This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To assess the effectiveness and safety of gonadotrophin‐releasing hormone analogues (GnRHas) in the treatment ...of endometriosis.
Recurrence rates of FIGO stage IB-IIA and IIB-IVA cervical cancer 28–64 respectively. There is a scarcity of data on the recurrence recurrence pattern for unusual sites and theirrecurrence pattern ...for unusual sites and its association with survival and prognosis.
To study overall survival in patients with distant metastasis compared to local and regional nodal metastasis.
A retrospective study was done from 1/1/2017 to 30/12/22. Cervical cancer patients post primary treatments were included. Survival was analyzed with respect to 3 groups local, regional nodalconducted from 1/1/2017 to 30/12/22. Cervical cancer patients who had received primary post-primary treatments were included. Survival was analyzed with respect to three groups: local, regional nodal, and distant metastasis.
225 patients had recurrences post-completion of primary treatment, of which 105 (46.6%)(46.6 %) had local, 46 (20.4%)(20.4 %) had regional nodal, and 74 (33.3%) had distant recurrences. The median time for recurrence in local, regional nodal, and atypical recurrences were 9, 9, and 13 months (p value - <0.05), respectively. Treatment included systemic chemotherapy 122 (54.2%), metronomic therapy 19 (8.4%), palliative radiotherapy 44 (19.5%), palliative surgery 8 (3.5%) and best supportive care 30 (13.3%) patients. Median Time to treatment-death of patients after recurrence in local, nodal and distant recurrences was 17.0 months, 18.0 months and 10.0 months respectively (p value - < 0.05). Overall Survival of patients after primary treatment with local, nodal and distant recurrences was 35.0 months, 47.0 months and 50.0 months respectively (p value <0.05).
Local recurrence is most common, followed by regional, nodal, and distant recurrences. Overall survival post recurrence was lowest for distant recurrences and highest for local recurrences however overall survival after primary treatment completion was highest for distant recurrence due to the late presen; however, tation of distant recurrences.
Objective
The coronavirus disease 2019 (COVID‐19) pandemic is disrupting health services worldwide. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the ...acute phase of the COVID‐19 pandemic.
Design
Interview‐based national survey.
Setting
Women's healthcare units in the National Health Service.
Population
Junior doctors in obstetrics and gynaecology.
Methods
Participants were interviewed by members of the UK Audit and Research in Obstetrics and Gynaecology trainees' collaborative between 28 March and 7 April 2020. We used a quantitative analysis for closed‐ended questions and a thematic framework analysis for open comments.
Results
We received responses from 148/155 units (95%), most of the participants were in years 3–7 of training (121/148, 82%). Most completed specific training drills for managing obstetric and gynaecological emergencies in women with COVID‐19 (89/148, 60.1%) and two‐person donning and doffing of Personal Protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID‐19‐specific protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID‐19 emergency theatres (105/148, 70.8%). Most units reduced face‐to‐face antenatal clinics (117/148, 79.1%) and suspended elective gynaecology services (131/148, 88.5%). The 2‐week referral pathway for oncological gynaecology was not affected in half of the units (76/148, 51.4%), but half reported a planned reduction in oncology surgery (82/148, 55.4%).
Conclusion
The provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID‐19 pandemic seems to be in line with current guidelines, but strategic planning is needed to restore routine gynaecology services and ensure safe access to maternity care in the long term.
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Provision of obstetrics and gynaecology services during the acute phase of COVID‐19 is in line with current guidelines, strategic planning is needed to restore routine services and ensure safe access to care in the long term.
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Provision of obstetrics and gynaecology services during the acute phase of COVID‐19 is in line with current guidelines, strategic planning is needed to restore routine services and ensure safe access to care in the long term.
This paper includes Author Insights, a video available at https://vimeo.com/rcog/authorinsights16313
Objective
To explore the impact of attending a clinical placement in considering a career in obstetrics and gynaecology.
Design
Mixed methods study.
Setting
London Medical School.
Population
Fifth ...year medical students attending a clinical placement in obstetrics and gynaecology.
