1
|
Shen Y, Hu C, Li L, Chen Z, Chen W, Lin Z, Zhu P, Tan Q, Huang W, Sun X, Deng L, Xia Q. What should be measured and reported in clinical trials for the treatment of patients with acute pancreatitis? A study protocol for establishing a core outcome set. BMJ Open 2023; 13:e075859. [PMID: 38070929 PMCID: PMC10729096 DOI: 10.1136/bmjopen-2023-075859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Acute pancreatitis (AP) is characterised by inflammation of the exocrine pancreas, which potentially leads to local complications and organ failure resulting in significant morbidity and mortality. A long-term follow-up by an experienced team is needed. Currently, a variety of outcome measures are used in clinical trials for patients with AP. However, due to heterogeneous and selective outcome reporting across trials of interventions, it is hard to combine or compare the trial results compromising systematic evaluations of effectiveness and safety. A core outcome set is demanded to standardise reporting for the management of AP in clinical trials, so as to conduct systematic reviews and to improve the quality of the existing evidence base on the management of AP. We designed a study to establish a core outcome set (COS) on what indicators should be measured and reported in clinical trials of patients with AP (COS-AP). METHODS AND ANALYSIS This study protocol outlines the following five phases: Phase I will be a systematic review of randomised control trials and semistructured interviews with patients to initially establish a preliminary list of potential outcomes. Phase II will be the recruitment of key stakeholders' groups comprising experts in pancreatic disease, clinical researchers, methodologists, journal editors and patients. Phase III will be two rounds of the Delphi surveys with key stakeholder groups. Phase IV will be a consensus on the outcomes that should be included in a final COS-AP. Phase V will be dissemination of COS-AP. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Biomedical Research Ethics Committee (BREC) of West China Hospital of Sichuan University (2020 No.691). The findings will be disseminated in peer-reviewed journals and meetings. TRIAL REGISTRATION This study was registered with Core Outcome Measures in Effectiveness Trials (COMET) database as study 2573.
Collapse
Affiliation(s)
- Yuxin Shen
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chen Hu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ling Li
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyao Chen
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Weiwei Chen
- Department of Gastroenterology, Subei People's Hospital, Yangzhou University, Yangzhou, Jiangsu, China
| | - Ziqi Lin
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ping Zhu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qingyuan Tan
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihui Deng
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qing Xia
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
2
|
The Vaginal Patch Plastron Associated to the Anterior Sacrospinous Ligament Fixation for the Treatment of Advanced Anterior Vaginal Wall Prolapse. J Clin Med 2022; 11:jcm11226684. [PMID: 36431162 PMCID: PMC9699260 DOI: 10.3390/jcm11226684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: this study aims to compare the efficacy and safety of vaginal patch plastron (VPP) associated to anterior sacrospinous ligament fixation (SSLF-A) with SSLF-A associated or not to the anterior colporrhaphy (AC) for cystocele treatment. Methods: single-center retrospective study in women with cystocele ≥ III stage submitted to surgery. The primary outcome was to compare objective and subjective cystocele relapse and reoperation rate at follow-up > 6 months. The secondary outcome was to describe peri- and postoperative complications and risk factors for cystocele objective relapse. Results: 75 women were submitted to SSLF-A and 61 women to VPP. VPP objective and subjective relapse (6.5%, 4/61 and 1.1%, 1/61) were lower than SSLF-A (26.7%, 20/75 and 20%, 15/75; p = 0.002 and p = 0.001, respectively). SSLF-A had a higher reintervention rate, but not significantly (6.6%, 5/75 vs. 0%, 0/61; p = 0.06). Previous hysterectomy was a risk factor (HR 4; 1.3−12.1) while VPP was protective factor (HR 0.2; 0.1−0.9) for cystocele anatomical relapse. Postoperative buttock pain was more prevalent in VPP (57.4%, 35/75 vs. 34.7%, 26/61; p = 0.01). Conclusions: VPP is effective and safe for advanced cystocele treatment, with lower objective and subjective relapse rates in comparison to isolated SSLF-A or associated with the AC.
Collapse
|
3
|
Divakova O, Panayi D, Khan Z, Doumouchtsis SK. A rapid systematic review of postpartum bladder care guidelines and recommendations in the context of the COVID-19 pandemic. J OBSTET GYNAECOL 2022; 42:2634-2642. [PMID: 36222025 DOI: 10.1080/01443615.2022.2126751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
New pathways for the management of postpartum voiding dysfunction and postpartum urinary retention should be considered to shorten hospital stays and promote early discharge during the COVID-19 pandemic. This rapid systematic review aimed to identify relevant national and international guidelines, and summarise available recommendations on postpartum bladder care that are relevant to women's care and management at the time of the pandemic. We searched Medline, Embase and Cochrane from inception till September 2021. Hand-searching of national and international specialist societies' websites was performed. We identified one international technical consultation, one international society's report of recommendations and two national guidelines. Guidelines stated that postnatal women should not be left more than 6 hours without voiding and assessed for postpartum urinary retention. As the cut-off of 150 ml for the diagnosis of significant postvoid residual volume is commonly used with no reported adverse outcomes, it could be beneficial to adopt this instead of 100 ml as further unnecessary interventions can be avoided. Such changes can reduce the number of women staying in the hospital. Clean intermittent self-catheterisation for the management of postpartum urinary retention could be considered as an option during the COVID-19 pandemic aiming to shorten hospital stays and avoid further attendances. Optimised bladder care has become more relevant during the coronavirus pandemic by striving towards self-care, community-based and remote care. We propose consideration of intermittent self-catheterisation in cases of postpartum urinary retention enabling self-care and avoidance of hospital visits.
Collapse
Affiliation(s)
- Olga Divakova
- Epsom and St Helier University Hospital NHS Trust, St Helier Hospital, Department of Obstetrics and Gynecology, Carshalton, UK
| | - Demetri Panayi
- Epsom and St Helier University Hospital NHS Trust, St Helier Hospital, Department of Obstetrics and Gynecology, Carshalton, UK
| | - Zainab Khan
- Epsom and St Helier University Hospital NHS Trust, St Helier Hospital, Department of Obstetrics and Gynecology, Carshalton, UK
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK
- St Helier Hospital, Department of Obstetrics and Gynecology, Carshalton, UK
- Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- St George's University of London, London, UK
- School of Medicine, American University of the Caribbean, Pembroke Pines, Florida, USA
- School of Medicine, Ross University, Miramar, FL, USA
| |
Collapse
|
4
|
Moussa R, Rada MP, Durnea C, Falconi G, Betschart C, Haddad JM, Sedgwick P, Doumouchtsis SK. Outcome reporting in randomized controlled trials (RCTs) on the pharmacological management of idiopathic overactive bladder (OAB) in women; a systematic review for the development of core outcome sets (COS). Int Urogynecol J 2022; 33:1243-1250. [PMID: 35006311 PMCID: PMC9120103 DOI: 10.1007/s00192-021-05040-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Evidence on OAB management remains suboptimal and methodological limitations in randomized control trials (RCTs) affect their comparability. High quality meta-analyses are lacking. This study aimed to compare selection and reporting of outcomes and outcome measures across RCTs as well as evaluate methodological quality and outcome reporting quality as a first stage in the process of developing core outcome sets (COS). METHODS RCTs were searched using Pubmed, EMBASE, Medline, Cochrane, ICTRP and Clinicaltrials.gov from inception to January 2020, in English language, on adult women. Pharmacological management, interventions, sample size, journal type and commercial funding were documented. Methodological and outcome reporting quality were evaluated using JADAD and MOMENT scores. RESULTS Thirty-eight trials (18,316 women) were included. Sixty-nine outcomes were reported, using 62 outcome measures. The most commonly reported outcome domains were efficacy (86.8%), safety (73.7%) and QoL (60.5%). The most commonly reported outcomes in each domain were urgency urinary incontinence episodes (UUI) (52.6%), antimuscarinic side effects (76.3%) and change in validated questionnaire scores (36.8%). A statistically significant correlation was found between JADAD and MOMENT (Spearman's rho = 0.548, p < 0.05) scores. This indicates that higher methodological quality is associated with higher outcome reporting quality. CONCLUSIONS Development of COS and core outcome measure sets will address variations and lead to higher quality evidence. We recommend the most commonly reported outcomes in each domain, as interim COS. For efficacy we recommend: UUI episodes, urgency and nocturia episodes; for safety: antimuscarinic adverse events, other adverse events and discontinuation rates; for QoL: OAB-q, PPBC and IIQ scores.
