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Notes: Abstract Meconium-stained amniotic fluid was recently reported to be significantly correlated with a higher incidence of otitis media during infancy. In order to verify this connection, a case-control study was performed on 71 pairs of infants, with and without meconium aspiration, matched for gestational age, birth weight and sex. Data were collected by questionnaire or telephone, the response rate being 88,7%. No significant difference in incidence of otitis media between the two groups was observed. This study demonstrated that newborns with meconium aspiration are not at greater risk for otitis media in the 1st year of life.

Notes: The Claude Moore Health Sciences Library at the University of Virginia is one of several libraries taking a leadership role with personal digital assistants (PDAs). The mission of the Library is to provide information management expertise and institutional leadership to connect students, researchers, clinicians and staff with the biomedical information they need to advance the education, research, patient care and public service programs of the University of Virginia Health System. As a corollary to the mission, the Library's PDA services are built around the premise that users need the skills and knowledge to effectively use PDAs in their workflow.

Notes: To provide effective managerial support for decisions related to production planning and scheduling processes, it is useful to partition the set of decisions into a hierarchical framework. In the resulting system, higher level decisions impose constraints on lower level actions, and lower level decisions provide the necessary feed-back to reevaluate higher level actions. The purpose of this paper is to suggest optimum procedures to deal with the resulting subproblems and to analyze the interaction mechanisms among the different hierarchical levels. Computational results are given.

Notes: To perform a meta-analysis of studies comparing twice daily, one-week triple therapy with a proton pump inhibitor, clarithromycin (C) and amoxycillin (A) (PCA) vs. those using proton pump inhibitor, clarithromycin and a nitroimidazole (N) (PCN) for H. pylori eradication.〈section xml:id="abs1-2"〉〈title type="main"〉Review methods:Selection criteria: Comparative randomized trials of PCA vs. PCN were included. Data sources: PubMed database and abstracts from congresses until September 1999. Statistics: Meta-analysis was performed combining the Odds Ratios (OR) of the individual studies in a global OR (Peto method) both on an intention-to-treat (ITT) and on a per protocol (PP) basis.〈section xml:id="abs1-3"〉〈title type="main"〉Results:Twenty-two studies fulfilled the inclusion criteria. Eighteen studies reported ITT and 20 PP analysis. Mean H. pylori eradication rates were 81% (95% CI: 79–83%) ITT, and 84% (82–86%) PP with PCA, and 81% (78–83%) ITT and 84% (82–86%) PP with PCN; the odds ratio for the effect of PCA vs. PCN was 1 (0.83–1.22) on an ITT, and 0.98 (0.8–1.2) on a PP basis. Subanalysis showed that mean H. pylori eradication efficacy with PC(250 b.d.)A was 81% (78–85%) ITT, vs. 86% (83–89%) with PC(250 b.d.)N. The odds ratio for this comparison was 0.68 (0.48–0.98). Finally, when comparing PC(500 b.d.)A against PC(250 b.d.)N ITT cure rates were 77% (74–80%), and 75% (72–78%) with an odds ratio of 1.18 (0.93–1.5).〈section xml:id="abs1-4"〉〈title type="main"〉Conclusion:Overall, one-week combination regimens of PCA and PCN present similar H. pylori eradication efficacy. Nevertheless, the PCN regimen obtains significantly better results when using low doses of C (250 mg b.d.).

Notes: To evaluate whether proton pump inhibitors are more effective than H2-antagonists (H2-A) for the treatment of bleeding peptic ulcer.〈section xml:id="abs1-2"〉〈title type="main"〉Data sources:PubMed database until January 2000.〈section xml:id="abs1-3"〉〈title type="main"〉Study selection:Comparative randomized trials of proton pump inhibitors (omeprazole, lansoprazole, or pantoprazole) vs. H2-A (cimetidine, ranitidine or famotidine).〈section xml:id="abs1-4"〉〈title type="main"〉Data extraction:Meta-analysis combining the odds ratios (OR) of the individual studies in a global OR (Peto method).〈section xml:id="abs1-5"〉〈title type="main"〉Outcomes evaluated:Persistent or recurrent bleeding, need for surgery, or mortality.〈section xml:id="abs1-6"〉〈title type="main"〉Data synthesis:Eleven studies fulfilled the inclusion criteria and contained data for at least one of the planned comparisons. Persistent or recurrent bleeding was reported in 6.7% (95% CI: 4.9–8.6%) of the patients treated with proton pump inhibitors, and in 13.4% (95% CI: 10.8–16%) of those treated with H2-A (OR 0.4; 95% CI: 0.27–0.59) (χ2-homogeneity test, 18; P=0.09). Surgery was needed in 5.2% (95% CI: 3.4–6.9%) of the patients treated with proton pump inhibitors, and in 6.9% (95% CI: 4.9–8.9%) of the patients treated with H2-A (OR 0.7; 95% CI: 0.43–1.13). Respective percentages for mortality were 1.6% (95% CI: 0.9–2.9%) and 2.2% (95% CI: 1.3–3.7%) (OR 0.69; 95% CI: 0.31–1.57).〈section xml:id="abs1-7"〉〈title type="main"〉Sub-analysis:Five studies evaluated the effect of both therapies given in bolus injections on persistent or recurrent bleeding rate, which was 6% (95% CI: 3.6–8.3%) and 8.1% (95% CI: 5.3–10.9%), respectively (OR, 0.57; 95% CI: 0.31–1.05). Persistent or recurrent bleeding in high risk patients (Forrest Ia, Ib and IIa) occurred in 13.2% (95% CI: 7.9–8%) of the patients treated with proton pump inhibitors and in 34.5% (27–42%) of those treated with H2-A (OR 0.28; 95% CI: 0.16–0.48). In patients not having endoscopic therapy, persistent or recurrent bleeding was reported, respectively, in 4.3% (95% CI: 2.7–6.7%) and in 12% (95% CI: 8.7–15%) (OR 0.24; 95% CI: 0.13–0.43). Less marked differences were observed in patients having adjunct endoscopic therapy: 10.3% (95% CI: 6.7–13.8%) and 15.2% (11.1–19.3%) (OR 0.59; 95% CI: 0.36–0.97). Moreover, the significance disappeared in this group when a single outlier study was excluded.〈section xml:id="abs1-8"〉〈title type="main"〉Conclusions:Proton pump inhibitors are more effective than H2-A in preventing persistent or recurrent bleeding from peptic ulcer, although this advantage seems to be more evident in patients not having adjunct sclerosis therapy. This beneficial effect seems to be similar or even more marked in patients with Forrest Ia, Ib or IIa ulcers. However, proton pump inhibitors are not more effective than H2-A for reducing surgery or mortality rates. Nevertheless, the data are too scarce and heterogeneous to draw definitive conclusions, and further comparative trials are clearly warranted.