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Watkins S, Isichei O, Gentles TL, Brown R, Percival T, Sadler L, Gorinski R, Crengle S, Cloete E, de Laat MWM, Bloomfield FH, Ward K. What is Known About Critical Congenital Heart Disease Diagnosis and Management Experiences from the Perspectives of Family and Healthcare Providers? A Systematic Integrative Literature Review. Pediatr Cardiol 2023; 44:280-296. [PMID: 36125507 PMCID: PMC9895021 DOI: 10.1007/s00246-022-03006-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
The experience of diagnosis, decision-making and management in critical congenital heart disease is layered with complexity for both families and clinicians. We synthesise the current evidence regarding the family and healthcare provider experience of critical congenital heart disease diagnosis and management. A systematic integrative literature review was conducted by keyword search of online databases, MEDLINE (Ovid), PsycINFO, Cochrane, cumulative index to nursing and allied health literature (CINAHL Plus) and two journals, the Journal of Indigenous Research and Midwifery Journal from 1990. Inclusion and exclusion criteria were applied to search results with citation mining of final included papers to ensure completeness. Two researchers assessed study quality combining three tools. A third researcher reviewed papers where no consensus was reached. Data was coded and analysed in four phases resulting in final refined themes to summarise the findings. Of 1817 unique papers, 22 met the inclusion criteria. The overall quality of the included studies was generally good, apart from three of fair quality. There is little information on the experience of the healthcare provider. Thematic analysis identified three themes relating to the family experience: (1) The diagnosis and treatment of a critical congenital heart disease child significantly impacts parental health and wellbeing. (2) The way that healthcare and information is provided influences parental response and adaptation, and (3) parental responses and adaptation can be influenced by how and when support occurs. The experience of diagnosis and management of a critical congenital heart disease child is stressful and life-changing for families. Further research is needed into the experience of minority and socially deprived families, and of the healthcare provider, to inform potential interventions at the healthcare provider and institutional levels to improve family experience and support.
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Affiliation(s)
- S. Watkins
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - O. Isichei
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | | - R. Brown
- National Hauora Coalition, Auckland, New Zealand
| | - T. Percival
- Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | | | - R. Gorinski
- Heart Kids New Zealand, Tamariki Manawa Maia, Auckland, New Zealand
| | - S. Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - E. Cloete
- Te Whatu Ora, Christchurch, New Zealand
| | | | - F. H. Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - K. Ward
- School of Nursing, The University of Auckland, Auckland, New Zealand
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2
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Uthayakumaran G, Sadler L, Stein-de Laat M, Bloomfield F, Gentles T. Congenital Heart Disease in Stillborn Fetuses in New Zealand: A 10 Year Retrospective Review. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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3
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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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4
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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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Soszyn N, Cloete E, Sadler L, Laat MSD, Crengle S, Bloomfield F, Gentles T. Does Disease Severity Contribute to Disparity in Outcome Amongst Ethnic Groups in Patients with Hypoplastic Left Heart syndrome in New Zealand? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- M R Ordway
- Yale University School of Nursing, West Haven, CT
| | - S Jeon
- Yale University, Yale University School of Nursing, CT
| | - L Sadler
- Yale University, Yale Univeristy School of Nursing, CT
| | - C Canapari
- Yale University, Yale University School of Medicine, CT
| | - N Redeker
- Yale University, Yale University School of Nursing, CT
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7
