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 to improve obstetrics outcomes in overweight and obese pregnant women?

We will discuss “Self-weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial” by McCarthy and co-workers from 24 February 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: 24 February 2016 (the discussion will open for 7 days between 27 January to 3 February 2016)

First hosted discussion session(s) starts at: GMT 8pm (UK time) *** NOTE: new start time for #BlueJC in 2016

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 obstetrician at 13+0 weeks. Her body mass index (BMI) is 35 kg/m2, but she has no other medical history. Her dating ultrasound scan was normal. Her obstetrician explained the risks of obesity on her pregnancy. She asks, “what can I do to minimise these risks?”.

Description of research

Participants Overweight or obese pregnant women at <20 weeks with a singleton pregnancy, without pre-existing diabetes
Intervention Simple dietary advice, written personalised weight gain targets, encouragement of regular self-weighing and discussions of weight gain with the obstetric care provider
Comparison Written personalised weight gain targets only
Outcomes Composite primary outcome including any of: gestational diabetes; pregnancy-induced hypertension and pre-eclampsia; mode of birth other than spontaneous vertex; post-partum haemorrhage; 3rd or 4th degree perineal tear; admission to adult intensive care/ high-dependence units, maternal death
Study design Randomised controlled trial (Trial registration number: NCT01001689)
Authors’ conclusion Randomised controlled trial (RCT; Trial registration number: ACTRN12611000881932)


Discussion Points

  • What are the risks of obesity in pregnancy for mothers and babies?
  • How would you manage the woman in the scenario, compared to women with normal weight?
  • What are the strengths and weaknesses of this RCT?
  • How do the demographics of the study participants compare to women in your practice (see Table 1)?
  • Analysis of covariance (ANCOVA) was used to analyse the difference in gestational weight gain. What is ANCOVA and was its use appropriate?
  • Are the outcomes of women who were overweight different from those who were obese (see supplementary figure S2 and S4)?
  • How did the authors assess the impact of missing data (18%) in this study (see supplementary figure S3)?
  • 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/).
  • Thangaratinam S, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012 May 16;344:e2088.
  • Brownfoot FC, Davey MA, Kornman L. Routine weighing to reduce excessive antenatal weight gain: A randomised controlled trial. BJOG. 2016.
  • Sagedal LR, Øverby NC, Bere E, Torstveit MK, Lohne-Seiler H, Småstuen M, Hillesund ER, Henriksen T, Vistad I. Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial. BJOG. 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 avoid excessive weight gain during pregnancy?

We will discuss “Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial” by Sagedal and co-workers from 27 January 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: 27 January 2016 (the discussion will open for 7 days between 27 January to 3 February 2016)

First hosted discussion session(s) starts at: GMT 8pm (UK time) *** NOTE: new start time for #BlueJC in 2016

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 manuscript)

Scenario

A nulliparous woman visits with her midwife at 13 week of her pregnancy. Her body mass index is 23 kg/m2 and she is healthy. Her dating ultrasound scan was normal. She is concerned about weight gain during pregnancy because her sister became overweight during pregnancy and struggled to lose weight after birth. She asks, “what can I do to avoid gaining too much weight during my pregnancy?”.

Description of research

Participants Healthy, non-diabetic, nulliparous women, ≥18 years, body mass index ≥19 kg/m2, with a singleton pregnancy of ≤20 gestational-weeks.
Intervention Dietary counselling twice by telephone and access to twice-weekly exercise groups
Comparison Standard prenatal care
Outcomes Primary outcomes: maternal gestational weight gain (GWG), weight of the newborn, maternal fasting serum glucose level, incidence of operative delivery, maternal body composition

Secondary outcomes: proportion of newborns with weight ≥90th percentile, the proportion of women with elevated 2-hour glucose tolerance tests, measurement of hormones related to glucose metabolism, the incidence of delivery complications and postpartum weight retention

Study design Randomised controlled trial (Trial registration number: NCT01001689)
Authors’ conclusion Despite a modest but significant decrease in GWG, lifestyle intervention had no measurable effect on obstetrical or neonatal outcomes.


Discussion Points

  • Which additional factors you may consider when you counsel this woman?
  • Which interventions have been used to maintain maternal weight during pregnancy? Are they effective? (See suggested reading)
  • Critically appraise this randomised controlled trial (RCT) using the Critical Appraisal Skill Programme (CASP; http://www.casp-uk.net/) checklist.
  • Based on your assessment, what are the strengths and weaknesses of this RCT?
  • Which parameter was used in the power calculation of this RCT? How does it impact on the design of this study?
  • How do the demographics of the study participants compare to women you encounter in your usual practice?
  • In this study how do the measured outcomes differ between women who had normal BMI (<25 kg/m2), women who were overweight (20-25 kg/m2) and obese (>25 kg/m2)
  • How would you advice the woman in the scenario?