Collapse
Affiliation(s)
- Reem Moussa
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Maria Patricia Rada
- 2nd Department of Obstetrics-Gynaecology, "luliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Constantin Durnea
- Department of Obstetrics and Gynaecology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Gabriele Falconi
- Complex Operative Unit of Gynecology, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | | | - Jorge Milhem Haddad
- Hospital das Clinicas da Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
| | - Philip Sedgwick
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Stergios K Doumouchtsis
- Institute of Medical and Biomedical Education, St George's University of London, London, UK.
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
- American University of the Caribbean, School of Medicine, Pembroke Pines, Florida, USA.
- Ross University, School of Medicine, Miramar, Florida, USA.
| |
Collapse
|
5
|
Zhang T, Li X, Zhao L, Zhang J, Tian J, Zhang J. Development of a Core Outcome Set in the Clinical Trials of Traditional Chinese Medicine for Stroke: A Study Protocol. Front Med (Lausanne) 2022; 9:753138. [PMID: 35308498 PMCID: PMC8927076 DOI: 10.3389/fmed.2022.753138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Stroke, an acute cerebrovascular disease, is mainly caused by the sudden rupture or occlusion of blood vessels, and is subdivided into ischemic stroke and hemorrhagic stroke. It has become the second leading cause of death worldwide. In Chinese clinical practice, traditional Chinese medicine (TCM)/Integrative Medicine has been widely used for the treatment of stroke. Numerous randomized controlled trials (RCTs) of TCM/Integrative Medicine for stroke have been conducted to improve the efficacy and safety outcomes. However, their conclusions should be treated with caution because of the methodological quality defects in the clinical research. Pervasive inconsistencies are present in the outcomes collected and reported across these studies, which may lead to the pooling of discrepant data and preclude meta-analysis. The issue could be addressed by developing a core outcome set (COS). Aim The aim of this study is to develop a COS in the clinical trials of TCM/Integrative Medicine in the treatment of stroke. Method and Analysis A steering group will be set up to organize and guide the development of the COS. The study contains three phases: (I) development of an initial outcome list covering all relevant outcomes, via two steps: (i) systematic reviews of outcomes for clinical trials of TCM/ Integrative Medicine for stroke; (ii) semi-structured interviews with patients suffering from stroke; (II) conduction of three round of Delphi surveys with different stakeholder groups to prioritize important outcomes; (III) integration of outcomes into a core outcome set by a consensus meeting. Ethics and Dissemination This study has been granted by the Ethics Committee of Tianjin University of Traditional Chinese Medicine (TJUTCM-EC20210003). When the COS is completed, we will publish it in an appropriate journal to promote further widespread use. Registration This study has been registered at the Core Outcome Measures in Effectiveness Trials initiative, COMET database (Registration #1678).
Collapse
Affiliation(s)
- Ting Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xuechao Li
- Clinical Research Center, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Liang Zhao
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Jiaoyan Zhang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Provinch, Lanzhou, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
6
|
Ali HTO, Alqahtani SAS, Alqahtani MSS, Alasiri SA, Mgbel AS. Urinary Complications among Women with Cystoceles: A Systematic Review. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2022. [DOI: 10.51847/yjik2qz5wi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
7
|
Doumouchtsis SK, Nama V, Falconi G, Rada MP, Manonai J, Iancu G, Haddad JM, Betschart C. Developing Core Outcome Sets (COS) and Core Outcome Measures Sets (COMS) in Cosmetic Gynecological Interventions: Protocol for a Development and Usability Study. JMIR Res Protoc 2021; 10:e28032. [PMID: 34779787 PMCID: PMC8663614 DOI: 10.2196/28032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/31/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Studies evaluating cosmetic gynecological interventions have followed variable methodology and reported a diversity of outcomes. Such variations limit the comparability of studies and the value of research-based evidence. The development of core outcome sets (COS) and core outcome measures sets (COMS) would help address these issues, ensuring a minimum of outcomes important to all stakeholders, primarily women requesting or having experienced cosmetic gynecological interventions. Objective This protocol describes the methods used in developing a COS and COMS for cosmetic gynecological interventions. Methods An international steering group within CHORUS, including health care professionals, researchers, and women with experience in cosmetic gynecological interventions from 4 continents, will guide the development of COS and COMS. Potential outcome measures and outcomes will be identified through comprehensive literature reviews. These potential COS and COMS will be entered into an international, multi-perspective web-based Delphi survey where Delphi participants judge which domains will be core. A priori thresholds for consensus will get established before each Delphi round. The Delphi survey results will be evaluated quantitatively and qualitatively in subsequent stakeholder group consensus meetings in the process of establishing “core” outcomes. Results Dissemination and implementation of the resulting COS and COMS within an international context will be promoted and reviewed. Conclusions This protocol presents the steps in developing a COS and COMS for cosmetic gynecological interventions. Embedding the COS and COMS for cosmetic gynecological interventions within future clinical trials, systematic reviews, and practice guidelines could contribute to enhancing the value of research and improving overall patient care. Trial Registration Core Outcome Measures in Effectiveness Trials (COMET) 1592; https://tinyurl.com/n8faysuh International Registered Report Identifier (IRRID) PRR1-10.2196/28032
Collapse
Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynecology, Epsom & St Helier University Hospital NHS Trust, London, United Kingdom.,Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens, Greece.,Institute of Medical and Biomedical Education, St George's University of London, London, United Kingdom.,School of Medicine, American University of the Caribbean, Coral Gables, FL, United States.,School of Medicine, Ross University, Miramar, FL, United States.,CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom
| | - Vivek Nama
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Obstetrics and Gynecology, Croydon University Hospital, London, United Kingdom
| | - Gabriele Falconi
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Surgical Sciences, Complex Operative Unit of Gynecology, Fondazione PTV Policlinico Tor Vergata, University Hospital, Rome, Italy
| | - Maria Patricia Rada
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Obstetrics and Gynecology, Universitatea de Medicina si Farmacie Iuliu Hatieganu din Cluj-Napoca, Cluj-Napoca, Romania
| | - Jittima Manonai
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - George Iancu
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Obstetrics and Gynecology, Universitatea de Medicina si Farmacie Carol Davila din Bucuresti, Bukarest, Romania
| | - Jorge Milhem Haddad
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Urogynecology Division, Department of Obstetrics and Gynecology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cornelia Betschart
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Gynecology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
8
|
Khan K, Rada M, Elfituri A, Betschart C, Falconi G, Haddad JM, Doumouchtsis SK. Outcome reporting in trials on conservative interventions for pelvic organ prolapse: A systematic review for the development of a core outcome set. Eur J Obstet Gynecol Reprod Biol 2021; 268:100-109. [PMID: 34894536 DOI: 10.1016/j.ejogrb.2021.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Significant risk of bias and limitations in outcome selections in trials evaluating conservative treatments for the management of Pelvic Organ Prolapse (POP) have been highlighted and preclude comparability of outcomes, synthesis of primary studies and high quality evidence. OBJECTIVES As systematic review of the reported outcomes is the first step in the process of development of a Core Outcome Set (COS), we aimed to systematically review reporting of outcomes and outcome measures in Randomised Control Trials (RCTs) on conservative treatments for POP and develop an inventory of them for consideration as core outcome and outcome measures sets. We evaluated methodological quality, outcome reporting quality and publication characteristics and their associations among published RCTs. STUDY DESIGN Systematic review of RCTs identified from the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and MEDLINE (Pubmed). RCTs evaluating the effectiveness of conservative interventions for the management of POP were considered for inclusion. Outcomes and outcome measures were obtained from the RCTs and an inventory was created. Outcomes were grouped in domains and themes. Methodological quality, outcome reporting quality and publication characteristics were evaluated and statistically analysed. RESULTS Twenty-five trials (3179 women) were included and reported 31 outcomes and 50 outcome measures. Reporting rates of the outcomes investigated ranged between 4% and 56%. The most commonly reported outcome domains were patient reported symptoms, stage of POP expressed as POP-Q stage, and quality of life. Univariate analysis demonstrated no significant correlations of methodological and outcome reporting parameters. CONCLUSIONS There is a need to increase comparability of RCTs. Reporting standardized outcomes included in a COS for conservative interventions for POP will facilitate the comparability across RCTs. While the process of developing COS is in progress, we propose the interim use of the three most commonly reported outcomes in each domain: patient-reported outcomes (symptom distress including bowel and urinary symptoms, sexual function), stage of prolapse and quality of life parameters using validated questionnaires (Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire/Health related quality of life (PFIQ-7/HRQOL) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7).
