Évaluation de la prescription de doxylamine dans le traitement des nausées et vomissements gravidiques : enquête auprès de 752 médecins généralistes
Bibliographic record
Abstract
Context: Nausea and vomiting of pregnancy (NVP) are very common. Usually present in the first quarter, they can last throughout pregnancy. Reassure patients and the lavish lifestyle advice is sufficient in most cases but the use of drug therapy is sometimes necessary. But in France no anti emetic class is approved by health authorities regarding pregnant women. The molecule having the most favorable profile in the literature is doxylamine, recommended as first in the specific treatment of NVP in the United States and Canada. In France, it is available with the sole indication specified is the treatment of occasional insomnia in adults. Objectives: We conducted a survey to assess the prescription doxylamine by GPs. Do they know this molecule and this indication? If yes, how ? Does the use they first line? If not why ? Method: 752 GPs practicing in France responded to a semi structured questionnaire sent by email in spring 2015. Results: Only 32.8% of respondents prescribe doxylamine. 21.5% in first intention after failure of dietary measures. Women doctors and under 40 are significantly more likely to prescribe. The most cited sources of information are le CRAT site and Prescrire review. The main obstacles to prescription doxylamine in NVG are ignorance of the molecule (22.5% of non-prescribers) and / or the indication (50%), lack of AMM (21.5%) and fear of side effects for the mother (12.5%) and child (9.5%). Conclusion: Despite the absence of marketing authorization, the conditions are met to justify the prescription of doxylamine and avoid legal risk mentioned by many doctors in our survey. With efficiency and safety amply demonstrated in the literature and a major setback for use, doxylamine should be the reference drug treatment in NVP. A more developed information to prescribers who prefer molecules at least advantageous profile seems necessary.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".