Suggested reading

  • Sagedal LR, Øverby NC, Lohne-Seiler H, Bere E, Torstveit MK, Henriksen T, Vistad I. Study protocol: fit for delivery – can a lifestyle intervention in pregnancy result in measurable health benefits for mothers and newborns? A randomized controlled trial. BMC Public Health. 2013 Feb 13;13:132.
  • Thangaratinam S, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012 May 16;344:e2088.

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 vaginal progesterone prevent preterm labour?

We will discuss “Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double-blind placebo-controlled trial” by the 4P trial group from 29 April 2015 for 7 days.

*This paper has been made FREE-TO-VIEW. We are also on LinkedIn: http://linkd.in/1BVrpad (simply ask to join)!

 

Linked article: This article is commented on by ER Norwitz, “Clarifying when to recommend progesterone to prevent preterm birth: clear as mud“. To view this mini commentary visit http://dx.doi.org/10.1111/1471-0528.13108.

 

Start date: 29 April 2015 (the discussion will open for 7 days)

First hosted discussion session(s) starts at: BST 7pm (UK time)

Host: @BlueJCHost

Platforms: Twitter and LinkedIn

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. You can access the slide set of this paper here (data S1).

The discussion points are attached below (quoted from the published manuscript)

Scenario

A woman, 32 weeks pregnant, attends antenatal assessment unit with regular and painful uterine contractions. She describes two contractions every 10 minutes. She had one previous preterm delivery at 33 weeks of gestation and this is her second pregnancy. Transvaginal ultrasound on admission shows her cervical length to be 20 mm. Antenatal corticosteroids and tocolysis with atosiban have just been initiated. She asks, “Is there anything else you can do to stop the baby coming early again?”

Description of research

Participants Women presenting with preterm labour (24+0 to 33+6 weeks) to 29 centres in Switzerland and Argentina, started on tocolysis for less than 48 hours
Intervention 200 mg of vaginal progesterone daily (self-administered)
Comparison Placebo
Outcomes

Primary outcome: delivery before 37 weeks of gestation

Secondary outcomes: delivery before 32 and 34 weeks, side-effects, duration of tocolysis, re-admissions for signs and symptoms of preterm labour, length of hospital stay, and neonatal morbidity and mortality

Study design A multicentre, randomised, double-blind, placebo-controlled trial

Discussion Points

  • What are the clinical indications for vaginal progesterone? Are they based on robust evidence?
  • What are the advantages and disadvantages of prospective registration of clinical trials (http://www.alltrials.net/)?
  • What are the potential reasons for a steering committee to recommend stopping study enrolment early?
  • Should a trial be allowed to stop because it is suspected that evidence of harm may become apparent?
  • How did the early closure of this clinical trial influence its results?
  • Critically appraise this trial using the Critical Appraisal Skill Programme (CASP) checklist for randomised controlled trials (available from http://www.casp-uk.net/).
  • Can you summarise the available evidence in a single sentence?
  • How would the results of this study influence your practice?

Suggested reading

  • Khan KS, Hills R. Can we trust the results of trials that are stopped early? BJOG. 2006;113:766-8.
  • DAMOCLES Study Group, NHS Health Technology Assessment Programme. A proposed charter for clinical trial data monitoring committees: helping them to do their job well. Lancet. 2005;365:711-22.

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 progestogens improve twin pregnancy outcomes?

We will discuss “Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis” by a Global Obstetrics Network (GONet) collaboration from 25 March 2015 for 7 days.

*This paper has been made FREE-TO-VIEW. We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Linked article: This article is commented on by A Gimovsky and V Berghella,There is still insufficient data to recommend screening twin pregnancies with transvaginal ultrasound cervical length, but this might change soon!

Start date: 25 March 2015 (the discussion will open for 7 days)

First hosted discussion session(s) starts at: GMT 7pm (UK time)

Host: @BlueJCHost

Platforms: Twitter and LinkedIn

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. You can access the slide set of this paper here (data S1).

The discussion points are attached below (quoted from the published manuscript)

Scenario

A woman attends your antenatal clinic at 14 weeks of gestation with dichorionic twins after in vitro fertilization. This is her forth pregnancy and she had two early miscarriages and one late miscarriage at 22 weeks. She asks: ‘doctor, is there anything I could do to prevent me losing my babies again?’