Collapse
Affiliation(s)
- Kimmee Khan
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.
| | - Maria Rada
- Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Abdullatif Elfituri
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - Cornelia Betschart
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Gabriele Falconi
- Department of Surgical Sciences, Complex Operative Unit of Gynecology, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Jorge Milhem Haddad
- Department of Obstetrics and Gynaecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK; Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, University of Athens, Medical School, Athens, Greece; St George's University of London, London, UK; American University of the Caribbean, School of Medicine, Pembroke Pines, FL, USA; Ross University, School of Medicine, Miramar, FL, USA.
| | | |
Collapse
|
9
|
Tsiapakidou S, Nygaard CC, Falconi G, Pape J, Betschart C, Doumouchtsis SK. Systematic review and appraisal of clinical practice guidelines on pelvic organ prolapse using the AGREE II tool. Neurourol Urodyn 2021; 40:1402-1413. [PMID: 34350610 DOI: 10.1002/nau.24709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/06/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
AIMS To systematically evaluate the content and quality of national and international clinical guidelines on pelvic organ prolapse (POP). METHODS We searched medical databases and organizations websites, to identify national and international guidelines on diagnosis and management of POP. Five authors independently assessed guidelines using the validated AGREE II tool. Its six domains include (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence. RESULTS Eight guidelines met the inclusion criteria. Three hundred and thirteen different recommendations were identified. One hundred and ninety-nine recommendations were comparable across guidelines. Thirty-one recommendations were not supported by research evidence. Assessment by history and physical examination using the POP quantification system and consideration of imaging were recommendations featuring in all guidelines. Conservative treatment recommendations namely pelvic floor muscle training and vaginal pessaries were also found in all guidelines. Regarding surgical management, patient counseling, treating only symptomatic POP, consideration of apical fixation during surgical treatment, and use of biological or synthetic implants in recurrent cases were recommendations in all guidelines. Overall, the highest median scores were in the domains "scope and purpose" and "rigor of development". The lowest median score was for applicability (28.3%). Although the median score of "editorial independence" was high (85.4%), variability was also substantial (interquartile range: 12.5-100). CONCLUSION We identified variations in quality and deficiencies in certain areas, especially "applicability" and "editorial independence." Improvements in these key domains may enhance the quality and clinical impact of clinical practice guidelines.
Collapse
Affiliation(s)
- Sofia Tsiapakidou
- Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christiana Campani Nygaard
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK
- Obstetrics and Gynecology Department, Medical School, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriele Falconi
- Department of Obstetrics and Gynecology, "San Bortolo" Hospital, Vicenza, Italy
| | - Janna Pape
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens Medical School, Athens, Greece
- School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
- Ross University, School of Medicine, Miramar, Florida, USA
| |
Collapse
|
10
|
van Zanten F, Lenters E, Broeders IAMJ, Schraffordt Koops SE. Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study. Int Urogynecol J 2021; 33:377-384. [PMID: 34159402 PMCID: PMC8803761 DOI: 10.1007/s00192-021-04740-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/11/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Surgery for pelvic organ prolapse (POP) has high recurrence rates. Long-term anatomical and patient-reported outcomes after pelvic floor repair are therefore required. METHODS This prospective observational cohort study was conducted in a teaching hospital with tertiary referral function for patients with POP. Patients with symptomatic vaginal vault or uterine prolapse (simplified POP Quantification [sPOPQ] stage ≥2), who underwent robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS), were included. Follow-up visits with sPOPQ evaluations were planned 4 years after surgery. Patients received pre- and postoperative questionnaires reporting symptoms of vaginal bulge, Urogenital Distress Inventory (UDI-6), and Pelvic Floor Impact Questionnaire (PFIQ-7). Primary outcome was patient self-reported symptoms. Secondary outcome was anatomical cure (sPOPQ stage 1) for all vaginal compartments. RESULTS Seventy-seven patients were included. Sixty-one patients (79%) were evaluated after 50 months (physical examination n = 51). Symptoms of bulge (95% vs 15% p ˂ 0.0005), median UDI-6 scores (26.7 vs 22.2, p = 0.048), median PFIQ-7 scores (60.0 vs 0, p = 0.008), and median sPOPQ stages in all landmarks improved significantly from the pre- to the postoperative visit. Thirty patients (59%) were completely recurrence free and 96% of patients had no apical recurrence. Most recurrences were asymptomatic cystoceles (20%). There was one surgical re-intervention for recurrent prolapse (1.6%). CONCLUSIONS Robot-assisted sacrocolpopexy and RSHS show sustainable results in the treatment of prolapse. Symptoms of bulge, urinary symptoms, and quality of life improved substantially 50 months postoperatively. Patients should be counseled about the risk of anterior wall recurrence and the small chance of recurrent symptoms that need treatment.
