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Jones GL, Budds K, Taylor F, Musson D, Raymer J, Churchman D, Kennedy SH, Jenkinson C. A systematic review to determine use of the Endometriosis Health Profiles to measure quality of life outcomes in women with endometriosis. Hum Reprod Update 2024; 30:186-214. [PMID: 38007607 PMCID: PMC10905511 DOI: 10.1093/humupd/dmad029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/06/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The Endometriosis Health Profiles (EHPs), the EHP-30 and EHP-5, are patient-reported outcome measures that were developed to measure the health-related quality of life (HRQoL) of women living with endometriosis. Prior to their development, a systematic review was undertaken which identified that the HRQoL of women living with endometriosis was poorly understood, with only three medical and one surgical study identified. OBJECTIVE AND RATIONALE The 20-year anniversary of the EHP-30 provided a timely opportunity to assess how the tools have been used and explore what the findings tell us about the impact of endometriosis and its associated treatments upon women's QoL. Applying robust systematic review methodology, following PRISMA guidelines, we sought to answer: How many studies have used the EHP and for what purpose?; What are the demographic characteristics and international context of the studies?; What is the methodological nature and quality of the studies?; Which interventions have been assessed and what are the reported EHP outcomes?; and Can the EHP outcomes of these interventions be analysed using a meta-analysis and, if so, what do the results show? SEARCH METHODS The electronic databases MEDLINE, CINAHL, PsycINFO, PubMed, and Google Scholar were searched from the year the EHP was first published, in 2001 to 26 February 2020 using the search terms 'EHP30', 'EHP5', 'EHP-30', 'EHP-5', 'endometriosis health profile 30', and 'endometriosis health profile 5'. We updated the searches on 9 April 2021. All included studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). OUTCOMES The review included 139 papers. In clinical intervention studies, the EHPs were deployed most frequently to measure the outcomes of medical (n = 35) and surgical (n = 21) treatment. The EHPs were also used in 13 other intervention studies, 29 non-interventional studies, 32 psychometric/cross cultural validation studies; six diagnostic studies, and in three other studies to measure outcomes in related conditions. They were mainly deployed in studies undertaken in Europe and North America. Overall, regardless of the nature of the intervention, most women reported improvements in HRQoL after treatment. Surgical interventions generally resulted in significant improvements for the longest amount of time. There was also evidence that when participants stopped taking medication their EHP scores worsened, perhaps reinforcing the temporary impact of medical treatment. Younger patients reported more negative impact upon their HRQoL. Further evidence using classical test theory to support the EHPs' robust psychometric properties, including acceptability, dimensionality, reliability, validity (including cross-cultural), and responsiveness, was demonstrated, particularly for the EHP-30. Strikingly, using anchor-based methods, EHP-30 responsiveness studies demonstrate the largest mean changes in the 'control and powerlessness' domain post-intervention, followed by 'pain'. MMAT outcomes indicated the quality of the papers was good, with the exception of five studies. A meta-analysis was not undertaken owing to the heterogeneity of the interventions and papers included in this review. WIDER IMPLICATIONS Women with endometriosis face a lifetime of surgical and/or medical interventions to keep the condition under control. Less invasive treatments that can lead to improved longer term physical and psycho-social outcomes are needed. The EHPs are reliable, valid, acceptable, and responsive tools, but more assessment of EHP outcomes using modern psychometric methods and in the context of women from ethnically diverse backgrounds and in routine clinical care would be beneficial. Given the brevity of the EHP-5, it may be the most appropriate version to use in routine clinical practice, whereas the longer EHP-30, which provides more granularity, is more appropriate for research.
