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Vergote S, De Bie FR, Duffy JMN, Bosteels J, Benachi A, Power B, Meijer F, Hedrick HL, Fernandes CJ, Reiss IKM, De Coppi P, Lally KP, Deprest JA. Core outcome set for perinatal interventions for congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2023; 62:374-382. [PMID: 37099763 DOI: 10.1002/uog.26235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To develop a core set of prenatal and neonatal outcomes for clinical studies evaluating perinatal interventions for congenital diaphragmatic hernia, using a validated consensus-building method. METHODS An international steering group comprising 13 leading maternal-fetal medicine specialists, neonatologists, pediatric surgeons, patient representatives, researchers and methodologists guided the development of this core outcome set. Potential outcomes were collected through a systematic review of the literature and entered into a two-round online Delphi survey. A call was made for stakeholders with experience of congenital diaphragmatic hernia to review the list and score outcomes based on their perceived relevance. Outcomes that fulfilled the consensus criteria defined a priori were discussed subsequently in online breakout meetings. Results were reviewed in a consensus meeting, during which the core outcome set was defined. Finally, the definitions, measurement methods and aspirational outcomes were defined in online and in-person definition meetings by a selection of 45 stakeholders. RESULTS Overall, 221 stakeholders participated in the Delphi survey and 198 completed both rounds. Fifty outcomes met the consensus criteria and were discussed and rescored by 78 stakeholders in the breakout meetings. During the consensus meeting, 93 stakeholders agreed eventually on eight outcomes, which constituted the core outcome set. Maternal and obstetric outcomes included maternal morbidity related to the intervention and gestational age at delivery. Fetal outcomes included intrauterine demise, interval between intervention and delivery and change in lung size in utero around the time of the intervention. Neonatal outcomes included neonatal mortality, pulmonary hypertension and use of extracorporeal membrane oxygenation. Definitions and measurement methods were formulated by 45 stakeholders, who also added three aspirational outcomes: duration of invasive ventilation, duration of oxygen supplementation and use of pulmonary vasodilators at discharge. CONCLUSIONS We developed with relevant stakeholders a core outcome set for studies evaluating perinatal interventions in congenital diaphragmatic hernia. Its implementation should facilitate the comparison and combination of trial results, enabling future research to better guide clinical practice. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Vergote
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - F R De Bie
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - J M N Duffy
- Department of Women and Children's Health, King's College London, London, UK
| | - J Bosteels
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - A Benachi
- Service de Gynécologie-Obstétrique, Hôpital Antoine-Béclère, AP-HP, Clamart, France
- Centre de Référence Maladies Rares Hernie de Coupole Diaphragmatique, Hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - B Power
- The Congenital Diaphragmatic Hernia Charity (CDH UK), King's Lynn, UK
| | - F Meijer
- PlatformCHD, Arnhem, The Netherlands
| | - H L Hedrick
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - C J Fernandes
- Division of Neonatology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - I K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P De Coppi
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, London, UK
- Stem Cells and Regenerative Medicine Section, Institute of Child Health, University College London, London, UK
| | - K P Lally
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J A Deprest
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Women and Children's Health, King's College London, London, UK
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2
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Duffy JMN, Bhattacharya S, Bhattacharya S, Bofill M, Collura B, Curtis C, Evers JLH, Giudice LC, Farquharson RG, Franik S, Hickey M, Hull ML, Jordan V, Khalaf Y, Legro RS, Lensen S, Mavrelos D, Mol BW, Niederberger C, Ng EHY, Puscasiu L, Repping S, Sarris I, Showell M, Strandell A, Vail A, van Wely M, Vercoe M, Vuong NL, Wang AY, Wang R, Wilkinson J, Youssef MA, Farquhar CM. Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study† ‡. Hum Reprod 2021; 35:2735-2745. [PMID: 33252643 PMCID: PMC7744157 DOI: 10.1093/humrep/deaa243] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Can consensus definitions for the core outcome set for infertility be identified in order to recommend a standardized approach to reporting? SUMMARY ANSWER Consensus definitions for individual core outcomes, contextual statements and a standardized reporting table have been developed. WHAT IS KNOWN ALREADY Different definitions exist for individual core outcomes for infertility. This variation increases the opportunities for researchers to engage with selective outcome reporting, which undermines secondary research and compromises clinical practice guideline development. STUDY DESIGN, SIZE, DURATION Potential definitions were identified by a systematic review of definition development initiatives and clinical practice guidelines and by reviewing Cochrane Gynaecology and Fertility Group guidelines. These definitions were discussed in a face-to-face consensus development meeting, which agreed consensus definitions. A standardized approach to reporting was also developed as part of the process. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus development methods. MAIN RESULTS AND THE ROLE OF CHANCE Forty-four potential definitions were inventoried across four definition development initiatives, including the Harbin Consensus Conference Workshop Group and International Committee for Monitoring Assisted Reproductive Technologies, 12 clinical practice guidelines and Cochrane Gynaecology and Fertility Group guidelines. Twenty-seven participants, from 11 countries, contributed to the consensus development meeting. Consensus definitions were successfully developed for all core outcomes. Specific recommendations were made to improve reporting. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods, which have inherent limitations. There was limited representation from low- and middle-income countries. WIDER IMPLICATIONS OF THE FINDINGS A minimum data set should assist researchers in populating protocols, case report forms and other data collection tools. The generic reporting table should provide clear guidance to researchers and improve the reporting of their results within journal publications and conference presentations. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials statement, and over 80 specialty journals have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility Group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and a financial interest in NexHand. E.H.Y.N. reports research sponsorship from Merck. A.S. reports consultancy fees from Guerbet. J.W. reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. A.V. reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from Human Fertilisation and Embryology Authority for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials Initiative: 1023.