Collapse
Affiliation(s)
- Femke van Zanten
- Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands. .,Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, The Netherlands.
| | - Egbert Lenters
- Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - Ivo A M J Broeders
- Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, The Netherlands.,Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | | |
Collapse
|
11
|
Doumouchtsis SK, Loganathan J, Fahmy J, Falconi G, Rada M, Elfituri A, Haddad JM, Pergialiotis V, Betschart C. Patient-reported outcomes and outcome measures in childbirth perineal trauma research: a systematic review. Int Urogynecol J 2021; 32:1695-1706. [PMID: 34143238 DOI: 10.1007/s00192-021-04820-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/18/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In evaluating the effectiveness of interventions in perineal trauma research, outcomes reported by patients should have a prominent focus. There is no international consensus regarding the use of either patient-reported outcomes (PROs) or tools used to determine these outcomes (patient-reported outcome measures, PROMs). The objective was to evaluate the selection, reporting and geographical variations of PROs and PROMs in randomised controlled trials (RCTs) on perineal trauma. METHODS We performed a systematic review of RCTs in perineal trauma research evaluating outcome and outcome measure reporting. We identified PROs and PROMs and grouped PROs into domains and themes, a classification system based on a medical outcome taxonomy. RESULTS Of 48 included RCTs, 47 reported PROs. In total, we identified 51 PROs. Outcome reporting consistency was low, with 27 PROs reported only once. Nine PROs were reported more than five times, the most frequent being perineal pain, with no geographical variation in reporting. Four themes encompassing 12 domains were identified. The most frequently reported theme was "Clinical", with 25 PROs grouped within four domains. "Resource use" and "Adverse events" themes were rarely reported, with only five PROs. PROMs also exhibited variation. Most common were visual analogue scale (VAS; 100 mm), Cleveland Clinic Continence Score, The Faecal Incontinence Quality of Life scale, VAS (0-10) and the McGill Pain Questionnaire. CONCLUSIONS Significant heterogeneity in PROs and PROMs was observed among RCTs. Despite inconsistency, PROs are the most prevalent outcome in perineal trauma research. Patient-reported adverse events are underreported. Their use in determining the effectiveness and safety of interventions makes their integration important in perineal trauma core outcome sets. Identification and grouping of outcomes will assist future core outcome consensus studies.
Collapse
Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, UK.,St George's University of London, London, UK.,Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", National and Kapodistrian University of Athens, Medical School, Athens, Greece.,School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten.,School of Medicine, Ross University, Miramar, Florida, United States
| | - Jemina Loganathan
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, UK.
| | - John Fahmy
- St George's University of London, London, UK
| | - Gabriele Falconi
- Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Maria Rada
- 2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Abdullatif Elfituri
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, UK
| | - Jorge Milhem Haddad
- Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, Butanta, Brazil
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Athens University Medical School, Athens, Greece
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | | |
Collapse
|
12
|
Quality assessment of outcome reporting, publication characteristics and overall methodological quality in trials on synthetic mesh procedures for the treatment of pelvic organ prolapse for development of core outcome sets. Int Urogynecol J 2021; 32:2913-2919. [PMID: 33830304 PMCID: PMC8536576 DOI: 10.1007/s00192-021-04749-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
Introduction and hypothesis Variations in outcome measures and reporting of outcomes in trials on surgery for pelvic organ prolapse (POP) using synthetic mesh have been evaluated and reported. However, the quality of outcome reporting, methodology of trials and their publication parameters are important considerations in the process of development of Core Outcome Sets. We aimed to evaluate these characteristics in randomized controlled trials on surgery for POP using mesh. Methods Secondary analysis of randomized controlled trials on surgical treatments using synthetic mesh for POP previously included in a systematic review developing an inventory of reported outcomes and outcome measures. The methodological quality was investigated with the modified Jadad criteria. Outcome reporting quality was evaluated with the MOMENT criteria. Publication parameters included publishing journal, impact factor and year of publication. Results Of the 71 previously reviewed studies published from 2000 to 2017, the mean JADAD score was 3.59 and the mean MOMENT score was 4.63. Quality of outcomes (MOMENT) was related to methodological quality (JADAD) (rho = 0.662; p = 0.000) and to year of publication (rho = 0.262; p = 0.028). Conclusions Methodological quality and outcome reporting quality appear correlated. However, publication characteristics do not have strong associations with the methodological quality of the studies. Evaluation of the quality of outcomes, methodology and publication characteristics are all an indispensable part of a staged process for the development of Core Outcome and Outcome Measure Sets. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04749-3.
Collapse
|
13
|
Tsiapakidou S, Campani Nygaard C, Pape J, de Mattos Lourenço TR, Falconi G, Betschart C, Doumouchtsis SK. Evaluation of guidelines on the use of vaginal mesh implants for pelvic organ prolapse using the AGREE II instrument. Int J Gynaecol Obstet 2021; 154:400-411. [PMID: 33486756 DOI: 10.1002/ijgo.13622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To systematically evaluate the content and quality of national and international guidelines on vaginal mesh procedures for pelvic organ prolapse (POP). METHODS We searched PubMed, Medline, Web of Science, and ScienceDirect from inception to March 2020 and organizations' websites. The quality of the guidelines was assessed independently by six appraisers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS Five guidelines were included. Most guidelines recommended individualized treatments, clinical observation, and conservative treatment for asymptomatic women discouraging the use of mesh. Vaginal pessary and pelvic floor muscle training are unanimously considered effective treatments. Only two guidelines recommended weight loss. Each guideline recommended patient counseling supported by data on success rates and complications. Most guidelines highlighted the importance of a specialist experienced surgeon, multidisciplinary teams, and national/international registries. All guidelines highlighted potential benefits of the use of mesh and reported possible complications. The overall quality rating ranged between 4.2 and 6.3, suggestive of moderate to high quality. The highest mean score (92.5%) pertained to "Scope and Purpose" and "Clarity of Presentation", and the lowest to "Editorial Independence" (18%). Three out of five guidelines were "strongly recommended" by the appraisers. CONCLUSION Although most guidelines were of moderate to high quality, methodological applicability, stakeholder involvement, and editorial independence were domains with low scores.
Collapse
Affiliation(s)
- Sofia Tsiapakidou
- 1st Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christiana Campani Nygaard
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK.,Department of Obstetrics and Gynecology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janna Pape
- Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Thais R de Mattos Lourenço
- Department of Urogynecology, Discipline of Gynecology, Hospital das Clínicas da Faculdade de Medicina da USP, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriele Falconi
- Department of Surgical Sciences, Complex Operative Unit of Gynecology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK.,St George's University of London, London, UK.,School of Medicine, American University of the Caribbean, Pembroke Pines, FL, USA
| | | |
Collapse
|
14
|
Belayneh T, Gebeyehu A, Adefris M, Rortveit G, Gjerde JL, Ayele TA. Pelvic organ prolapse surgery and health-related quality of life: a follow-up study. BMC WOMENS HEALTH 2021; 21:4. [PMID: 33388056 PMCID: PMC7778798 DOI: 10.1186/s12905-020-01146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Symptomatic prolapse impairs quality of life. Health-related quality of life (HRQoL) is considered an important outcome of pelvic organ prolapse (POP) surgery. However, it is rarely reported, and measures are inadequately used. Thus, studies reporting patient-reported surgical outcomes in low-income contexts are needed. This study aims to evaluate the effect of prolapse surgery on patient HRQoL and determine the predictive factors for change in HRQoL. METHODS A total of 215 patients who had prolapse stage III or IV were enrolled. Patients underwent vaginal native tissue repair, and their HRQoL was evaluated at baseline, 3 and 6 months postoperatively. Effect of surgery on subjective outcomes were measured using validated Prolapse Quality of Life (P-QoL-20), Prolapse Symptom Score (POP-SS), Body Image in Prolapse (BIPOP), Patient Health Questionnaire (PHQ-9), and Patient Global Index of Improvement (PGI-I) tools. A linear mixed-effect model was used to compare pre- and postoperative P-QoL scores and investigate potential predictors of the changes in P-QoL scores. RESULTS In total, 193 (89.7%) patients were eligible for analysis at 3 months, and 185 (86.0%) at 6 months. Participant's mean age was 49.3 ± 9.4 years. The majority of patients had prolapse stage III (81.9%) and underwent vaginal hysterectomy (55.3%). All domains of P-QoL improved significantly after surgery. Altogether more than 72% of patients reported clinically meaningful improvement in condition-specific quality of life measured with P-QoL-20 at 6 months. An improvement in POP-SS, BIPOP, and the PHQ-9 scores were also observed during both follow-up assessments. At 6 months after surgery, only 2.7% of patients reported the presence of bulge symptoms. A total of 97.8% of patients had reported improvement in comparison to the preoperative state, according to PGI-I. The change in P-QoL score after surgery was associated with the change in POP-SS, PHQ, BIPOP scores and marital status (p < 0.001). However, age, type of surgery, and prolapse stage were not associated with the improvement of P-QoL scores. CONCLUSIONS Surgical repair for prolapse effectively improves patient's HRQoL, and patient satisfaction is high. The result could be useful for patient counselling on the expected HRQoL outcomes of surgical treatment. Surgical service should be accessible for patients suffering from POP to improve HRQoL.