Methods
Between January 2021 and January 2022, questionnaires were used and semi‐structured focus groups conducted, which were audio‐recorded. Descriptive statistics were conducted and a framework analysis on transcribed focus groups.
Main outcome measure
The impact of the clinical placement on career choice.
Results
Six main themes were identified from the analysis; three contributing to considering a career in obstetrics and gynaecology; pregnancy is not an illness, extraordinary experience of observing childbirth and variable specialty and three themes emerged contributing to not considering a career; lack of work–life balance, high stakes specialty and the emotional toll. Even at an undergraduate level, medical students exhibited concerns about the long‐term feasibility of achieving work–life balance and avoiding professional burnout, which was partly attributed to the responsibility of looking after both the woman and their baby.
Conclusions
Obstetrics and gynaecology is perceived as an exciting and variable speciality by medical students. Students’ experiences on the labour ward during a clinical placement appear to contribute to the consideration of a career in obstetrics and gynaecology. Students should be given opportunities to discuss their concerns about obstetrics, particularly over the potential psychological impact of adverse/traumatic birth events. It is crucial to provide a realistic introduction to obstetrics, to recruit enthusiastic junior doctors who will be resilient to the pressures of the speciality, to avoid burnout and minimise attrition rates.
Linked article: This article is commented on by Charles Weissman, pp.969 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17751.
Antidepressants for menopausal symptoms Karanth, Laxminarayan; Chuni, Neena; Nair N, Sreekumaran
Cochrane database of systematic reviews,
05/2021, Letnik:
2021, Številka:
5
Journal Article
Recenzirano
Odprti dostop
This protocol for a Cochrane Review has been withdrawn as the subject matter of the proposed review is covered in another review "Non‐hormonal, pharmacological treatments for hot flushes in ...perimenopausal women".
Can plasma miRNAs be used for the non-invasive diagnosis of endometriosis in infertile women?
miRNA-based diagnostic models for endometriosis failed the test of independent validation.
Circulating ...miRNAs have been described to be differentially expressed in patients with endometriosis compared with women without endometriosis, suggesting that they could be used for the non-invasive diagnosis of endometriosis. However, these studies have shown limited consistency or conflicting results, and no miRNA-based diagnostic test has been validated in an independent patient cohort.
We performed genome-wide miRNA expression profiling by small RNA sequencing to identify a set of plasma miRNAs with discriminative potential between patients with and without endometriosis. Expression of this set of miRNAs was confirmed by RT-qPCR. Diagnostic models were built using multivariate logistic regression with stepwise feature selection. In a final step, the models were tested for validation in an independent patient cohort.
Plasma of all patients was available in the biobank of the Leuven Endometriosis Centre of Excellence. Biomarker discovery and model development were performed in a discovery cohort of 120 patients (controls = 38, endometriosis = 82), and models were tested for validation in an independent cohort of 90 patients (controls = 30, endometriosis = 60). RNA was extracted with the miRNeasy Plasma Kit. Genome-wide miRNA expression analysis was done by small RNA sequencing using the NEBNext small RNA library prep kit and the NextSeq 500 System. cDNA synthesis and qPCR were performed using the Qiagen miScript technology.
We identified a set of 42 miRNAs with discriminative power between patients with and without endometriosis based on genome-wide miRNA expression profiling. Expression of 41 miRNAs was confirmed by RT-qPCR, and 3 diagnostic models were built. Only the model for minimal-mild endometriosis (Model 2: hsa-miR-125b-5p, hsa-miR-28-5p and hsa-miR-29a-3p) had diagnostic power above chance performance in the independent validation (AUC = 60%) with an acceptable sensitivity (78%) but poor specificity (37%).
The diagnostic models were built and tested for validation in two patient cohorts from a single tertiary endometriosis centre. Further validation tests in large cohorts with patients from multiple endometriosis centres are needed.
Our study supports a possible biological link between certain miRNAs and endometriosis, but the potential of these miRNAs as clinically useful biomarkers is questionable in women with infertility. Large studies in well-described patient cohorts, with rigorous methodology for miRNA expression analysis, sufficient statistical power and an independent validation step, are necessary to answer the question of whether miRNAs can be used as diagnostics markers for endometriosis.
