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.

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.

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.

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.

#BlueJC in 2015- ended on a high at #RCOGNTC

At the RCOG National Trainees’ Conference (#RCOGNTC) in December 2015, #BlueJC team had the opportunity to speak to doctors about engagement using social media. 

Social media- What’s in it for me?

Dr. Ann-Marie Cunningham, Primary Care Clinical Director at Aneurin Bevan University Health Board, has succinctly summarised the potential of social media for doctors using her wonderful infographic and slideshare slides.

someblog 

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.