Collapse
Affiliation(s)
- Tadesse Belayneh
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Abebaw Gebeyehu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Adefris
- Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Guri Rortveit
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Center, Bergen, Norway
| | - Janne Lillelid Gjerde
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tadesse Awoke Ayele
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
15
|
Leow HW, Tan EL, Black M. Reported outcomes for planned caesarean section versus planned vaginal delivery: A systematic review. Eur J Obstet Gynecol Reprod Biol 2020; 256:101-108. [PMID: 33197678 DOI: 10.1016/j.ejogrb.2020.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is currently no consensus regarding the outcomes and outcome measures that should be reported in studies assessing planned mode of birth. OBJECTIVE To develop an inventory for reported outcomes for studies comparing planned caesarean section (CS) and planned vaginal delivery (VD) for women age 18-45. METHODS A systematic review of outcomes reported in prospective studies investigating planned CS and planned VD was conducted. Three online databases, Ovid SP version of MEDLINE and EMBASE and the Cochrane Pregnancy and Childbirth Group's Trials Register, were searched from 2011 to June 2019. The inclusion criteria were: prospective studies evaluating planned mode of birth, age 18-45, singleton pregnancy, gestational age 37-40 weeks, >100 participants, middle or high income countries. No language restrictions were applied. Two researchers independently screened titles and abstracts, and subsequently reviewed the full text of each selected study to assess for eligibility. Discrepancies were resolved by discussion with a third author. The selected studies were evaluated using the MOMENT criteria. Outcomes and outcome measures were systematically extracted and organised into an inventory. RESULTS 63 prospective studies comparing planned CS versus planned VD including data from 6,397,310 women were included. 37 studies (59%) investigating planned CS versus planned VD fulfilled four or more MOMENT criteria. In total, 43 different primary outcomes and 79 different primary outcome measures, and 12 different secondary outcomes and 31 secondary outcome measures were identified from studies investigating planned CS versus planned VD. CONCLUSION The findings of this study will contribute to the development of a core outcome set for planned mode of birth in the future. Standardising outcomes will aid comparison and interpretation of data pertaining to planned CS versus planned VD. PROSPERO registration: CRD42019133104.
Collapse
Affiliation(s)
- Hui Wei Leow
- University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom.
| | - Elizabeth Lilinn Tan
- University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - Mairead Black
- University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| |
Collapse
|
16
|
Ghai V, Subramanian V, Jan H, Pergialiotis V, Thakar R, Doumouchtsis SK. A systematic review on reported outcomes and outcome measures in female idiopathic chronic pelvic pain for the development of a core outcome set. BJOG 2020; 128:628-634. [PMID: 32654406 DOI: 10.1111/1471-0528.16412] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND A core outcome set (COS) is required to address inconsistencies in outcome reporting in chronic pelvic pain (CPP) trials. OBJECTIVES Evaluation of reported outcomes and selected outcome measures in CPP trials by producing a comprehensive inventory to inform a COS. SEARCH STRATEGY Systematic review of randomised controlled trials (RCTs) identified from Cochrane Central Register of Controlled Trials (CENTRAL), Embase and MEDLINE databases. SELECTION CRITERIA RCTs assessing efficacy and safety of medical, surgical and psychological interventions for women with idiopathic CPP. DATA COLLECTION AND ANALYSIS Two independent researchers extracted outcomes and outcome measures. Similar outcomes were grouped and classified into domains to produce a structured inventory. MAIN RESULTS Twenty-four trials were identified including 136 reported outcomes and outcome measures. Rates of reporting outcomes varied (4-100%) and pelvic pain was the most frequently reported outcome (100%). All trials reported the pain domain; however, only half reported quality of life, clinical effectiveness and adverse events. No differences in outcome reporting were observed in five high-quality trials (21%). Univariate analysis demonstrated an association between quality of outcome reporting and methodological quality of studies (rs = 0.407, P = 0.048). CONCLUSION There is wide variation in reported outcomes and applied outcome measures in CPP trials. While a COS is being developed and implemented, we propose the interim use of commonly reported outcomes in each domain: pain (pelvic pain, dyspareunia, dysmenorrhoea), life impact (quality of life, emotional functioning, physical functioning), clinical effectiveness (efficacy, satisfaction, cost effectiveness, return to daily activities) and adverse events (surgical, perioperative observations, nonsurgical). TWEETABLE ABSTRACT There is significant variation in outcome reporting in CPP trials. Our systematic review forms the basis for the development of a core outcome set.
Collapse
Affiliation(s)
- V Ghai
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.,St George's University of London, London, UK
| | - V Subramanian
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - H Jan
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece
| | - R Thakar
- Department of Urogynaecology, Croydon University Hospital NHS Trust, London, UK
| | - S K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.,St George's University of London, London, UK.,Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece.,American University of the Caribbean, School of Medicine, Pembroke Pines, FL, USA
| | | |
Collapse
|
17
|
Mattsson NK, Karjalainen P, Heikkinen AM, Nieminen K, Jalkanen J, Tolppanen AM. Agreement between patient global impression scale of improvement, pelvic floor distress inventory and 15D in measuring the outcome of pelvic organ prolapse surgery. Neurourol Urodyn 2020; 39:2171-2178. [PMID: 32697861 DOI: 10.1002/nau.24467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 11/08/2022]
Abstract
AIMS To evaluate the correlation between three commonly used patient-reported outcome measures, two generic and one condition-specific instrument, in assessing the change in health-related quality of life following pelvic organ prolapse surgery. METHODS The generic health-related quality of life measure 15-dimensional instrument (15D), Patient Global Impression of Improvement (PGI-I), and prolapse-specific Pelvic Floor Distress Inventory (PDFI-20) were used to assess the effectiveness of pelvic organ prolapse surgery in the national FINPOP study of 3535 surgeries (83% of all pelvic organ prolapse operations) performed in Finland in 2015. Spearman correlations between PGI-I, change in 15D and its dimensions and change in PFDI-20 and its subscales over a 2-year follow-up were investigated. The proportion of concordant ratings was also studied by investigating the proportion of women rated similarly (worse/no change/better/much better) by two instruments according to validated cutoffs. RESULTS Among 2248 women for whom the 2-year change in all instruments could be measured, changes in PFDI-20 and 15D and its dimensions were weak (ρ < 0.2 for all except excretion; ρ = 0.39 and sexual activity; ρ = 0.27). PFDI-20 change (ρ = 0.39) and its subscales (ρ = 0.19-0.40, all P < .001) were more strongly correlated with PGI-I. The proportion of fully concordant ratings were higher for PFDI-20 and PGI-I (50.6%) than for PFDI-20 and 15D (33.0%). CONCLUSION The weak correlations between 15D, PGI-I, and PDFI-20 observed in this study show that the quantified health gains are strongly dependent on the chosen patient-reported outcome measures. This demonstrates the importance of using condition-specific sensitive outcome measures in assessing the impact of surgical treatment in pelvic organ prolapse.
