Re: OOB: Meta-analysis of tocolysis FRI
From: R. Daniel Braun (rd.braun@gmail.com)
Wed Apr 22 15:14:18 2009
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The members of the Department of Gastroenterology that were involved were
the PhD infomatics people.
Dan
On Wed, Apr 22, 2009 at 2:43 PM, art fougner, md <evsono@pipeline.com>wrote:
> Does the involvement of the Dept of Gastroenterology mean some found the
> conclusions hard to swallow?
>
> Art
>
> At Wed, 22 Apr 2009, DoctorJoe@aol.com wrote:
> >
> >Interesting study.
> >
> >Tocolytic therapy: a meta-analysis and decision analysis.
> >
> >Obstet Gynecol. 2009; 113(3):585-94
> >
> >OBJECTIVE: To determine the optimal first-line tocolytic agent for
> >treatment of premature labor.
> >
> >METHODS: We performed a quantitative analysis of randomized controlled
> >trials of tocolysis, extracting data on maternal and neonatal outcomes,
> and
> >pooling rates for each outcome across trials by treatment. Outcomes were
> delay
> >of delivery for 48 hours, 7 days, and until 37 weeks; adverse effects
> causing
> >discontinuation of therapy; absence of respiratory distress syndrome; and
> >neonatal survival. We used weighted proportions from a random-effects
> >meta-analysis in a decision model to determine the optimal first-line
> tocolytic
> >therapy. Sensitivity analysis was performed using the standard errors of
> the
> >weighted proportions.
> >
> >RESULTS: Fifty-eight studies satisfied the inclusion criteria. A
> >random-effects meta-analysis showed that all tocolytic agents were
> superior to placebo
> >or control groups at delaying delivery both for at least 48 hours (53% for
> >placebo compared with 75-93% for tocolytics) and 7 days (39% for placebo
> >compared with 61-78% for tocolytics). No statistically significant
> differences
> >were found for the other outcomes, including the neonatal outcomes of
> >respiratory distress and neonatal survival. The decision model
> demonstrated that
> >prostaglandin inhibitors provided the best combination of tolerance and
> >delayed delivery. In a hypothetical cohort of 1,000 women receiving
> prostaglandin
> >inhibitors, only 80 would deliver within 48 hours, compared with 182 for
> >the next-best treatment.
> >
> >CONCLUSION: Although all current tocolytic agents were superior to no
> >treatment at delaying delivery for both 48 hours and 7 days, prostaglandin
> >inhibitors were superior to the other agents and may be considered the
> optimal
> >first-line agent before 32 weeks of gestation to delay delivery.
> >
> >Department of Obstetrics & Gynecology, Division of Gastroenterology,
> >Indiana University School of Medicine, Indianapolis, Indiana, USA.
> >
> >Joe P.
> >
> >web. Get the Radio Toolbar!
> >(http://toolbar.aol.com/aolradio/download.html?ncid=emlcntusdown00000003)
>
> --
> art fougner, md
> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
--
R. Daniel Braun, MD FACOG(L) ABMP CMTh
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
--
R. Daniel Braun
“Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
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The members of the Department of Gastroenterology that were involved were the PhD infomatics people.<br><br>Dan<br><br><div class="gmail_quote">On Wed, Apr 22, 2009 at 2:43 PM, art fougner, md <span dir="ltr"><<a href="mailto:evsono@pipeline.com">evsono@pipeline.com</a>></span> wrote:<br>
<blockquote class="gmail_quote" style="border-left: 1px solid rgb(204, 204, 204); margin: 0pt 0pt 0pt 0.8ex; padding-left: 1ex;">Does the involvement of the Dept of Gastroenterology mean some found the<br>
conclusions hard to swallow?<br>
<br>
Art<br>
<br>
At Wed, 22 Apr 2009, <a href="mailto:DoctorJoe@aol.com">DoctorJoe@aol.com</a> wrote:<br>
><br>
>Interesting study.<br>
><br>
>Tocolytic therapy: a meta-analysis and decision analysis.<br>
><br>
>Obstet Gynecol. 2009; 113(3):585-94<br>
><br>
>OBJECTIVE: To determine the optimal first-line tocolytic agent for<br>
>treatment of premature labor.<br>
><br>
>METHODS: We performed a quantitative analysis of randomized controlled<br>
>trials of tocolysis, extracting data on maternal and neonatal outcomes, and<br>
>pooling rates for each outcome across trials by treatment. Outcomes were delay<br>
>of delivery for 48 hours, 7 days, and until 37 weeks; adverse effects causing<br>
>discontinuation of therapy; absence of respiratory distress syndrome; and<br>
>neonatal survival. We used weighted proportions from a random-effects<br>
>meta-analysis in a decision model to determine the optimal first-line tocolytic<br>
>therapy. Sensitivity analysis was performed using the standard errors of the<br>
>weighted proportions.<br>
><br>
>RESULTS: Fifty-eight studies satisfied the inclusion criteria. A<br>
>random-effects meta-analysis showed that all tocolytic agents were superior to placebo<br>
>or control groups at delaying delivery both for at least 48 hours (53% for<br>
>placebo compared with 75-93% for tocolytics) and 7 days (39% for placebo<br>
>compared with 61-78% for tocolytics). No statistically significant differences<br>
>were found for the other outcomes, including the neonatal outcomes of<br>
>respiratory distress and neonatal survival. The decision model demonstrated that<br>
>prostaglandin inhibitors provided the best combination of tolerance and<br>
>delayed delivery. In a hypothetical cohort of 1,000 women receiving prostaglandin<br>
>inhibitors, only 80 would deliver within 48 hours, compared with 182 for<br>
>the next-best treatment.<br>
><br>
>CONCLUSION: Although all current tocolytic agents were superior to no<br>
>treatment at delaying delivery for both 48 hours and 7 days, prostaglandin<br>
>inhibitors were superior to the other agents and may be considered the optimal<br>
>first-line agent before 32 weeks of gestation to delay delivery.<br>
><br>
>Department of Obstetrics & Gynecology, Division of Gastroenterology,<br>
>Indiana University School of Medicine, Indianapolis, Indiana, USA.<br>
><br>
>Joe P.<br>
><br>
>web. Get the Radio Toolbar!<br>
>(<a href="http://toolbar.aol.com/aolradio/download.html?ncid=emlcntusdown00000003" target="_blank">http://toolbar.aol.com/aolradio/download.html?ncid=emlcntusdown00000003</a>)<br>
<font color="#888888"><br>
--<br>
art fougner, md<br>
"May The Wings of Liberty Never Lose a Feather." - Jack Burton<br>
</font></blockquote></div><br>
MD FACOG(L) ABMP CMTh<br>Professor Emeritus<br>Dept. of Obstetrics and Gynecology<br>Indiana U. School of Medicine<br><br><br>R. Daniel Braun<br>
<br> “Science without Religion is LAME; Religion without Science is BLIND"<br> Einstein 1941<br>
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