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Affiliation(s)
- J M N Duffy
- King's Fertility, Fetal Medicine Research Institute, London, UK.,Institute for Women's Health, University College London, London, UK
| | - S Bhattacharya
- School of Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - S Bhattacharya
- School of Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - M Bofill
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - B Collura
- RESOLVE, The National Infertility Association, VA, USA
| | - C Curtis
- Fertility New Zealand, Auckland, New Zealand.,School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, CA, USA.,International Federation of Fertility Societies, Philadelphia, PA, USA
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - M L Hull
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - V Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Y Khalaf
- Department of Women and Children's Health, King's College London, Guy's Hospital, London
| | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, PA, USA
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong.,Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - L Puscasiu
- Pharmacy, Sciences and Technology, University of Medicine, Targu Mures, Romania
| | - S Repping
- Amsterdam University Medical Centers, Amsterdam, The Netherlands.,National Health Care Institute, Diemen, The Netherlands
| | - I Sarris
- King's Fertility, Fetal Medicine Research Institute, London, UK
| | - M Showell
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - A Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Vercoe
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Faculty of Health, University of Technology, Sydney, Broadway, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M A Youssef
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - C M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.,Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
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3
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Duffy JMN, AlAhwany H, Bhattacharya S, Collura B, Curtis C, Evers JLH, Farquharson RG, Franik S, Giudice LC, Khalaf Y, Knijnenburg JML, Leeners B, Legro RS, Lensen S, Vazquez-Niebla JC, Mavrelos D, Mol BWJ, Niederberger C, Ng EHY, Otter AS, Puscasiu L, Rautakallio-Hokkanen S, Repping S, Sarris I, Simpson JL, Strandell A, Strawbridge C, Torrance HL, Vail A, van Wely M, Vercoe MA, Vuong NL, Wang AY, Wang R, Wilkinson J, Youssef MA, Farquhar CM. Developing a core outcome set for future infertility research: an international consensus development study† ‡. Hum Reprod 2021; 35:2725-2734. [PMID: 33252685 PMCID: PMC7744160 DOI: 10.1093/humrep/deaa241] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION Can a core outcome set to standardize outcome selection, collection and reporting across future infertility research be developed? SUMMARY ANSWER A minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential treatments for infertility. WHAT IS KNOWN ALREADY Complex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret. STUDY DESIGN, SIZE, DURATION A three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries). PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus science methods. MAIN RESULTS AND THE ROLE OF CHANCE The core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition and an arbitrary consensus threshold. WIDER IMPLICATIONS OF THE FINDINGS Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. The funder had no role in the design and conduct of the study, the collection, management, analysis or interpretation of data, or manuscript preparation. B.W.J.M. is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT1082548). S.B. was supported by University of Auckland Foundation Seelye Travelling Fellowship. S.B. reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.J.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. A.S. reports consultancy fees from Guerbet. E.H.Y.N. reports research sponsorship from Merck. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials Initiative: 1023.
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Affiliation(s)
- J M N Duffy
- King's Fertility, Fetal Medicine Research Institute, London, UK.,Institute for Women's Health, University College London, London, UK
| | - H AlAhwany
- School of Medicine, University of Nottingham, Derby, UK
| | - S Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - B Collura
- RESOLVE: The National Infertility Association, VA, USA
| | - C Curtis
- Fertility New Zealand, Auckland, New Zealand.,School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, CA, USA.,International Federation of Fertility Societies, Philadelphia, PA, USA
| | - Y Khalaf
- Department of Women and Children's Health, King's College London, Guy's Hospital, London, UK
| | | | - B Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, PA, USA
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - J C Vazquez-Niebla
- Cochrane Iberoamerica, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong.,Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - A S Otter
- Osakidetza OSI, Bilbao, Basurto, Spain
| | - L Puscasiu
- University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | | | - S Repping
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - I Sarris
- King's Fertility, Fetal Medicine Research Institute, London, UK
| | - J L Simpson
- Department of Human and Molecular Genetics, Florida International University, FL, USA
| | - A Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | | | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M A Vercoe
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Faculty of Health, University of Technology, Sydney, Broadway, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M A Youssef
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - C M Farquhar
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
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Hirsch M, Duffy JMN, Farquhar CM. Re: Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial. Ultrasound Obstet Gynecol 2021; 57:849. [PMID: 33939210 DOI: 10.1002/uog.23636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Affiliation(s)
- M Hirsch
- Institute for Women's Health, University College London, London, UK
| | - J M N Duffy
- Institute for Women's Health, University College London, London, UK
- King's Fertility, The Fetal Medicine Research Institute, London, UK
| | - C M Farquhar
- Cochrane Gynaecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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5
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Duffy JMN, Adamson GD, Benson E, Bhattacharya S, Bhattacharya S, Bofill M, Brian K, Collura B, Curtis C, Evers JLH, Farquharson RG, Fincham A, Franik S, Giudice LC, Glanville E, Hickey M, Horne AW, Hull ML, Johnson NP, Jordan V, Khalaf Y, Knijnenburg JML, Legro RS, Lensen S, MacKenzie J, Mavrelos D, Mol BW, Morbeck DE, Nagels H, Ng EHY, Niederberger C, Otter AS, Puscasiu L, Rautakallio-Hokkanen S, Sadler L, Sarris I, Showell M, Stewart J, Strandell A, Strawbridge C, Vail A, van Wely M, Vercoe M, Vuong NL, Wang AY, Wang R, Wilkinson J, Wong K, Wong TY, Farquhar CM. Top 10 priorities for future infertility research: an international consensus development study. Fertil Steril 2021; 115:180-190. [PMID: 33272617 DOI: 10.1016/j.fertnstert.2020.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/05/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022]
Abstract
STUDY QUESTION Can the priorities for future research in infertility be identified? SUMMARY ANSWER The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care for people with fertility problems were identified. WHAT IS KNOWN ALREADY Many fundamental questions regarding the prevention, management, and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems. STUDY DESIGN, SIZE, DURATION Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, people with fertility problems, and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. MAIN RESULTS AND THE ROLE OF CHANCE The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties were entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities, and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, IUI, and IVF), and ethics, access, and organization of care, were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings, and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research, and population science. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgement, and arbitrary consensus definitions. WIDER IMPLICATIONS OF THE FINDINGS We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems, and others, will help research funding organizations and researchers to develop their future research agenda. STUDY FUNDING/ COMPETING INTEREST(S) The study was funded by the Auckland Medical Research Foundation, Catalyst Fund, Royal Society of New Zealand, and Maurice and Phyllis Paykel Trust. Geoffrey Adamson reports research sponsorship from Abbott, personal fees from Abbott and LabCorp, a financial interest in Advanced Reproductive Care, committee membership of the FIGO Committee on Reproductive Medicine, International Committee for Monitoring Assisted Reproductive Technologies, International Federation of Fertility Societies, and World Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. Hans Evers reports being the Editor Emeritus of Human Reproduction. Andrew Horne reports research sponsorship from the Chief Scientist's Office, Ferring, Medical Research Council, National Institute for Health Research, and Wellbeing of Women and consultancy fees from Abbvie, Ferring, Nordic Pharma, and Roche Diagnostics. M. Louise Hull reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. Neil Johnson reports research sponsorship from Abb-Vie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics, and Vifor Pharma. José Knijnenburg reports research sponsorship from Ferring and Theramex. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Ernest Ng reports research sponsorship from Merck. Craig Niederberger reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. Jane Stewart reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring, and being a clinical subeditor of Human Fertility. Annika Strandell reports consultancy fees from Guerbet. Jack Wilkinson reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. Andy Vail reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from HFEA for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- J M N Duffy
- King's Fertility, Fetal Medicine Research Institute, London, UK; Institute for Women's Health, University College London, London, UK.