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Ordway MR, Jeon S, Canapari C, Sadler L, Redeker N. 0998 PARENTING INTERACTIVE BEDTIME BEHAVIORS AND SLEEP AMONG TODDLERS LIVING IN SOCIOECONOMICALLY DISADVANTAGED HOMES. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Gallagher R, Gallagher P, Zhang L, Kirkness A, Glinatsis H, Roach K, Belshaw J, Sadler L, Neubeck L. Technology Use and Confidence in Cardiac Rehabilitation Patients. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Battin M, Sadler L, Masson V, Farquhar C. Neonatal encephalopathy in New Zealand: Demographics and clinical outcome. J Paediatr Child Health 2016; 52:632-6. [PMID: 27148886 DOI: 10.1111/jpc.13165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/03/2015] [Accepted: 01/07/2016] [Indexed: 11/26/2022]
Abstract
AIM To establish the incidence of moderate to severe neonatal encephalopathy (NE) in term infants from New Zealand and to document demographic characteristics and neonatal outcomes. METHODS Cases were reported monthly via the New Zealand Paediatric Surveillance Unit (NZPSU). Data were collected from paediatricians for neonatal items and lead maternity carers for pregnancy and birth details. Term neonatal deaths in the Perinatal and Maternal Mortality Review Committee dataset that were because of hypoxia and/or neonatal deaths from hypoxic ischaemic encephalopathy were added to the cases identified via the NZPSU, if they had not previously been ascertained. RESULTS For the period January 2010 to December 2012, there were 227 cases, equivalent to a rate of 1.30/1000 term births (95% CI 1.14-1.48). Rates of NE were high in babies of Pacific and Indian mothers but only reached statistical significance for the comparison between Pacific and NZ European. There was also a significant increase in NE rates with increasing deprivation. Resuscitation at birth was initiated for 209 (92.1%) infants with NE. Mechanical ventilation was required, following neonatal unit admission, in 171 (75.3%) infants. Anticonvulsants were used in 157 (69.2%) infants with phenobarbitone (65.6%), phenytoin (14.5%) and benzodiazapines (21.1%), the most common. Cooling was induced in 168 infants (74%) with 145 (86.3%) reported as commenced within a 6-h window. CONCLUSIONS The rate of NE in New Zealand is consistent with reported international rates. Establishing antecedent factors for NE is an important part of improving care, which may inform strategic efforts to decrease rates of NE.
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Affiliation(s)
- M Battin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - L Sadler
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.,Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Perinatal and Maternal Mortality Review Committee (PMMRC), Health Quality and Safety Commission, Wellington, New Zealand
| | - V Masson
- Perinatal and Maternal Mortality Review Committee (PMMRC), Health Quality and Safety Commission, Wellington, New Zealand
| | - C Farquhar
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.,Perinatal and Maternal Mortality Review Committee (PMMRC), Health Quality and Safety Commission, Wellington, New Zealand.,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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Lensen S, Sadler L, Farquhar C. Endometrial scratching for subfertility: everyone's doing it. Hum Reprod 2016; 31:1241-4. [PMID: 27008891 DOI: 10.1093/humrep/dew053] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 12/21/2015] [Accepted: 02/26/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What proportion of clinicians across Australia, New Zealand and the UK are currently offering or recommending endometrial scratching for subfertility? SUMMARY ANSWER Eighty-three percent of clinicians responding to this survey are recommending endometrial scratching to women undergoing IVF. WHAT IS KNOWN ALREADY Endometrial scratching is currently being proposed as a technique to increase the probability of implantation in women undergoing IVF. While trial results provide evidence in favour of this procedure, there remains some uncertainty about both the extent of any beneficial effect and the subgroups of women most likely to benefit. STUDY DESIGN, SIZE, DURATION Cross-sectional survey with responses from a total of 143 public and private fertility care providers surveyed between August and October 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS An online survey was distributed to all 189 fertility clinics across Australia, New Zealand and the UK. All clinicians, nurses and embryologists were eligible to take part. One hundred and forty-three of the 152 responses received were eligible for inclusion, with multiple responses per clinic in 33 cases. At least one response was received from 68 clinics (36% response rate per clinic). MAIN RESULTS AND THE ROLE OF CHANCE This survey found that 83% of clinicians commend endometrial scratching prior to IVF. Of these, 92% recommend endometrial scratching to women with recurrent implantation failure (RIF) and 6% recommend it to all women having IVF. Most respondents (73%) agreed that the procedure is beneficial in women with RIF undergoing IVF and disagreed (53%) that the