The project was funded by a grant from the Research Foundation - Flanders (FWO). A.V., D.F.O. and D.P. are PhD fellows from the FWO. T.D. is vice president and Head of Global Medical Affairs Fertility, Research and Development, Merck KGaA, Darmstadt, Germany. He is also a professor in Reproductive Medicine and Biology at the Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium and an adjunct professor at the Department of Obstetrics and Gynecology in the University of Yale, New Haven, USA. Neither his corporate role nor his academic roles represent a conflict of interest with respect to the work done by him for this study. The other co-authors have no conflict of interest.
Not applicable.
Background
Variation in outcome collection and reporting is a serious hindrance to progress in our specialty; therefore, over 80 journals have come together to support the development, dissemination, ...and implementation of core outcome sets.
Objective
This study systematically reviewed and characterised registered, progressing, or completed core outcome sets relevant to women's and newborn health.
Search strategy
Systematic search using the Core Outcome Measures in Effectiveness Trial initiative and the Core Outcomes in Women's and Newborn Health initiative databases.
Selection criteria
Registry entries, protocols, systematic reviews, and core outcome sets.
Data collection and analysis
Descriptive statistics to describe characteristics and results.
Results
There were 49 core outcome sets registered in maternal and newborn health, with the majority registered in 2015 (n = 22; 48%) or 2016 (n = 16; 32%). Benign gynaecology (n = 8; 16%) and newborn health (n = 3; 6%) are currently under‐represented. Twenty‐four (52%) core outcome sets were funded by international (n = 1; <1%), national (n = 18; 38%), and regional (n = 4; 8%) bodies. Seven protocols were published. Twenty systematic reviews have characterised the inconsistency in outcome reporting across a broad range of relevant healthcare conditions. Four core outcome sets were completed: reconstructive breast surgery (11 outcomes), preterm birth (13 outcomes), epilepsy in pregnancy (29 outcomes), and maternity care (48 outcomes). The quantitative, qualitative, and consensus methods used to develop core outcome sets varied considerably.
Conclusions
Core outcome sets are currently being developed across women's and newborn health, although coverage of topics is variable. Development of further infrastructure to develop, disseminate, and implement core outcome sets is urgently required.
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Forty‐nine women's and newborn core outcome sets registered. 50% funded. 7 protocols, 20 systematic reviews, and 4 core outcome sets published. @coreoutcomes @jamesmnduffy
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Forty‐six women's and newborn core outcome sets registered. 50% funded. 7 protocols, 20 systematic reviews, and four core outcome sets published. @coreoutcomes
This article includes Author Insights, a video available at https://vimeo.com/rcog/authorinsights14694.
Introduction
Studies that use standardized ultrasonographic criteria to diagnose adenomyosis in subfertile women are needed. These would improve the understanding of the disease burden and enable ...further studies on its impact on fertility and assisted reproductive treatment (ART) outcome. The aim of this study was to determine the prevalence of different features of adenomyosis in women scheduled for their first ART, diagnosed at two (2D) and three‐dimensional (3D) transvaginal ultrasonography (TVUS) using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions.
Material and methods
This was a prospective, observational cross‐sectional study of subfertile women aged 25 to ≤39 years, that were referred to a university hospital for their first ART between December 2018 and May 2021. Of 1224 eligible women, 1160 women fulfilled the inclusion criteria and consented to participate in the study. All women underwent a systematic 2D and 3D TVUS examination. The primary outcome was the presence of direct and indirect features of adenomyosis, as proposed by the MUSA group. Secondary outcomes were to describe the ultrasonographic characteristics of the different features, as well as any difference in the diagnostics at 2D or 3D TVUS and any association with clinical characteristics such as endometriosis.
Results
At least one direct or indirect feature of adenomyosis was observed in 272 (23.4%, 95% confidence interval CI 21.0–25.9) women. Direct features that are pathognomonic for the disease were observed in 111 (9.6%, 95% CI, 7.9–11.3) women. Direct features were visible only at 3D TVUS in 56 (4.8%, 95% CI 3.6–6.1) women, that is, 56/111 (50.5%) of women with at least one direct adenomyosis feature. Direct features were more common in women with endometriosis (OR 2.8, 95% CI 1.8–4.3).
