Cranberry capsules to prevent bacteriuria after pelvic surgery. #BlueJC

We will discuss Cranberry capsules to prevent nosocomial urinary tract bacteriuria after pelvic surgery: a randomized controlled trial by Letouzey and co-authors on the 22nd February for 7 days. This paper is open access

Start date: 22 February 2017. The discussion will continue for 7 days until 1st March 2017.

First hosted discussion session(s) on Twitter starts at GMT 8pm (3pm EST/12 noon PST) on 22 February 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Follow us: Twitter

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are attached below:

Scenario

A 43 year-old woman is scheduled to undergo a vaginal hysterectomy. After a previous hysteroscopy she developed a bothersome urinary tract infection (UTI). She wonders if cranberry capsules could help prevent another UTI during her upcoming surgery. Would you recommend cranberry capsules to prevent postoperative bacteriuria?

cranberry-capsulesopt

 

 

 

 

 

 

 

Description of Research:

Participants Women undergoing pelvic surgery requiring urinary catheter for at least 24 postoperative hours.
Intervention Prophylactic cranberry juice capsule proanthocyanidins (PAC) 36 mg from day 0 to day 10.
Comparison Placebo from day 0 to day 10.
Outcomes Postoperative culture-proven bacteriuria within 15 days after surgery.
Study design Double-blind, Randomized Controlled Trial (RCT)
Authors’ conclusion PAC prophylaxis does not reduce the risk of postoperative bacteriuria in patients undergoing pelvic surgery.

 

Discussion Points:

  • What are your current practices for reducing urinary tract infections after pelvic surgery?
  • Do you think the primary outcome (bacteriuria within 15 days of operation) is a valid surrogate for urinary tract infection? Why, or why not?
  • This study was, in the end, underpowered to detect a difference in the primary outcome. List the reasons why.
  • Many participants were excluded or dropped out after randomization, how might a high dropout rate (1) affect power, and (2) introduce bias?
  • If you were asked to design this trial, what effect size (reduction in bacteriuria) would you say is sufficient to consider routine use of cranberry capsules for prevention of postoperative UTIs? (10%? 25%? 50%?)
  • How do you interpret these results, considering the totality of evidence in the literature as outlined by the authors?
  • Summarise this trial’s results in the form of a tweet. (140 characters)
  • Will your practice change because of this study?

Suggested reading

  1. Newgard CD and Lewis RJ. Missing Data: How to Best Account for What is Not Known. JAMA 2015;314(9):940-941. DOI: 10.1001/jama.2015.10516 – Link
  2. Pocock SJ and Stone GW. The Primary Outcome Fails – What Next? N Eng J Med 2016;375:861-870. DOI: 10.1056/NEJMra1510064 
- Link

 

Heavy periods and bleeding between periods in pre-menopausal women: is it OK to wait and see without biopsy?

We will discuss “Premenopausal abnormal uterine bleeding and risk of endometrial cancer” by Pennant and co-workers from 30 November 2016 for 7 days.

*This paper is open accesshttp://bit.ly/2fEA3TV.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 30 November 2016 (the discussion will continue for 7 days between 30 November – 7 December 2016)

First hosted discussion session(s) on Twitter starts at GMT+1 (British Summer Time) 8pm on 30 November 2016 (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are attached below (quoted from the published Journal Club guide)

 

Scenario

A 32-year-old nulliparous woman presented to your clinic with bleeding in between her periods for the past 6 months.

Her periods had been regular prior to her new symptom. She had an up-to-date and normal smear, and recent tests for genital tract infections were negative. She had no other medical history.

How would you manage this woman?

