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  • 1
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    Worth the paper it’s written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK
    Oxford University Press (OUP) ; 2023
    In:  International Journal of Epidemiology Vol. 52, No. 1 ( 2023-02-08), p. 295-308
    Details
    In: International Journal of Epidemiology, Oxford University Press (OUP), Vol. 52, No. 1 ( 2023-02-08), p. 295-308
    Abstract: The Medical Certificate of Stillbirth (MCS) records data about a baby’s death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual ‘ideal MCSs’ and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated ‘substantial’ agreement [K = 0.73 (95% CI 0.70–0.76)]. Primary cause of death (COD) showed ‘fair’ agreement [K = 0.26 (95% CI 0.24–0.29)] . Major errors [696/1120; 62.1% (95% CI 59.3–64.9%)] included certificates issued for fetal demise at & lt;24 weeks’ gestation [23/696; 3.3% (95% CI 2.2–4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1–1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1–97.1%)]. Of 540/1246 [43.3% (95% CI 40.6–46.1%)] ‘unexplained’ stillbirths, only 119/540 [22.0% (95% CI 18.8–25.7%)] remained unexplained; the majority were redesignated as either fetal gro wth restriction [FGR: 195/540; 36.1% (95% CI 32.2–40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2–38.2)] . Overall, FGR [306/1246; 24.6% (95% CI 22.3–27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5–22.1%)] FGR cases were originally attributed correctly. Conclusion This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.
    Type of Medium: Online Resource
    ISSN: 0300-5771 , 1464-3685
    URL: Article
    DOI: 10.1093/ije/dyac100
    RVK:
    XF 4100
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1494592-7
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  • 2
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    Risk Factors for Ovarian Cancer: An Umbrella Review of the Literature
    MDPI AG ; 2022
    In:  Cancers Vol. 14, No. 11 ( 2022-05-30), p. 2708-
    Details
    In: Cancers, MDPI AG, Vol. 14, No. 11 ( 2022-05-30), p. 2708-
    Abstract: Several non-genetic factors have been associated with ovarian cancer incidence or mortality. To evaluate the strength and validity of the evidence we conducted an umbrella review of the literature that included systematic reviews/meta-analyses that evaluated the link between non-genetic risk factors and ovarian cancer incidence and mortality. We searched PubMed, EMBASE, Cochrane Database of Systematic Reviews and performed a manual screening of references. Evidence was graded into strong, highly suggestive, suggestive or weak based on statistical significance of the random effects summary estimate and the largest study in a meta-analysis, the number of cases, between-study heterogeneity, 95% prediction intervals, small study effects, and presence of excess significance bias. We identified 212 meta-analyses, investigating 55 non-genetic risk factors for ovarian cancer. Risk factors were grouped in eight broad categories: anthropometric indices, dietary intake, physical activity, pre-existing medical conditions, past drug history, biochemical markers, past gynaecological history and smoking. Of the 174 meta-analyses of cohort studies assessing 44 factors, six associations were graded with strong evidence. Greater height (RR per 10 cm 1.16, 95% confidence interval (CI) 1.11–1.20), body mass index (BMI) (RR ≥ 30 kg/m2 versus normal 1.27, 95% CI 1.17–1.38) and three exposures of varying preparations and usage related to hormone replacement therapy (HRT) use increased the risk of developing ovarian cancer. Use of oral contraceptive pill reduced the risk (RR 0.74, 95% CI 0.69–0.80). Refining the significance of genuine risk factors for the development of ovarian cancer may potentially increase awareness in women at risk, aid prevention and early detection.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    URL: Article
    DOI: 10.3390/cancers14112708
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2527080-1
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  • 3
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    Infertility: Understanding investigation and treatment options
    SAGE Publications ; 2020
    In:  InnovAiT: Education and inspiration for general practice Vol. 13, No. 7 ( 2020-07), p. 394-401
    Details
    In: InnovAiT: Education and inspiration for general practice, SAGE Publications, Vol. 13, No. 7 ( 2020-07), p. 394-401
    Abstract: The World Health Organisation has defined infertility as the inability to become pregnant after 12 months of regular unprotected vaginal sexual intercourse. Primary infertility refers to couples that have never conceived, whereas secondary infertility refers to couples that have failed to conceive despite previous pregnancy. In the general population, 80% of couples are expected to be able to conceive within a year and 90% by the end of 2 years. With the rising trend for increasing maternal age at time of first pregnancy and the obesity epidemic, the incidence of infertility is likely to increase. Couples unable to conceive will seek help and advice from their GP. Infertility is highly emotive, and patients and their partners subject to investigation and management for infertility are likely to experience anxiety. Although primarily managed in secondary care, a robust understanding of investigation and treatment options for infertility can enable GPs to educate and support patients, as well as manage expectations.