Collapse
Affiliation(s)
- Nina K Mattsson
- Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Päivi Karjalainen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Anna-Mari Heikkinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Terveystalo, Finland
| | - Kari Nieminen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | | |
Collapse
|
18
|
Valtersson E, Husby KR, Elmelund M, Klarskov N. Evaluation of suture material used in anterior colporrhaphy and the risk of recurrence. Int Urogynecol J 2020; 31:2011-2018. [DOI: 10.1007/s00192-020-04415-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/24/2020] [Indexed: 12/19/2022]
|
19
|
Mattsson NK, Karjalainen PK, Tolppanen AM, Heikkinen AM, Sintonen H, Härkki P, Nieminen K, Jalkanen J. Pelvic organ prolapse surgery and quality of life-a nationwide cohort study. Am J Obstet Gynecol 2020; 222:588.e1-588.e10. [PMID: 31836546 DOI: 10.1016/j.ajog.2019.11.1285] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment, and large, prospective clinical studies reporting the patient-reported surgical outcomes are needed. OBJECTIVE To evaluate the effect of female pelvic organ prolapse surgery on health-related quality of life and patient satisfaction and to determine predictors of outcome. STUDY DESIGN This prospective nationwide cohort study consisted of 3515 women undergoing surgery for pelvic organ prolapse in 2015. The outcomes were measured by validated health-related quality of life instruments (generic 15D, Pelvic Floor Distress Inventory-20, and Patient Global Impression of Improvement) at 6 months and 2 years postoperatively. The baseline predictors of outcomes were studied with logistic regression analysis. RESULTS In total, 2528 (72%) women were eligible for analysis at 6 months and 2351 (67%) at 2 years. The mean change in the total 15D score suggested a clinically important improvement at 6 months but not at 2 years. However, an improvement in sexual activity, discomfort and symptoms, and excretion was observed during both follow-up assessments. Altogether, 77% and 72% of the participants reported a clinically significant improvement in Pelvic Floor Distress Inventory-20 at the 6-month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison with the preoperative state with Patient Global Impression of Improvement-I. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio, 2.06; 95% confidence interval, 1.58-2.70) and vaginal bulge (1.90, 1.30-2.80). Smoking was associated with an unfavorable outcome as measured by Patient Global Index of Improvement-I (1.69, 1.02-2.81). CONCLUSION Pelvic organ prolapse surgery improved health-related quality of life in 7 of 10 patients over a 2-year follow-up period, and patient satisfaction was high. Apical prolapse beyond the hymen and vaginal bulge were the most consistent predictors for improvement. Our results suggest that patients should be encouraged to stop smoking to avoid an unfavorable outcome.
Collapse
Affiliation(s)
- Nina K Mattsson
- Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Päivi K Karjalainen
- Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Anna-Mari Heikkinen
- Terveystalo, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Päivi Härkki
- Helsinki University Hospital and University of Helsinki Helsinki, Finland
| | - Kari Nieminen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jyrki Jalkanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Central Finland Hospital District, Jyväskylä, Finland
| |
Collapse
|
20
|
Rada MP, Jones S, Falconi G, Milhem Haddad J, Betschart C, Pergialiotis V, Doumouchtsis SK. A systematic review and meta-synthesis of qualitative studies on pelvic organ prolapse for the development of core outcome sets. Neurourol Urodyn 2020; 39:880-889. [PMID: 32040864 DOI: 10.1002/nau.24297] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/23/2020] [Indexed: 01/08/2023]
Abstract
AIMS In the current climate of evidence-based health care, the aim of this meta-synthesis was to collect and systematically analyse data from primary qualitative studies on pelvic organ prolapse (POP), to identify patient-centered perspectives on the natural course of POP. Information acquired in this study may be useful for ongoing research towards the development of core outcome sets (COS) in pelvic floor disorders. METHODS A CHORUS Working Group performed a standardized search of three different databases (Medline, Embase, Scopus), from inception to October 2019. We selected qualitative studies on women's perspectives on POP that were published in the English language. Three reviewers independently evaluated the quality of eligible papers and highlighted recurrent themes based on patient perspectives. RESULTS Eighteen qualitative studies including a total of 497 patients were assessed in this analysis. Our study revealed five superordinate themes, recurrently encountered in qualitative studies on POP: awareness of POP (6 studies), communication (9 studies), treatments (10 studies), effects on quality of life (6 studies), and self-image (3 studies). Five out of 10 quality criteria were met by all the studies included, based on an assessment performed using the critical appraisal skills program. CONCLUSIONS This is the first synthesis of qualitative studies that address POP-related experiences of women, highlighting five superordinate themes, of which treatment was the most commonly reported one. This synthesis' findings may guide quantitative research priorities and will hopefully contribute to the development of a COS for POP.
Collapse
Affiliation(s)
- Maria Patricia Rada
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stephanie Jones
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriele Falconi
- Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Jorge Milhem Haddad
- Urogynaecology Division, Department of Obstetrics and Gynaecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, Athens University Medical School, Athens, Greece
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,School of Medicine, American University of the Caribbean, Pembroke Pines, Florida.,Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, Athens University Medical School, Athens, Greece.,Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | | |
Collapse
|
21
|
Lourenço TRM, Pergialiotis V, Durnea CM, Elfituri A, Haddad JM, Betschart C, Falconi G, Nygaard CC, Bergstrom L, Pattel M, Doumouchtsis SK. A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set. Int J Gynaecol Obstet 2020; 148:271-281. [PMID: 31814121 DOI: 10.1002/ijgo.13079] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/05/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent systematic reviews have demonstrated wide variations on outcome measure selection and outcome reporting in trials on surgical treatments for anterior, apical and mesh prolapse surgery. A systematic review of reported outcomes and outcome measures in posterior compartment vaginal prolapse interventions is highly warranted in the process of developing core outcome sets. OBJECTIVE To evaluate outcome and outcome measures reporting in posterior prolapse surgical trials. SEARCH STRATEGY We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). SELECTION CRITERIA Randomized trials evaluating the efficacy and safety of different surgical interventions for posterior compartment vaginal prolapse. DATA COLLECTION AND ANALYSIS Two researchers independently assessed studies for inclusion, evaluated methodological quality, and extracted relevant data. Methodological quality, outcome reporting quality and publication characteristics were evaluated. MAIN RESULTS Twenty-seven interventional and four follow-up trials were included. Seventeen studies enrolled patients with posterior compartment surgery as the sole procedure and 14 with multicompartment procedures. Eighty-three reported outcomes and 45 outcome measures were identified. The most frequently reported outcomes were blood loss (20 studies, 74%), pain (18 studies, 66%) and infection (16 studies, 59%). CONCLUSIONS Wide variations in reported outcomes and outcome measures were found. Until a core outcome set is established, we propose an interim core outcome set that could include the three most commonly reported outcomes of the following domains: hospitalization; intraoperative, postoperative urinary, gastrointestinal, vaginal and sexual outcomes; clinical effectiveness. PROSPERO CRD42017062456.
