RESUMEN
OBJECTIVE: To analyse the delivery room management of babies born between 22 and 26â weeks of completed gestational age and to identify the factors associated with the withholding or withdrawal of intensive care. STUDY DESIGN: Population-based cohort study. PATIENTS AND METHODS: Our study population comprised 2145 births between 22 and 26 completed weeks enrolled in the EPIPAGE-2 study, a French cohort of very preterm infants born in 2011. The primary outcome measure was withholding or withdrawal of intensive care in the delivery room. RESULTS: Among infants born alive at 22-23â weeks, intensive care was withheld or withdrawn for >90%. At 24â weeks, resuscitative measures were withheld or withdrawn for 38%, at 25â weeks for 8% and at 26â weeks for 3%. Other factors besides gestational age at birth associated with this withholding or withdrawal for infants born at 24-26â weeks were birth weight <600â g, emergency delivery (within 24â h of the mother's admission) and singleton pregnancy. Although rates of withholding or withdrawal of intensive care varied substantially between maternity units (from 0% to 100%), the variability was primarily explained by differences in distributions of gestational age at birth. CONCLUSIONS: Although gestational age is only one factor predicting survival of preterm infants, practices in France appear to be based primarily on this factor, which thus has direct effects on the survival of extremely preterm infants. The ethical implications of basing life and death decisions only on gestational age before 25â weeks require further examination.
Asunto(s)
Mortalidad Infantil , Recien Nacido Extremadamente Prematuro , Cuidado Intensivo Neonatal , Toma de Decisiones Clínicas , Salas de Parto , Francia , Edad Gestacional , Humanos , Lactante , Tasa de Supervivencia , Privación de TratamientoRESUMEN
OBJECTIVES: Prostate cancer is the most frequent cancer and the third leading cause of cancer death in men in France. The development of treatment for prostate cancer is fast and sometimes relies on costly innovations. Medico-economic studies are however rare in this area. This literature review aims to summarize available medico-economic data on the initial management of localized prostate cancer and discuss the quality and usability of existing economic studies on the subject. MATERIALS AND METHOD: Literature review was done using PubMed and Cochrane databases. Studies and articles were selected based on several criteria: population with initial treatment for localized prostate cancer (without metastasis), comparative studies with surgery as control treatment, studies in countries members of the OECD, articles in English or French published between 2004 and 2014. RESULTS: The surgical robot, one of the newest innovations, is more expensive than conventional open surgery or no robotic laparoscopy, even if it is associated with a reduction of the original period of stay. Radiation therapy seems more expensive than surgery as initial therapy of localized prostate cancer. CONCLUSION: Conclusions remain limited because of the rarity of reliable health economic studies on the subject.