    Type of Medium: Online Resource
    ISSN: 1755-7380 , 1755-7399
    URL: Article
    DOI: 10.1177/1755738020923714
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2416002-7
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  • 4
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    Online Resource
    Effects of obesity and post-bariatric surgery weight loss on the vaginal microbiota
    Springer Science and Business Media LLC ; 2021
    In:  Microbiome Vol. 9, No. 1 ( 2021-12)
    Details
    In: Microbiome, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2021-12)
    Abstract: Obesity and vaginal microbiome (VMB) dysbiosis are each risk factors for adverse reproductive and oncological health outcomes in women. Here, we investigated the relationship between obesity, vaginal bacterial composition, local inflammation and bariatric surgery. Methods Vaginal bacterial composition assessed by high-throughput sequencing of bacterial 16S rRNA genes and local cytokine levels measured using a multiplexed Magnetic Luminex Screening Assay were compared between 67 obese and 42 non-obese women. We further assessed temporal changes in the microbiota and cytokines in a subset of 27 women who underwent bariatric surgery. Results The bacterial component of the vaginal microbiota in obese women was characterised by a lower prevalence of a Lactobacillus -dominant VMB and higher prevalence of a high diversity ( Lactobacillus spp., and Gardnerella - spp. depleted) VMB, compared with non-obese subjects ( p 〈 0.001). Obese women had higher relative abundance of Dialister species ( p 〈 0.001), Anaerococcus vaginalis ( p =0.021), and Prevotella timonensis ( p =0.020) and decreased relative abundance of Lactobacillus crispatus ( p =0.014). Local vaginal IL-1β, IL-4, IL-6, IL-8, IFNγ, MIP-1α and TNFα levels were all higher among obese women, however, only IL-1β and IL-8 correlated with VMB species diversity. In a subset of obese women undergoing bariatric surgery, there were no significant overall differences in VMB following surgery; however, 75% of these women remained obese at 6 months. Prior to surgery, there was no relationship between body mass index (BMI) and VMB structure; however, post-surgery women with a Lactobacillus -dominant VMB had a significantly lower BMI than those with a high diversity VMB. Conclusions Obese women have a significantly different vaginal microbiota composition with increased levels of local inflammation compared to non-obese women. Bariatric surgery does not change the VMB; however, those with the greatest weight loss 6-month post-surgery are most likely to have a Lactobacillus -dominant VMB.
    Type of Medium: Online Resource
    ISSN: 2049-2618
    URL: Article
    URL: Article
    DOI: 10.1186/s40168-021-01011-2
    DOI: 10.21203/rs.3.rs-979076/v1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2697425-3
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  • 5
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    Effectiveness of a web-based virtual journal club to promote medical education (Web-Ed): protocol of a multicentre pragmatic randomised trial
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 6 ( 2022-06), p. e058610-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 6 ( 2022-06), p. e058610-
    Abstract: A journal club (JC) is a commonly used medical educational tool. Videoconferencing technology can facilitate the delivery of JCs, however, there remains no evidence on the role of web-based virtual JCs in promoting the acquisition and retention of medical knowledge. The Web-Ed trial aims to evaluate the educational benefits, feasibility and acceptability of web-based virtual JCs compared with traditional face-to-face ones. Methods and analysis Web-Ed is a multicentre pragmatic parallel-group randomised trial across teaching hospitals within the UK National Health Service (NHS). We will enrol qualified doctors or medical students who are 〉 18 years old, proficient in English and able to use online videoconferencing software. Block randomisation will be used to allocate participants in 1:1 ratio to either intervention group. Both groups will be presented with the same educational material and follow a standardised JC structure hosted by nominated moderators and medical faculty members. The primary outcome is the difference in participants’ knowledge acquisition and retention 7 days after the JCs evaluated using standardised multiple-choice questions. We will report secondarily on the feasibility and acceptability of the JCs using Likert scale questionnaires. Assuming a 30% drop-out rate, we aim to enrol 75 participants to detect a 20% improvement in knowledge acquisition at 80% power and 5% significance. We will report using mean difference or risk ratio with 95% CIs and assess significance using parametric/non-parametric testing. Where relevant, we will adjust for predetermined characteristics (age, grade of training and session duration) using multivariate regression analyses. Ethics and dissemination Web-Ed was designed by doctors in training to address their learning needs and evaluate the preferred mode of learning. The trial results will be published in peer-reviewed journals and presented at relevant scientific conferences. The trial has been approved by the NHS Health Regulation Authority (21/HRA/3361). Trial registration number ISRCTN18036769 .
