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8

Safety of psychotropic drugs in pregnancy

Mental illness in pregnancy is common—around 10% of women experience a major depressive illness or anxiety disorder,1 and an increasing number of women with psychotic disorders are able to conceive owing to the decreased use of antipsychotics with prolactin raising properties.2 Women who have severe mental illness in the perinatal period are at risk of considerable psychological morbidity, including suicide,2 but they often discontinue psychotropics,3 largely because of concerns about safety.4 Evidence on the risks of drugs from observational data is limited and contradictory, with important methodological limitations due to bias, confounding, and small sample sizes.5 In two linked papers in this issue, Furu and colleagues (doi:10.1136/bmj.h17986 and Vigod and colleagues (doi:10.1136/bmj.h2298)7 tackle some of these limitations by using novel methods to reduce confounding in large linked datasets, and thus provide a valuable addition to the evidence base on the safety of psychotropic drugs in pregnancy.  
feeds.bmj.com
about 5 years ago
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0
4

Safety of psychotropic drugs in pregnancy

Mental illness in pregnancy is common—around 10% of women experience a major depressive illness or anxiety disorder,1 and an increasing number of women with psychotic disorders are able to conceive owing to the decreased use of antipsychotics with prolactin raising properties.2 Women who have severe mental illness in the perinatal period are at risk of considerable psychological morbidity, including suicide,2 but they often discontinue psychotropics,3 largely because of concerns about safety.4 Evidence on the risks of drugs from observational data is limited and contradictory, with important methodological limitations due to bias, confounding, and small sample sizes.5 In two linked papers in this issue, Furu and colleagues (doi:10.1136/bmj.h17986 and Vigod and colleagues (doi:10.1136/bmj.h2298)7 tackle some of these limitations by using novel methods to reduce confounding in large linked datasets, and thus provide a valuable addition to the evidence base on the safety of psychotropic drugs in pregnancy.  
feeds.bmj.com
about 5 years ago
Preview
0
6

Safety of psychotropic drugs in pregnancy

Mental illness in pregnancy is common—around 10% of women experience a major depressive illness or anxiety disorder,1 and an increasing number of women with psychotic disorders are able to conceive owing to the decreased use of antipsychotics with prolactin raising properties.2 Women who have severe mental illness in the perinatal period are at risk of considerable psychological morbidity, including suicide,2 but they often discontinue psychotropics,3 largely because of concerns about safety.4 Evidence on the risks of drugs from observational data is limited and contradictory, with important methodological limitations due to bias, confounding, and small sample sizes.5 In two linked papers in this issue, Furu and colleagues (doi:10.1136/bmj.h17986 and Vigod and colleagues (doi:10.1136/bmj.h2298)7 tackle some of these limitations by using novel methods to reduce confounding in large linked datasets, and thus provide a valuable addition to the evidence base on the safety of psychotropic drugs in pregnancy.  
feeds.bmj.com
about 5 years ago
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0
13

Resorbable Stents with Sensors and On-demand Drug Delivery for Cardiovascular Diseases | Medgadget

Traditional methods of treating blood vessel blockages include the use of bare metal stents (designed to keep the vessel open) or drug eluting stents (meta  
medgadget.com
about 5 years ago
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0
9

Psychological therapies for sickle cell disease and pain | Cochrane

Sickle cell disease is a group of blood disorders. It can cause anaemia, which if severe can reduce mobility. It may also allow small blood vessels to become blocked causing pain in muscle and bone and it can damage major organs such as the spleen, liver, kidneys, and lungs. People with sickle cell disease are more vulnerable to severe infections. Treatment is usually in response to symptoms and designed to ease pain. Psychological treatment to help people cope with sickle cell disease might complement current medical treatment. There are four types of treatment: patient education; cognitive therapy (to do with thoughts and feelings); behavioural therapy (to do with actions); psychodynamic psychotherapy (talking to relieve emotional pain). We searched for randomised or quasi-randomised controlled trials which compared psychological treatments to each other or to no treatment in sickle cell disease. We included seven studies in the review, of which five, with 260 people, had data we could enter into the review. One study showed that cognitive behaviour therapy reduced the affective part of pain (feelings about pain), but not the sensory part (pain intensity). Another study of this therapy had inconclusive results for coping strategies and showed no difference on how different groups used the health service. A study using cognitive behavioural therapy with teenagers and their families at home did not show any difference when compared with education about sickle cell disease. One education study did not show a reduction in depression. Furthermore, one study in patient education helped improve attitudes to healthcare workers and medication use in adolescents and young adults. The authors believe that some patient education seems relevant for children, adolescents and young adults, while methods to improve the ability to cope in both children and adults are important. Nonetheless, these results may not apply to across all ages, clinical severity, types of pain (acute or chronic) that people with sickle cell disease have, or which country they live in. More research needs to be done in this area.  
cochrane.org
about 5 years ago
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19

Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension | Cochrane

Acute bleeding from ruptured gastric varices (enlarged veins), the most severe consequence of portal hypertension (that is increased pressure in the veins leading to the liver), is associated with high death rates. The most promising treatment for this condition is considered to be endoscopic sclerotherapy (passing a flexible tube with a camera at the end down the oesophagus (swallowing tube) allowing direct visualisation and treatment of bleeding varices) with N-butyl-2-cyanoacrylate (cyanoacrylate), which is a glue that causes blood clots to form and stops the bleeding. However, incidence of re-bleeding and complications have opened a debate on when this glue should be used compared with other endoscopic procedures.  
cochrane.org
about 5 years ago
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5
70

Female Catheterisation Procedure

Female catheterisation performed following the official University Hospitals of Leicester (UHL) guidelines.  
youtube.com
about 5 years ago
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1
51

Paediatric Respiratory Medicine

Paediatric Respiratory Medicine, second edition remains the first point of reference for those faced with treating acute or chronic respiratory problems. The handbook discusses the approach to clinical problems, specific conditions, supportive care and practical procedures, and includes vital appendices covering specific tests and statistics. Designed as a practical guide, it serves general and specialist paediatricians at both consultant and trainee level. The book is divided into five parts. Part I provides a practical approach to acute and non-acute clinical problems. Part II provides detailed information about common and more rare clinical conditions. Part III provides useful information on supportive care, including for example, use of non-invasive ventilation and the care of a child with a tracheotomy. Part IV gives details on how to perform several practical procedures, such as ciliary brush biopsy, flexible bronchoscopy, and inserting a chest drain. The appendices provide information on lung function testing and tables of age-corrected normal values for several respiratory parameters. Written by three consultants in paediatric respiratory medicine, their expertise in the subject provides all levels of paediatricians with practical guide on a subject that is increasingly relevant in paediatrics.  
books.google.co.uk
about 5 years ago
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1
6

Clinical Examination in Rheumatology

An exhaustive history and extensive examination for all conceivable rheumatological abnormalities in every patient are time-consuming and unnecessary. As with other systems, a brief screening procedure to pick up problems in defined regions is more appropriate. If an abnormality is detected, a more detailed examination of affected regions (as described in subsequent chapters) can be undertaken to define the problem more precisely.  
nle.nottingham.ac.uk
about 5 years ago
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2
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Informed consent? How do primary care professionals prepare women for cervical smears: A qualitative study

Cervical screening is a procedure that is mainly carried out in primary care, predominantly by general practitioners (GPs) and practice nurses (PNs). Much has been published about the effects on women of receiving an abnormal smear result but little has been done to investigate the preparation of women by primary care professionals for this.  
sciencedirect.com
about 5 years ago
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1
2

Cost-effectiveness of hormone replacement therapy for menopausal symptoms in the UK

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.  
crd.york.ac.uk
about 5 years ago
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1
35

Surgical Management of Pelvic Organ Prolapse

Surgical Management of Pelvic Organ Prolapse is the ideal way to enhance your surgical skills in this key area of gynecology, urogynecology, and urology. In this volume in the Female Pelvic Surgery Video Atlas Series, written by series editor Mickey Karram, MD, detailed discussions and illustrations, case studies, and video footage clarify how to most effectively perform a variety of procedures and manage complications. Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located.Case-based presentations and videos, narrated by the authors, take you step-by-step through a variety of procedures including abdominal sacral colpohysteropexy, laparoscopic sacral colpopexy, high uterosacral suspension, and more.Coverage of hot topics such as robotic and laparoscopic prolapse repairs, prolapse repairs and uterine preservation, the role of mesh augmentation, techniques and indications for native tissue prolapse repair, and surgical management and prevention of POP surgery complications keeps you current with the latest advancements in the field.Highly illustrated, quick-reference chapters discuss all of the possible diagnoses for which each procedure is indicated.Case studies describe the clinical history surrounding each case featured in the videos.An overview of how the entire pelvis functions as a unit helps illustrate the importance of a multidisciplinary, team approach in diagnosing and treating abnormalities.Online access at expertconsult.com places the full text, video clips, and more at your fingertips on any computer or mobile device.  
books.google.co.uk
about 5 years ago
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1
1

