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Background Rapid development in health care has resulted in an increasing number of screening and treatment options. Consequently, there is an urgency to provide people with relevant information about benefits and risks of healthcare options in an unbiased way. Decision aids help people to make decisions by providing unbiased non-directive research evidence about all treatment options.Objective To determine the effectiveness of decision aids to improve informed decision making in pregnancy care.Search strategy We searched MEDLINE (1953-2011), EMBASE (1980-2011, CENTRAL (CENTRAL, the Cochrane Library; 2011, Issue 4), Psycinfo (1806Psycinfo ( -2011 and Research Registers of ongoing trials (www.clinicaltrials.gov, www.controlled-trials.com).Selection criteria We included randomised controlled trials comparing decision aids in addition to standard care. The study population needed to be pregnant women making actual decisions concerning their pregnancy.Data collection and analysis Two independent researchers extracted data on quality of the randomised controlled trial (GRADE criteria), quality of the decision aid (IPDAS criteria), and outcome measures. Data analysis was undertaken by assessing group differences at first follow up after the interventions.Main results Ten randomised controlled trials could be included. Pooled analyses showed that decision aids significantly increased knowledge, (weighted mean difference 11.06, 95% confidence interval 4.85-17.27), decreased decisional conflict scores (weighted mean difference À3.66, 95% confidence interval À6.65 to À0.68) and decreased anxiety (weighted mean difference À1.56, 95% confidence interval À2.75 to À0.43).Conclusions Our systematic review showed the positive effect of decision aids on informed decision making in pregnancy care. Future studies should focus on increasing the uptake of decision aids in clinical practice by identifying barriers and facilitators to implementation.

Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.

D rug-eluting stents became commercially available in 2002 in Europe and Canada and in 2003 in the United States 1 and are now widely used in the treatment of coronary artery disease. Restenosis of the target lesion has been the "Achilles heel" of percutaneous coronary interventions (PCIs), with 15%-40% of patients in randomized controlled trials (RCTs) who received bare-metal stents needing repeat revascularization within 6 months. 2 Numerous RCTs 3-6 and meta-analyses 7 have shown that the use of drug-eluting stents reduces this risk by an estimated 83%. Given their comparable short-term safety profiles, drugeluting stents have been seen as an attractive clinical alternative to bare-metal stents. However, no differences in deaths or myocardial infarctions have been seen between study groups receiving either type of stent. 7 Furthermore, the absolute reductions in the rate of repeat revascularization observed with drug-eluting stents may be overestimated, owing to protocoldriven angiographic follow-up in RCTs. 8,9 Nevertheless, the clinical benefits of fewer repeat revascularizations with drugeluting stents and improved quality of life, even if ephemeral, are enticing.Because drug-eluting stents are considerably more expensive than bare-metal stents, with an estimated world market of $6 billion annually, 10 cost-effectiveness analyses may help decision-makers assess the value of this additional investment. Although many cost-effectiveness studies have been carried out, they have arrived at different conclusions despite using a relatively constant measure of the efficacy of drugeluting stents. By systematically reviewing all published costeffectiveness analyses, we attempt to understand the determinants of the different conclusions. MethodsWe performed an extensive literature search for all Englishlanguage cost-effectiveness studies published between Jan. 1, 2000, and July 31, 2006, that assessed the impact of costs of drug-eluting stents compared with bare-metal stents on a health care system. We decided not to distinguish between the different models of drug-eluting stents because, although sirolimus-eluting stents appear to be more clinically effective than paclitaxel-eluting ones, 11 both are extensively used in clinical practice and because the prices of drug-eluting stents