 

Description of research

Participants Studies reporting rates of endometrial carcinoma and/or atypical hyperplasia of women with pre-menopausal abnormal uterine bleeding
Intervention Endometrial biopsy and histological analysis
Comparison Prevalence of endometrial malignancy
Outcomes Risk of endometrial cancer or atypical hyperplasia
Study design Studies reporting rates of endometrial carcinoma and/or atypical hyperplasia of women with pre-menopausal abnormal uterine bleeding
Authors’ conclusion The combined risk of endometrial cancer is low (0.34%; 95% CI 0.28 to 0.42%, n=28,162; 96 cases)

Discussion Points

  • Which additional factors would you consider when you manage the woman in the above scenario?
  • How do you currently manage the women in the clinical scenario?
  • What is the best way to determine the prevalence of a disease in different subgroups of the population?
  • What are the strengths and weaknesses of this meta-analysis for this research question? (see suggested reading)
  • In particular, do you have additional comments with regards to the search strategy and selection criteria?
  • What is the prevalence (with confidence intervals) of endometrial cancer and atypical hyperplasia identified in this study?
  • Are the results of the existing study consistent with published guidelines?

Suggested reading

Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 1: Systematic reviews and meta-analyses. http://www.sign.ac.uk/methodology/checklists.html (Last access 20 July 2016)

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Is surgical lymph node assessment necessary for women with mucinous ovarian cancer?

We will discuss “Surgical lymph node assessment in mucinous ovarian carcinoma staging: a systematic review and meta-analysis” by Hoogendam and co-workers from 26 October 2016 for 7 days.

*This paper is now free-to-view. The linked mini-commentary by Nagar H on this paper can also be found via this research report.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 26 October 2016 (the discussion will continue for 7 days between 26 October- 2 November 2016)

First hosted discussion session(s) on Twitter starts at GMT+1 (British Summer Time) 8pm on 26 October 2016 (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (click on the “supporting information” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A 50-year-old woman attended your gynaeoncology clinic regarding the management of a complex ovarian mass. A staging CT confirmed a unilateral mass with features suggestive of malignancy. There was no radiological evidence of metastasis. Multidisciplinary team discussion suggested upfront surgery. She had no comorbidity.

How would you counsel this woman about the proposed operation?

Description of research

Participants Women diagnosed with mucinous ovarian carcinoma undergoing surgical staging
Intervention Studies with ≥10 mucinous ovarian carcinoma cases and surgical lymph nodal assessment
Comparison No surgical lymph nodal assessment
Outcomes Prevalence of lymph node metastases, stage shift based on lymph node assessment and survival data
Study design Systematic review and meta-analysis
Authors’ conclusion Less than 1 in 100 (0.8%) women with stage 1-2 mucinous ovarian cancer undergoing lymph node assessment had metastases in resected lymph nodes.

Discussion Points

  • How do you currently assess the risks of malignancy in women presenting with ovarian masses?
  • How do the different subtypes of ovarian cancers differ in terms of clinical presentation and underlying genetic aberrations? (see suggested reading)
  • What did the Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions (ACROBAT-NRSI) show?
  • What are the strengths and weaknesses of this meta-analysis?
  • Is lymph node dissection a more sensitive method to detect metastases, compared to lymph node sampling?
  • How common is lymph node metastasis in women with other subtypes of ovarian cancer?
  • How often do we know an ovarian mass is likely to be mucinous carcinoma prior to surgery?
  • How may the results influence the current management pathway of women with ovarian masses?

Suggested reading

  • Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 1: Systematic reviews and meta-analyses. http://www.sign.ac.uk/methodology/checklists.html (Last access 20 July 2016)
  • Vaughan S, Coward JI, Bast RC Jr, Berchuck A, Berek JS, Brenton JD, Coukos G, Crum CC, et al. Rethinking ovarian cancer: recommendations for improving outcomes. Nat Rev Cancer. 2011 Sep 23;11(10):719-25.
  • Royal College of Obstetricians and Gynaecologists. Green-Top Guideline No. 34. Management of suspected ovarian masses in post-menopausal women (July 2016)

 

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

How can we improve care for pregnant and post-partum migrants?

We will discuss “Migration and perinatal mental health in women from low- and middle-income countries: a systematic review and meta-analysis” by Fellmeth and co-workers from 28 September 2016 for 7 days.