procedure is beneficial for women undergoing their first IVF cycle. The most common timeframe for performing endometrial scratching is the luteal phase of the cycle prior to the IVF cycle. Additionally, only 4% of clinicians recommend endometrial scratching to women undergoing intrauterine insemination or trying to conceive naturally. LIMITATIONS, REASONS FOR CAUTION Fertility care providers who recommend endometrial scratching may be more likely to respond to the survey and this could exaggerate the use of the procedure reported here. WIDER IMPLICATIONS OF THE FINDINGS This study was conducted across three countries and may be generalizable to similar settings. While this procedure already appears to be offered by the majority of respondents, the results of further studies in this area may further refine or expand the context in which this procedure is beneficial. STUDY FUNDING/COMPETING INTERESTS No funding or competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Lensen
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - L Sadler
- Women's Health, Auckland District Health Board, Auckland, New Zealand
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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Carmona-Vicente N, Buesa J, Brown PA, Merga JY, Darby AC, Stavisky J, Sadler L, Gaskell RM, Dawson S, Radford AD. Phylogeny and prevalence of kobuviruses in dogs and cats in the UK. Vet Microbiol 2013; 164:246-52. [PMID: 23490561 PMCID: PMC7127238 DOI: 10.1016/j.vetmic.2013.02.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/13/2013] [Accepted: 02/15/2013] [Indexed: 01/12/2023]
Abstract
The kobuviruses represent an emerging genus in the Picornaviridae. Here we have used next generation sequencing and conventional approaches to identify the first canine kobuvirus (CaKoV) from outside the USA. Phylogenetic analysis suggests that a single lineage genotype of CaKoV now exists in Europe and the USA with 94% nucleotide similarity in the coding region. CaKoV was only identified in a single case from a case–control study of canine diarrhoea, suggesting this virus was not a frequent cause of disease in this population. Attempts to grow CaKoV in cell culture failed. Sequence analysis suggested CaKoV was distinct from human Aichi virus (AiV), and unlikely to pose a significant zoonotic risk. Serosurveys by ELISA, immunofluorescence and neutralisation tests, using AiV as antigen, suggested kobuvirus infection is prevalent in dogs. In addition, IgG antibody to AiV was also detected in cat sera, indicating for the first time that cats may also be susceptible to kobuvirus infection.
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Affiliation(s)
- N Carmona-Vicente
- Department of Microbiology, School of Medicine, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
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Abstract
AIMS To compare maternal and neonatal outcomes in women with gestational diabetes treated with diet, metformin and/or insulin in routine clinical practice in a single centre. METHODS We analysed prospectively collected data from the National Women's Health database for all women with gestational diabetes who delivered between January 2007 and December 2009. Since June 2007, women requiring medication have been given a choice of either metformin or insulin treatment, except women with a fetal abdominal circumference less than the 10th percentile, who were not offered metformin. RESULTS There were 1269 women with gestational diabetes; treatment was diet in 371, insulin in 399 and metformin in 465 (249 metformin alone, 216 metformin and insulin). Women treated with metformin and/or insulin had significantly higher BMIs compared with those in the diet group (P < 0.001) and had a higher fasting glucose at diagnosis (p < 0.001). Women treated with insulin had higher rates of Caesarean delivery (45.6% insulin, 37% metformin, 34% diet, P = 0.02) than women treated with metformin or diet. They also had higher rates of preterm births (19.2% insulin, 12.5% metformin, 12.1% diet, P = 0.005), customized large-for-gestational-age infants (18.5% insulin, 12.5% metformin, 12.4% diet, P = 0.02), neonatal admissions (18.7% insulin, 12.7% metformin, 14.0% diet, P = 0.04) and neonatal intravenous dextrose use (11.1% insulin, 5.1% metformin, 7.4% diet, P = 0.004). Neonatal outcomes were similar between diet- and metformin-treated women. CONCLUSIONS In routine practice, use of metformin in gestational diabetes was associated with fewer adverse outcomes compared with insulin, but baseline differences between treatment groups may have contributed to this.
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Affiliation(s)
- J E L Goh
- Department of Endocrinology, Auckland Hospital, Auckland, New Zealand
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Abstract
Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties.