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Affiliation(s)
- Georgina L Jones
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Kirsty Budds
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Francesca Taylor
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Danielle Musson
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | | | | | - Stephen H Kennedy
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Mikuš M, Matak L, Vujić G, Škegro B, Škegro I, Augustin G, Lagana AS, Ćorić M. The short form endometriosis health profile questionnaire (EHP-5): psychometric validity assessment of a Croatian version. Arch Gynecol Obstet 2023; 307:87-92. [PMID: 35819491 DOI: 10.1007/s00404-022-06691-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To translate, adapt and validate the Endometriosis Health Profile-5 (EHP-5) in Croatian population. METHODS This validation study is a part of a prospective, observational study (EHP-5 CRO) with aim of implementation of EHP-5 and to provide better insight in quality of life consideration of women with endometriosis in Croatian clinical practice. A 150 consecutive patients with surgically proven endometriosis were enrolled. The translation to Croatian followed standardized procedure. Cronbach's Alpha was calculated to calculate internal consistency reliability of EHP-5. The test-retest reliability was calculated using intraclass correlation coefficient (ICC). The t test for independent samples was used to assess known-groups validity. RESULTS Both EHP-5 core and EHP-5 modular parts of the questionnaire had good internal consistency, assessed by the Cronbach's Alpha coefficient (α = 0.793 and α = 0.842, respectively). Obtained results indicate very good reliability for core as well as for modular part of EHP-5 questionnaire (ICC = 0.896 and 0.936, respectively). The independent t test showed that women who reported their pain with VAS scale 7 or more had significantly higher results (p < 0.001) on EHP-5 (M = 50.63) compared with women who reported their pain 6 or less (M = 26.91). Furthermore, we found statistically significant difference between women who are infertile with women who are fertile (p < 0.001), whereby infertile women had higher average result on EHP-5 (M = 49.55) compared with fertile women (M = 34.36). CONCLUSIONS The Croatian version of the EHP-5 have very good psychometric characteristics and can be used as a reliable tool for assessing patients with endometriosis in everyday clinical practice.
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Affiliation(s)
- Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center, Zagreb, Croatia
| | - Luka Matak
- Department of Obstetrics and Gynecology, General Hospital, Zadar, Croatia.
| | - Goran Vujić
- Department of Obstetrics and Gynecology, University Hospital Center, Zagreb, Croatia
| | - Bernarda Škegro
- Department of Rheumatology, Physical and Rehabilitation Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivan Škegro
- Department of Ophthalmology, University Hospital Center, Zagreb, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Center, Zagreb, Croatia
| | - Antonio Simone Lagana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Gynecology Oncology, University of Palermo, Palermo, Italy
| | - Mario Ćorić
- Department of Obstetrics and Gynecology, University Hospital Center, Zagreb, Croatia
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Gallagher B, Mallick R, Odejinmi F, Hosni MM. Perspectives on modes of labour and delivery after different modalities of surgery for bowel endometriosis. J OBSTET GYNAECOL 2021; 42:1443-1447. [PMID: 34964412 DOI: 10.1080/01443615.2021.1997957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Bowel or intestinal endometriosis is estimated to affect 5-37% of women with deep infiltrative endometriosis (DIE), especially in the rectum and recto-sigmoid junction. However, there are no current guidelines or consensus regarding safest mode of delivery in pregnant women after different surgical interventions for bowel/intestinal endometriosis. From October 2019 to February 2020, we conducted an online survey of members of the British Society for Gynaecological Endoscopy (BSGE). These included questions on what gynaecologist members would recommend as modes of delivery in women who had different surgical modalities for bowel endometriosis, and the particular factors that influence such recommendations. Analysis of data was performed using SPSS for Windows (V9) software package. One hundred and two members of BSGE completed the survey (61.76% of BSGE gynaecologist members). Only 30.39% of respondents counsel women, pre-operatively, about possible effects of surgical treatment of bowel endometriosis on their subsequent mode of delivery. Our survey highlights wide variation in practice that currently exists. Around 70% of clinicians are not counselling patients regarding delivery options pre-surgery despite almost one-third recommending planned caesarean section if the vagina is opened. Further studies are required to stratify the risk factors for such patients when attempting vaginal delivery or caesarean section.IMPACT STATEMENTWhat is already known on this subject? Treatment of colorectal endometriosis consists of rectal shaving, discoid resection or segmental colorectal resection. However, the relationship between different surgical modalities for bowel endometriosis and the subsequent safe mode of labour and delivery remains unclear.What do the results of this study add? No study has been published that specifically looked at the particular course and outcome of labour and delivery after each of these bowel surgeries; rectal shaving, disc excision, or segmental colorectal resection. Our study highlights the wide variations in practice that currently exists. Despite around 70% of clinicians not counselling women regarding delivery options pre-surgery, almost one-third would recommend a planned caesarean section if the vagina is opened.What are the implications of these findings for clinical practice and/or further research? This study suggests that risk factors should be stratified for such patients when attempting a vaginal delivery or undergoing a caesarean section. Guidance from the ESGE and/or BSGE would be useful to aid in the counselling and informed consent of such patients.
