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J Robins

Publications and source records attributed to J Robins.

At least 37 records · Page 2Linked to original sources
PubMed1985

The problem of multiple inference in studies designed to generate hypotheses.

Epidemiologic research often involves the simultaneous assessment of associations between many risk factors and several disease outcomes. In such situations, often designed to generate hypotheses, multiple univariate hypothesis-testing is not an appropriate basis for inference. The number of true positive associations in a collection of many associations can be estimated by comparing the observed distribution of p values for the positive associations to a theoretical uniform distribution, or to the observed distribution of negative associations, or to an empiric randomization distribution. None of these approaches, however, will distinguish the true from the false positive associations. Various criteria for selecting a subset of associations to report are considered by the authors, including Bonferoni adjustment of p values, splitting the sample for searching and testing, Bayesian inference, and decision theory. The authors prefer an approach in which all associations in the data are reported, whether significant or not, followed by a ranking in order of priority for investigation using empirical Bayes techniques. Methods are illustrated by application to preliminary data from a study aimed at identifying hitherto unsuspected occupational carcinogens.

Bayes Theorem↗
PubMed1985

Acupuncture for the induction of cervical dilatation in preparation for first-trimester abortion and its influence on HCG.

Cervical dilatation in preparation for first-trimester abortion using acupuncture at loci SP6 and LI4 was studied in 20 patients, who were compared to a control group in whom no preparation was used. Ninety percent of the patients had successful acupuncture procedures. As judged by Hegar dilators, the increase in cervical dilatation in those 18 patients was significantly greater than in the controls. No significant side effects were observed. The effect of acupuncture on serum human chorionic gonadotropin (HCG) as a pregnancy marker was evaluated in 12 patients. No statistically significant difference in the change in HCG was noted in terms of the controls, indicating an absence of abortifacient activity with acupuncture.

Abortion, Induced↗
PubMed1982

Midtrimester pregnancy termination by intravaginal administration of prostaglandin E2.

The intravaginal administration of prostaglandin E2 (PGE2) in repeated doses of 20 mg was evaluated for efficacy and safety in 400 midtrimester pregnancy terminations. Patients were assigned to three treatment groups. Group A (232 patients) received PGE2 alone, Group B (106 patients) had prior intracervical laminaria insertion, Group C (62 patients) received both laminaria and continuous intravenous oxytocin infusion. Complete abortion was achieved in 328 cases (82 per cent) and there were 13 failures (3.3 per cent). Mean instillation treatment groups were not statistically significant but outcome was more favorable in pregnancies of 16 to 19 weeks' gestation as compared with those between 13 and 15 weeks. Gastrointestinal symptoms and temperature elevation constituted the most frequent side effects. Excessive blood loss occurred in 11 cases (2.8 per cent) and live births were encountered in 12 cases (3.0 per cent). Vaginal PGE2 is felt to be particularly acceptable for the termination of pregnancies of 16 to 19 weeks' gestation.

Abortion, Induced↗
PubMed1982

Early midtrimester pregnancy termination. A comparison of dilatation and evacuation and intravaginal prostaglandin E2.

Pregnancy termination by dilatation and evacuation (D&E) during the early midtrimester has been recommended as being more safe and acceptable than delaying for later induction with an intraamniotic instillation procedure. The availability of prostaglandin E2 (PGE2) for vaginal administration provides an alternative that is noninvasive and applicable in the early midtrimester without delay. This study compared the results of 400 consecutive abortions by D&E at 13 through 15 weeks' gestation to those previously obtained in 112 patients at the same period of gestation treated with PGE2 by serial vaginal administration. The PGE2 group experienced a complete abortion rate of 75%, a failure of 7.1% and a mean initiation-to-abortion time of 14.1 hours. Prostaglandin reactions, consisting of vomiting, diarrhea and transient temperature elevation, each occurred in about one-third of these patients. There were no failures in the D&E group and no increased risk of major complications. It is concluded that termination of pregnancy by D&E is preferable to the use of intravaginal PGE2, at least through the 15th week of gestation.

Abortion, Induced↗
PubMed1980

Alternatives in midtrimester abortion induction.

To develop objective criteria for the individualization of patient management, the results of a series of investigations of 1764 midtrimester pregnancy terminations are examined. These include intraamniotic instillation of hypertonic saline or prostaglandin F2 alpha, intramuscular 15(S)15-methyl prostaglandin F2 alpha, and intravaginal prostaglandin E2. Laminaria and intravenous oxytocin augmentation have also been used. The relative advantages and disadvantages of these techniques are evaluated in terms of safety, efficacy, and acceptability. The effects of parity and length of gestation are considered. Before 20 weeks' gestation, vaginal prostaglandin E2 is believed superior to the other techniques by most criteria, and intraamniotic saline is the authors' method of choice in amore advanced pregnancies.

Abortion, Induced↗
PubMed1979

Ripening of the term cervix with laminaria.

Laminaria tents were used to ripen the cervix in cases where induction of labor was indicated and the Bishop score was less than or equal to 5. Induction of labor was significantly more successful in these cases as compared with a matched control group where the cervix had not been ripened.