Antenatal care for uncomplicated pregnancies | 1-guidance | Guidance and guidelines | NICE

The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance (see section 5 for details).  
nice.org.uk
about 5 years ago
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1
17

Abortion Care

This comprehensive review of the emotive and often controversial topic of abortion provides clinicians with a multidisciplinary focus on abortion services, discussing clinical topics in their sociological, legal and ethical context. It is particularly timely as novel methods of service delivery make this vital resource more accessible, allowing abortion to be performed in community settings. Topics include medical and surgical methods of abortion, ultrasound scanning, pain control, complications, and abortion in women with medical conditions, as well as ethics, stigma, and human rights. Written by leading authorities in their subject areas, Abortion Care is essential reading for medical and nursing specialists and forms a useful resource in the delivery of graduate courses in the fields of obstetrics and gynaecology and sexual and reproductive healthcare. It is also of interest to professionals involved in planning, delivering and managing women's health services, including counsellors, service managers and public health specialists.  
books.google.co.uk
about 5 years ago
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16

Call for cosmetic surgery 'cooling off' period - BBC News

Doctors who carry out cosmetic procedures should allow patients a ''cooling off" period before going ahead with treatment.  
bbc.co.uk
about 5 years ago
Www.bmj
0
5

Diagnosis and treatment of cancer using genomics

The field of cancer diagnostics is in constant flux as a result of the rapid discovery of new genes associated with cancer, improvements in laboratory techniques for identifying disease causing events, and novel analytic methods that enable the integration of many different types of data. These advances have helped in the identification of novel, informative biomarkers. As more whole genome sequence data are generated and analyzed, emerging information on the baseline variability of the human genome has shown the importance of the ancestral genomic background in patients with a potential disease causing variant. The recent discovery of many novel DNA sequence variants, advances in sequencing and genomic technology, and improved analytic methods enable the impact of germline and somatic genome variation on tumorigenesis and metastasis to be determined. New molecular targets and companion diagnostics are changing the way geneticists and oncologists think about the causes, diagnosis, and treatment of cancer.  
feeds.bmj.com
about 5 years ago
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0
6

Doctor accused of drugging, experimenting on, and sexually exploiting military trainees

A US physician who provided medical training to troops in the United States and the United Kingdom has had his license suspended after he allegedly had medical students and military officers perform invasive medical procedures on each other without supervision, administered drugs such as ketamine to students, in some cases without their consent, conducted “shock labs” in which blood was withdrawn from students to induce hypovolemia, and exploited at least one student “for personal gain and sexual gratification.”  
feeds.bmj.com
about 5 years ago
Www.bmj
0
2

Medical abortions more common than surgery for first time in 2014 in England and Wales

Medical means were used in 51% of abortions carried out in England and Wales in 2014, the first year there were more medical than surgical procedures, figures from the Department of Health show.1 In 2013 just under half of terminations (49%) involved pills, while in 2004 the figure was 20%.  
feeds.bmj.com
about 5 years ago
Www.bmj
0
11

Mesh use in surgery for pelvic organ prolapse

By age 80 years, one in eight women will undergo surgery for pelvic organ prolapse (POP), a condition where the pelvic organs descend into or through the vaginal canal.1 In the United States, about 80% of procedures are performed transvaginally.2 3 4 Building on the experience of general surgeons and the treatment of abdominal hernias, pelvic surgeons began using synthetic mesh to augment prolapse repairs to reduce prolapse recurrence seen frequently after native tissue (non-mesh) repairs. However, use of synthetic mesh also results in increased adverse events, in some cases with serious consequences.2 5 As a result, the use of mesh for transvaginal POP surgery has been the source of much scrutiny, including two public health notifications from the US Food and Drug Administration (FDA), a change in the US regulatory process for mesh devices, and substantial litigation.2 6  
feeds.bmj.com
about 5 years ago
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0
5

Doctor accused of drugging, experimenting on, and sexually exploiting military trainees

A US physician who provided medical training to troops in the United States and the United Kingdom has had his license suspended after he allegedly had medical students and military officers perform invasive medical procedures on each other without supervision, administered drugs such as ketamine to students, in some cases without their consent, conducted “shock labs” in which blood was withdrawn from students to induce hypovolemia, and exploited at least one student “for personal gain and sexual gratification.”  
feeds.bmj.com
about 5 years ago