Background: All guidelines regarding electronic fetal heart monitoring (EFM) before 2008 were designed to avoid more hypoxia than acidosis. In addition, the results of the Cochrane meta-analysis of 2013 do not show a significant improvement in neonatal outcomes using EFM or intermittent auscultation (IA).
Objectives: We retrospectively evaluated the results on delivery outcomes arising from a comparison between EFM and IA during labor of 2 specific and high-quality trials. We hypothesized that revisiting the delivery outcomes through the adoption of the recent National Institute of Child Health and Human Development (NICHHD) guidelines, the reported delivery outcomes would be different.
Material And Methods: The study retrospectively evaluated the results on delivery outcomes arising from the comparison between EFM and IA during labor of the "Dublin trial" and "Vintzileos trial" published, respectively, in 1985 and 1993. A translational model was constructed to recalculate these results, applying a correction factor to estimate the number of pathological patterns using the NICHHD guidelines for EFM.
Results: After the reevaluation of the 2 trials using the proposed correction factor, the comparison of the recalculated cesarean section and operative delivery rates for fetal distress between EFM and IA group were no longer statistically significant, both in the Dublin trial and Vintzileos trial. Even the comparison of the recalculated incidence of the rate of non-reassuring fetal heart rate (FHR) patterns in the EFM and IA groups has not given any indication of significance for the Vintzileos trial.
Conclusions: Our results lead to reconsidering the results of the Dublin trial and Vintzileos trial in terms of operational rates of births, hypothesizing that these results would have been significantly lower if FHR traces were interpreted using the current NICHHD guidelines, which aim to identify potential acidotic fetuses rather than hypoxic ones.
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http://dx.doi.org/10.17219/acem/103843 | DOI Listing |
J Med Internet Res
December 2024
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Background: Mobile health (mHealth) interventions have gained popularity in augmenting psychiatric care for adults with psychosis. Interest has grown in leveraging mHealth to empower individuals living with severe mental illness and extend continuity of care beyond the hospital to the community. However, reported outcomes have been mixed, likely attributed in part to the intervention and adopted outcomes, which affected between-study comparisons.
View Article and Find Full Text PDFJAMA Neurol
December 2024
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Importance: Gestational hypertension, preeclampsia, and eclampsia are established risk factors for stroke and dementia later in life. Whether these pregnancy complications are associated with an increased risk of new-onset neurological disorders within months to years after giving birth is not known.
Objective: To explore whether gestational hypertension, preeclampsia, and eclampsia are associated with new-onset migraine, headache, epilepsy, sleep disorder, or mental fatigue within months to years after giving birth.
JAMA Netw Open
December 2024
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Importance: Access to appropriate postpartum care is essential for improving maternal health outcomes and promoting maternal health equity.
Objective: To analyze the impact of the Nurse-Family Partnership (NFP) home visiting program on use of routine and emergency postpartum care.
Design, Setting, And Participants: This study was a secondary analysis of a randomized clinical trial that enrolled eligible participants between 2016 and 2020 to receive NFP or usual care from a South Carolina Medicaid program.
Environ Sci Pollut Res Int
December 2024
Department of Physical, Earth and Environmental Sciences, University of Siena, 53100, Siena, Italy.
Sewage sludge applications as soil amendment call for a proper ecological risk assessment due to unexpected delivery of toxic chemicals and materials. Standardized acute toxicity assays have proven to provide limited information in terms of potential hazard for soil organisms. Here, sublethal endpoints as physiological and tissue alterations were proposed as suitable tools for sewage sludge ecological risk assessment.
View Article and Find Full Text PDFInt J Clin Oncol
December 2024
Translational Research Support Office, Division of Drug and Diagnostic Development Promotion, Department for the Promotion of Drug and Diagnostic Development, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Background: The implementation of cancer precision medicine in Japan is deeply intertwined with insurance reimbursement policies and requires case-by-case reviews by Molecular Tumor Boards (MTBs), which impose considerable operational burdens on healthcare facilities. The extensive preparation and review times required by MTBs hinder their ability to efficiently assess comprehensive genomic profiling (CGP) test results. Despite attempts to optimize MTB operations, significant challenges remain.
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