| | - G D Adamson
- ARC Fertility, Cupertino, California, United States
| | - E Benson
- Patient and Public Participation Group, Priority Setting Partnership for Infertility, University of Auckland, Auckland, New Zealand
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M Bofill
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - K Brian
- Women's Network, Royal College of Obstetricians and Gynecologists, London, UK
| | - B Collura
- Resolve: The National Infertility Association, Virginia, United States
| | - C Curtis
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Centre for Reproductive Medicine and Biology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, California, United States; International Federation of Fertility Societies, Mount Royal, New Jersey, United States
| | - E Glanville
- Auckland District Health Board, Auckland, New Zealand
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - A W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - M L Hull
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - N P Johnson
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - V Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Y Khalaf
- Department of Women and Children's Health, Kings College London, London, UK
| | | | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, Pennsylvania
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | | | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - D E Morbeck
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Fertility Associates, Auckland, New Zealand
| | - H Nagels
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong; Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | - L Puscasiu
- Pharmacy, Science, and Technology, University of Medicine, Targu Mures, Romania; Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - L Sadler
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Auckland District Health Board, Auckland, New Zealand
| | - I Sarris
- King's Fertility, Fetal Medicine Research Institute, London, UK
| | - M Showell
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - J Stewart
- British Fertility Society, Middlesex, UK
| | - A Strandell
- Sahlgrenska Academy, Dept of Obstetrics and Gynecology, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M Vercoe
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - K Wong
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - T Y Wong
- Auckland District Health Board, Auckland, New Zealand
| | - C M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
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6
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Duffy JMN, Adamson GD, Benson E, Bhattacharya S, Bhattacharya S, Bofill M, Brian K, Collura B, Curtis C, Evers JLH, Farquharson RG, Fincham A, Franik S, Giudice LC, Glanville E, Hickey M, Horne AW, Hull ML, Johnson NP, Jordan V, Khalaf Y, Knijnenburg JML, Legro RS, Lensen S, MacKenzie J, Mavrelos D, Mol BW, Morbeck DE, Nagels H, Ng EHY, Niederberger C, Otter AS, Puscasiu L, Rautakallio-Hokkanen S, Sadler L, Sarris I, Showell M, Stewart J, Strandell A, Strawbridge C, Vail A, van Wely M, Vercoe M, Vuong NL, Wang AY, Wang R, Wilkinson J, Wong K, Wong TY, Farquhar CM. Top 10 priorities for future infertility research: an international consensus development study† ‡. Hum Reprod 2020; 35:2715-2724. [PMID: 33252677 PMCID: PMC7744161 DOI: 10.1093/humrep/deaa242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/05/2020] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Can the priorities for future research in infertility be identified? SUMMARY ANSWER The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care for people with fertility problems were identified. WHAT IS KNOWN ALREADY Many fundamental questions regarding the prevention, management and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems. STUDY DESIGN, SIZE, DURATION Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, people with fertility problems and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. MAIN RESULTS AND THE ROLE OF CHANCE The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties was entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, IUI and IVF) and ethics, access and organization of care were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research and population science. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgment and arbitrary consensus definitions. WIDER IMPLICATIONS OF THE FINDINGS We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems and others, will help research funding organizations and researchers to develop their future research agenda. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Auckland Medical Research Foundation, Catalyst Fund, Royal Society of New Zealand and Maurice and Phyllis Paykel Trust. G.D.A. reports research sponsorship from Abbott, personal fees from Abbott and LabCorp, a financial interest in Advanced Reproductive Care, committee membership of the FIGO Committee on Reproductive Medicine, International Committee for Monitoring Assisted Reproductive Technologies, International Federation of Fertility Societies and World Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. A.W.H. reports research sponsorship from the Chief Scientist's Office, Ferring, Medical Research Council, National Institute for Health Research and Wellbeing of Women and consultancy fees from AbbVie, Ferring, Nordic Pharma and Roche Diagnostics. M.L.H. reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. N.P.J. reports research sponsorship from AbbVie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics and Vifor Pharma. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from AbbVie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. E.H.Y.N. reports research sponsorship from Merck. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring and retains a financial interest in NexHand. J.S. reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring and being a clinical subeditor of Human Fertility. A.S. reports consultancy fees from Guerbet. J.W. reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. A.V. reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and the journal Reproduction. His employing institution has received payment from Human Fertilisation and Embryology Authority for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J M N Duffy
- King’s Fertility, Fetal Medicine Research Institute, London, UK
- Institute for Women’s Health, University College London, London, UK
| | | | - E Benson
- Patient and Public Participation Group, Priority Setting Partnership for Infertility, University of Auckland, Auckland, New Zealand
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M Bofill
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - K Brian
- Women’s Network, Royal College of Obstetricians and Gynecologists, London, UK
| | - B Collura
- Resolve: The National Infertility Association, VA, USA
| | - C Curtis
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Centre for Reproductive Medicine and Biology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, CA, USA
- International Federation of Fertility Societies, Mount Royal, NJ, USA
| | - E Glanville
- Auckland District Health Board, Auckland, New Zealand
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - A W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - M L Hull
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - N P Johnson
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - V Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Y Khalaf
- Department of Women and Children’s Health, Kings College London, London, UK
| | | | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, PA, USA
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | | | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - D E Morbeck
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Fertility Associates, Auckland, New Zealand
| | - H Nagels
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | | | - L Puscasiu
- ARC Fertility, Cupertino, CA, USA
- Institute for Women’s Health, University College London, London, UK
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - L Sadler
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - I Sarris
- King’s Fertility, Fetal Medicine Research Institute, London, UK
| | - M Showell
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - J Stewart
- British Fertility Society, Middlesex, UK
| | - A Strandell
- Sahlgrenska Academy, Department of Obstetrics and Gynecology, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M Vercoe
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - K Wong
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - T Y Wong
- Auckland District Health Board, Auckland, New Zealand
| | - C M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
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7
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Duffy JMN, AlAhwany H, Bhattacharya S, Collura B, Curtis C, Evers JLH, Farquharson RG, Franik S, Giudice LC, Khalaf Y, Knijnenburg JML, Leeners B, Legro RS, Lensen S, Vazquez-Niebla JC, Mavrelos D, Mol BWJ, Niederberger C, Ng EHY, Otter AS, Puscasiu L, Rautakallio-Hokkanen S, Repping S, Sarris I, Simpson JL, Strandell A, Strawbridge C, Torrance HL, Vail A, van Wely M, Vercoe MA, Vuong NL, Wang AY, Wang R, Wilkinson J, Youssef MA, Farquhar CM. Developing a core outcome set for future infertility research: an international consensus development study. Fertil Steril 2020; 115:191-200. [PMID: 33272618 DOI: 10.1016/j.fertnstert.2020.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022]
Abstract
STUDY QUESTION Can a core outcome set to standardize outcome selection, collection, and reporting across future infertility research be developed? SUMMARY ANSWER A minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCT) and systematic reviews evaluating potential treatments for infertility. WHAT IS KNOWN ALREADY Complex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions, and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret. STUDY DESIGN, SIZE, DURATION A three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries). PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, researchers, and people with fertility problems were brought together in an open and transparent process using formal consensus science methods. MAIN RESULTS AND THE ROLE OF CHANCE The core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin, and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth, and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition, and an arbitrary consensus threshold. WIDER IMPLICATIONS OF THE FINDINGS Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection, and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Ferility and Sterility, and Human Reproduction, have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund, and Maurice and Phyllis Paykel Trust. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. Hans Evers reports being the Editor Emeritus of Human Reproduction. José Knijnenburg reports research sponsorship from Ferring and Theramex. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Craig Niederberger reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. Annika Strandell reports consultancy fees from Guerbet. Ernest Ng reports research sponsorship from Merck. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials Initiative: 1023.
