.3 Why it is important to do this review -
The points below help to identify a rationale for this SR.
1.3.1 What is known already -?
From Guidelines-
RCOG - (Evidence from observational SRs, Cochrane, and some individual RCTs) They suggest single (max 2-3) dose regimes of MTX (50mg/m2) without folinic acid in selected patients. AEs listed are nausea, vomiting, flatulence and abnormal liver function tests. Elson 2016
ACOG - (Evidence from observational SRs) They suggest multiple/variable dose regimes of MTX with folinic acid. AEs listed are the same as shown in Table 1.Pfeifer 2013
NICE- (Evidence from observational SRs, individual RCTs and Cochrane) No AEs listed. NICE 2012
From SRs –
SRs of observational studies-
One SR 49 quote AEs of
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Many of these SRs 3, 5, 30 have not commented on the quality or the strength of their evidence. Neither were they done thoroughly – most of them (except the Cochrane SR)16 looked at one or two electronic databases. The Cochrane SR 16, have not commented clearly on any individual or total AEs.
One way of addressing this problem is to study MTX AEs (total and individual), reported in randomised, placebo-controlled trials and presenting an overall summary.
1.2.3 Aim of this SR -
This SR, aims to identify the total and individual rates of treatment associated AEs, (expected or not expected but collected) from systemic MTX use, in ectopic pregnancy (compared to placebo or any other one drug or different doses of MTX) through a systematic search of all available literature.
Chapter 2 Methods - 2.1 Inclusion and exclusion criteria-
To do a SR on drug AEs, it is best to compare this with a placebo 17,31. Initial scoping searches discovered, that there were only 3 RCTs comparing MTX with placebo. Some authors feel it may be even unethical to do an RCT, given the limited evidence for expectant management.17 Hence the research question was broadened to include-RCT's (of tubal and extra tubal pregnancies) comparing systemic MTX with other drugs. Additionally, various doses and different ways of giving the drug, were included in the comparator arm.
Fosamax is a biphosphonate that is commonly used for the prevention and treatment of osteoporosis. It would be best to take Fosamax on an empty stomach with plenty of water. Do not lie down or eat for at least 30 minutes after taking the pill. The side effects for Fosamax are abdominal pain, bone/skeletal pain, constipation, diarrhea, dyspepsia, and nausea. I would also tell M.S that osteonecrosis of the jaw may occur after dental extraction, root canal, dental implant or other oral surgeries. Lastly I would tell M.S. that oral biphosphonates are commonly associated with a serious problem called esophagitis which is inflammation of the esophagus. If chest discomfort occurs which is a symptom of esophageal irritation, she should discontinue the drug and contact her health care provider. I would assess her for poor renal function, hypocalcemia, and GERD because if she has any of these, she would not be able to take Fosamax.
Ingham, R. J., Ingham, J. C., Bothe, A. K., Wang, Y., & Kilgo, M. (2015, May 01). Efficacy of
The decision for a woman to abort her child can be influenced by many different factors to come to that conclusion and with this major decision comes a few different ways in which the abortion can be executed. Examples of different abortion methods include surgical and medication. This essay will discuss the ‘abortion drug’, Mifepristone or RU486 and the effect it has on the female reproductive system. In August 2012, the TGA announced on that two drugs, mifepristone and misoprostol, had been approved for distribution in Australia for use in early medical abortion (Children By Choice, 2016).
medicines to cause a miscarriage or by surgery, where the pregnancy is out of the uterus. The
In their research, Cohen, et al. (2001) and colleagues suggest that randomized controlled trials conducted in research settings, may not provide the whole picture about the most
Is this Safe?: NO. The dose should be lesser. 25-50mg for lesser interval of q2H.
