Cybermedlife - Therapeutic Actions Freedom To Choose

Expectant management versus surgical evacuation in first trimester miscarriage: health-related quality of life in randomized and non-randomized patients.

Abstract Title: Expectant management versus surgical evacuation in first trimester miscarriage: health-related quality of life in randomized and non-randomized patients. Abstract Source: Hum Reprod. 2002 Jun;17(6):1638-42. PMID: 12042291 Abstract Author(s): Margreet Wieringa-De Waard, Esther E Hartman, Willem M Ankum, Johannes B Reitsma, Patrick J E Bindels, Gouke J Bonsel Article Affiliation: Academic Medical Center-University of Amsterdam, Department of General Practice/Family Medicine, Amsterdam, The Netherlands. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: Expectant management, although less effective, is an alternative treatment option for surgical evacuation in women with a miscarriage. We assessed health-related quality of life (HRQL) differences over time between expectant and surgical management in women with a miscarriage. METHODS: Women with a miscarriage were randomized to either expectant (n = 64) or surgical (n = 58) management, and 305 eligible women who refused randomization because of a preference for either treatment option were managed according to their choice following the same clinical protocol (126 expectant, 179 surgical). The main outcome measures were score differences of HRQL during 12 weeks. Repeated measures analysis was applied. RESULTS: Out of a total of 427 women, 198 were excluded in the questionnaire follow-up, leaving 229 women who participated. Mental health of women allocated to expectant management improved more and earlier (treatment effect) than of women allocated to surgical evacuation. Mental health scores were significantly better in women who chose, rather than women who were randomized, to curettage. The groups managed according to their own preference showed no differences in mental health scores. CONCLUSION: Women with a miscarriage who chose their own treatment had the best HRQL over time, supporting the role of free choice from a clinical point of view. Women without a treatment preference should be encouraged to start with expectant management for psychological reasons. Article Published Date : Jun 01, 2002
Therapeutic Actions Freedom To Choose

NCBI pubmed

Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report.

Related Articles Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report. Am J Kidney Dis. 2018 Dec 10;: Authors: Chan CT, Wallace E, Golper TA, Rosner MH, Seshasai RK, Glickman JD, Schreiber M, Gee P, Rocco MV Abstract Home dialysis therapy, including home hemodialysis and peritoneal dialysis, is underused as a modality for the treatment of chronic kidney failure. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative sponsored a home dialysis conference in late 2017 that was designed to identify the barriers to starting and maintaining patients on home dialysis therapy. Clinical, operational, policy, and societal barriers were identified that need to be overcome to ensure that dialysis patients have the freedom to choose their treatment modality. Education of patients and patient partners, as well as health care providers, about home dialysis therapy, if offered at all, is often provided in a cursory manner. Lack of exposure to home dialysis therapies perpetuates a lack of familiarity and thus a hesitancy to refer patients to home dialysis therapies. Patient and care partner support, both psychosocial and financial, is also critical to minimize the risk for burnout leading to dropout from a home dialysis modality. Thus, the facilitation of home dialysis therapy will require a systematic change in chronic kidney disease education and the approach to dialysis therapy initiation, the creation of additional incentives for performing home dialysis, and breakthroughs to simplify the performance of home dialysis modalities. The home dialysis work group plans to develop strategies to overcome these barriers to home dialysis therapy, which will be presented at a follow-up home dialysis conference. PMID: 30545707 [PubMed - as supplied by publisher]
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