Conclusions
We found than one in 10 women scheduled for ART had direct features of adenomyosis at ultrasound examination. The present study suggests that the use of 3D TVUS is an important complement to 2D in the diagnostics of adenomyosis. Our results may further improve the counseling of women scheduled for ART and enables future studies on the impact of different features of adenomyosis on subfertility, ART results and obstetric outcomes.
Adenomyosis may affect reproductive outcomes and a correct diagnosis is of clinical importance. This study describes the prevalence and ultrasonographic characteristics of features of adenomyosis, as defined by the Morphological Uterus Sonographic Assessment (MUSA) group, in women planned for their first IVF treatment.
The first ever report of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynaecological was reported in 2012. There has been an exponential uptake of the number of ...surgeons performing such procedures worldwide with no official guidance to ensure the safe implementation of this technique into gynaecological practice due its recency. The objective of this study is to report an international consensus-based statement to help guide a basis for adopting vNOTES into clinical practice.
The consensus-based statement was developed amongst 39 international experts using the Delphi methodology over three successive rounds. Consensus was pre-defined as an agreement of 80% or more by the experts. Consensus sought over eight key concepts pertaining to vNOTES including patient selection, perioperative management, surgical technique, instruments, anatomy, training, registries and trials and definition of the surgical technique. Recommendations from an expert anaesthetist and urogynaecologist were also sought to give a broader perspective with respect to the implementation of vNOTES.
Fifty nine international surgeons were invited to participate and 39 (66%) agreed to participate based on being involved in a minimum of 20 vNOTES procedures. They were from 13 countries across 5 continents (Europe, North America, South America, Australia and Asia). Participation was 100% on all three rounds. Overall, consensus was reached in 50 of the 56 questions (89%) with the remaining 6 questions where consensus was not reached pertaining to the domain of patient selection.
An international expert based vNOTES statement is presented here to help guide adoption of vNOTES based on the experience of early adopters. Consensus was achieved on most components of this consensus statement. Given the recency of this technique, until high-level evidence becomes available, this statement provides an appropriate guidance to the safe implementation of vNOTES into gynaecological practice.
Objective
To evaluate the effectiveness of nurse‐led telephone follow‐up (TFU) for patients with stage–I endometrial cancer.
Design
Multicentre, randomised, non‐inferiority trial.
Setting
Five ...centres in the North West of England.
Sample
A cohort of 259 women treated for stage–I endometrial cancer attending hospital outpatient clinics for routine follow‐up.
Methods
Participants were randomly allocated to receive traditional hospital based follow‐up (HFU) or nurse‐led TFU.
Main outcome measures
Primary outcomes were psychological morbidity (State Trait Anxiety Inventory, STAI–S) and patient satisfaction with the information provided. Secondary outcomes included patient satisfaction with service, quality of life, and time to detection of recurrence.
Results
The STAI–S scores post‐randomisation were similar between groups mean (SD): TFU 33.0 (11.0); HFU 35.5 (13.0). The estimated between‐group difference in STAI–S was 0.7 (95% confidence interval, 95% CI −1.9 to 3.3); the confidence interval lies above the non‐inferiority limit (−3.5), indicating the non‐inferiority of TFU. There was no significant difference between groups in reported satisfaction with information (odds ratio, OR 0.9; 95% CI 0.4–2.1; P = 0.83). Women in the HFU group were more likely to report being kept waiting for their appointment (P = 0.001), that they did not need any information (P = 0.003), and were less likely to report that the nurse knew about their particular case and situation (P = 0.005).
Conclusions
The TFU provides an effective alternative to HFU for patients with stage–I endometrial cancer, with no reported physical or psychological detriment. Patient satisfaction with information was high, with similar levels between groups.
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ENDCAT trial shows effectiveness of nurse‐led telephone follow‐up for patients with stage‐I endometrial cancer.
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ENDCAT trial shows effectiveness of nurse‐led telephone follow‐up for patients with stage‐I endometrial cancer.
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