The government in the United States has three branches, which are executive, legislative and judicial. The United States of America declared the independence from Britain since 1976. Since success of revolution, the United States founded their first government in 1789 with following ideas: freedom, liberty, democracy. Until now, the United States have more than forty presidents indirectly elected by civilian citizens. Presidents will be reelected every four years. Changing in presidents will also change ideas about the role of government. Barry Goldwater, Lyndon Johnson, Ronald Reagan and Barack Obama these four renowned presidents demonstrated their different views on establishing government with four speeches in 1964, 1965, 1981 and
One of the nine reasons found that we should not legalize abortion is the laws against abortion kill women (Kilinger). Many women are killed each year during childbirth, but almost four times more women are killed when they have an abortion (Lowen). Women need to know the health risks involved with abortions before making that choice. Having an abortion has many long lasting effects such as: emotional disorders, blood infections, and an increase in breast cancer (Lowen). The leading causes of death for the women who had an abortion are infection, hemorrhage, bowel injuries, clotting disorders. If air was to get to the amniotic fluid, or fetal tissue to get into the woman’s blood stream they would die (Kilinger).Sometimes abortions are not effective, and
In general, if medication is required, the lowest dose possible should be used and combination drug therapies and first trimester exposures should be avoided (“Teratogens/Prenatal”, 2008).
To have fun doesn't mean having the best and most expensive equipment. Some people don't have as much money as other people, so they can't get the new and improved equipment. To be good doesn't mean you have a lot of money or good equipment. To be great you have to practice on your own time and make yourself better. You don't have to have good equipment to be great.
b.ii. The dosage will depend on the age, weight, and other health issues of the person.
In the United States today, 25% of all pregnancies end in abortion (Abortion: All Sides). With so many lives in the balance, one of the primary arguments has become the physical health of women who have abortions. Of the women that previously had a surgical abortion 90% said they would prefer the pill if they had another abortion and would recommend it to others (Robinson). However one of the side effects of RU 486 is bleeding up to 9 days, compared to a surgical abortion’s five day duration (Robinson). The recovery process is quicker with a surgical abortion but more traumatic. One death in 200,000 occur with a surgical abortion, compared to one in 500,000 with the abortion pill. Both of these alternatives are far safer for the mother than childbirth that claims one death in every 14,300 births (Robinson). These statistics prove that the safest alternative for the mother in the event of a pregnancy is an abortion using the abortion pill and the most dangerous is going through with childbirth. However the safest thing for the child is natural childbirth by far. The voice of the life in question is never heard and it has a one hundred percent chance of death in the first 2 cases.
Although, Cytotec is used to abort the fetus, it is only successful in 85% of cases, in the other 15% of cases, the pregnancy has continued or complications have occurred. The reason is because Cytotec does not have the ingredient that stops the development of the fetus like RU-486.
Obscenity revolves around what constitutes pornography and sexually explicit material to be protected by the First Amendment rights of freedom of speech and press as stated in the Constitution. I want to look at the language and definitions of obscenity created by the Supreme Court and interrupt their effects on society. In this essay, I want to argue that the creation of the definition of obscenity and obscenity laws constructed from community standards can be harmful to society because they can be interrupted in many different ways.
Methotrexate has been used in the US since 1953, when it was approved by the FDA to treat certain types of cancer. Since that time, “medical researchers have discovered other important uses for the drug” (Ankerberg and Weldon 4). One of these uses is to end unintended pregnancies. Although the “FDA did not consider methotrexate for this specific purpose, clinicians may prescribe and are now prescribing methotrexate for early abortion”(Ankerberg and Weldon 4). Methotrexate is usually given to a pregnant woman in the form of an injection or shot, although it can be taken orally. “Methotrexate stops the ongoing implantation process that occurs during the first several weeks after conception. Another medication that might be used is mifepristone”(Ankerberg and Weldon 4). Mifepristone is a newer medication that was developed and tested specifically as an abortion inducing agent. It works by blocking the hormone progesterone, which is necessary to sustain pregnancy. Without this hormone, “the lining of the uterus breaks down, the cervix opening of the uterus or womb softens, and bleeding begins”(Ankerberg and Weldon 5). A few days after taking either methotrexate or mifepristone, a second drug, misoprostol, is taken. “Misoprostol tablets cause the uterus to contract and empty”(Ankerberg and Weldon 5).