摘要:

ObjectiveTo test the hypothesis that infection withHelicobacter pyloriis associated with hyperemesis gravidarum.MethodsFrom January 1995 to November 1996 we enrolled 105 patients with hyperemesis gravidarum in a prospective study. The Helicobacter serum Immunoglobulin (Ig) G concentrations in these patients were compared with those in asymptomatic gravidas matched for week of gestation.ResultsPositive serum IgG concentrations were found in 95 of the 105 hyperemesis patients (90.5%) compared with 60 of 129 controls (46.5%). A χ2test showed statistical significance (P< .001). The mean (± standard deviation) index percentages of the IgG titers were 74.2 ± 23.6% in the hyperemesis group and 24.3 ± 4.4% in the control group (P< .01, Studentttest).ConclusionInfection withH pylorimay cause hyperemesis gravidarum.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo develop and test a simple MEDLINE search strategy for identification of randomized controlled trials (RCTs) in obstetrics and gynecology.MethodsTo develop our search strategy, we asked clinicians in our department to indicate, from a list of search terms, the terms they would use to identify RCTs in MEDLINE. The two most common terms, controlled-clinical-trial (publication type) and randomized-controlled-trial (publication type), were combined with the link word, OR, and then used to identify RCTs in four obstetrics and gynecology journals for the years 1975, 1980, 1985, 1990, and 1995. Concurrently, a handsearch of these same journals and years was performed to identify RCTs. The sensitivity and precision of MEDLINE and handsearch were calculated using the total number of RCTs identified by both methods as a reference standard. Sensitivity is the RCTs identified by search strategy as a percentage of all RCTs identified by reference standard. Precision is the RCTs identified by a search strategy as a percentage of all articles identified by it.ResultsThe overall sensitivity of our MEDLINE search strategy was 72.5%, and the precision was 83.4%. Over 2 decades, sensitivity of our MEDLINE search increased from 0% to 94.9% (P< .001), while its precision dropped from 100% to 75.5% (P= .003). For 1990 and 1995 combined, sensitivity and precision of our MEDLINE search strategy were 90.3% and 79.6%, respectively. Overall sensitivity for handsearch was 96.5%; its precision was 5.0%. Over 2 decades, the sensitivity of handsearch dropped insignificantly from 100% to 92.3% (P= .05), while the precision increased from 2.6% to 6.3% (P< .001).ConclusionOur simple MEDLINE search strategy has a high sensitivity and precision, especially in more recent years. Obstetricians and gynecologists may use it to search quickly for RCTs to guide patient care.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveUse of ordinal numbers (eg, twelfth) instead of cardinal numbers (eg, twelve) to measure gestational age often leads to clinical confusion. We conducted this study to document the prevalence of ambiguous or contradictory use of ordinal numbers for gestational age and to discuss some clinical implications.Materials and MethodsWe reviewed a convenience sample of standard texts in obstetrics and in abortion and examined a random sample of articles on abortion.ResultsImprecise or incorrect use of ordinal numbers for gestational age was common: Eight of nine (89%) obstetrics texts and all six abortion texts had this problem. The corresponding figure for the abortion articles was 32 of 88 (36%).ConclusionUse of ordinal numbers for gestational age introduces information bias (misclassification) into the scientific literature. More importantly, it may lead to clinical errors related to the timing of administration of antenatal corticosteroids and the upper limit for induced abortions. Gestational age measurements should use only cardinal numbers (eg, twelve) of completed days or weeks from the last menstrual period. Clinicians should abandon use of ordinal numbers for gestational age.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo quantify by meta-analysis the performance of colposcopy to set a standard against which new technologies can be compared.Data SourcesMEDLINE was searched for articles on colposcopy for diagnosis of squamous intraepithelial lesions (SIL). The search selected articles from 1960 to 1996 combining the key word “colposcopy” with key words “diagnosis,” “positive predictive value,” “negative predictive value,” “likelihood ratio,” and “receiver operating characteristic (ROC) curve.”Methods of Study SelectionArticles were selected if the authors studied a population of patients with abnormal screening Papanicolaou smears and presented raw data showing for each cervical lesion type the number of patients judged positive and negative by colposcopic impression versus the standard of colposcopic biopsy results. Nine of 86 studies met these criteria.Tabulation, Integration, and ResultsBiopsies had been categorized as normal, atypia, cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, carcinoma in situ, and invasive cancer; we recalculated performance measures using the Bethesda system. Overall sensitivity, specificity, likelihood ratios, ROC curves, and the corresponding areas under the curves were calculated. The average weighted sensitivity of diagnostic colposcopy for the threshold normal compared with all cervix abnormalities (atypia, low-grade SIL, high-grade SIL, cancer) was 96% and the average weighted specificity 48%. For the threshold normal cervix and low-grade SIL compared with high-grade SIL and cancer, average weighted sensitivity was 85% and average weighted specificity 69%. Likelihood ratios generated small but important changes in probability for distinguishing normal cervix and low-grade SIL from high-grade SIL and cancer. Areas under the ROC curve were 0.80 for the threshold normal cervix compared with all abnormalities and 0.82 for the threshold normal cervix and low-grade SIL compared with high-grade SIL and cancer.ConclusionColposcopy compares favorably with other medical diagnostic tests in terms of sensitivity, specificity, and area under the ROC curve. New diagnostic methods for the cervix can be compared with colposcopy using these quantified values.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID