What advice do you give about the risk of fetal abnormality and IVF conception?

We will be discussing: Maternal factors and the risk of birth defects after IVF and ICSI: a whole of population cohort study by Davies and colleagues.

Wednesday 31st May 2017, 8pm BST

The hosted discussion will take place on Twitter, with the discussion continuing for up to 7 days. Remember to use #BlueJC in all your Tweets!
Host: @bluejchost

Scenario

A 41-year-old nulliparous woman presents to your clinic wishing to get pregnant. What advice do you give her about her risk of fetal abnormality and IVF conception?

Description of research

Participants: 304 670 birth episodes in South Australia for the period January 1986 to December 2002.
Intervention: Assisted conception with IVF or ICSI.
Comparison: Natural conception.
Outcomes: Odds ratios of major birth defects.
Study design: Retrospective cohort study.

Discussion points

  • How does this study define birth defects? How would you explain this to a patient?
  • This study used linked data. What routine data sets did it link between? Do these data sets exist in your healthcare system?
  • Why is linked data of use? Can you think of other areas where this sort of linkage would be helpful?
  • Does this study attain the standards for reporting studies using linked routine data (the RECORD statement)?
  • Do you agree with the authors’ conclusion that this study refutes the assumption that the known risk between assisted conception and birth defects is linked to age, or is more investigation needed?
  • Can you briefly summarise the results of this study? How would the results of this study influence your counselling of the woman in the scenario?

Suggested reading

Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med 2015;12:e1001885. https://doi.org/10.1371/journal.pmed.1001885

How would you help a colleague dealing with the stress of an adverse outcome?

We will discuss ‘Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross-sectional retrospective survey by Wahlberg and coauthors on the 26th April 2017. This paper is free to view from 17th April.

Start date: 26 April 2017. The discussion will continue for 7 days until 2nd May 2017.

First hosted discussion session(s) on Twitter starts at BST 8pm (3pm EST/12 noon PST) on 26 April 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Follow us: Twitter

The 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 below:

Scenario

A colleague working in another part country calls to tell you that she delivered a patient whose full term baby died in the NICU a few days after delivery. During the course of the hospital safety committee’s review of the case, it was determined that a delay in delivery likely contributed to complications leading to the neonate’s death.  Your colleague asks for advice and help “sorting it all out”.

How will you help?

Description of Research:

Participants 1,459 midwives and 706 obstetricians from Sweden. Mostly women.
Exposure A serious and potentially traumatic event on the delivery unit, such as (1) a child died or had severe asphyxia, (2) maternal near-miss or death during delivery, or (3) other difficult event such as violence or threat.
Outcomes Provider experience of probably post-traumatic stress disorder (PTSD) or partial PTSD.
Study design Cross-sectional survey.
Authors’ conclusion A substantial proportion of obstetricians and midwives experiences PTSD-like symptoms after serous traumatic events related to delivery.

Discussion Points:

  • Describe a time when you have been the “second victim” of an adverse event. How did it affect you? Did it have an effect on your other patients?
  • Did the authors have an adequate response rate to their survey? What means could they have used to improve response rates?
  • The authors cite probable selection bias and recall bias as limitations of the study. How would you design a study addressing the same objective, but with less potential for these biases?
  • In what ways might non-responders have biased this study?
  • What were the main differences between obstetrician responders and midwife responders in this study?
  • Obstetricians reported negative experiences with debriefings (or reassembly) in this study. In your experience, what are the ways debriefings can be helpful or harmful?
  • How would you use the results of this study in your own practice?

Suggested reading

  1. Scott et al. The natural history of recovery for healthcare provider “second victim” after adverse patient events. Qual Saf Health Care Care 2009;18:325-330.
  2. Schroder et al. Guilt without fault: a qualitative study into the ethics of forgiveness after traumatic childbirth. Social Science & Medicine 2017;176:14-20.
  3. Grimes and Schulz. Descriptive studies: what they can and cannot do. Lancet 2002;359:145-49.

Is induction of labour at term a cost-effective option for nulliparous women over 35?

We will discuss Labour induction near term for women aged 35 or over: an economic evaluation by Walker and coauthors on the 29th March 2017This paper is free to view from 20th March.

Start date: 29 March 2017. The discussion will continue for 7 days until 5th April 2017.

First hosted discussion session(s) on Twitter starts at BST 8pm (3pm EST/12 noon PST) on 29 March 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Follow us: Twitter

The 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 below:

Scenario

Recent evidence has suggested that there may be some benefit in inducing nulliparous women at 39 weeks if they are 35 years of age or older.  Do you think your health system should change to a policy of offering this routinely?

Description of Research:

Participants 380 nulliparous women aged 35 years or older with an ongoing singleton pregnancy at 39 weeks, with the fetus in cephalic position.

Women were excluded if they had any contraindication to labour, vaginal delivery or expectant management; if they had known fetal abnormality; if they had not had an ultrasound before 22 weeks (no anomaly scan); or if they had undergone IVF with the use of donor eggs.

Intervention Induction between 39+0 and 39+6 weeks of gestation.
Comparison Expectant management of pregnancy.
Outcomes Resource utilization was captured through routine health service data collection, verified by reseach staff, and patient questionnaires at one month postnatal.
Study design Cost-utility analysis: secondary economic analysis of subset of paricipants in a randomised controlled trial.

Discussion Points:

  • How do you currently manage a woman aged 35 or over in her first pregnancy?
  • Why measure economic outcomes? What is the difference between economic outcomes and a cost-utility analysis?
  • Healthcare spending is not normally distributed, as a small number of people will have very high costs. What steps did the researchers take to mitigate this? Are these adequate?
  • What is a Quality Adjusted Life Year (QALY)?
  • A prospective economic evaluation of the intervention (induction for primparous mothers over 35 at 39 weeks) was embedded into the trial design. How did the authors do this?
  • This study was conducted from the perspective of the NHS in England, which is a universal coverage system that is free at the point of need. How might this translate to another healthcare system (your own, if not in the UK?
  • Can you briefly summarise the results of this study? How would the results of this study influence your practice?

Suggested reading

National Institute of Care Excellence. Guide to Methods of Technology Appraisal, 2013.

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

 

Induction of labour: should we prefer balloons to prostaglandins?

We will discuss Double-balloon catheter versus prostaglandin E2 for cervical ripening and labour induction by Du and co-authors on the 25th January for 7 days.

This paper is open access: http://bit.ly/2j9ZmNY

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

Start date: 25 January 2017 (the discussion will continue for 7 days between 25th January and 1st February 2017.

First hosted discussion session(s) on Twitter starts at GMT 8pm (3pm EST/12 noon PST) on 25 January 2017 (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:

 

 

Scenario

A 26 year old woman in her first pregnancy requires induction of labour at term for reduced fetal movements.   She has a normal CTG, normal scan with normal umbilical artery Doppler studies, and no other risk factors.

What method of induction of labour would you recommend? 

Description of Research:

Participants Women with singleton pregnancies with live fetuses in vertex presentation, intact membranes, and unfavourable cervices, requiring induction of labour.
Intervention Transcervical double balloon catheter
Comparison Locally applied prostaglandin E2 analogues
Outcomes Primary:  (1) proportion of women achieving vaginal delivery within 24 hours, (2) proportion of women delivering by Caesarean

Secondary: (1) Uterine hyperstimulation; (2) Neonatal unit admission; (3) Maternal adverse events (PPH, uterine rupture).

Study design Metanalysis of randomised controlled trials

 

 

Discussion Points:

  • How do you currently counsel women similar to the one in the scenario?
  • Have you used double-balloon catheters? Do you find that they are well tolerated?
  • How did the authors assess the quality of individual studies?
  • What were the problems identified by their quality assessment of individual studies?
  • Critically appraise this meta-analysis using the PRISMA checklist (http://prisma-statement.org/PRISMAStatement/Checklist.aspx)
  • Can you briefly summarise the results of this study as a one-sentence take-home message?
  • Would the results of this study influence your management of the woman in the scenario?
  • How would 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)

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).

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