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Affiliation(s)
- J M N Duffy
- King's Fertility, Fetal Medicine Research Institute, London, UK; Institute for Women's Health, University College London, London, UK.
| | - H AlAhwany
- School of Medicine, University of Nottingham, Derby, UK
| | - S Bhattacharya
- School of Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - B Collura
- RESOLVE: The National Infertility Association, Virginia, United States
| | - C Curtis
- Fertility New Zealand, Auckland, New Zealand; School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, California, United States; International Federation of Fertility Societies, Philadelphia, Pennsylvania, United States
| | - Y Khalaf
- Department of Women and Children's Health, King's College London, Guy's Hospital, London
| | | | - B Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, Pennsylvania
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - J C Vazquez-Niebla
- Cochrane Iberoamerica, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong; Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - A S Otter
- Osakidetza OSI, Bilbao, Basurto, Spain
| | - L Puscasiu
- University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | | | - S Repping
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - I Sarris
- King's Fertility, Fetal Medicine Research Institute, London, UK
| | - J L Simpson
- Department of Human and Molecular Genetics, Florida International University, Florida, United States
| | - A Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | | | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M A Vercoe
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Faculty of Health, University of Technology, Sydney, Broadway, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M A Youssef
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - C M Farquhar
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
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8
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Duffy JMN, Bhattacharya S, Bhattacharya S, Bofill M, Collura B, Curtis C, Evers JLH, Giudice LC, Farquharson RG, Franik S, Hickey M, Hull ML, Jordan V, Khalaf Y, Legro RS, Lensen S, Mavrelos D, Mol BW, Niederberger C, Ng EHY, Puscasiu L, Repping S, Sarris I, Showell M, Strandell A, Vail A, van Wely M, Vercoe M, Vuong NL, Wang AY, Wang R, Wilkinson J, Youssef MA, Farquhar CM. Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study. Fertil Steril 2020; 115:201-212. [PMID: 33272619 DOI: 10.1016/j.fertnstert.2020.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 01/21/2023]
Abstract
STUDY QUESTION Can consensus definitions for the core outcome set for infertility be identified in order to recommend a standardized approach to reporting? SUMMARY ANSWER Consensus definitions for individual core outcomes, contextual statements, and a standardized reporting table have been developed. WHAT IS KNOWN ALREADY Different definitions exist for individual core outcomes for infertility. This variation increases the opportunities for researchers to engage with selective outcome reporting, which undermines secondary research and compromises clinical practice guideline development. STUDY DESIGN, SIZE, DURATION Potential definitions were identified by a systematic review of definition development initiatives and clinical practice guidelines and by reviewing Cochrane Gynaecology and Fertility Group guidelines. These definitions were discussed in a face-to-face consensus development meeting, which agreed consensus definitions. A standardized approach to reporting was also developed as part of the process. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, researchers, and people with fertility problems were brought together in an open and transparent process using formal consensus development methods. MAIN RESULTS AND THE ROLE OF CHANCE Forty-four potential definitions were inventoried across four definition development initiatives, including the Harbin Consensus Conference Workshop Group and International Committee for Monitoring Assisted Reproductive Technologies, 12 clinical practice guidelines, and Cochrane Gynaecology and Fertility Group guidelines. Twenty-seven participants, from 11 countries, contributed to the consensus development meeting. Consensus definitions were successfully developed for all core outcomes. Specific recommendations were made to improve reporting. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods, which have inherent limitations. There was limited representation from low- and middle-income countries. WIDER IMPLICATIONS OF THE FINDINGS A minimum data set should assist researchers in populating protocols, case report forms, and other data collection tools. The generic reporting table should provide clear guidance to researchers and improve the reporting of their results within journal publications and conference presentations. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials statement, and over 80 specialty journals have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund, and Maurice and Phyllis Paykel Trust. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. Hans Evers reports being the Editor Emeritus of Human Reproduction. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Craig Niederberger reports being the Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and a financial interest in NexHand. Ernest Ng reports research sponsorship from Merck. Annika Strandell reports consultancy fees from Guerbet. Jack Wilkinson reports being a statistical editor for the Cochrane Gynaecology and Fertility group. Andy Vail reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from HFEA for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials Initiative: 1023.
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Affiliation(s)
- J M N Duffy
- King's Fertility, Fetal Medicine Research Institute, London, UK; Institute for Women's Health, University College London, London, UK.