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Affiliation(s)
- Brendan Gallagher
- Brighton and Sussex University Hospitals NHS Foundation Trust, Princess Royal Hospital, Haywards Heath, UK
| | - Rebecca Mallick
- Brighton and Sussex University Hospitals NHS Foundation Trust, Princess Royal Hospital, Haywards Heath, UK
| | - Funlayo Odejinmi
- Obstetrics and Gynaecology, Barts Health NHS Trust, Whipps Cross Hospital, UK
| | - Mohamed M Hosni
- Brighton and Sussex University Hospitals NHS Foundation Trust, Princess Royal Hospital, Haywards Heath, UK.,Obstetrics and Gynaecology, Ain Shams University Hospitals, Cairo, Egypt
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Namazi M, Behboodi Moghadam Z, Zareiyan A, Jafarabadi M. Impact of endometriosis on reproductive health: an integrative review. J OBSTET GYNAECOL 2021; 41:1183-1191. [PMID: 33645413 DOI: 10.1080/01443615.2020.1862772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Endometriosis is a debilitating chronic disease that affects 10% of the general female population, with a frequency of 38% in infertile women. This review aims to provide an overview of the impact of endometriosis on different aspects of reproductive health. A literature search was performed in four international databases, including PubMed, Science Direct, Scopus, and Google scholar, from January 1995 to December 2019 to identify the potentially relevant articles. We included all relevant articles published in English and identified 46 studies on health issues in women with endometriosis. The research suggests that women with endometriosis are at risk for physical, psychosocial, social, and sexual disturbances and obstetrical complications. More research is needed to clarify better understanding of endometriosis complications specifically obstetrical consequences.
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Affiliation(s)
- Masoumeh Namazi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Armin Zareiyan
- Public Health Department, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Mina Jafarabadi
- Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ekin M, Kaya C, Erdoğan ŞV, Bahçeci E, Baghaki S, Yaşar L. The effect of new cross linked hyaluronan gel on quality of life of patients after deep infiltrating endometriosis surgery: a randomized controlled pilot study. J OBSTET GYNAECOL 2020; 41:263-268. [PMID: 32530335 DOI: 10.1080/01443615.2020.1755628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this prospective randomised placebo-controlled study, we aimed to evaluate the effect of New Cross linked Hyaluronan Gel (NCH gel) on the quality of life of patients who underwent laparoscopic surgery due to Deep Infiltrating Endometriosis (DIE). The intervention group received 40 mL of NCH gel, and the control group had a 40 mL sterile saline solution instilled into the peritoneal cavity following standard laparoscopic procedures. The patients were called in the third and sixth postoperative months and requested to fill the Visual Analogue Scale (VAS), Endometriosis Health Profile (EHP-5), and Short Form for Mental and Physical Health (SF-12) questionnaires. There was a significant reduction in dysmenorrhoea, dyschezia, dyspareunia VAS scores at 3rd, and 6th-month visits in NCH gel group. The postoperative 6th-month EHP-5 scores were significantly lower (1.16 ± 1.51, p-value: .02) in NCH gel group. Besides, NCH gel group had higher SF-12 mental and SF-12 physical scores. Clinical Trials registration number: NCT04023383IMPACT STATEMENTWhat is already known on this subject? Application of solid or liquid physical barriers is believed to be a promising strategy to reduce adhesions after laparoscopic endometriosis surgery. However, comparable data regarding the effects of adhesion barriers are still lacking.What the results of this study add? We revealed that there was a significantly higher decrease in VAS and EHP-5 scores and an increase in SF-12 physical-mental ratings after surgery in NCH gel group.What are the implications of these findings for clinical practice and/or further research? Using NHC gel in addition to standard surgical procedure improves postoperative VAS scores, and provides better quality of life scores.