*This paper will be made free-to-view  approximately 10 days before the start of #BlueJC. The linked mini-commentary on this paper can also be found via this research report.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 28 September 2016 (the discussion will continue for 7 days between 28 September 2016 – 5 October 2016)

First hosted discussion session(s) on Twitter starts at: GMT+1 (British Summer Time) 8pm (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (click on the “supporting information” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A pregnant woman came to see her midwife for the first time with her two young children after arriving from Syria 2 weeks ago as asylum seekers, with no other relatives in the UK. She spoke poor English and you communicated with her via an interpreter. She had 2 normal vaginal births and no other significant medical history. Symphysis fundal height was 22cm and fetal heart sounds were heard.

What additional questions would you ask this woman? How would you manage this pregnancy?

Description of research

Participants Pregnant and post-partum migrants, including refugees & asylum-seekers, from low-and-middle income countries (LMICs)
Intervention Prevalence, risk factor and intervention studies
Comparison Non-migrants
Outcomes Prevalence and risk factors for depressive disorders, and treatment given
Study design Systematic review and meta-analysis
Authors’ conclusion Overall, 3 in 10 pregnant and post-partum migrant had depressive disorders, and they are associated with prior history of depressive disorder and poor social support.

Discussion Points

  • Which additional factors would you consider when you counsel the woman in the above scenario?
  • How did the authors assess heterogeneity and address its problem in this systematic review (see suggested reading)?
  • What are the strengths and weaknesses of this meta-analysis (see suggested reading)?
  • How does the prevalence of perinatal mental disorders in your practice compare to that reported in this study?
  • What were the most significant risk factors for perinatal depression in migrants?
  • What were the gaps identified in the evidence on perinatal mental health in migrants?
  • How can health professionals minimise the negative impact of perinatal mental disorders in migrants and their families?
  • How may the results of this study influence your daily practice?

Suggested reading

  • Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 1: Systematic reviews and meta-analyses. http://www.sign.ac.uk/methodology/checklists.html (Last access 20 July 2016)
  • The Cochrane Collaboration. Part 2 Section 9.5: Heterogeneity. Cochrane Handbook for Systematic Reviews of Interventions. 2011. Version 5.1.0. Available from http://handbook.cochrane.org/.

 

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Doctor, why are you testing me for syphilis? I thought it was eradicated.

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We will discuss “Syphilis screening in pregnancy in the United Kingdom, 2010-2011: a national surveillance study.” by Townsend and co-workers from 31 August 2016 for 7 days.

*This paper will be made free-to-view  approximately 10 days before the start of #BlueJC. The published Journal Club guide can be found via this link.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 31 August 2016 (the discussion will open for 7 days between 31 August to 7 September 2016)

First hosted discussion session(s) on Twitter starts at: GMT+1 (British Summer Time) 8pm (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (click on the “supporting information” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A healthy nulliparous woman attended her first antenatal visit. She was surprised when she was offered screening tests for sexually transmitted diseases, including syphilis. She asked, “Doctor, why are you testing me for so many sexually transmitted diseases? I thought nobody gets syphilis nowadays!” How would you address her concerns?

Description of research

Participants All pregnant women screened positive for syphilis between 2010 and 2011
Intervention Antenatal screening test for syphilis
Comparison Not applicable
Outcomes Proportion of screen-positive women with newly or previously confirmed diagnosis of syphilis

Proportion of women with newly or previously diagnosed syphilis requiring treatment in pregnancy

Study design Population-based cohort study
Authors’ conclusion One in four pregnant women screen-positive for syphilis in the UK had newly diagnosed syphilis (40% of them needed treatment).

Discussion Points

  • What is the epidemiology of syphilis in pregnancy in the UK? How does it compare to the rest of the world (See suggested reading)?
  • Using antenatal syphilis screening as an example, what are the differences between a screening test and a diagnostic test?
  • What was the proportion of women with false positive syphilis screening results?
  • What are the known factors associated with false positive syphilis screening?
  • What were the characteristics of women who were screened positive for syphilis and required treatment?
  • When were antibiotics initiated in women who required treatment for syphilis in pregnancy?
  • What advice would you give to the woman in the scenario?
  • How may the results of this study enhance your daily practice?