| | - S Bhattacharya
- School of Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - S Bhattacharya
- School of Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - M Bofill
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - B Collura
- RESOLVE: The National Infertility Association, Virginia, United States
| | - C Curtis
- Fertility New Zealand, Auckland, New Zealand; School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, California, United States; International Federation of Fertility Societies, Philadelphia, Pennsylvania, United States
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - M L Hull
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - V Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Y Khalaf
- Department of Women and Children's Health, King's College London, Guy's Hospital, London
| | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, Pennsylvania
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong; Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - L Puscasiu
- University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - S Repping
- Amsterdam University Medical Centers, Amsterdam, The Netherlands; National Health Care Institute, Diemen, The Netherlands
| | - I Sarris
- King's Fertility, Fetal Medicine Research Institute, London, UK
| | - M Showell
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - A Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Vercoe
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Faculty of Health, University of Technology, Sydney, Broadway, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M A Youssef
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - C M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
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9
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Townsend R, Duffy JMN, Sileo F, Perry H, Ganzevoort W, Reed K, Baschat AA, Deprest J, Gratacos E, Hecher K, Lewi L, Lopriore E, Oepkes D, Papageorghiou A, Gordijn SJ, Khalil A. Core outcome set for studies investigating management of selective fetal growth restriction in twins. Ultrasound Obstet Gynecol 2020; 55:652-660. [PMID: 31273879 DOI: 10.1002/uog.20388] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/07/2019] [Accepted: 06/21/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Selective fetal growth restriction (sFGR) occurs in monochorionic twin pregnancies when unequal placental sharing leads to restriction in the growth of just one twin. Management options include laser separation of the fetal circulations, selective reduction or expectant management, but what constitutes the best treatment is not yet known. New trials in this area are urgently needed but, in this rare and complex group, maximizing the relevance and utility of clinical research design and outputs is paramount. A core outcome set ensures standardized outcome collection and reporting in future research. The objective of this study was to develop a core outcome set for studies evaluating treatments for sFGR in monochorionic twins. METHODS An international steering group of clinicians, researchers and patients with experience of sFGR was established to oversee the process of development of a core outcome set for studies investigating the management of sFGR. Outcomes reported in the literature were identified through a systematic review and informed the design of a three-round Delphi survey. Clinicians, researchers, and patients and family representatives participated in the survey. Outcomes were scored on a Likert scale from 1 (limited importance for making a decision) to 9 (critical for making a decision). Consensus was defined a priori as a Likert score of ≥ 8 in the third round of the Delphi survey. Participants were then invited to take part in an international meeting of stakeholders in which the modified nominal group technique was used to consider the consensus outcomes and agree on a final core outcome set. RESULTS Ninety-six outcomes were identified from 39 studies in the systematic review. One hundred and three participants from 23 countries completed the first round of the Delphi survey, of whom 88 completed all three rounds. Twenty-nine outcomes met the a priori criteria for consensus and, along with six additional outcomes, were prioritized in a consensus development meeting, using the modified nominal group technique. Twenty-five stakeholders participated in this meeting, including researchers (n = 3), fetal medicine specialists (n = 3), obstetricians (n = 2), neonatologists (n = 3), midwives (n = 4), parents and family members (n = 6), patient group representatives (n = 3), and a sonographer. Eleven core outcomes were agreed upon. These were live birth, gestational age at birth, birth weight, intertwin birth-weight discordance, death of surviving twin after death of cotwin, loss during pregnancy or before final hospital discharge, parental stress, procedure-related adverse maternal outcome, length of neonatal stay in hospital, neurological abnormality on postnatal imaging and childhood disability. CONCLUSIONS This core outcome set for studies investigating the management of sFGR represents the consensus of a large and diverse group of international collaborators. Use of these outcomes in future trials should help to increase the clinical relevance of research on this condition. Consensus agreement on core outcome definitions and measures is now required. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Townsend
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J M N Duffy
- Balliol College, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F Sileo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - H Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - K Reed
- Twin and Multiple Births Association (TAMBA), Aldershot, UK
| | - A 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
| | - E Gratacos
- Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals of KU Leuven, Leuven, Belgium
| | - E Lopriore
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - D Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Papageorghiou
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - S J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, 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, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
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10
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Jansen LAW, Koot MH, van‘t Hooft J, Dean CR, Duffy JMN, Ganzevoort W, Gauw N, Goes BY, Rodenburg J, Roseboom TJ, Painter RC, Grooten IJ. A core outcome set for hyperemesis gravidarum research: an international consensus study. BJOG 2020; 127:983-992. [DOI: 10.1111/1471-0528.16172] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
Affiliation(s)
- LAW Jansen
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
- Department of Obstetrics and Gynaecology Franciscus Gasthuis Rotterdam the Netherlands
| | - MH Koot
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - J van‘t Hooft
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - CR Dean
- Pregnancy Sickness Support Bodmin UK
| | - JMN Duffy
- Institute for Women’s Health University College London London UK
| | - W Ganzevoort
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - N Gauw
- Dutch Hyperemesis Gravidarum Patient Foundation (ZEHG) Dussen the Netherlands
| | - BY Goes
- Department of Obstetrics and Gynaecology Leiden University Medical Centre Leiden the Netherlands
| | - J Rodenburg
- General practice Czaar Peter Medical Centre Amsterdam the Netherlands
| | - TJ Roseboom
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - RC Painter
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - IJ Grooten
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
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11
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Townsend R, Duffy JMN, Khalil A. Increasing value and reducing research waste in obstetrics: towards woman-centered research. Ultrasound Obstet Gynecol 2020; 55:151-156. [PMID: 30980569 DOI: 10.1002/uog.20294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/24/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Affiliation(s)
- R Townsend
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J M N Duffy
- Balliol College, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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12
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Lam JR, Liu B, Bhate R, Fenwick N, Reed K, Duffy JMN, Khalil A. Research priorities for the future health of multiples and their families: The Global Twins and Multiples Priority Setting Partnership. Ultrasound Obstet Gynecol 2019; 54:715-721. [PMID: 31600847 DOI: 10.1002/uog.20858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 05/27/2023]
Affiliation(s)
- J R Lam
- Twins Research Australia, The University of Melbourne, Melbourne, Australia
| | - B Liu
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - R Bhate
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - N Fenwick
- Twins and Multiple Births Association, London, UK
| | - K Reed
- Twins and Multiple Births Association, London, UK
| | - J M N Duffy
- Institute for Women's Health, University College London, London, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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13
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Abstract
The conclusion of the Human Fertilisation and Embryology Authority that ‘add-on’ therapies in IVF are not supported by high-quality evidence has prompted new questions regarding the role of the randomized controlled trial (RCT) in evaluating infertility treatments. Critics argue that trials are cumbersome tools that provide irrelevant answers. Instead, they argue that greater emphasis should be placed on large observational databases, which can be analysed using powerful algorithms to determine which treatments work and for whom. Although the validity of these arguments rests upon the sciences of statistics and epidemiology, the discussion to date has largely been conducted without reference to these fields. We aim to remedy this omission, by evaluating the arguments against RCTs in IVF from a primarily methodological perspective. We suggest that, while criticism of the status quo is warranted, a retreat from RCTs is more likely to make things worse for patients and clinicians.
