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

 

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.