Suggested reading

  • Kingston M, et al; Members of the Syphilis guidelines revision group 2015. UK national guidelines on the management of syphilis 2015. Int J STD AIDS. 2016 May;27(6):421-46.Checklist 3.
  • Scottish Intercollegiate Guidelines Network (SIGN) Checklist for cohort studies. http://bit.ly/1rzfjfD.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Can we reassure women with post-menopausal bleeding by negative blind endometrial sampling?

We will discuss “Diagnostic workup for postmenopausal bleeding: a randomised controlled trial.” by van Hanegem and co-workers from 27 July 2016 for 7 days.

*This paper will be made free-to-view  approximately 10 days before the start of #BlueJC. The linked mini-commentary on this paper can be found via this study.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 27 July the discussion will open for 7 days between 27 July to 3 August 2016)

First hosted discussion session(s) on Twitter starts at: GMT+1 (British Summer Time) 8pm (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (click on the “supporting information” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A post-menopausal woman was referred by her primary care physician with post-menopausal bleeding. Her transvaginal ultrasound showed an endometrial thickness of 9mm, but no other abnormality. She has a BMI of 26kg/m2, but no other medical history. You performed an endometrial sampling using Pipelle, which showed no malignancy. During the investigations, she had no further post-menopausal bleeding. Could you reassure this woman?

Description of research

Participants Women with post-menopausal bleeding (PMB), endometrial thickness > 4mm and benign endometrial sampling results
Intervention Operative hysteroscopy after saline infusion sonography (SIS)
Comparison Expectant management
Outcomes Primary outcome: recurrence of PMB within a year after randomisation

Secondary outcomes: time to recurrent bleeding and recurrent bleeding after > 1 year

Study design Multicentre randomised controlled trial (Dutch trial register number NTR2130)
Authors’ conclusion Operative hysteroscopy did not reduce recurrent PMB, but 6% of women with benign Pipelle biopsies were found to have high-risk endometrial pathologies.

Discussion Points

  • What advice would you give to the woman in the scenario?
  • Is outpatient operative hysteroscopy acceptable to post-menopausal women in your practice?
  • Can you describe the differences between a diagnostic randomised controlled trial and diagnostic accuracy study?
  • What are the strengths and weaknesses of this RCT?
  • Could you suggest an alternative primary outcome to answer the clinical question?
  • How would this alternative primary outcome impact on the design and conduct of this trial?
  • Base on the results of this RCT, does SIS enhance the current diagnostic work-up?
  • How does this RCT enhance your practice, in view of the existing evidence (see suggested reading)?

Suggested reading

  • Critical Appraisal Skill Programme (CASP). CASP checklist for Randomised Controlled Trials (http://www.casp-uk.net/).
  • Rodger M, Ramsay T, Fergusson D. Diagnostic randomised controlled trials: the final frontier. Trials. 2012 Aug 16;13:137. doi: 10.1186/1745-6215-13-137. PubMed PMID: 22897974
  • Cooper NAM, Barton PM, Breijer M, Caffrey O, Opmeer BC, Timmermans A, et al. Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis. Health Technol Assess 2014;18(24).

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Can we justify the under-representation of pregnant women in clinical trials?

We will discuss “The pregnant women as a drug orphan: a global survey of registered clinical trials of pharmacological interventions in pregnancy.” by Scaffidi and co-workers from 29 June 2016 for 7 days.

*This paper is now free-to-view!

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 29 June (the discussion will open for 7 days between 29 June to 6 July 2016)

First hosted discussion session(s) on Twitter starts at: GMT+1 (British Summer Time) 8pm (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (click on the “supporting information” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A young woman attends a multidisciplinary clinic for prenatal counseling. She has been on sodium valproate for her epilepsy since she was a teenager. She has no other medical concerns. She asks, “is my medication going to harm my baby?”  How would you counsel this woman?

Description of research

Participants Pregnant women
Intervention Participation in drug trials during pregnancy
Comparison Not applicable
Outcomes The numbers, location, funding sources, and areas of interest/development of pregnancy drug trials (PDTs)
Study design Comprehensive analysis of sixteen WHO-certified clinical trial registries
Authors’ conclusion Pregnant women are significantly under-represented in global clinical drug trials

Discussion Points

  • How do health professionals determine whether a drug is safe to use during pregnancy?
  • What are the barriers to the inclusion of women in pharmacological interventional trials during pregnancy?
  • What are the potential benefits of including women in pharmacological interventional trials during pregnancy?
  • In figure 1, which medical conditions had the highest number of pregnancy-related drug trials?
  • Which factors may have contributed to the emphases on the above conditions?
  • Which factors may have contributed to the geographic distribution of pregnancy-related drug trials (see the results section)?
  • Suggest one pregnancy-related drug trial that would be the most relevant, acceptable and safe.
  • What could be done to improve the current under-representation of pregnant women in clinical trials?

Suggested reading

  • Quinn SC, Butler J 3rd, Fryer CS, Garza MA, Kim KH, Ryan C, Thomas SB. Attributes of researchers and their strategies to recruit minority populations: results of a national survey. Contemp Clin Trials. 2012 Nov;33(6):1231-7.
  • Legro RS. Barriers to conducting clinical research in reproductive medicine: United States of America. Fertil Steril. 2011 Oct;96(4):817-9.
  • Milliez J. Just inclusion of women of reproductive age in research: FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Int J Gynaecol Obstet. 2009 Nov;107(2):168.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Is paternal depression a significant risk factor of preterm birth?

We will discuss “Prenatal parental depression and preterm birth: a national cohort study” by Liu and co-workers from 25 May 2016 for 7 days.

*This paper is now online and FREE-TO-VIEW

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 25 May (the discussion will open for 7 days between 25 May to 1 June 2016)

First hosted discussion session(s) starts at: GMT+1 (British Summer Time) 8pm 

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

Mental health awareness in pregnancy was emphasised during an obstetrics continual professional development event. The speaker summarised adverse perinatal outcomes that has been linked with maternal depression. A midwife asked, “Does depression in dads have similar impact on these outcomes?”

Description of research

Participants Singleton births recorded in the Medical Birth Register of Sweden between 2007–2012
Intervention Parents with depression
Comparison Parents without depression
Outcomes Odds ratios (ORs) for very preterm and moderately preterm births
Study design A population-based cohort study
Authors’ conclusion New paternal and maternal prenatal depression are potential risk factors for preterm birth

Discussion Points

  • How common is paternal depression in the perinatal period? (See suggested reading)
  • What are the risk factors of parental depression identified in this study?
  • How was parental depression defined in this study? What are the pros and cons of using this definition?
  • What is Huber-White sandwich estimates of variance? Was its use appropriate?
  • What were the relationships between paternal depression, spontaneous preterm births and medically-indicated preterm births?
  • How was cohabitation of parents related to preterm birth rates?
  • What are the possible mechanisms behind the above associations?
  • How do the demographics of the study participants compare to parents you encounter in your usual practice? (See Table 1–2)
  • How may the results of this study influence your daily practice?

Suggested reading

  • Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010 May 19;303(19):1961-9.
  • Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 3: Cohort study. http://www.sign.ac.uk/methodology/checklists.html (Last access 15 February 2016)

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

How to compare quality and safety of surgery for cancer?

We will discuss “Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study” by Burnell and co-workers from 27 April 2016 for 7 days.

*This paper is now online and FREE-TO-VIEW

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 27 April (the discussion will open for 7 days between 27 April to 4 May 2016)

First hosted discussion session(s) starts at: GMT+1 (British Summer Time) 8pm 

Host: @BlueJCHost

Platforms: Twitter, FacebookLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A specialist gynaecological oncology centre reviewed complication rates of their patients who had undergone surgery in the last decade; they observed a gradual improvement over time. A trainee doctor asked, ‘how do specialist gynaecological oncology centres compare on these key quality and safety indicators?

Description of research

Participants Ten UK gynaecological oncology centres.
Intervention Prospective collection of surgery and morbidity data (both intraoperative and postoperative) on consented patients.
Comparison Crude and risk-adjusted intraoperative and postoperative complication rates between centres.
Outcomes Benchmarking using colour-coded funnel plots and observed-to-expected ratios.
Study design Risk-prediction modelling using penalised (lasso) logistic regression.
Authors’ conclusion Risk adjustment had a modest effect on the complication rates of the centres but helped to better delineate the outliers.

Discussion Points

  • How does your hospital collate and disseminate data on safety and quality indicators of surgery performed?
  • Which additional indicators could be collated routinely to help determine quality and safety of surgery (see suggested reading)?
  • What is benchmarking in healthcare? Why is it important?
  • What is the lasso method for penalised logistic regression?
  • Only half (1462/2948) of the procedures had follow-up data. How does this impact on the results in this study?
  • Refer to the funnel plots, how were the ‘warning bands’ determined? Are there alternative ways to identify outliers?
  • How can we improve quality and safety of surgery once outliers are identified?
  • How would the results of this study influence your daily practice?

Suggested reading

  • Iyer R, Gentry-Maharaj A, Nordin A, Burnell M, Liston R, Manchanda R, et al. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications). Br J Cancer2015;112:475–84.
  • Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, et al. ICBP Module 1 Working Group. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007: an analysis of population-based cancer registry data. Lancet2011;377(9760):127–38.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Why is it important to identify intimate partner violence during pregnancy?

We will discuss “Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis” by Donovan and co-workers from 30 March 2016 for 7 days.

*This paper is now online and will be FREE-TO-VIEW

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 30 March 2016 (the discussion will open for 7 days between 30 March to 6 April 2016)

First hosted discussion session(s) starts at: GMT+1 (British Summer Time) 8pm 

Host: @BlueJCHost

Platforms: Twitter, FacebookLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A nulliparous woman visits her midwife at 13+0 weeks with her partner. She is a healthy non-smoker. Her dating ultrasound scan was normal. She works as a shop assistant and lives with her partner. This is an unplanned but wanted pregnancy. She reports no concern. You notice small circular burn marks on her forearm, which the woman described as accidental burn by an iron. How would you counsel this woman?

Description of research

Participants Pregnant women
Intervention Women who experienced intimate partner violence (IPV) during pregnancy
Comparison Women who did not experience IPV during pregnancy
Outcomes
  • Preterm birth (PTB): infants born before 37 weeks gestation
  • Low birth weight (LBW): infants born <2500g
  • Small-for-gestational age (SGA): birth weight <10th percentile for a given gestational age
Study design Systematic review and meta-analysis of observational studies
Authors’ conclusion The risks of PTB and LBW were significantly increased in women who experienced IPV.

Discussion Points

  • In your practice, how prevalent is IPV during pregnancy?
  • Which additional factors would you consider when you counsel the woman in the scenario?
  • How was IPV identified in the included studies of this meta-analysis?
  • How was quality of the included studies assessed? (See Table 1 and S1)
  • What are the different factors leading to heterogeneity in a systematic review?
  • How did the authors assess heterogeneity in this systematic review?
  • How did the authors subsequently address the identified heterogeneity of the included studies?
  • Which interventions aimed at preventing IPV have been tested? Are they effective? (See suggested reading)
  • How would the results of this study influence your daily practice?

Suggested reading

  • The Centre for Evidence-based Medicine. Critical appraisal worksheet on systematic review. Available from: http://www.cebm.net/critical-appraisal/.
  • National Institute for Health and Care Excellence. Guideline PH50. Domestic violence and abuse: multi-agency working. February 2014. Available from: https://www.nice.org.uk/guidance/ph50.
  • The Cochrane Collaboration. Part 2 Section 9.5: Heterogeneity. Cochrane Handbook for Systematic Reviews of Interventions. 2011. Version 5.1.0. Available from http://handbook.cochrane.org/.
  • Van Parys A-S, Verhamme A, Temmerman M, Verstraelen H. Intimate Partner Violence and Pregnancy: A Systematic Review of Interventions. Vermund SH, ed. PLoS ONE. 2014;9(1):e85084.

 

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.