Collapse
Affiliation(s)
- Thais R M Lourenço
- Department of Urogynecology, Clinical Hospital of the University of São Paulo School of Medicine, São Paulo University, São Paulo, Brazil
| | - Vasilis Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", Athens University Medical School, Athens, Greece
| | - Constantin M Durnea
- Department of Obstetrics and Gynecology, Epsom and St Helier University Hospitals NHS Trust, London, UK.,Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Abdullatif Elfituri
- Department of Obstetrics and Gynecology, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Jorge M Haddad
- Department of Urogynecology, Clinical Hospital of the University of São Paulo School of Medicine, São Paulo University, São Paulo, Brazil
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Gabriele Falconi
- Department of Obstetrics and Gynecology, San Bortolo Hospital, Vicenza, Italy
| | - Christiana C Nygaard
- Department of Obstetrics and Gynecology, Epsom and St Helier University Hospitals NHS Trust, London, UK.,Department of Obstetrics and Gynecology, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | | | | | - Stergios K Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", Athens University Medical School, Athens, Greece.,Department of Obstetrics and Gynecology, Epsom and St Helier University Hospitals NHS Trust, London, UK.,St George's University of London, London, UK
| | | |
Collapse
|
22
|
Qiu R, Zhong C, Han S, He T, Huang Y, Guan M, Hu J, Li M, Lin Y, Chen J, Shang H. Development of a core outcome set for myocardial infarction in clinical trials of traditional Chinese medicine: a study protocol. BMJ Open 2019; 9:e032256. [PMID: 31796484 PMCID: PMC6924774 DOI: 10.1136/bmjopen-2019-032256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Myocardial infarction (MI) is the most dangerous complication in patients with coronary heart disease. In China, there is an increasing number of randomised controlled trials (RCTs) of traditional Chinese medicine (TCM) for treating MI. However, the inconsistency of outcome reporting means that a large number of clinical trials cannot be included in systematic reviews to provide the best evidence for clinical practice. The aim of this study is to develop a core outcome set (COS) for future TCM clinical trials of MI, which may improve the consistency of outcome reporting and facilitate the synthesis of data across studies in systematic reviews. METHODS AND ANALYSIS We will conduct a systematic review of MI clinical trials with any intervention. Semistructured interviews will be conducted to obtain the perspectives of patients with MI. The outcomes from the systematic review and semistructured interviews will be grouped and used to develop a questionnaire. The questionnaire will be developed as a supplement for the TCM syndromes of MI and will be constructed from the results of a systematic review, existing medical records and a cross-sectional study. Then two rounds of the Delphi survey will be conducted with different stakeholders (TCM experts and Western medicine experts in cardiovascular disease, methodologists, magazine editors and patients) to determine the importance of the outcomes. Only the TCM experts will need to response to the questionnaire for core TCM syndromes. A face-to-face consensus meeting will be conducted to create a final COS and recommend measurement time for each outcome. ETHICS AND DISSEMINATION This project has been approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine. The final COS will be published and freely available. TRIAL REGISTRATION NUMBER This study is registered with the Core Outcome Measures in Effectiveness Trials database as study 1243 (available at: http://www.comet-initiative.org/studies/details/1243).
Collapse
Affiliation(s)
- Ruijin Qiu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Changming Zhong
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Songjie Han
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianmai He
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ya Huang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Manke Guan
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiayuan Hu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Min Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yiyi Lin
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Chen
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
23
|
Duffy J, Hirsch M, Ziebland S, McManus RJ. Methodological decisions influence the identification of potential core outcomes in studies related to pre-eclampsia: an analysis informing the development of recommendations for future core outcome set developers. BJOG 2019; 126:1482-1490. [PMID: 31359560 DOI: 10.1111/1471-0528.15892] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To quantify the effect of different methodological decisions on the identification of potential core outcomes to inform the development of recommendations for future core coutcome set developers. DESIGN Mixed methods study. SETTING A core outcome set for pre-eclampsia was used as an exemplar. SAMPLE A long list of potential core outcomes was developed by undertaking a systematic review of pre-eclampsia trials and performing a thematic analysis of in-depth patient interviews. METHODS Specific methods used to generate long lists of potential core outcomes were evaluated. RESULTS Different methodological decisions had a substantial impact on the identification of potential core outcomes. Extracting outcomes from published pre-eclampsia trials was an effective way of identifying 48 maternal, eight fetal, 25 neonatal outcomes, and eight patient-reported outcomes. Limiting the extraction of outcomes to primary outcomes or outcomes commonly reported in pre-eclampsia trials reduced the number and diversity of potential core outcomes identified. Thematic analysis of in-depth patient interviews ensured an additional five patient reported outcomes and six outcomes related to future child health were identified. CONCLUSIONS Future core outcome set developers should use quantitative and qualitative methods when developing a long list of potential core outcomes. TWEETABLE ABSTRACT: @OfficialNIHR research published in @BJOGtweets informs new recommendations for future @coreoutcomes developers.
Collapse
Affiliation(s)
- Jmn Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Institute for Women's Health, University College London, London, UK
| | - M Hirsch
- Institute for Women's Health, University College London, London, UK
| | - S Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
24
|
Doumouchtsis SK, Pookarnjanamorakot P, Durnea C, Zini M, Elfituri A, Haddad JM, Falconi G, Betschart C, Pergialiotis V. A systematic review on outcome reporting in randomised controlled trials on surgical interventions for female stress urinary incontinence: a call to develop a core outcome set. BJOG 2019; 126:1417-1422. [DOI: 10.1111/1471-0528.15891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 12/22/2022]
Affiliation(s)
- SK Doumouchtsis
- Department of Obstetrics and Gynaecology Epsom & St Helier University Hospitals NHS Trust London UK
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas University of Athens, Medical School Athens Greece
- St George's University of London London UK
| | | | - C Durnea
- Department of Obstetrics and Gynaecology Epsom & St Helier University Hospitals NHS Trust London UK
| | - M Zini
- Department of Obstetrics and Gynaecology Epsom & St Helier University Hospitals NHS Trust London UK
| | - A Elfituri
- Department of Obstetrics and Gynaecology Epsom & St Helier University Hospitals NHS Trust London UK
| | - JM Haddad
- Chair of Urogynaecology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - G Falconi
- Department of Obstetrics and Gynaecology San Bortolo Hospital Vicenza Italy
| | - C Betschart
- Department of Gynaecology University Hospital of Zurich Zurich Switzerland
| | - V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas University of Athens, Medical School Athens Greece
| | | |
Collapse
|
25
|
Rada MP, Pergialiotis V, Betschart C, Falconi G, Haddad JM, Doumouchtsis SK. A protocol for developing, disseminating, and implementing a core outcome set for stress urinary incontinence. Medicine (Baltimore) 2019; 98:e16876. [PMID: 31517813 PMCID: PMC6750288 DOI: 10.1097/md.0000000000016876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Randomized trials evaluating interventions for stress urinary incontinence (SUI) have been using variable outcome measures, reporting a variety of outcomes. Alongside this variation across studies, outcome-reporting flaws contribute to a limited use of research to inform clinical practice. The development and use of core outcome sets (COSs) in future trials would ensure that outcomes important to different stakeholders and primarily women with SUI are reported more consistently and comprehensively. METHODS An international steering group including healthcare professionals, researchers, and women with urinary incontinence will guide the development of this COS. Potential outcomes will be identified through comprehensive literature reviews. These outcomes will be entered into an international, multiperspective online Delphi survey. All key stakeholders, including healthcare professionals, researchers, and women with urinary incontinence, will be invited to participate. The modified Delphi method encourages stakeholder group convergence toward collective agreement, also referred as consensus, core outcomes. DISCUSSION Dissemination and implementation of the resulting COS within an international context will be promoted and reviewed. Embedding the COS for SUI within future clinical trials, systematic reviews and clinical practice guidelines could make a significant contribution to advancing the value of research in informing clinical practice, enhancing patient care and improving outcomes. The infrastructure created by developing a COS for SUI could be leveraged in other settings, for example, selecting research priorities and clinical practice guideline development.