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-058610
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 6
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    Spectroscopy of blood samples for the diagnosis of endometrial cancer and classification of its different subtypes.
    American Society of Clinical Oncology (ASCO) ; 2017
    In:  Journal of Clinical Oncology Vol. 35, No. 15_suppl ( 2017-05-20), p. 5596-5596
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. 5596-5596
    Abstract: 5596 Background: Symptoms of endometrial cancer often appear in early stages, thus a diagnosis, based on microscopic histological examination of endometrial tissue, can be given relatively on time. However, this procedure interferes subjective interpretation allowing human error, while screening of the asymptomatic population is not widely performed because of the high cost of the available tests (e.g. transvaginal ultrasound) and the relative invasiveness [biopsy or dilation and curettage (D+C)]. Consequently, there is a widespread need to develop inexpensive, non-invasive techniques that would accurately diagnose endometrial cancer, as well as classify the different subtypes. Spectrochemical methods generate a signature fingerprint of biological material in the form of spectra. Unlike immunological methods, which detect only one molecule at a time, the spectra obtained from a clinical sample represent all the molecular constituents within that sample, including proteins, lipids and carbohydrates; this provides a holistic picture of the sample. Previous studies have confirmed spectroscopy’s ability to diagnose gynecologic cancers in blood. Methods: Attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy was used to analyse blood plasma and serum from 71 women with endometrial cancer and 18 age-matched healthy controls; classification algorithms were then applied to extract the underlying biological information. Results: Principal component analysis followed by support vector machine (PCA-SVM) diagnosed endometrial cancer with 100% accuracy in plasma and 95% in serum. Discrimination between the different subtypes [endometrioid adenocarcinoma (n = 43) vs carcinosarcoma (n = 14)] was achieved with 98.33% accuracy in both plasma and serum. The spectral regions responsible for discrimination were attributed to protein and lipid alterations. Conclusions: Our preliminary results suggest an accurate and objective diagnostic tool for endometrial cancer with blood testing, allowing therefore thoughts for a potential screening test in high risk populations. Future work will include higher number of normal cases and different subtypes and grades.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2017.35.15_suppl.5596
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
    detail.hit.zdb_id: 2005181-5
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  • 7
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    P139 Women's Health Care during COVID-19
    Oxford University Press (OUP) ; 2021
    In:  BJS Open Vol. 5, No. Supplement_1 ( 2021-04-08)
    Details
    In: BJS Open, Oxford University Press (OUP), Vol. 5, No. Supplement_1 ( 2021-04-08)
    Abstract: The coronavirus disease 2019 (COVID-19) pandemic is disrupting health services worldwide. Women's health care is often acute and in continual demand, with poor health outcomes seen in women's health in particular in the recent Ebola and Swine flu epidemics. Regrettably, early reports globally and in the UK have shown a rise in the stillbirth rate. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic. Methods We undertook an interview-based national survey of junior doctors in obstetrics and gynaecology in women’s healthcare units in the National Health Service using the network of the UK Audit and Research Collaborative in Obstetrics and Gynaecology. We sought responses on general training, labour ward care, antenatal and postnatal care, benign gynaecology and gynaecology oncology services. Results We received responses from 148/155 units (95%) contacted. Most completed specific training drills for managing obstetric and gynaecological emergencies (89/148, 60.1%) and two-person donning and doffing of personal protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID-19-specific protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID-19 emergency theatres (105/148,70.8%). Most units suspended elective gynaecology services (131/148, 88.5%). The 2-week referral pathway for oncological gynaecology was not affected in half of the units (76/148,51.4%), but half reported a planned reduction in oncology surgery (82/148, 55.4%) Discussion Women's health care services have responded well to the acute phase of the COVID-19 pandemic, however further planning is required for the long term.