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Gallagher R, Belshaw J, Kirkness A, Roach K, Sadler L, Warrington D. Brief, Standardised Education Incorporating the National Heart Foundation Warning Signs of Heart Attack Materials Improves Knowledge and Chest Pain Action Plans in Patients with Coronary Heart Disease. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Increased maternal age is associated with pregnancy complications and there are few data available on neonatal outcome and utilization of neonatal resources. Our first aim was to use national New Zealand data to determine if the outcomes following admission to NICU are different for infants born to women aged 40 years and over, compared with those born to women under 40 years of age. The second aim was to document trends in the requirement of neonatal intensive care in infants born to women aged 40 years and older. METHOD Eligible infants were identified from registration with the Australian and New Zealand Neonatal Network for 1995-2004 inclusive. The relationship between maternal age and neonatal outcome was tested using univariate and multivariate analysis, and trends in the number of infants in maternal age groups below 35 years, 35-39 years and over 40 years were determined. RESULTS On multivariate analysis using logistic regression, maternal age over 40 years was not found to be associated with a significant increase in the odds ratio for the composite poor outcome. However, over the 10-year period, there was an increase in the number of admissions and the percentage of admissions of infants born to women over 40 years of age. CONCLUSION Although the number of infants admitted for neonatal care following birth to women over 40 years of age has increased, these infants do not appear to have an increased risk of severe abnormal outcome.
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Affiliation(s)
- M Battin
- Auckland City Hospital, University of Auckland, Auckland, New Zealand.
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Gallagher R, Belshaw J, Kirkness A, Roach K, Sadler L, Warrington D. SP6 Availability and Understanding of Short-Acting Nitrates in Coronary Artery Disease (CAD) Patients. Eur J Cardiovasc Nurs 2009. [DOI: 10.1016/s1474-5151(09)60117-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R. Gallagher
- University of Technology, Sydney, Sydney, Australia
| | - J. Belshaw
- Northern Sydney Central Coast Area Health Ser, Sydney, Australia
| | - A. Kirkness
- Northern Sydney Central Coast Area Health Ser, Sydney, Australia
| | - K. Roach
- Northern Sydney Central Coast Area Health Ser, Sydney, Australia
| | - L. Sadler
- Northern Sydney Central Coast Area Health Ser, Sydney, Australia
| | - D. Warrington
- Northern Sydney Central Coast Area Health Ser, Sydney, Australia
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Gallagher R, Belshaw J, Kirkness A, Roach K, Sadler L, Warrington D. Short Acting Nitrate Prescription and Patient Knowledge. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Groom KM, North RA, Poppe KK, Sadler L, McCowan LME. The association between customised small for gestational age infants and pre-eclampsia or gestational hypertension varies with gestation at delivery. BJOG 2007; 114:478-84. [PMID: 17378821 DOI: 10.1111/j.1471-0528.2007.01277.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES (1) To describe the association between small for gestational age (SGA) infants and pre-eclampsia (PE) and gestational hypertension (GH) and (2) to determine how this association changes with gestational age at delivery using customised centiles to classify infants as SGA. DESIGN A retrospective observational study. SETTING National Women's Hospital, a Tertiary Referral Centre in Auckland, New Zealand. POPULATION A total of 17 855 nulliparous women delivering between 1992 and 1999. METHODS A comparison of the number of women with a customised SGA infant, PE and GH according to gestational age at delivery. MAIN OUTCOME MEASURES The incidence of SGA infants (defined as birthweight <10th customised centile), PE and GH at <34, 34-36(+6) and > or =37 weeks. RESULTS A total of 1847 (10.3%) infants were SGA, 520 (2.9%) women had PE and 1361 (7.6%) had GH. SGA, PE and GH all occurred more commonly with increasing gestation at delivery with 85%, 62% and 90% of cases delivered at term. In women delivering SGA infants, coexisting PE was more likely to occur among those delivered preterm than at term (38.6% at <34 weeks [relative risk, RR 10.2 95%CI 7.3-14.4], 22.4% at 34-36(+6) weeks [RR 6.0 95%CI 4.1-8.6] and 3.8% at > or =37 weeks [OR 1.0]). Women with preterm PE were more likely to have a SGA infant than women with term PE (57.1% at <34 weeks [RR 3.1 95%CI 2.3-4.2], 31.7% at 34-36(+6) weeks [RR 1.7 95%CI 1.2-2.5]) and 18.3% at > or =37 weeks [OR 1.0]). There was a similar association between GH and SGA infants as gestation advanced (57.6% at <34 weeks [RR 4.8 95%CI 3.4-6.6], 30.5% at 34-36(+6) weeks [RR 2.5 95%CI 1.8-3.5] and 12.1% > or =37 weeks [OR 1.0]). CONCLUSIONS SGA infants and PE are more likely to coexist in preterm births compared with term births. This is likely to reflect the degree of placental involvement in each disease process.
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Affiliation(s)
- K M Groom
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, School of Population Health (Building 730), University of Auckland, Tamaki Campus, Auckland, New Zealand.
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Priest P, Sadler L, Peters J, Crengle S, Bethwaite P, Medley G, Jackson R. Pathways to diagnosis of cervical cancer: screening history, delay in follow up, and smear reading. BJOG 2007; 114:398-407. [PMID: 17166215 DOI: 10.1111/j.1471-0528.2006.01207.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to determine the most important ways to reduce incidence of and mortality from cervical cancer by a nationally co-ordinated screening programme. DESIGN Descriptive study. SETTING The New Zealand National Cervical Screening Programme: a nationally organised and co-ordinated programme. SAMPLE Women aged younger than 80 years with histologically proven primary invasive cervical cancer, including microinvasive disease, diagnosed between 1 January 2000 and 30 September 2002. Consent for access to medical records was gained for 371 of 445 eligible women (83%). A total of 359 (81%) of eligible women or their next of kin consented to interview. METHODS Data on events prior to diagnosis were obtained from routine sources, interview, medical record review and slide reread. MAIN OUTCOME MEASURES Frequency of screening in the 7 years prior to diagnosis, time from abnormal smear or symptoms to appropriate diagnostic confirmation, proportion of negative smears upgraded to high grade on reread. RESULTS Half of the 371 participants (83% of 445 eligible women) had not had a screening smear in the 3 years prior to diagnosis, and 80% were defined as inadequately screened. A maximum of 17% of women overall or within any defined subgroup experienced delays in follow up of abnormal smears or bleeding. Only 11% of women overall had had a high-grade smear, which was originally read as negative. CONCLUSIONS The most important factor in women's pathways to a diagnosis of cervical cancer was inadequate screening. While delays in diagnosis could be reduced and laboratory performance improved, priority must be given to improving uptake and frequency of screening.
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Affiliation(s)
- P Priest
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
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Johnson NP, Farquhar CM, Hadden WE, Suckling J, Yu Y, Sadler L. The FLUSH trial--flushing with lipiodol for unexplained (and endometriosis-related) subfertility by hysterosalpingography: a randomized trial. Hum Reprod 2004; 19:2043-51. [PMID: 15271870 DOI: 10.1093/humrep/deh418] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To assess the effectiveness of flushing with the oil-soluble contrast medium lipiodol in women with unexplained infertility. METHODS An open randomized controlled trial design in a single centre secondary and tertiary level infertility service setting. A total of 158 women with unexplained infertility were stratified into two populations: 96 women without confirmed endometriosis and 62 women with endometriosis who had normal Fallopian tubes and ovaries. Randomization was computer-generated, with allocation concealment by opaque sequentially numbered envelopes. Lipiodol flushing was tested versus no intervention. The main outcome measures were clinical pregnancy (assessed at 6 months following randomization) and live birth. RESULTS Lipiodol flushing resulted in a significant increase in pregnancy [48.0 versus 10.8%, relative risk (RR) 4.44, 95% confidence interval (CI) 1.61-12.21] and live birth (40.0 versus 10.8%, RR 3.70, 95% CI 1.30-10.50) rates versus no intervention for women with endometriosis, although there was no significant difference in pregnancy (33.3 versus 20.8%, RR 1.60, 95% CI 0.81-3.16) or live birth (27.1 versus 14.6%, RR 1.86, 95% CI 0.81-4.25) rates for women with unexplained infertility without confirmed endometriosis. CONCLUSIONS Lipiodol flushing is an effective treatment for couples with unexplained infertility (based on meta-analysis data), but is particularly effective for women with endometriosis who have normal Fallopian tubes and ovaries.
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Affiliation(s)
- N P Johnson
- University of Auckland Department of Obstetrics and Gynaecology, National Women's Hospital, Auckland, New Zealand.
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Farquhar CM, Sadler L, Harvey S, McDougall J, Yazdi G, Meuli K. A prospective study of the short-term outcomes of hysterectomy with and without oophorectomy. Aust N Z J Obstet Gynaecol 2002; 42:197-204. [PMID: 12069150 DOI: 10.1111/j.0004-8666.2002.00197.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the symptom profile and satisfaction rate for women undergoing hysterectomy with and without oophorectomy STUDY DESIGN Women under 46 years of age who underwent hysterectomy with (n = 266) and without oophorectomy (n = 57) were followed for six months. RESULTS Satisfaction was high at six months. In-hospital complication rates were 28% in Group 1 and 39% in Group 2 (p = 0.11). Pelvic pain was reported in more than half the women at six weeks. A reduction in constipation, diarrhoea, abdominal and pelvic pain, and depression was reported at six months. Quality of sexual function in women did not improve. New symptoms of pelvic pain or depression were present at six months in more than 16% to 37% of the women. Regrets about loss of fertility were increased at six months. CONCLUSIONS Although levels of satisfaction with the procedure of hysterectomy were high, new symptoms and regrets about the loss of fertility were commonly reported.
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Affiliation(s)
- C M Farquhar
- Department of Obstetrics and Gynaecology, National Women's Hospital, The University of Auckland, New Zealand
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Yedavalli RV, Loth F, Yardimci A, Pritchard WF, Oshinski JN, Sadler L, Charbel F, Alperin N. Construction of a physical model of the human carotid artery based upon in vivo magnetic resonance images. J Biomech Eng 2001; 123:372-6. [PMID: 11563764 DOI: 10.1115/1.1385845] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A method is described for construction of an in vitro flow model based on in vivo measurements of the lumen geometry of the human carotid bifurcation. A large-scale physical model of the vessel lumen was constructed using fused deposition modeling (a rapid prototyping technique) based on magnetic resonance (MR) images of the carotid bifurcation acquired in a healthy volunteer. The lumen negative was then used to construct a flow model for experimental studies that examined the hemodynamic environment of subject-specific geometry and flow conditions. The physical model also supplements physician insight into the three-dimensional geometry of the arterial segment, complementing the two-dimensional images obtained by MR. Study of the specific geometry and flow conditions in patients with vascular disease may contribute to our understanding of the relationship between their hemodvnamic environment and conditions that lead to the development and progression of arterial disease.
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Affiliation(s)
- R V Yedavalli
- College of Medicine, The University of Illinois at Chicago 60607, USA
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Johnson N, Busfield R, Sadler L, Lethaby A, Farquhar C. The management of menorrhagia--SMART study (Satisfaction with Mirena and Ablation: a Randomised Trial). BJOG 2001; 108:773-4. [PMID: 11467716 DOI: 10.1111/j.1471-0528.2001.00163.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Farquhar C, Arroll B, Ekeroma A, Fentiman G, Lethaby A, Rademaker L, Roberts H, Sadler L, Strid J. An evidence-based guideline for the management of uterine fibroids. Aust N Z J Obstet Gynaecol 2001; 41:125-40. [PMID: 11453261 DOI: 10.1111/j.1479-828x.2001.tb01198.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C Farquhar
- Department of Obstetrics and Gynecology, School of Medicine, University of Auckland, New Zealand
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Sadler L, McCowan L, White H, Stewart A, Bracken M, North R. Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves. BJOG 2000; 107:245-53. [PMID: 10688509 DOI: 10.1111/j.1471-0528.2000.tb11696.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Firstly, to compare pregnancy outcomes and cardiac complications in women with: 1) either mechanical or bioprosthetic valves at the mitral site; 2) mechanical valves treated with warfarin or subcutaneous heparin. Secondly, to determine pregnancy and cardiac outcomes in women with aortic homograft valves. DESIGN Historical cohort study. SETTING Greenlane Hospital, Auckland, New Zealand. POPULATION Young women (n = 255) who had valve replacements between 1972 and 1992. Seventy-nine women underwent 147 pregnancies. MAIN OUTCOME MEASURES Pregnancy loss, cardiac complications. RESULTS Pregnancy loss occurred in 59% of pregnancies with mitral mechanical valves (n = 50) and 7% with mitral bioprosthetic valves (n = 33) (RR 8 x 20, 95% CI 2 x 10-31 x 93). Pregnancy loss rate was 70% in pregnancies treated with warfarin, compared with 25% for those switched from warfarin to heparin (RR 2 x 81, 95% CI 1 x 03-7 x 73). All heparin-associated losses occurred in the first trimester, whereas there were four stillbirths with warfarin. Cardiac complications occurred in 10 pregnancies (20%) in the women with mitral mechanical valves and four (13%) with mitral bioprosthetic valves (RR 1 x 55, 95% CI 0 x 53-4 x 52). All four thromboembolic complications with mechanical valves occurred in the 14 women treated with heparin throughout pregnancy. Structural valve deterioration occurred in four pregnancies (10%) with mitral bioprosthetic valves. No cardiac complications or known pregnancy losses occurred with aortic homograft valves (n = 41). CONCLUSION The high pregnancy loss rate in women with mitral mechanical valves was associated with warfarin throughout pregnancy, whereas the thromboembolic cardiac complications were associated with heparin. Pregnancy outcome was very good in women with bioprosthetic and homograft valves.