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Affiliation(s)
- J Wilkinson
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - D R Brison
- Department of Reproductive Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Maternal and Fetal Health Research Centre, Faculty of Life Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - J M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Balliol College, University of Oxford, Oxford, UK
| | - C M Farquhar
- Cochrane Gynecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - S Lensen
- Cochrane Gynecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - S Mastenbroek
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - M van Wely
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - A Vail
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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14
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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 Obstet Gynecol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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15
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Sileo FG, Duffy JMN, Townsend R, Khalil A. Variation in outcome reporting across studies evaluating interventions for selective fetal growth restriction. Ultrasound Obstet Gynecol 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] [What about the content of this article? (0)] [Affiliation(s)] [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
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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17
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Illingworth BJG, Duffy JMN. Chewing gum improves postoperative recovery of gastrointestinal function after caesarean delivery: a systematic review and meta-analysis of randomized trials. J Matern Fetal Neonatal Med 2018; 33:2310. [PMID: 30376744 DOI: 10.1080/14767058.2018.1543394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - J M N Duffy
- Balliol College, University of Oxford, Oxford, UK
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18
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Perry H, Duffy JMN, Umadia O, Khalil A. Outcome reporting across randomized trials and observational studies evaluating treatments for twin-twin transfusion syndrome: systematic review. Ultrasound Obstet Gynecol 2018; 52:577-585. [PMID: 29607558 DOI: 10.1002/uog.19068] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Twin-twin transfusion syndrome (TTTS) is associated with significant mortality and morbidity. Potential treatments for the condition require robust evaluation. The aim of this study was to evaluate outcome reporting across observational studies and randomized controlled trials assessing treatments for TTTS. METHODS Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE were searched from inception to August 2016. Observational studies and randomized controlled trials reporting outcome following treatment for TTTS in monochorionic-diamniotic twin pregnancy and monochorionic-triamniotic or dichorionic-triamniotic triplet pregnancy were included. Outcome reporting was systematically extracted and categorized. RESULTS Six randomized trials and 94 observational studies were included, reporting data from 20 071 maternal participants and 3199 children. Six different treatments were evaluated. Included studies reported 62 different outcomes, including six fetal, seven offspring mortality, 25 neonatal, six early childhood and 18 maternal/operative outcomes. Outcomes were reported inconsistently across trials. For example, when considering offspring mortality, 31 (31%) studies reported live birth, 31 (31%) reported intrauterine death, 49 (49%) reported neonatal mortality and 17 (17%) reported perinatal mortality. Four (4%) studies reported respiratory distress syndrome. Only 19 (19%) studies were designed for long-term follow-up and 11 (11%) of these reported cerebral palsy. CONCLUSIONS Studies evaluating treatments for TTTS have often neglected to report clinically important outcomes, especially neonatal morbidity outcomes, and most are not designed for long-term follow-up. The development of a core outcome set could help standardize outcome collection and reporting in TTTS studies. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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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, Radcliffe Observatory Quarter, Oxford, UK
- Balliol College, University of Oxford, Oxford, UK
| | - O Umadia
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - 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
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19
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Wilkinson J, Bhattacharya S, Duffy JMN, Kamath MS, Marjoribanks J, Repping S, Vail A, Wely M, Farquhar CM. Reproductive medicine: still moreARTthan science? BJOG 2018; 126:138-141. [DOI: 10.1111/1471-0528.15409] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- J Wilkinson
- Centre for Biostatistics University of Manchester Manchester UK
| | - S Bhattacharya
- College of Biomedical and Life Sciences Cardiff University School of Medicine Cardiff UK
| | - JMN Duffy
- Primary Care Health Sciences University of Oxford Oxford UK
- Balliol College University of Oxford Oxford UK
| | - MS Kamath
- Reproductive Medicine Unit Christian Medical College Vellore India
| | - J Marjoribanks
- Cochrane Gynecology and Fertility Group University of Auckland Auckland New Zealand
| | - S Repping
- Centre for Reproductive Medicine Academic Medical Centre University of Amsterdam Amsterdam the Netherlands
| | - A Vail
- Centre for Biostatistics University of Manchester Manchester UK
| | - M Wely
- Centre for Reproductive Medicine Academic Medical Centre University of Amsterdam Amsterdam the Netherlands
| | - CM Farquhar
- Cochrane Gynecology and Fertility Group University of Auckland Auckland New Zealand
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20
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Duffy JMN, Bhattacharya S, Curtis C, Evers JLH, Farquharson RG, Franik S, Khalaf Y, Legro RS, Lensen S, Mol BW, Niederberger C, Ng EHY, Repping S, Strandell A, Torrance HL, Vail A, van Wely M, Vuong NL, Wang AY, Wang R, Wilkinson J, Youssef MA, Farquhar CM. A protocol developing, disseminating and implementing a core outcome set for infertility. Hum Reprod Open 2018; 2018:hoy007. [PMID: 30895248 PMCID: PMC6276643 DOI: 10.1093/hropen/hoy007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/12/2018] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTIONS We aim to produce, disseminate and implement a core outcome set for future infertility research. WHAT IS KNOWN ALREADY Randomized controlled trials (RCTs) evaluating infertility treatments have reported many different outcomes, which are often defined and measured in different ways. Such variation contributes to an inability to compare, contrast and combine results of individual RCTs. The development of a core outcome set will ensure outcomes important to key stakeholders are consistently collected and reported across future infertility research. STUDY DESIGN, SIZE, DURATION This is a consensus study using the modified Delphi method. All stakeholders, including healthcare professionals, allied healthcare professionals, researchers and people with lived experience of infertility will be invited to participate. PARTICIPANTS/MATERIALS, SETTING, METHODS An international steering group, including people with lived experience of infertility, healthcare professionals, allied healthcare professionals and researchers, has been formed to guide the development of this core outcome set. Potential core outcomes have been identified through a comprehensive literature review of RCTs evaluating treatments for infertility and will be entered into a modified Delphi method. Participants will be asked to score potential core outcomes on a nine-point Likert scale anchored between one (not important) and nine (critical). Repeated reflection and rescoring should promote convergence towards consensus ‘core’ outcomes. We will establish standardized definitions and recommend high-quality measurement instruments for individual core outcomes. STUDY FUNDING/COMPETING INTEREST(S) This project is funded by the Royal Society of New Zealand Catalyst Fund (3712235). BWM reports consultancy fees from Guerbet, Merck, and ObsEva. R.S.L. reports consultancy fees from Abbvie, Bayer, Fractyl and Ogeda and research sponsorship from Ferring. S.B. is the Editor-in-Chief of Human Reproduction Open. The remaining authors declare no competing interests.
