PLoS medicine
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Globally, over one-third of pulmonary tuberculosis (TB) disease diagnoses are made based on clinical criteria after a negative bacteriological test result. There is limited information on the factors that determine clinicians' decisions to initiate TB treatment when initial bacteriological test results are negative. ⋯ Multiple factors influenced decisions to initiate TB treatment despite negative test results. Clinicians were substantially less likely to treat in the absence of a positive test result when using more sensitive, PCR-based diagnostics.
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The French guidelines have recommended a restrictive policy of episiotomy since 2005. We aimed to assess variations in the prevalence of both episiotomy and obstetric anal sphincter injury (OASI) from the 2010, 2016, and 2021 National Perinatal Surveys. ⋯ The significant overall reduction in the prevalence of episiotomy in France has not been followed by an overall increase in OASI. However, subgroup analyses revealed a significant rise in OASI among nulliparous women giving birth by spatula (Group 2b), and a clinically relevant but statistically nonsignificant rise among nulliparous women delivering by forceps (Group 2a), while the prevalence of episiotomy significantly decreased. These results should be interpreted with caution given the low prevalence of OASI in some subgroups. Further research is needed to predict the optimal rate of episiotomy for instrumental deliveries. In hospitals with high episiotomy rates, our findings suggest that episiotomy could be safely reduced for spontaneous vaginal deliveries to comply with international guidelines and women's requests.