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Affiliation(s)
- L Sadler
- Department of Obstetrics and Gynaecology, University of Auckland, New Zealand
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Sadler L, Belanger K, Saftlas A, Leaderer B, Hellenbrand K, McSharry JE, Bracken MB. Environmental tobacco smoke exposure and small-for-gestational-age birth. Am J Epidemiol 1999; 150:695-705. [PMID: 10512423 DOI: 10.1093/oxfordjournals.aje.a010072] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this analysis was to examine the effect of environmental tobacco smoke exposure on the risk of small-for-gestational-age (SGA) birth. The study population included 2,283 nonsmokers from a nested cohort study undertaken in southern Connecticut from 1988 to 1992. The duration and intensity of exposures incurred at multiple locations during the third trimester of pregnancy were measured by postpartum interview. The effect of exposure on birth weight and on incidence of SGA birth was assessed by multivariate logistic and linear regression. An estimated 26.5% of the women had been exposed to environmental tobacco smoke for at least 1 hour per week during the third trimester. The median duration of exposure among the exposed over all locations was 5 hours per week. The adjusted odds ratio for SGA birth in exposed mothers compared with unexposed mothers, using a dichotomous exposure variable, was 0.82 (95% confidence interval: 0.51, 1.33). The adjusted birth weight difference associated with exposure was -1.2 g (95% confidence interval: -43.3, 41.0). No effect of environmental tobacco smoke exposure on fetal growth was seen in this relatively homogeneous upper middle class group of women exposed at low levels. This is reassuring for women exposed at low levels, but it does not exclude the possibility of an effect in women exposed to higher levels of environmental tobacco smoke.
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Affiliation(s)
- L Sadler
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
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Abstract
BACKGROUND The type of cardiac valve replacement associated with the lowest health risks for young women who may undergo pregnancies is unknown. We investigated which valve type was associated with greatest patient and valve survival and the effect of pregnancy on valve loss. METHODS AND RESULTS In this retrospective study, all women 12 to 35 years old who underwent valve replacements between 1972 and 1992 at Greenlane Hospital were identified, and follow-up was available in 93%. The 232 women were followed up for 1499 patient-years. Ten-year survival of women with mechanical (n=178), bioprosthetic (n=73), and homograft (n=72) valves was 70% (95% CI, 59% to 83%), 84% (95% CI, 72% to 99%), and 96% (95% CI, 91% to 100%), P=0.002. After adjustment for confounding variables, the relative risk (RR) of death with mechanical compared with bioprosthetic valves was 2.17 (95% CI, 0.78 to 5.88). Thromboembolic events occurred in 45% of women with mechanical valves within 5 years, compared with 13% with bioprosthetic valves, P=0.0001. Valve loss at 10 years was higher in bioprosthetic valves [82% (95% CI, 62% to 92%)] than in mechanical [29% (95% CI, 17% to 39%)] or homograft [28% (95% CI, 12% to 41%)] valves, P=0.0001. Pregnancy was not associated with increased bioprosthetic (RR, 0.96; 95% CI, 0.68 to 1. 35), homograft (RR, 0.65; 95% CI, 0.37 to 1.13), or mechanical (RR, 0.54; 95% CI, 0.27 to 1.08) valve loss. CONCLUSIONS Although 10-year valve survival was greater with mechanical than bioprosthetic valves, mechanical valves may be associated with reduced patient survival in young women. Thromboembolic complications, often with long-term sequelae, were common with mechanical valves. Pregnancy did not increase structural deterioration or reduce survival of bioprosthetic valves.
