Outpatient uterine assessment and treatment unit in patients with abnormal uterine bleeding: an economic modelling study

Ultrasound and blind endometrial sampling for detection of endometrial cancer in women with postmenopausal bleeding

OBJECTIVES

This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To assess the diagnostic accuracy of endometrial sampling with histology in the diagnosis of endometrial cancer in women with postmenopausal bleeding and thickened endometrium on ultrasound. Diagnosis will be verified by the reference standards, hysteroscopy with histology, obtained by targeted (such as grasp biopsy of the endometrium or resection of focal pathology) or global sampling (with dilation and curettage), and histology of hysterectomy specimens. Secondary objectives To determine the diagnostic accuracy of different sampling devices and methods in the detection of endometrial cancer To assess the diagnostic accuracy of endometrial sampling devices and methods to detect endometrial hyperplasia To determine accuracy in diagnosing endometrial cancer and endometrial hyperplasia at different endometrial thicknesses of 3 mm, 4 mm and 5 mm To investigate sources of heterogeneity.

Interventions to improve access to care for abnormal uterine bleeding: A systematic scoping review

BACKGROUND

Women with abnormal uterine bleeding (AUB) experience barriers to accessing healthcare services.

OBJECTIVES

To identify and describe the evidence on interventions to improve healthcare access of women with AUB.

SEARCH STRATEGY

A systematic search of databases including Medline, CINAHL, EMBASE, Scopus, and Cochrane register for clinical trials on February 26, 2021.

SELECTION CRITERIA

Studies including women with AUB and investigating an intervention to improve access at the levels of individual patient, community, organization, health system, or medical education.

DATA COLLECTION AND ANALYSIS

Data extraction and descriptive analysis of the country, study design, settings, participant characteristics, intervention, outcome measures, and key findings.

MAIN RESULTS

We identified 20 studies and most interventions (13 studies) targeted organizational changes. Creating a multidisciplinary team, bringing services together and developing a care pathway improved the availability of services. Management of AUB in an outpatient setting improved the affordability. The use of decision aids improved patient engagement in consultations. There is a lack of interventions at an individual or community level targeting health literacy, health beliefs, social acceptability, and opportunity to reach and pay for services.

CONCLUSIONS

Community-based culturally-adapted interventions focusing on access to women with different socio-economic and cultural backgrounds should be investigated.