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Biomedical subjects

A Rice

Publications and source records attributed to A Rice.

79 records · Page 5Linked to original sources
PubMedDate not supplied

Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis.

CONTEXT: Epidural labor analgesia, if selected by the patient, is associated with high cesarean delivery rates. Results of randomized trials comparing rates of cesarean delivery using epidural anesthesia vs parenteral opioids are inconsistent. OBJECTIVE: To review the effects of epidural vs parenteral opioid analgesia on cesarean delivery rates. DATA SOURCES: Studies were identified by searching MEDLINE from January 1966 through January 1998, the Cochrane Database of Perinatal Trials, and relevant nonindexed journals and abstracts. STUDY SELECTION: We included all studies that randomized patients to epidural vs parenteral opioid labor analgesia. DATA EXTRACTION: Two authors independently extracted data from 10 trials enrolling 2369 patients. Odds ratios (ORs) for categorical data, weighted mean differences (WMDs) for continuous data, and 95% confidence intervals (CIs) were calculated using a random-effects model. DATA SYNTHESIS: The risk of cesarean delivery did not differ between patients receiving epidural (8.2%) vs parenteral opioid (5.6%) analgesia (OR, 1.5; 95% CI, 0.81-2.76). Epidural patients had longer first (WMD, 42 minutes; 95% CI, 17-68 minutes) and second (WMD, 14 minutes; 95% CI, 5-23 minutes) labor stages. While epidural patients were more likely to have instrumented delivery (OR, 2.19; 95% CI, 1.32-7.78), they were no more likely to have instrumented delivery for dystocia (OR, 0.68; 95% CI, 0.31-1.49). After epidural analgesia, neonates were less likely to have low 5-minute Apgar scores (OR, 0.38; 95% CI, 0.18-0.81) or to need naloxone (OR, 0.24; 95% CI, 0.07-0.77). Women receiving epidural analgesia had lower pain scores during the first (WMD, -40 mm on a 100-mm scale; 95% CI, -42 to -38 mm) and second (WMD, -29 mm; 95% CI, -38 to -21 mm) stages of labor. The odds of dissatisfaction were lower with epidural analgesia (OR, 0.25; 95% CI, 0.20-0.32). CONCLUSIONS: Epidural labor analgesia is not associated with increased rates of instrumented vaginal delivery for dystocia or cesarean delivery. Patients receiving epidural analgesia have longer labors. Patient satisfaction and neonatal outcome are better after epidural than parenteral opioid analgesia.

Analgesics, Opioid↗
PubMedDate not supplied

Cytokines in implantation.

Implantation is a complex process which involves the 'invasion' of the maternal endometrium by the trophoblast surrounding the developing blastocyst. In response to this interaction there is a cellular reaction within the endometrium which has some features analogous to invasion by a tumour and some which are more characteristic of an inflammatory response. In addition, and also in common with cancer and inflammation, there is a release of biologically active molecules, including cytokines, at and around the implantation site. The information on cytokines is complex and often contradictory but it is recognised that they play an important role in the successful establishment of pregnancy. The evidence for this role is examined in this review.

Animals↗
PubMedDate not supplied

Wilms tumor associated with polycythemia: case report and review of the literature.

PURPOSE AND METHODS: A case of polycythemia with a normal serum erythropoietin is described, which led to the diagnosis of Wilms tumor. The clinical features of the reported cases of Wilms tumor associated with polycythemia are reviewed. RESULTS: An asymptomatic 6-year-old boy with polycythemia, a normal serum erythropoietin, and no evidence of erythroid colony forming activity in his serum was found to have a Wilms tumor. After resection and chemotherapy, he has had no recurrence of either the polycythemia or the Wilms tumor. There have now been 10 cases of Wilms tumor reported: 7 patients were more than 16 years of age, 8 were boys, and 9 were clinical stage I with a favorable histology. CONCLUSIONS: Polycythemia is a rare manifestation of Wilms tumor that can occur in the absence of an elevated serum erythropoietin and has an association with male gender, older patient age, and low clinical stage. Children with unexplained polycythemia should be investigated for Wilms tumor, even if the serum erythropoietin level is normal.

Child↗
PubMedDate not supplied

Creating an effective marketing team. Six leading healthcare marketers offer their perspectives. Interview by Richard D. Stier.

Richard D. Stier, senior vice president and chief marketing officer, Adventist Health System, Shawnee Mission, Kansas, asked six top healthcare marketers to assume they had just been appointed vice president and chief marketing officer for a medium-sized, 300-bed, not-for-profit community hospital. Their mission: Create the most effective, powerhouse marketing team in the country.

Hospital Bed Capacity, 300 to 499↗
PubMedDate not supplied

Midwifery soon to be an option in B.C. for low-risk births.

Midwifery has recently been established in British Columbia as a self-regulating profession with its own regulatory body, the College of Midwives of British Columbia. Within the next few months, registered midwives will join the other members of the health care team as legitimate providers of care for childbearing women and their families. Midwifery care will be an option for low-risk women who, as long as they continue to experience a healthy pregnancy, will be able to choose to give birth attended by a midwife.

British Columbia↗
PubMedDate not supplied

Application of micropreparative capillary electrophoresis and polymer gel desalting techniques to biological samples illustrated using human synovial fluid.

A component of human synovial fluid (SF) has been separated by micropreparative capillary electrophoresis. The problems associated with application of this technique to a raw body fluid are discussed. Desalting of SF by passage through a capillary formed from polyacrylamide gel is examined and shown to cause loss of hyaluronan polymer as well as low-molecular-mass components of the fluid.

Acrylic Resins↗