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Selected AbstractsGP prescribing of nicotine replacement and bupropion to aid smoking cessation in England and WalesADDICTION, Issue 11 2004Andy McEwen ABSTRACT Aims Prescribing nicotine replacement therapy (NRT) or bupropion for smoking cessation is of considerable importance to public health but little is known about prescribing practices. This paper examines general practitioners' (GPs') prescribing patterns in Britain where these drugs are reimbursed. The results have implications for other health-care systems considering introducing reimbursement. Design, participants and setting Postal survey conducted in 2002 of a random sample of 1088 GPs in England and Wales, of whom 642 (59%) responded. Measures Number of requests GPs reported having received from patients for NRT and bupropion over the past month, the number of prescriptions they reported issuing and ratings of attitudes to these medications. Findings GPs reported receiving an average of 4.3 requests for NRT and 1.9 for bupropion in the previous month. They reported issuing 3.5 prescriptions for NRT and 1.2 for bupropion. Almost all GPs accepted that NRT (95%) and bupropion (97%) should be reimbursable on National Health Service (NHS) prescription. However, a significant minority of those who received requests for prescriptions did not issue any (8% for NRT and 26% for bupropion). This was related to whether they thought these products should be available on NHS prescription for both NRT and bupropion (OR = 0.66, P < 0.05), which in turn was related to beliefs about whether smokers should have to pay for treatment themselves, the cost-effectiveness of NRT/bupropion and the low priority they would give NRT/bupropion in the drug budget. For bupropion, concern about side-effects independently predicted not prescribing [odds ratio (OR) = 1.46, P < 0.03]. Conclusion In the British health-care system, which has a well-established system for technology assessment and professionally endorsed guidelines, a significant minority of GPs decline all patient requests for stop-smoking medicines. [source] A randomised controlled trial of moxibustion for breech presentationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2005Francesco Cardini Objectives To evaluate the efficacy of moxibustion for the correction of fetal breech presentation in a non-Chinese population. Design Single-blind randomised controlled trial (RCT). Setting Six obstetric departments in Italy. Sample Healthy non-Chinese nulliparous pregnant women at 32,33 weeks + 3 days of gestational age with the fetus in breech presentation. Methods Random assignment to treatment or observation. Treatment consisted of moxibustion (stimulation with heat from a stick of Artemisia vulgaris) at the BL 67 acupuncture point (Zhiyin) for one or two weeks. Two weeks after recruitment, each participant was subjected to an ultrasonic examination of the fetal presentation. Main outcome measure Number of participants with cephalic presentation in the 35th week. Results The study was interrupted when 123 participants had been recruited (46% of the planned sample). Intermediate data monitoring revealed a high number of treatment interruptions. At this point no difference was found in cephalic presentation in the 35th week (treatment group: 22/65, 34%; control group: 21/58, 36%; RR 0.95; 99% CI 0.59,1.5). Conclusions The results underline the methodological problems evaluating of a traditional treatment transferred from a different cultural context. They do not support either the effectiveness or the ineffectiveness of moxibustion in correcting fetal breech presentation. [source] Carbohydrate solution intake during labour just before the start of the second stage: a double-blind study on metabolic effects and clinical outcomeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2004H.C.J. Scheepers Objective To study the effects of oral carbohydrate ingestion on clinical outcome and on maternal and fetal metabolism. Design Prospective, double-blind, randomised study. Setting Leyenburg Hospital, The Hague, The Netherlands. Population Two hundred and two nulliparous women. Methods In labour, at 8 to 10 cm of cervical dilatation, the women were asked to drink a solution containing either 25 g carbohydrates or placebo. In a subgroup of 28 women, metabolic parameters were measured. Main outcome measures Number of instrumental deliveries, fetal and maternal glucose, free fatty acids, lactate, pH, Pco2, base excess/deficit and ,-hydroxybutyrate. Results Drinking a carbohydrate-enriched solution just before starting the second stage of labour did not reduce instrumental delivery rate (RR 1.1, 95% CI 0.9,1.3). Caesarean section rate was lower in the carbohydrate group, but the difference did not reach statistical significance (1%vs 7%, RR 0.2, 95% CI 0.02,1.2). In the carbohydrate group, maternal free fatty acids decreased and the lactate increased. In the umbilical cord there was a positive venous,arterial lactate difference in the carbohydrate group and a negative one in the placebo group, but the differences in pH and base deficit were comparable. Conclusion Intake of carbohydrates just before the second stage does not reduce instrumental delivery rate. The venous,arterial difference in the umbilical cord suggested lactate transport to the fetal circulation but did not result in fetal acidaemia. [source] von Willebrand disease in women with menorrhagia: a systematic reviewBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2004Meena Shankar Objective To determine the prevalence of von Willebrand disease in women presenting with menorrhagia. Design Systematic review of studies evaluating the prevalence of von Willebrand disease in women with menorrhagia. Setting Hospital outpatient clinics (mainly gynaecological) and population surveys. Population Women presenting with menorrhagia. Methods Relevant studies were extracted from MEDLINE search, bibliographies of identified articles and published proceedings of meetings and conferences. Main outcome measures Number of women with von Willebrand disease. Results Eleven studies were included, totalling 988 women with menorrhagia. One hundred and thirty-one women were diagnosed to have von Willebrand disease with prevalences in individual studies ranging from 5% to 24%. The overall prevalence was 13% (95% CI 11,15.6%). The prevalence was higher in the European studies,18% (95% CI 15,23%) compared with that in North American studies,10% (95% CI 7.5,13%). This difference (P= 0.007) is likely to be the result of differences in the studies, which include method of recruitment of study population, method of assessing menstrual blood loss ethnic composition of study population, criteria for diagnosis and use of race- and ABO blood group-specific values for von Willebrand factor. Conclusions The prevalence of von Willebrand disease is increased in women with menorrhagia and is the underlying cause in a small but significant group of women with menorrhagia across the world. Testing for this disorder should be considered when investigating women with menorrhagia, especially those of Caucasian origin, those with no obvious pelvic pathology or with additional bleeding symptoms. [source] Antenatal screening and intrapartum management of Group B Streptococcus in the UKBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2004Sara Kenyon Objective To determine whether there has been any change in UK policy for the screening and intrapartum management of Group B Streptococcus in pregnancy over a two year period. Design Two national survey's of practice carried out in 1999 and 2001. Setting All obstetric units in the UK. Population Clinical directors of maternity services. Methods A questionnaire was sent to all clinical directors of maternity services in the UK requesting information about their policy and practice with respect to antenatal screening for Group B Streptococcus colonisation. Reminders were sent after one month. Main outcome measures Number of maternity units in the UK screening and offering intrapartum antibiotic prophylaxis for Group B Streptococcus colonisation in pregnancy. Results The response rates were 84% in 1999 and 82% in 2001. Of the responding units, six (3%) in 1999 and four (2%) in 2001 used vaginal swab based screening for Group B Streptococcus colonisation in the antenatal period. In 1999, intrapartum antibiotic prophylaxis was offered to women with a previous baby affected by Group B Streptococcus in 85% (176/207) of maternity units and in 2001 this had risen to 95% (193/203). Similarly, in 1999 intrapartum antibiotic prophylaxis was offered to women who were known carriers of Group B Streptococcus in 87% (179/207) of maternity units and in 2001 this had risen to 95% (193/203). Appropriate dosage of a recommended antibiotic was prescribed in 7% (9/123) units in 1999 and in 20% (35/178) units in 2001. Conclusions Although intrapartum antibiotic prophylaxis for women at high risk of giving birth to babies with Group B Streptococcus is widely practiced in the UK, a programme of antenatal screening for Group B Streptococcus colonisation has not been adopted along the lines advocated in the USA. There therefore remains an opportunity to evaluate such a screening programme in a randomised trial. [source] | ||||||||||