    Type of Medium: Online Resource
    ISSN: 2474-9842
    URL: Article
    DOI: 10.1093/bjsopen/zrab032.138
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2902033-5
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  • 8
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    Online Resource
    Risk factors for endometrial cancer: An umbrella review of the literature
    Wiley ; 2019
    In:  International Journal of Cancer Vol. 145, No. 7 ( 2019-10), p. 1719-1730
    Details
    In: International Journal of Cancer, Wiley, Vol. 145, No. 7 ( 2019-10), p. 1719-1730
    Abstract: Although many risk factors could have causal association with endometrial cancer, they are also prone to residual confounding or other biases which could lead to over‐ or underestimation. This umbrella review evaluates the strength and validity of evidence pertaining risk factors for endometrial cancer. Systematic reviews or meta‐analyses of observational studies evaluating the association between non‐genetic risk factors and risk of developing or dying from endometrial cancer were identified from inception to April 2018 using PubMed, the Cochrane database and manual reference screening. Evidence was graded strong, highly suggestive, suggestive or weak based on statistical significance of random‐effects summary estimate, largest study included, number of cases, between‐study heterogeneity, 95% prediction intervals, small study effects, excess significance bias and sensitivity analysis with credibility ceilings. We identified 171 meta‐analyses investigating associations between 53 risk factors and endometrial cancer incidence and mortality. Risk factors were categorised: anthropometric indices, dietary intake, physical activity, medical conditions, hormonal therapy use, biochemical markers, gynaecological history and smoking. Of 127 meta‐analyses including cohort studies, three associations were graded with strong evidence. Body mass index and waist‐to‐hip ratio were associated with increased cancer risk in premenopausal women (RR per 5 kg/m 2 1.49; CI 1.39–1.61) and for total endometrial cancer (RR per 0.1unit 1.21; CI 1.13–1.29), respectively. Parity reduced risk of disease (RR 0.66, CI 0.60–0.74). Of many proposed risk factors, only three had strong association without hints of bias. Identification of genuine risk factors associated with endometrial cancer may assist in developing targeted prevention strategies for women at high risk.
    Type of Medium: Online Resource
    ISSN: 0020-7136 , 1097-0215
    URL: Issue
    URL: Article
    DOI: 10.1002/ijc.v145.7
    DOI: 10.1002/ijc.31961
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 218257-9
    detail.hit.zdb_id: 1474822-8
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  • 9
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    Aluminium foil as an alternative substrate for the spectroscopic interrogation of endometrial cancer
    Wiley ; 2018
    In:  Journal of Biophotonics Vol. 11, No. 7 ( 2018-07)
    Details
    In: Journal of Biophotonics, Wiley, Vol. 11, No. 7 ( 2018-07)
    Abstract: Biospectroscopy has the potential to investigate and characterize biological samples and could, therefore, be utilized to diagnose various diseases in a clinical environment. An important consideration in spectrochemical studies is the cost‐effectiveness of the substrate used to support the sample, as high expense would limit their translation into clinic. In this paper, the performance of low‐cost aluminium (Al) foil substrates was compared with the commonly used low‐emissivity (low‐E) slides. Attenuated total reflection‐Fourier transform infrared spectroscopy was used to analyse blood plasma and serum samples from women with endometrial cancer and healthy controls. The 2 populations were differentiated using principal component analysis with support vector machines with 100% sensitivity in plasma samples (endometrial cancer = 70; healthy controls = 15) using both Al foil and low‐E slides as substrates. The same sensitivity results (100%) were achieved for serum samples (endometrial cancer = 60; healthy controls = 15). Specificity was found higher using Al foil (90%) in comparison to low‐E slides (85%) and lower using Al foil (70%) in comparison to low‐E slides in serum samples. The establishment of Al foil as low‐cost and highly performing substrate would pave the way for large‐scale, multicentre studies and potentially for routine clinical use. image
    Type of Medium: Online Resource
    ISSN: 1864-063X , 1864-0648
    URL: Issue
    URL: Article
    DOI: 10.1002/jbio.2018.11.issue-7
    DOI: 10.1002/jbio.201700372
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2403788-6
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  • 10
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    Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature
    Wiley ; 2017
    In:  International Journal of Cancer Vol. 140, No. 1 ( 2017-01), p. 216-223
    Details
    In: International Journal of Cancer, Wiley, Vol. 140, No. 1 ( 2017-01), p. 216-223
    Abstract: What's new? Although one in ten women undergoing cervical cancer screening will have a minor abnormality in their cytology result, the optimum way of managing these cases remains debatable. Here the authors performed a meta‐analysis of published literature in search for the optimal management strategy. They find that in the absence of HPV DNA testing, colposcopy may be the first choice as compared to cytology surveillance when good compliance is not assured. As this also increases detection of insignificant lesions, the study underscores the need for a triage method that reliably distinguishes women with further diagnostic needs from those who can continue routine screening.
    Type of Medium: Online Resource
    ISSN: 0020-7136 , 1097-0215
    URL: Issue
    URL: Article
    DOI: 10.1002/ijc.v140.1
    DOI: 10.1002/ijc.30419
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 218257-9
    detail.hit.zdb_id: 1474822-8
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