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Affiliation(s)
- R A North
- Department of Obstetrics and Gynaecology, University of Auckland, New Zealand.
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Juszczak L, Sadler L. Adolescent development: setting the stage for influencing health behaviors. Adolesc Med 1999; 10:1-11, v. [PMID: 10086162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Adolescent development is viewed as the overarching framework for approaching disease prevention and health promotion. This chapter is a review of salient developmental issues in adolescence, identification of the potential effects of adolescent development on health behaviors, identification of conceptual and theoretical frameworks to address the behaviors, and suggestions for the timing and tailoring of interventions to prevent health risk behaviors and promote health.
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Affiliation(s)
- L Juszczak
- Yale University School of Nursing, New Haven, Connecticut, USA
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Knox AJ, Sadler L, Pattison NS, Mantell CD, Mullins P. An obstetric scoring system: its development and application in obstetric management. Obstet Gynecol 1993; 81:195-9. [PMID: 8423949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To develop a statistically derived but clinically usable antenatal risk scoring system. METHODS Data from 20,985 pregnancies were statistically analyzed to identify significant risk factors. Logistic regression analysis was then used to produce a final scoring system, which was subsequently tested for validity on a separate population of 3120 pregnancies. RESULTS Twenty-seven significant antenatal variables were included in the final scoring system. Application of the system in early pregnancy resulted in a predictive accuracy of 0.73; at the onset of labor, predictive accuracy was 0.91. At the time of labor, 87% of poor outcomes were accurately identified by allocation of only 16% of the women to the high-risk group. CONCLUSIONS It was possible to develop a risk scoring system with a predictive accuracy higher than any previously reported statistically derived score. Summation of the logistic coefficients provides a score that by comparison with a chosen threshold identifies a high-risk pregnancy. In this way, despite the complexity of statistical analysis, all clinicians can quickly apply this scoring system.
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Affiliation(s)
- A J Knox
- Department of Obstetrics and Gynecology, National Women's Hospital, Auckland, New Zealand
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32
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Affiliation(s)
- J Gu
- Department of Biology, University of Houston, TX 77204
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33
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Affiliation(s)
- Y Wang
- University of Texas Medical School, Houston
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34
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Sadler L. Injuries are not accidents. J Tenn Med Assoc 1991; 84:128. [PMID: 2067370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- L Sadler
- Tennessee Department of Health and Environment, Nashville
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35
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Pattison NS, Sadler L, Mullins P. Obstetric risk factors: can they predict fetal mortality and morbidity? N Z Med J 1990; 103:257-9. [PMID: 2356042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An antepartum fetal risk score was developed and applied to 29,101 pregnancies which delivered at National Women's Hospital between January 1983 and April 1988. Twenty-one past and current obstetric and medical factors available at the onset of pregnancy or labour were weighed to obtain a risk score. The scoring system developed compared favourably with international systems. An antepartum fetal risk score of three or more was chosen to select a high risk group. These 10,859 women, 37% of the total population, identified 90% of those who had a fetal or neonatal loss. The perinatal mortality rate was 34.7/1000. Twenty-eight percent of this group had a caesarean section and 23% gave birth to a low birth weight infant. Women who had an antepartum risk score of seven or more had a perinatal mortality rate of 200/1000. The remaining women, a low risk group of 18,242 (63%), had a perinatal mortality rate of 4.1/1000. However 60% had a complicated pregnancy including 8.2% who required a caesarean section and 2.7% who gave birth to a low birth weight infant. The antepartum fetal risk score clearly identified the population at risk of fetal or neonatal loss. In addition significantly more medical intervention was provided to the high risk group. It is important to note that 60% of the low risk group had a complicated pregnancy leaving only 24% of the total population whose pregnancy was normal.
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Affiliation(s)
- N S Pattison
- Department of Obstetrics and Gynaecology, University of Auckland
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Abstract
Deep femoral artery aneurysms are rarely atherosclerotic in origin and infrequently rupture. A case of spontaneous rupture of an isolated deep femoral atherosclerotic aneurysm is presented. The computed tomographic, angiographic, and clinical findings are discussed. These findings allowed preoperative diagnosis of this lesion.
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Affiliation(s)
- L Sadler
- Montefiore Hospital, University Health Center, Pittsburgh, Pennsylvania
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