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Affiliation(s)
- Murat Ekin
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Cihan Kaya
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Şakir Volkan Erdoğan
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Ece Bahçeci
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Sema Baghaki
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Levent Yaşar
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
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Khazali S, Gorgin A, Mohazzab A, Kargar R, Padmehr R, Shadjoo K, Minas V. Laparoscopic excision of deeply infiltrating endometriosis: a prospective observational study assessing perioperative complications in 244 patients. Arch Gynecol Obstet 2019; 299:1619-1626. [PMID: 30953187 DOI: 10.1007/s00404-019-05144-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/26/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine peri-operative complications in patients undergoing laparoscopic excision of deeply infiltrating endometriosis (DIE). METHODS This was a prospective study of a case series of women having laparoscopic excision of deeply infiltrating endometriosis from September 2013 through August 2016 in a tertiary referral center for endometriosis and minimally invasive gynaecological surgery in Iran. Data collected included demographics, baseline characteristics, intraoperative and postoperative data up to 1 month following surgery. RESULTS We analysed data from 244 consecutive patients, who underwent radical laparoscopic excision of all visible DIE. Major postoperative complications occurred in 3 (1.2%) and minor complications in 27 (11.1%) of patients. 80.3% of our patient group had Stage IV endometriosis. Segmental bowel resection was performed in 34 (13.9%), disc resection in 7 (2.9%), rectal shave in 53 (21.7%). Joint operating between a gynaecologist and colorectal and/or urological colleague was required in 29.6% of cases. The mean operating time was 223.8 min (± 80.7 standard deviation, range 60-440 min) and mean hospital stay was 2.9 days (± 1.5 standard deviation, range 1-11). The conversion to laparotomy rate was 1.6%. CONCLUSIONS A combination of different laparoscopic surgical techniques to completely excise all visible DIE, within the context of a tertiary referral center offering multi-disciplinary approach, produces safe outcomes with low complication rates.
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Affiliation(s)
- Shaheen Khazali
- Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG), Ashford & St. Peter's Hospital NHS Foundation Trust, Chertsey, UK. .,Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran. .,Royal Holloway-University of London, Egham, UK.
| | - Atefeh Gorgin
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Arash Mohazzab
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Roxana Kargar
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Roya Padmehr
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Khadije Shadjoo
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Vasilis Minas
- Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG), Ashford & St. Peter's Hospital NHS Foundation Trust, Chertsey, UK
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Effect of danefukang on symptoms and biomarkers in women with endometriosis. Taiwan J Obstet Gynecol 2019; 58:218-222. [DOI: 10.1016/j.tjog.2019.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2018] [Indexed: 11/20/2022] Open
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Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
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Surgery using plasma energy for deep endometriosis: A quality of life assessment. J Gynecol Obstet Hum Reprod 2018; 47:359-364. [DOI: 10.1016/j.jogoh.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 11/19/2022]
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Fauconnier A, Huchon C, Chaillou L, Aubry G, Renouvel F, Panel P. Development of a French version of the Endometriosis Health Profile 5 (EHP-5): cross-cultural adaptation and psychometric evaluation. Qual Life Res 2016; 26:213-220. [DOI: 10.1007/s11136-016-1346-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 12/30/2022]
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Change in Pain and Quality of Life Among Women Enrolled in a Trial Examining the Use of Narrow Band Imaging During Laparoscopic Surgery for Suspected Endometriosis. J Minim Invasive Gynecol 2015; 22:1208-14. [DOI: 10.1016/j.jmig.2015.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/19/2022]
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