Adult↗
PubMed1977

Amniotic fluid adenosine 3',5' - monophosphate in prostaglandin-induced midtrimester abortions.

Cyclic adenosine 3'5-monophosphate (cAMP) was serially measured in the amniotic fluid (AF) of 9 patients undergoing midtrimester abortions induced by intraamniotic prostaglandins. The results demonstrate an increase in AF cAMP ranging from 2- to 7-fold within the 6 hours of observation. The fetal heart tones were closely monitored by a Doppler instrument and the time from injection of abortifacient to fetal demise (IDT) and to fetal expulsion (IAT) was accurately recorded. No correlation between the rate of AF cAMP increase and IDT or IAT could be demonstrated. The concentration of cAMP in amniotic fluid obtained from patients with fetal demise in utero was lower than that found in AF of fetuses of corresponding gestational age where the fetus was alive. The significance of AF cAMP as a potential indicator of fetal distress is discussed.

Abortion, Induced↗
PubMed1977

Early first-trimester abortion induction by Silastic vaginal devices for continuous release of 15(S)=15-methyl prostaglandin F2alpha methyl ester.

The abortifacient efficacy of four Silastic devices containing 15(S)-15-methyl prostaglandin F2alpha methyl ester (15-Me-PGF2alpha methyl ester) was evaluated by single vaginal insertion and retention for 24 hours in four groups of ten patients each at 31 to 49 days beyond the 1st day of the last menstrual period. There were eight complete and two incomplete abortions in the group receiving a device with a drug concentration of 0.5% and a surface area of 20 sq cm. Four complete abortions, four incomplete abortions, and two failures occurred with a 0.2%, 10 sq cm device. Seven complete and two incomplete abortions were obtained with a 0.5%, 10 dq cm device; one patient in this group was found to have aborted prior to treatment. A 0.5%, 2o sq cm device with one-half the thickness of the other 0.5% devices yielded five complete abortions, one incomplete abortion, and four failures. Side effects were minor and well tolerated in each group. Serial determinations of plasma progesterone, human chorionic gonadotropin, and 15-Me-PGF2alpha were obtained and related to the outcome of therapy. Because of failure to achieve sustained blood levels of drug or satisfactory rates of complete abortions, this technique, with the devices used in this study, is not believed to be acceptable for routine early first-trimester pregnancy termination.

Abortion, Induced↗
PubMed1976

"Second generation" prostaglandins: midtrimester pregnancy termination by intramuscular injection of a 15-methyl analog of prostaglandin F2alpha.

Eighty midtrimester gravid patients were treated with prostaglandin 15(S)-15-methyl Fa alpha by repeated intramuscular injections of 250 mug at 2-hour intervals for the elective termination of pregnancy. A success rate of 97.5% was achieved, with a mean initiation-to-abortion time of 17.2 +/- 1.0 hours. Gastrointestinal side effects were prominent but no serious complications occurred. Serial serum progesterone determinations and continuous intra-amniotic pressure recording were carried out in selected cases and correlated with abortifacient activity. This method of pregnancy termination appears particularly suitable for use in the early midtrimester of gestation.

Abortion, Induced↗
PubMed1976

Maternal serum and amniotic fluid alpha-fetoprotein as a marker of acute fetal distress in a midtrimester abortion model.

Maternal serum (MS) and amniotic fluid (AF) alpha-fetoprotein (alpha-FP) levels were serially determined in 18 cases of elective midtrimester abortion. Prostaglandin F2alpha (PGF2alpha) and 20% NaCl were used as the abortifacients in 2 groups of 9 patients, respectively. The time from instillation to abortion (IAT) was accurately recorded in all cases. A marked 260-600% increase in MS alpha-FP occurred prior to fetal demise in both groups. Amniotic fluid alpha-FP content remained largely unchanged for the first 6 hours following intraamniotic prostaglandin injection. A 50% INCREASE WAS OBSERVED IN THE AF alpha-FP content in the group with 20% NaCl-induced abortion (after an initial dilutionary drop). The results of this investigation confirm the value of alpha-FP in MS as a marker of impending fetal demise. This rise is not caused by a prior alpha-FP change in the AF. The data suggest a major fetomaternal transplacental route for alpha-FP.

Abortion, Induced↗
PubMed1976

Laminaria augmentation of midtrimester pregnancy termination by intramuscular prostaglandin 15 (S) 15-methyl F2 alpha.

A group of 15 midtrimester gravid patients underwent intracervical laminaria tent insertion prior to repeated intramuscular injections of 250mu g of prostaglandin 15 (S) 15-methyl F2 alpha at two-hour intervals for elective termination of pregnancy. This group was compared with a previously reported group of 80 patients who had received identical treatment without laminaria insertion. A significant reduction in mean abortion time and an increased 24-hour abortion rate were observed with the addition of laminaria. There was a proportionate decrease in gastrointestinal side effects as well as a reduced need for analgesia in the laminaria group with no complications attributable to the laminaria insertion.

Abortifacient Agents↗