Description of research

Participants Women with twin pregnancies
Intervention 17Pc or vaginal natural progesterone
Comparison Placebo or no treatment
Outcomes

Primary composite outcomes

For vaginal progesterone: perinatal death, respiratory distress syndrome, intraventricular haemorrhage, or necrotising enterocolitis.

For 17Pc: all outcomes for vaginal progesterone, plus bronchopulmonary dysplasia and culture-proven sepsis.

Study design Individual participant data meta-analysis (IPDMA)

Discussion Points

  • How would you currently manage the woman in the above scenario?
  • What are the differences between IPDMA and aggregated data meta-analysis (ADMA)?
  • What are the advantages and disadvantages of IPDMA and ADMA, respectively? (Chapter 19, Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0, http://www.cochrane-handbook.org).
  • How did the authors manage the different baseline characteristics and interventions of the included trials?
  • Are there any alternative methods to manage these differences?
  • Critically appraise the study using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist (www.prisma-statement.org).
  • Can you briefly summarise the results of this study? How would the results of this study influence your practice?

Suggested reading

  • Chapter 19, Cochrane Handbook for Systematic Reviews of Interventions verson 5.1.0, http://www.cochrane-handbook.org/
  • Riley RD, Lambert PC, Abo-Zaid G. Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ. 2010 Feb 5;340:c221.

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 global women’s health research after 2015?

We will discuss “Global women’s health: Current clinical trials in low and middle-income countries” by Merriel and co-workers from 25 February 2015 for 7 days.

*This paper will be made free-to-view on 11 February 2015.

Related conference: you may also be interested in attending Global Women’s Research Society (GLOW) Conference 2015, Reaching Every Woman and Every Newborn: The Post-2015 Research Agenda, on 4 March 2015. More details here or follow @GLOWconfUK.

Linked article: This article is commented on by AM Gülmezoglu, and J Bell and F Donnay, p. 199 and p. 200 in this issue. To view these mini commentaries visit http://dx.doi.org/10.1111/1471-0528.13181 and http://dx.doi.org/10.1111/1471-0528.13182.

Start date: 25 February 2015 (the discussion will open for 7 days)

First hosted discussion session(s) starts at: BST 7pm (UK time)

Host: @BlueJCHost

Platforms: 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. You can access the slide set of this paper here (data S1).

The discussion points are attached below (quoted from the published manuscript)

Scenario

During an international women’s health conference, a keynote speaker gave an overview of current clinical trials in low- and middle-income countries (LMICs). At the end of the plenary, she asked ‘how can we improve research in global women’s health after the era of Millennium Development Goals (MDGs)?’

Description of research

Participants All active randomised trials in LMICs registered on the WHO International Clinical Trials Registry Platform (ICTRP) between 1 April 2012 and 31 March 2014.
Intervention Trials of women’s health interventions or with a significant outcome for women.
Comparison Not applicable.
Outcomes Number of trials, their geographical spread, study size, speciality areas and sources of funding, and whether the trials were registered pre-enrolment.
Study design Review of the WHO ICTRP database.

Discussion Points

  • What are Sustainable Development Goals (SDGs)?
  • What are the differences between MDGs and SDGs? Which SDG is particularly relevant to women’s health?
  • Summarise the geographical spread and study size of the reported studies. How do they influence the implementation of research findings?
  • What are the potential benefits and pitfalls of the observed differences between women’s health research in low-income countries (LICs) and middle-income countries (MICs)?
  • The authors recognise that a some of trials were missed by the WHO ICTRP. How could we tackle this problem?
  • Only half of the trials were registered before enrolment. Why is pre-enrolment registration important?
  • How can we improve women’s health research in LMICs after 2015 based on the results of this study?

Suggested reading

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.

Next #BlueJC starts on 6 December 2013 at #SpROGs13

Added on 6 January 2014

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We 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.

The next #BlueJC will also have a live demonstration session at SpROGs 2013 Conference in Nottingham, the United Kingdom.

All BJOG #BlueJC papers also have a complementary slide set suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (data S1).

We will discuss “A comparison of intramuscular diamorphine and intramuscular pethidine for labour analgesia: a two-centre randomised blinded controlled trial” by Wee and co-workers.

The paper has been made free-to-view for three weeks in December 2013. Trial Registration numbers of this paper: EudraCT No: 2006-003250-18; ISRCTN14898678

Start date and time: 6 December 2013 at GMT 1245pm (for 7 days)

Platforms: Twitter

Hosts: @JamesMNDuffy and @EichelbergerK

The discussion points are attached below (quoted from the published manuscript):

#BlueJC discussion guide

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.