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.

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.

Who should get HPV vaccines in low-resource settings?

We will discuss “The value of male HPV vaccination in preventing cervical cancer and genital warts in a low resource setting” by Sharma and co-workers from 25 November 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 16 November 2015.

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

Start date: 25 November 2015 (the discussion will open for 7 days between 25 November to 2 December 2015)

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

Host: @BlueJCHost

Platforms: TwitterLinkedIn 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

At a conference on cervical cancer prevention, a speaker presented data on the cost-effectiveness of HPV vaccination for girls in Thailand (BJOG. 2012;119(2):166-76). An audience asked, “Would vaccinating both boys and girls be better than vaccinating girls only?”.

Description of research

Participants Male and female population (≥ 9 years old) in South Vietnam
Intervention HPV vaccination for both male and female
Comparison HPV vaccination for female only
Outcomes Economical costs, estimates of cervical cancer and genital warts incidence, mortality and quality-adjusted life years (QALYS)
Study design Economic evaluation using mathematical models


Discussion Points

  • What are the incidence of cervical cancer, uptake rate of cervical screening and coverage of HPV vaccine in your country?
  • What is GAVI Alliance? How does it achieve its goals?
  • What are the advantages and disadvantages of using a mathematical model to address this research question? Are there alternatives?
  • What is the purpose of sensitivity analysis in economical evaluations?
  • What is your interpretation of the results presented? Where may the results be generalisable?
  • What are the factors influencing how policy makers utilise findings of economical evaluations?
  • How can researchers maximise the potential of their research being utilised for health policy decision-making?
  • Should we give HPV vaccines to all boys in LMICs?

Suggested reading

  • Critical Appraisal Skills Programme checklist for economical evaluation. http://bit.ly/1EX0KXE
  • Cohen DJ, Reynolds MR. Interpreting the results of cost-effectiveness studies. J Am Coll Cardiol. 2008 Dec 16;52(25):2119-26.
  • Linhares IM, Witkin SS. HPV vaccination: unanswered questions remain. BJOG. 2015 Jan;122(1):118.
  • Gold M. Pathways to the use of health services research in policy. Health Serv Res. 2009 Aug;44(4):1111-36.
  • Haynes AS, Gillespie JA, Derrick GE, Hall WD, Redman S, Chapman S, Sturk H. Galvanizers, guides, champions, and shields: the many ways that policymakers use public health researchers. Milbank Q. 2011 Dec;89(4):564-98.

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.

Are invasive therapies for primary post-partum haemorrhage effective?

We will discuss “Invasive therapies for primary postpartum haemorrhage: a population-based study in France.” by Kayem and co-workers from 28 October 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 19 October 2015.

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

Start date: 28 October (the discussion will open for 7 days between 28 October to 4 November 2015)

First hosted discussion session(s) starts at: GMT 7pm (UK time- please note the clock changes on 24 October)

Host: @BlueJCHost

Platforms: TwitterLinkedIn 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

During a multidisciplinary training day on the management of post-partum haemorrhage (PPH), a number of invasive therapies were described. One of the delegates asked, “how often are these invasive therapies used? Are they effective?”.

Description of research

Participants Women who have participated in the PITHAGORE6 trial (106 maternity units in 6 French regions) and developed primary PPH between December 2004 and November 2006
Intervention Invasive therapies for PPH, including uterine suture, pelvic vessel ligation, arterial embolisation and hysterectomy.
Comparison National databases in the UK and Netherlands
Outcomes Maternal mortality, hysterectomy rate, incidence of conservative invasive therapies and their failure rates
Study design Observational study (retrospective analysis of a large clinical trial cohort)

Discussion Points

  • In your local practice, how often are invasive therapies used to manage PPH? Moreover, what is the most frequently used invasive therapies for PPH?
  • What are the advantages and disadvantages of a retrospective analysis of large clinical trial datasets compared to a prospective population-based surveillance programme?
  • How may a prospective population-based surveillance programme further improve the quality of the data collected in this study?
  • How do maternal mortality and morbidity rates from PPH in France compared to those in the UK and Netherlands (see Table 4)?
  • Which factors may have caused the observed differences in maternal mortality and morbidities?
  • Did the results of the current study support the authors’ conclusions?
  • How would the results of this study influence your daily practice?

Suggested reading

  • Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, Harvey T, Tessier V, Chauleur C, Pennehouat G, Morin X, Bouvier-Colle M, Rudigoz R. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG 2010;117:1278–1287.
  • Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, Gonzalez-Medina D, Barber R, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Sep 13;384(9947):980-1004.
  • Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG. 2014 Mar;121(4):382-8.

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 manage persistent pelvic pain after birth?

At this #BlueJC in May, the Blue Journal Club has teamed up with the International Pelvic Pain Society (IPPS) for a joint Twitter Journal Club. We will discuss “Breastfeeding and pelvic girdle pain: a follow-up study of 10 603 women 18 months after delivery” by Bjelland and co-workers from 27 May 2015 for 7 days.

*This paper has been made FREE-TO-VIEW. 

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

Start date: 27 May 2015 (the discussion will open for 7 days between May 27 – June 3)

First hosted discussion session(s) starts at: PST 7pm (1900)*** please note time zone difference!

Host: @intpelvicpain (Brad Fenton) and @BlueJCHost

Twitter hastags: #BlueJC and #IPPSJC

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 from the 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 with the Journal Club material.

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

Scenario

A woman who is 32 weeks pregnant with her second child comes to see you because she is worried about persistent pelvic girdle pain afterbirthshe had pelvic pain for 20 months after an uncomplicated vaginal delivery of her first child 3 years ago. She is overweight (body mass index = 27 kg/m2), has no other significant medical history and has had no complications during this pregnancy. How do you counsel this woman?

Description of research

Participants

Women who had singleton deliveries in the Norwegian Mother and Child Cohort Study and reported pelvic girdle pain at 0– 3 months postpartum

Intervention

Breastfeeding (coded as bottle-feeding, partial breastfeeding, and full breastfeeding).

Comparison

Four self-administered questionnaires about pelvic pain at second and third trimesters of pregnancy, as well as 6 and 18 months after birth

Outcomes

Persistent pelvic pain at 18 months after birth, defined as having combined anterior and bilateral posterior pelvic pain.

Study design

Population-based cohort study

Discussion Points

  • How do you currently manage women with persistent pelvic pain after birth?

  • What is the Norwegian Mother and Child Cohort Study (www.fhi.no/morogbarn)?

  • Were the analyses of the current study planned prospectively?

  • The majority of women in this study breast-fed for at least 3 months after birth. How does this breastfeeding rate compare

    with that of women in your daily practice?

  • Women who did not breastfeed at all were not more likely to have persistent pelvic girdle pain. How does this affect your interpretation of this study? (See suggested reading)

  • What are the potential study designs that could be used to evaluate further this clinical question?

  • How do the results of this study change your understanding on persistent pelvic pain after birth?

Suggested reading

  • Schunemann H, Hill S, Guyatt G, Akl EA, Ahmed F. The GRADE approach and Bradford Hill’s criteria for causation. J Epidemiol Community Health. 2011;65:392-5.

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.