Collapse
Affiliation(s)
- Maria-Patricia Rada
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, United Kingdom
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 2nd Department of Obstetrics and Gynaecology, “Dominic Stanca” Clinic, Romania
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Gabriele Falconi
- Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Jorge Milhem Haddad
- Department Obstetrics and Gynaecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stergios K. Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, United Kingdom
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece
- St George's University of London, London, UK
| |
Collapse
|
26
|
Qiu R, Hu J, Huang Y, Han S, Zhong C, Li M, He T, Lin Y, Guan M, Chen J, Shang H. Outcome reporting from clinical trials of non-valvular atrial fibrillation treated with traditional Chinese medicine or Western medicine: a systematic review. BMJ Open 2019; 9:e028803. [PMID: 31471437 PMCID: PMC6720335 DOI: 10.1136/bmjopen-2018-028803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To examine variation in outcomes, outcome measurement instruments (OMIs) and measurement times in clinical trials of non-valvular atrial fibrillation (NVAF) and to identify outcomes for prioritisation in developing a core outcome set (COS) in this field. DESIGN This study was a systematic review. DATA SOURCES Clinical trials published between January 2015 and March 2019 were obtained from PubMed, the Cochrane Library, Web of Science, Wanfang Database, the China National Knowledge Infrastructure and SinoMed. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and observational studies were considered. Interventions included traditional Chinese medicine and Western medicine. The required treatment duration or follow-up time was ≥4 weeks. The required sample size was ≥30 and≥50 in each group in RCTs and observational studies, respectively. We excluded trials that aimed to investigate the outcome of complications of NVAF, to assess the mechanisms or pharmacokinetics, or for which full text could not be acquired. DATA EXTRACTION AND SYNTHESIS The general information and outcomes, OMIs and measurement times were extracted. The methodological and outcome reporting quality were assessed. The results were analysed by descriptive analysis. RESULTS A total of 218 articles were included from 25 255 articles. For clinical trials of antiarrhythmic therapy, 69 outcomes from 16 outcome domains were reported, and 28 (31.82%, 28/88) outcomes were reported only once; the most frequently reported outcome was ultrasonic cardiogram. Thirty-one outcomes (44.93%, 31/69) were provided definitions or OMIs; the outcome measurement times ranged from 1 to 20 with a median of 3. For clinical trials of anticoagulation therapy, 82 outcomes from 18 outcome domains were reported; 38 (29.23%, 38/130) outcomes were reported only once. The most frequently reported outcome was ischaemic stroke. Forty (48.78%, 40/82) outcomes were provided OMIs or definitions; and the outcome measurement times ranged from 1 to 27 with a median of 8. CONCLUSION Outcome reporting in NVAF is inconsistent. Thus, developing a COS that can be used in clinical trials is necessary.
Collapse
Affiliation(s)
- Ruijin Qiu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiayuan Hu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ya Huang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Songjie Han
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Changming Zhong
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Min Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianmai He
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yiyi Lin
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Manke Guan
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Chen
- Baokang Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Evidence-based Medicine Center, Jiangxi University of Chinese Medicine, Nanchang, China
| |
Collapse
|
27
|
Perry H, Duffy JMN, Reed K, Baschat A, Deprest J, Hecher K, Lewi L, Lopriore E, Oepkes D, Khalil A. Core outcome set for research studies evaluating treatments for twin-twin transfusion syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:255-261. [PMID: 30520170 DOI: 10.1002/uog.20183] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/04/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop, using a Delphi procedure and a nominal group technique, a core outcome set (COS) for studies evaluating treatments for twin-twin transfusion syndrome (TTTS), which should assist in standardizing outcome selection, collection and reporting in future research studies. METHODS An international steering group comprising healthcare professionals, researchers and patients with experience of TTTS guided the development of this COS. Potential core outcomes, identified through a comprehensive literature review and supplemented by outcomes suggested by the steering group, were entered into a three-round Delphi survey. Healthcare professionals, researchers, and patients or relatives of patients who had experienced TTTS were invited to participate. Consensus was defined a priori using the 15%/70% definition of the Core Outcome Measures in Effectiveness Trials (COMET) initiative. The modified nominal group technique was used to evaluate the consensus outcomes in a face-to-face consultation meeting and identify the final COS. RESULTS One hundred and three participants, from 29 countries, participated in the three-round Delphi survey. Of those, 88 completed all three rounds. Twenty-two consensus outcomes were identified through the Delphi procedure and entered into the modified nominal group technique. The consensus meeting was attended by 11 healthcare professionals, two researchers and three patients; 12 core outcomes were prioritized for inclusion in the COS. Fetal core outcomes included live birth, pregnancy loss (including miscarriage, stillbirth, termination of pregnancy and neonatal mortality), subsequent death of a cotwin following single-twin demise at the time of treatment, recurrence of TTTS, twin anemia-polycythemia sequence and amniotic band syndrome. Neonatal core outcomes included gestational age at delivery, birth weight, brain injury syndromes and ischemic limb injury. Maternal core outcomes included maternal mortality and admission to Level-2 or -3 care setting. One aspirational outcome, neurodevelopment at 18-24 months of age, was also prioritized. CONCLUSIONS Implementing the COS for TTTS within future research studies could make a substantial contribution to advancing the usefulness of research in TTTS. Standardized definitions and measurement instruments are now required for individual core outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- H Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Balliol College, University of Oxford, Oxford, UK
| | - K Reed
- Twin and Multiple Births Association (TAMBA), Aldershot, UK
| | - A Baschat
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - J Deprest
- Department of Obstetrics and Gynecology, University Hospitals of KU Leuven, Leuven, Belgium
- Institute for Women's Health, University College London, London, UK
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Neues Klinikum, Hamburg, Germany
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals of KU Leuven, Leuven, Belgium
| | - E Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - D Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| |
Collapse
|
28
|
Sileo FG, Duffy JMN, Townsend R, Khalil A. Variation in outcome reporting across studies evaluating interventions for selective fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:10-15. [PMID: 30084183 DOI: 10.1002/uog.19192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Affiliation(s)
- F G Sileo
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - J M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Balliol College, University of Oxford, Oxford, UK
| | - R Townsend
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|
29
|
Duffy JMN, Thompson T, Hinton L, Salinas M, McManus RJ, Ziebland S. What outcomes should researchers select, collect and report in pre-eclampsia research? A qualitative study exploring the views of women with lived experience of pre-eclampsia. BJOG 2019; 126:637-646. [DOI: 10.1111/1471-0528.15616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- JMN Duffy
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
- Balliol College; University of Oxford; Oxford UK
| | - T Thompson
- Radcliffe Women's Health Patient and Public Involvement Panel; Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - L Hinton
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - M Salinas
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - RJ McManus
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - S Ziebland
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | | |
Collapse
|