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Affiliation(s)
- J M N Duffy
- Balliol College, University of Oxford, Oxford, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S Bhattacharya
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - C Curtis
- Fertility New Zealand, Auckland, New Zealand.,School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Centre for Reproductive Medicine and Biology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - Y Khalaf
- Assisted Conception Unit, Guy's Hospital, London, UK
| | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, PA, USA
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - B W Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Australia
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
| | - S Repping
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Academic Medical Centre, Amsterdam, The Netherlands
| | - A Strandell
- Sahlgrenska University Hospital, Göteborg, Sweden
| | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - M van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Academic Medical Centre, Amsterdam, The Netherlands
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Faculty of Health, University of Technology Sydney, Broadway, Australia
| | - R Wang
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - M A Youssef
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - C M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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Hirsch M, Begum MR, Paniz É, Barker C, Davis CJ, Duffy JMN. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 2017; 125:556-564. [DOI: 10.1111/1471-0528.14838] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 12/13/2022]
Affiliation(s)
- M Hirsch
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
- Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Trust; London UK
| | - MR Begum
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
| | - É Paniz
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
| | - C Barker
- Radcliffe Women's Health Patient and Public Involvement Group; University of Oxford; Oxford UK
| | - CJ Davis
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
| | - JMN Duffy
- Balliol College; University of Oxford; Oxford UK
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
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Duffy JMN, Rolph R, Gale C, Hirsch M, Khan KS, Ziebland S, McManus RJ. Core outcome sets in women's and newborn health: a systematic review. BJOG 2017; 124:1481-1489. [DOI: 10.1111/1471-0528.14694] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- JMN Duffy
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - R Rolph
- Department of Plastic and Reconstructive Surgery; Kings College London; London UK
| | - C Gale
- Neonatal Medicine; Faculty of Medicine; Imperial College London; London UK
| | - M Hirsch
- Women's Health Research Unit; Queen Mary; University of London; London UK
| | - KS Khan
- Women's Health Research Unit; Queen Mary; University of London; London UK
| | - S Ziebland
- 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
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Duffy JMN, Hirsch M, Kawsar A, Gale C, Pealing L, Plana MN, Showell M, Williamson PR, Khan KS, Ziebland S, McManus RJ. Outcome reporting across randomised controlled trials evaluating therapeutic interventions for pre-eclampsia. BJOG 2017; 124:1829-1839. [DOI: 10.1111/1471-0528.14702] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 02/05/2023]
Affiliation(s)
- JMN Duffy
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - M Hirsch
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
- Royal Free London NHS Trust; London UK
| | - A Kawsar
- Royal Free London NHS Trust; London UK
| | - C Gale
- Neonatal Medicine; Faculty of Medicine; Imperial College London; London UK
| | - L Pealing
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - MN Plana
- Clinical Biostatistics Unit; Ramon y Cajal Institute of Research and Centro de Investigación Biomédica en Red Epidemiology and Public Health; Madrid Spain
| | - M Showell
- Cochrane Gynaecology and Fertility Group; University of Auckland; Auckland New Zealand
| | - PR Williamson
- MRC North West Hub for Trials Methodology Research; Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - KS Khan
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
| | - S Ziebland
- 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
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Duffy JMN, Bhattacharya S, Herman M, Mol B, Vail A, Wilkinson J, Farquhar C. Reducing research waste in benign gynaecology and fertility research. BJOG 2017; 124:366-369. [DOI: 10.1111/1471-0528.14438] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2016] [Indexed: 01/08/2023]
Affiliation(s)
- JMN Duffy
- Balliol College University of Oxford Oxford UK
- Primary Care Health Sciences University of Oxford Oxford UK
| | - S Bhattacharya
- The Institute of Applied Health Sciences University of Aberdeen Aberdeen UK
| | - M Herman
- Department of Obstetrics and Gynaecology Máxima Medical Centre Veldhoven the Netherlands
| | - B Mol
- Robinson Research Institute University of Adelaide Adelaide SA Australia
| | - A Vail
- Centre for Biostatistics University of Manchester Manchester UK
| | - J Wilkinson
- Centre for Biostatistics University of Manchester Manchester UK
| | - C Farquhar
- Cochrane Gynecology and Fertility Group University of Auckland Auckland New Zealand
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Duffy JMN, McManus RJ. Influence of methodology upon the identification of potential core outcomes: recommendations for core outcome set developers are needed. BJOG 2016; 123:1599. [DOI: 10.1111/1471-0528.14219] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- JMN Duffy
- 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
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Duffy JMN, Chequer S, Braddy A, Mylan S, Royuela A, Zamora J, Ip J, Hayden S, Showell M, Kinnersley P, Chenoy R, Westwood OM, Khan KS, Cushing A. Educational effectiveness of gynaecological teaching associates: a multi-centre randomised controlled trial. BJOG 2016; 123:1005-10. [PMID: 26776314 DOI: 10.1111/1471-0528.13824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate, among medical students learning the female pelvic examination, the added benefits of training by gynaecological teaching associates compared with training involving a manikin only. DESIGN Randomised controlled trial. SETTING Nine university teaching hospitals. POPULATION Ninety-four medical students recruited prior to commencing a 4-week obstetrics and gynaecology rotation. METHODS The control training consisted of lectures, demonstration of the pelvic examination on a manikin, and opportunities to practise on this low-fidelity simulation (n = 40). The experimental group received additional gynaecological teaching associate training, delivered by pairs of experienced associates to groups of four medical students (n = 54). MAIN OUTCOME MEASURES Outcomes measured at the end of the rotation included knowledge of the correct order of examination components (Yes/No), and student comfort [Likert scales anchored between 1 (very uncomfortable) and 4 (very comfortable) on four items] and confidence [Likert scales anchored between 1 (No) and 3 (Yes) on six items]. The primary outcome, measured at the end of the academic year, was the objective structured clinical examination of a female pelvis (score range 0-54). RESULTS At baseline, the groups were similar in age, gender, and ethnicity. At the end of the clinical rotation, when compared with the control intervention, the experimental intervention had a moderate effect on student knowledge [difference 29.9% (95% CI 11.2-48.6%); P = 0.002] and confidence [difference 1 (95% CI 0-2); P < 0.001], and a large effect on student comfort [difference 1.8 (95% CI 0.6-3.0); P = 0.004]. At the end of the academic year, the experimental intervention had no impact on skills compared with the control [difference 2 (95% CI-1 to 4); P = 0.26]. CONCLUSIONS Among medical students taught the female pelvic examination by low-fidelity simulation, additional training by gynaecology teaching associates improved knowledge, comfort, and confidence at the end of the clinical rotation but did not improve examination skills at end of the academic year.
