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

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Should Clinicians Set Limits on Reproductive Autonomy?

Related Articles Should Clinicians Set Limits on Reproductive Autonomy? Hastings Cent Rep. 2017 Dec;47 Suppl 3:S50-S56 Authors: King LP Abstract As a gynecologic surgeon with a focus on infertility, I frequently hold complex discussions with patients, exploring with them the risks and benefits of surgical options. In the past, we physicians may have expected our patients to simply defer to our expertise and choose from the options we presented. In our contemporary era, however, patients frequently request options not favored by their physicians and even some they've found themselves online. In reproductive endocrinology and infertility, the range of options that may be offered or that patients may themselves seek out is continuously widening. Physicians certainly seek to find the option that will result in the best outcome for their patients, but the information to guide us in achieving the best outcome can be vague or conflicting. Add to this the financial and emotional pressures bearing on patients seeking assisted reproduction. In this essay, I explore the extent to which clinicians in reproductive medicine should follow patient requests with which they disagree or instead try to persuade the patient to do something else or simply refuse outright to meet the request. And if persuasion is to be used, what would be legitimate methods? Clearly, coercion is unacceptable, but the line between persuasion and coercion can be elusive. At what point can or should clinicians resist such requests-and to what degree? PMID: 29171893 [PubMed - indexed for MEDLINE]

Reproductive Autonomy and Regulation-Coexistence in Action.

Related Articles Reproductive Autonomy and Regulation-Coexistence in Action. Hastings Cent Rep. 2017 Dec;47 Suppl 3:S57-S63 Authors: Deech R Abstract On occasion, British in vitro fertilization practitioners look over the ocean to the practice of IVF and embryo research in the United States, wonder why these areas are subject to less regulation than in the United Kingdom, and ask how much less risky and more progressive IVF and embryo research might be if subject to additional federal, or at least state, regulation. To an American audience, imbued with the centuries-old spirit of independence, regulation and autonomy can seem in tension. From a British perspective, there is no necessary conflict. There is no dissent in the United Kingdom from the proposition that individual activities, services, and industries can be regulated and, at the same time, retain and exercise such autonomy as is their right within a safe sphere. From 1994 to 2002, I was the chair of the United Kingdom's Human Fertilisation and Embryology Authority, which regulates the practice of IVF and embryo research. The existence of the HFEA assures patients that safety and aspects of the practice of assisted reproduction are monitored, leaving them free to choose without worrying about danger, in the same way that the public may take only those drugs that have passed health and safety tests. I would propose that anxious and vulnerable patients do not have more autonomy in a less regulated, market-driven field. PMID: 29171890 [PubMed - indexed for MEDLINE]