with intravenous oxytocin, induction with vaginal prostaglandin E2 gel, or expectant management followed by induction with either oxytocin or with prostaglandin E2 gel if complications developed.

Induction of labour versus expectant management for prelabour rupture of the membranes at term: an economic evaluation. TERMPROM Study Group. Term Prelabour Rupture of the Membranes.

Background: As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. Recently the TERMPROM (Term Prelabor Rupture of the Membranes) Study Group reported the results of a randomized controlled trial comparing 4 management strategies: induction with oxytocin (IwO), induction with prostaglandin (IwP), and expectant management and induction with either oxytocin (EM-O) or prostaglandin (EM-P) if complications developed. The study found no statistically significant differences in neonatal infection and cesarean section rates between any of the 4 groups.

International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term.

Objectives: Our purpose was to determine significant predictors for the development of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term.

Study Design: Logistic regression analysis with odds ratios and 95% confidence intervals was used to determine the significant predictors of clinical chorioamnionitis and postpartum fever in women with prelabor rupture of membranes at term enrolled in this study. The study recently compared in a randomized controlled trial four strategies of management: induction with oxytocin, induction with prostaglandin, expectant management, and, if failed, induction with oxytocin or prostaglandin.

Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group.

Background: As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. It is not known whether inducing labor will reduce this risk or whether one method of induction is better then another.

Methods: We studied 5041 women with prelabor rupture of the membranes at term.

Doppler velocimetry of the fetal middle cerebral and renal arteries: interobserver reliability.

Using color and pulsed Doppler ultrasonography, the interobserver reliability of measurements in the fetal circulation was evaluated in 41 pregnancies of 25 to 39 weeks' gestation. Two observers recorded flow velocity waveforms from the middle cerebral and renal arteries for measurement of peak systolic, minimum diastolic, and mean velocities, pulsatility index, and resistive index. Intraclass correlation coefficient of reliability was calculated by analysis of variance.

Aminophylline and Doppler time-averaged mean velocity in the middle cerebral artery in preterm neonates.

Objective: The purpose of this study was to assess the effect of an intravenous loading dose of aminophylline (6 mg/kg) on Doppler time-averaged mean velocity in the middle cerebral artery in ventilated preterm neonates.

Methodology: Twenty infants were studied by colour/duplex Doppler technique prior to and at 5, 10, 30 and 60 min after the administration of aminophylline.

Results: Aminophylline treatment was associated with a statistically significant reduction in time-averaged mean velocity from baseline (P < 0.

Superior mesenteric artery and renal artery blood flow velocity measurements in neonates: technique and interobserver reliability.

The objective of this study was to establish the interobserver reliability for superior mesenteric artery (SMA) and renal artery (RA) Doppler blood flow velocity (BFV) measurements in neonates. Forty-two clinically stable infants were enrolled, mean (SD) gestational age 33 (2) weeks, birthweight 2.00 (0.

Uterine and umbilical blood flow velocity during epidural anaesthesia for caesarean section.

The purpose of this study was to use colour Doppler to determine the effect of epidural anaesthesia on the uterine and umbilical blood flow velocities. After determining the precision of the technique, Doppler insonation of the uterine and umbilical arteries was performed in consenting non-labouring patients requesting epidural anaesthesia for Caesarean section. Patients in Group I were normal and those in Group II were at high risk for uteroplacental blood flow abnormalities.

The effect of dexamethasone on time averaged mean velocity in the middle cerebral artery in very low birth weight infants.

The effect of repeated doses of dexamethasone (0.25 mg/kg/dose every 12 h) on time averaged mean velocity in the middle cerebral artery was assessed in ten ventilated very low birth weight infants requiring treatment with dexamethasone for bronchopulmonary dysplasia or airway obstruction. The infants were studied by colour/duplex Doppler technique prior to the administration of the first and the third dose of dexamethasone, and 10, 30, and 120 min after these doses.

Intrapartum chemoprophylaxis of perinatal group B streptococcal infections: a critical review of randomized controlled trials.

The purpose of this overview was to critically appraise all published randomized, controlled trials evaluating the efficacy of intrapartum chemoprophylaxis in reducing perinatal group B streptococcal infections. The Oxford Database of Perinatal Trials, Medline, Excerpta Medica, and personal files were used for the literature search. By means of present inclusion criteria to select relevant articles, two independent researchers identified nine randomized, controlled trials.

Long-term results of concurrent radiation and chemotherapy for carcinoma of the cervix recurrent after surgery.

Between 1981 and 1991, 41 patients with carcinoma of the cervix recurrent only in the pelvis, or pelvis and para-aortic nodes after initial surgery, were treated with concurrent chemo-radiation (CT-RT). The total dose of radiation was tailored to the disease extent. Radiation was delivered to the pelvis and/or pelvis plus para-aortic nodes.

Effect of indomethacin on cerebral blood flow velocities in very low birth weight neonates with a patent ductus arteriosus.

The effect of repeated doses of indomethacin on mean peak velocity (MPV) and time-averaged mean velocity in the middle cerebral artery was assessed in 10 ventilated neonates with a patent ductus arteriosus using colour/duplex Doppler technique prior to, and 10, 30, and 120 min after the first and the third dose. Velocities were significantly reduced up to 120 min after the first dose. The third dose resulted in a significant reduction in MPV at 10 and 30 min following treatment.