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Affiliation(s)
- J M N Duffy
- Balliol College, University of Oxford, Oxford, UK
| | | | - A Braddy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Mylan
- Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - A Royuela
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
| | - J Zamora
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
| | - J Ip
- Department of Obstetrics and Gynaecology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - S Hayden
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
| | - M Showell
- Cochrane Menstrual Disorders and Subfertility Group, University of Auckland, Auckland, New Zealand
| | - P Kinnersley
- Institute of Medical Education, Cardiff University, Cardiff, UK
| | - R Chenoy
- Women's Health Research Unit, Queen Mary, University of London, London, UK
| | - O M Westwood
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
| | - K S Khan
- Women's Health Research Unit, Queen Mary, University of London, London, UK
| | - A Cushing
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
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Liang H, Li L, Yuan W, Zou Y, Gao ES, Duffy JMN, Wu SC. Dimensions of the endometrial cavity and intrauterine device expulsion or removal for displacement: a nested case-control study. BJOG 2014; 121:997-1004. [DOI: 10.1111/1471-0528.12619] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 11/26/2022]
Affiliation(s)
- H Liang
- Department of Reproductive Epidemiology and Social Science; National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices; Shanghai Institute of Planned Parenthood Research; Shanghai China
| | - L Li
- National Research Institute for Family Planning; Beijing China
| | - W Yuan
- Department of Reproductive Epidemiology and Social Science; National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices; Shanghai Institute of Planned Parenthood Research; Shanghai China
| | - Y Zou
- National Research Institute for Family Planning; Beijing China
| | - E-S Gao
- Department of Reproductive Epidemiology and Social Science; National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices; Shanghai Institute of Planned Parenthood Research; Shanghai China
| | - JMN Duffy
- Women's Health Research Unit; Centre for Primary Care and Public Health; Blizard Institute; Barts and The London School of Medicine and Dentistry; London UK
| | - S-C Wu
- National Research Institute for Family Planning; Beijing China
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Abstract
BACKGROUND Pelvic adhesion can form as a result of inflammation, endometriosis or surgical trauma. During pelvic surgery, strategies to reduce pelvic adhesion formation may include placing synthetic barrier agents such as oxidised regenerated cellulose, polytetrafluoroethylene or Fibrin sheets between the pelvic structures. OBJECTIVES To assess the effect of physical barriers used during pelvic surgery in women of reproductive age on pregnancy rates, pelvic pain, or postoperative adhesion reformation. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched September 2007) which is based on regular searches of MEDLINE, EMBASE, CINAHL, PsycINFO and CENTRAL, plus handsearching of 20 relevant journals and conference proceedings, and searches of several key grey literature sources. In addition, companies were contacted for unpublished trials. SELECTION CRITERIA Any randomised controlled trials (RCTs) comparing the use of physical barriers versus no treatment or other physical barriers in the prevention of adhesions in women undergoing gynaecological surgery. DATA COLLECTION AND ANALYSIS Review authors assessed trial eligibility and quality. MAIN RESULTS Sixteen RCTs were included. Five trials randomised patients while the remainder randomised pelvic organs. Laparoscopy (six trials) and laparotomy (10 trials) were the primary surgical techniques. Indications for surgery included myomectomy (five trials), ovarian surgery (five trials), pelvic adhesions (four trials), endometriosis (one trial), and mixed (one trial). Eleven trials assessed Interceed versus no treatment, two assessed Interceed versus Gore-Tex, one trial assessed Gore-Tex versus no treatment, and one trial assessed Seprafilm versus no treatment. A single trial assessed Fibrin sheet versus no treatment. No studies reported pregnancy or reduction in pain as outcomes. The use of Interceed was associated with reduced incidence of pelvic adhesion formation, both new formation and reformation following laparoscopic surgery or laparotomy. However, this result should be interpreted with caution. Gore-Tex was more effective than no barrier or Interceed in preventing adhesion formation. There was only limited evidence that Seprafilm was effective in preventing adhesion formation following myomectomy and no evidence to support Fibrin sheet. AUTHORS' CONCLUSIONS The absorbable adhesion barrier Interceed reduces the incidence of adhesion formation following laparoscopy and laparotomy, but there are insufficient data to support its use to improve pregnancy rates. Gore-Tex may be superior to Interceed in preventing adhesion formation but its usefulness is limited by the need for suturing and later removal. There was no evidence of effectiveness of Seprafilm and Fibrin sheet in preventing adhesion formation.
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Affiliation(s)
- G Ahmad
- Stepping Hill Hospital, Obstetric & Gynaecology, 30 Badger Road, Altrincham, Cheshire, UK, WA14 5UZ.
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Abstract
BACKGROUND Laparoscopy is a very common procedure in gynaecology. Complications associated with laparoscopy are often related to entry. The life-threatening complications include injury to the bowel, bladder, major abdominal vessels, and anterior abdominal-wall vessel. Other less serious complications can also occur, such as post-operative infection, subcutaneous emphysema and extraperitoneal insufflation. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. OBJECTIVES The objective of this study was to compare the different laparoscopic entry techniques in terms of their influence on intra-operative and post-operative complications. SEARCH STRATEGY This review has drawn on the search strategy developed by the Menstrual Disorders and Subfertility Group. In addition MEDLINE and EMBASE were searched through to July, 2007. SELECTION CRITERIA Randomised controlled trials were included when one laparoscopic primary-port-entry technique was compared with another. DATA COLLECTION AND ANALYSIS Data were extracted independently by the first two authors. Differences of opinion were registered and resolved by the fourth author. Results for each study were expressed as odds ratio (Peto version) with their 95% confidence intervals. MAIN RESULTS The 17 included randomised controlled trials concerned 3,040 individuals undergoing laparoscopy. Overall there was no evidence of advantage using any single technique in terms of preventing major complications. However, there were two advantages with direct-trocar entry when compared with Veress-Needle entry, in terms of avoiding extraperitoneal insufflation (OR 0.06, 95%CI 0.02, 0.23) and failed entry (OR 0.22, 95%CI 0.08, 0.56). There was also an advantage with radially expanding access system (STEP) trocar entry when compared with standard trocar entry, in terms of trocar site bleeding (OR 0.06, 95%CI 0.01, 0.46). Finally, there was an advantage of not lifting the abdominal wall before Veress-Needle insertion when compared to lifting in terms of failed entry without an increase in the complication rate (OR 5.17, 95%CI 2.24, 11.90). However, studies were limited to small numbers, excluding many patients with previous abdominal surgery and women with a raised body mass index, who often had unusually high complication rates. AUTHORS' CONCLUSIONS On the basis of evidence investigated in this review, there appears to be no evidence of benefit in terms of safety of one technique over another. However, the included studies are small and cannot be used to confirm safety of any particular technique.
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Affiliation(s)
- G Ahmad
- Stepping Hill Hospital, Obstetric & Gynaecology, 30 Badger Road, Altrincham, Cheshire, UK, WA14 5UZ.
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Ahmad G, Duffy JMN, Watson AJS. Laparoscopic entry techniques and complications. Int J Gynaecol Obstet 2007; 99:52-5. [PMID: 17628561 DOI: 10.1016/j.ijgo.2007.04.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 04/23/2007] [Accepted: 04/26/2007] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify laparoscopic entry techniques employed by gynecologists in the United Kingdom to determine if the consensus technique is adhered to, and to observe whether entry technique affects complication rate. METHOD An anonymous postal questionnaire was sent to gynecologists with an interest in laparoscopic surgery in the United Kingdom. RESULTS At total of 568 questionnaires were sent and 345 (60.7%) were returned. Of gynecologists who returned the questionnaire 194 (57%) reported occurrence of a major bowel or vascular complication. In terms of the key elements of the consensus document there was no significant difference in entry technique used between those that reported major injury (vascular, bowel, or both), and those that did not. CONCLUSIONS This survey demonstrates the variation in entry techniques used by gynecologists in the United Kingdom. Without a good evidence-base to the contrary no entry technique can be stated as safer than another.
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Affiliation(s)
- G Ahmad
- Department of Obstetrics and Gynaecology, Burnley General Hospital, Burnley, UK.
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