The road to health care.

BMJ (online) (Impact Factor: 17.22). 08/2004; 329(7456):1-2. DOI: 10.1136/bmj.329.7456.1
Source: PubMed

ABSTRACT Balancing benefits and harms of interventions is essential

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    ABSTRACT: This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.
    Journal of the Royal Society of Medicine 05/2010; 103(5):178-87. · 1.72 Impact Factor
  • The European journal of general practice 09/2011; 17(3):143-5.
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    ABSTRACT: Operative vaginal delivery significantly increases the risk of anal sphincter injury compared with spontaneous vaginal delivery, particularly when an instrumental application at high station, persistent occipital posterior presentation and/or macrosomia are associated. Risks of vaginal tears, postpartum haemorrhage and urinary retention appear to be increased compared with spontaneous vaginal delivery. There is no evidence that one type of forceps is less safe than another. Different vacuum extractors (soft, rigid and single-use instruments) have similar maternal outcomes. A risk of anal incontinence in the first year postpartum is associated with operative vaginal delivery, particularly forceps. Operative vaginal delivery also appears to increase the risk of occult anal sphincter injury regardless of the instrument used, but does not appear to be associated with the risk of postpartum urinary incontinence and genital prolapse compared with spontaneous vaginal delivery. It does, however, increase the risks of perineal pain, postpartum dyspareunia and sexual disorders compared with spontaneous vaginal delivery, particularly in cases of perineal tears.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2008; 37 Suppl 8:S244-59. · 0.45 Impact Factor


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Jun 2, 2014