D Grimes

..To review published articles in four U.S. obstetrics and gynecology journals labeled "case-control" studies to estimate the frequency of mislabeling the type of study...

..When combined with an accurate clinical diagnosis, likelihood ratios from ancillary tests improve diagnostic accuracy in a synergistic manner...

..Although no ideal control group exists, readers need to think carefully about how representative the controls are. Poor choice of controls can lead to both wrong results and possible medical harm...

..When in doubt, clinicians should err on the side of optimism...

..To avoid bias, future trials need to pay more attention on the methodological requirements for randomized controlled trials. Trials with adequate power would also be helpful...

..The efficacy and acceptability of these methods are unclear...

..Clearly, a double standard prevails in prevention strategies for women. The Food and Drug Administration should approve over-the-counter availability of emergency contraception without further study or delay...

..Heart disease prevention strategies of proven value include exercise, weight control, blood pressure and lipid control, and avoidance of smoking. Hormone replacement therapy should not be used for this purpose...

..The clinical maxim that "a difference to be a difference must make a difference" applies to research as well. Clinical research should focus on outcomes that matter...

..Stated alternatively, the only class of contraceptives today with exclusively first-tier effectiveness is the one that can be started -- and then forgotten for years...

..Modern computing features both accuracy and speed; nomograms offer only the latter...

..Because of the difficulty in understanding odds ratios, their use should probably be limited to case-control studies and logistic regression, for which odds ratios are the proper measures of association...

..Although about one half of Clinical Expert Series articles cited relevant Cochrane reviews, most eligible reviews were not referenced. Wider use of Cochrane reviews could strengthen the scientific basis of this popular series...

..The best course is to abandon these vague and difficult labels and simply report semen analyses quantitatively...

..Intrauterine devices (IUDs) are the most widely used reversible contraceptives in the world today, and decisions about their use should reflect the best available evidence...

..Should tocolysis be desired, calcium channel blockers, such as nifedipine, seem preferable...

..Abortion (legal and spontaneous) was associated with the lowest risk, live birth intermediate risk, and ectopic pregnancy and fetal death the highest risk...

..Easier access to and wider use of emergency contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States...

..By contrast, p values address only chance. Testing null hypotheses at a p value of 0.05 has no basis in medicine and should be discouraged...

..Strengths of a cohort study include the ability to calculate incidence rates, relative risks, and 95% CIs. This format is the preferred way of presenting study results, rather that with p values...

..Differentiation between spurious, indirect, and causal associations can be difficult. Criteria such as temporal sequence, strength and consistency of an association, and evidence of a dose-response effect lend support to a causal link...

..Hypotheses about causation from descriptive studies are often tested in rigorous analytical studies...

..Our a priori hypothesis was that this practice is safe, but associated with higher expulsion rates than interval IUD insertion...

..The current prescription requirement is not only gratuitous but also harmful to women's health because it impedes access to this important therapy...

..Similarly, fair evidence indicates no important effect of IUD use on tubal infertility. Contemporary IUDs rival tubal sterilisation in efficacy and are much safer than previously thought...

..In addition, many participants have introduced the principles of evidence-based medicine in their own teaching programs...

..A more important finding in these trials is the low incidence of pelvic inflammatory disease with or without prophylactic antibiotics...

..However, this approach sets a worrisome precedent and further isolates the United States from the international medical community...

..However, inappropriate application or interpretation of screening tests can rob people of their perceived health, initiate harmful diagnostic testing, and squander health-care resources...

..To assess patients' ability to compare magnitudes of Down syndrome risk at maternal ages of 35 and 40 years, expressed as rates or as proportions...

..Although we lack a quantitative assessment of this approach, student feedback has been enthusiastic. Critical appraisal skills enable students to continue their medical education after completion of their formal training...

..Investigators and readers, however, need to grasp that the estimated treatment effects are prone to exaggeration, a random high, with early stopping...

..We examined randomized controlled trials of Sino-implant (II) for effectiveness and side effects...

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..Theories and models help explain how behavior change occurs. We systematically reviewed randomized controlled trials that examined theory-based interventions for improving contraceptive use...

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..Like oral contraceptives, intrauterine contraceptives confer important noncontraceptive health benefits...

..Simple randomisation contributes the unpredictability whereas permuted-block randomisation contributes the balance, but avoids the perfect balance that can result in selection bias...

..Unfortunately, many articles do not contain proper reporting. If an article claims blinding without any accompanying clarification, readers should remain sceptical about its effect on bias reduction...

..Hypothesis tests of baseline characteristics, however, are superfluous and could be harmful if they lead investigators to suppress reporting any baseline imbalances...

..Unbiased trials with imprecise results trump no results at all. Clinicians and patients deserve guidance now...

..Unfortunately, some explanations for mishandling exclusions intuitively appeal to readers, disguising the seriousness of the issues. Creative mismanagement of exclusions can undermine trial validity...

..Investigators should devote appropriate resources to the generation of properly randomised trials and reporting their methods clearly...

..This suggests that the choice of progestin may be more important that the phasic regimen in determining bleeding patterns...

..Devotion of meticulous attention to these points enhances the validity of the results and bolsters the reader's confidence in the findings...

..Trial registration and the development of comprehensive, computerized databases will promote transparency in research and help reduce publication bias...

..In these cases, adjustments somewhat rescue scattershot analyses. Readers need to be aware of the potential for under-reporting of analyses...

..Such a trial will be difficult to mount in the US. Hence, we suggest that it be done in a setting where labour-induction abortion is the norm...

..5 times more likely to have removals within 12 months (95% CI 1.4-9.2). Women reporting these menstrual problems during scheduled revisits may benefit from counseling and treatment with nonsteroidal anti-inflammatory drugs (NSAID)...

..According to the principles of evidence-based medicine and bioethics, these barriers to better care for women can and should be overcome...

..CONCLUSION: Available evidence is insufficient to determine the effect of combination contraceptives on weight, but no large effect is evident...

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..Unplanned pregnancy among teenagers remains epidemic, and long-acting methods, such as IUDs, offer the promise of top-tier effectiveness...

..Since no clear rationale exists for biphasic pills and since extensive evidence is available for monophasic pills, the latter are preferred...

..While the debate over abortion will continue, the public health record is settled: safe, legal, accessible abortion improves health...

..The cost of abortion (currently about 372 dollars at 10 weeks) has decreased in recent decades. Provision of ongoing contraception and encouragement of emergency contraception can reduce unintended pregnancies and the need for abortion...

..The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women...

..While health care providers and women might select COCs containing 20 microg EE based on theoretical improvements in safety profile from the reduced dose of estrogen, no evidence is available to support this choice...

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..To examine the effect of the levonorgestrel-releasing intrauterine system on glucose metabolism in diabetic women...

..Grimes, KF Schulz, Obstetrical and Gynecologic Survey, 57; Supplement 3: S35, September 2002; and D. Grimes, KF Schulz, Obstetrical and Gynecologic Survey, Supplement 2, S53-S69, September 2005.-RBJ...

..We found no evidence of systematic seasonal variation in PD incidence by birth date, or of clustering of birth dates during influenza pandemic years in PD patients...

..Systematic reviews of evidence, with an emphasis on randomized controlled trials when available, will continue to improve fertility regulation in the years ahead...

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