100 research outputs found
How should we manage women with unexplained chronic pelvic pain in light of uncertainty about the effectiveness of gabapentin?
No full textChronic pelvic pain affects 2.1% to 24% of the global female population, and up to half of the affected women have no obvious pathology. The neuromodulator gabapentin can be used to modulate pain, but the evidence for its effectiveness and safety is limited, as discussed by Andrew Horne and colleagues in a related article (doi:10.1136/bmj.j3520). Here, James Duffy explores how we should manage women with unexplained chronic pain in light of this uncertainty
Variation in outcome reporting across studies evaluating interventions for selective fetal growth restriction
No full textThe recent investigation of variation in outcome reporting in studies of twin-to-twin transfusion syndrome has highlighted the problem of variable and inconsistently defined outcome reporting in studies of twin-to-twin transfusion syndrome (TTTS).(1) Similar heterogeneity in outcome reporting has been identified across women's and newborn health including pre-eclampsia, childbirth trauma and endometriosis.(2-8) This article is protected by copyright. All rights reserved
Core outcome set for perinatal interventions for congenital diaphragmatic hernia
No full textObjective: To develop a core set of prenatal and neonatal outcomes for clinical studies evaluating perinatal interventions for congenital diaphragmatic hernia, using a validated consensus-building method. Methods: An international steering group comprising 13 leading maternal–fetal medicine specialists, neonatologists, pediatric surgeons, patient representatives, researchers and methodologists guided the development of this core outcome set. Potential outcomes were collected through a systematic review of the literature and entered into a two-round online Delphi survey. A call was made for stakeholders with experience of congenital diaphragmatic hernia to review the list and score outcomes based on their perceived relevance. Outcomes that fulfilled the consensus criteria defined a priori were discussed subsequently in online breakout meetings. Results were reviewed in a consensus meeting, during which the core outcome set was defined. Finally, the definitions, measurement methods and aspirational outcomes were defined in online and in-person definition meetings by a selection of 45 stakeholders. Results: Overall, 221 stakeholders participated in the Delphi survey and 198 completed both rounds. Fifty outcomes met the consensus criteria and were discussed and rescored by 78 stakeholders in the breakout meetings. During the consensus meeting, 93 stakeholders agreed eventually on eight outcomes, which constituted the core outcome set. Maternal and obstetric outcomes included maternal morbidity related to the intervention and gestational age at delivery. Fetal outcomes included intrauterine demise, interval between intervention and delivery and change in lung size in utero around the time of the intervention. Neonatal outcomes included neonatal mortality, pulmonary hypertension and use of extracorporeal membrane oxygenation. Definitions and measurement methods were formulated by 45 stakeholders, who also added three aspirational outcomes: duration of invasive ventilation, duration of oxygen supplementation and use of pulmonary vasodilators at discharge. Conclusions: We developed with relevant stakeholders a core outcome set for studies evaluating perinatal interventions in congenital diaphragmatic hernia. Its implementation should facilitate the comparison and combination of trial results, enabling future research to better guide clinical practice.</p
Influence of methodology upon the identification of potential core outcomes: recommendations for core outcome set developers are needed
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“HILANG DI MATE” TERINSPIRASI DARI KESENIAN TRADISI LISAN NANDONG DI DESA RAWAJADI KECAMATAN RENGAT KABUPATEN INDRAGIRI HULU
No full textIn the Malay community in the city of Rengat, the oral tradition is called Nandong, which in oral literature is used to put children to sleep, usually conveyed with poetry or rhymes and sung rhythmically or humming, this is because Malay culture is always synonymous with poetry or rhymes. Based on the results of the artist's analysis of Nandung art, the artist found uniqueness in the rhythm which has vibrations or vibrato in the swing of the sentences. Then the creator also saw the strength of the poetry or rhyme found in Nandung, where the poetry or rhyme contained in the pantun contained a moral utterance or message conveyed. This is the idea in creating musical compositions using a traditional approach. The author divides it into two parts, beginning and end. In the first part, the focus is on presenting the Nandong pantun as an opening to start this composition, then we move on to the pantun that the author developed accompanied by melodic instruments using working techniques. The author presents the final part of this composition with a work that has developed a vocal melody into a varied and melodic playing, especially on the vocals and rhythm patterns that the author has developed using the work technique
Diagnosis and management of endometriosis: a systematic review of international and national guidelines
No full textBackground
The development of robust clinical guidelines requires standardised
development methods informed by robust evidence synthesis.
Objectives
We evaluated the methodological quality of endometriosis guidelines,
mapped their recommendations, and explored the relationships between
recommendations and research evidence.
Search Strategy
We searched: [1] EMBASE; [2] Medline; and [3] Pubmed from inception to
February 2016.
Selection Criteria
We included guidelines related to the diagnosis and management of
endometriosis.
Data Collection and Analysis
The search strategy identified 879 titles and abstracts. We include two
international and five national guidelines. Four independent authors
assessed the methodological quality of included guidelines using the
Appraisal of Guidelines for REsearch and Evaluation (AGREE-II) instrument and
systematically extracted the guideline recommendations and supporting
research evidence.
Main Results
One hundred and fifty-two different recommendations were made. Ten
recommendations (7%) were comparable across guidelines. The European
Society of Human Reproduction and Embryology was objectively evaluated
as the highest quality guideline (methodological quality score: 88/100). There
was substantial variation between the supporting evidence presented by
individual guidelines for comparable recommendations. Forty-two
recommendations (28%) were not supported by research evidence. No
guideline followed the standardised guideline development methods
(AGREE-II).
Conclusion
There is substantial variation in the recommendations and methodological
quality of endometriosis guidelines. Future guidelines should be developed
with reference to high quality methods, in consultation with key stakeholders,
including women with endometriosis, ensuring their scope can truly inform
clinical practice and eliminate unwarranted and unjustified variations in
clinical practice
Prioritising unanswered research questions in obstetrics and gynaecology. A systematic review
No full textAB Objectives: Despite the escalation in research activity and an exponential rise in published papers, many of the fundamental questions in obstetrics and gynaecology remain. A prioritised list of unanswered research questions developed to specifically highlight the most pressing clinical needs as perceived by professionals, researchers, and patients should inform future research priorities. Awareness of completed priority setting initiatives is in our speciality is low. Therefore, we undertook a systematic review of studies prioritising unanswered research questions in obstetrics and gynaecology. Method: We searched bibliographical databases, including CENTRAL, Embase, and MEDLINE, from 2007 to February 2018. Studies prioritising unanswered research questions in obstetrics and gynaecology were included. Two researchers independently assessed studies for inclusion, evaluated methodological quality, and extracted relevant data. We used descriptive statistics to characterise the included studies, summarise methodological quality, and demonstrate the feasibility of prioritised unanswered research questions. Results: Eight studies were included. All studies were conducted in higher resource settings. Two studies have prioritised unanswered research questions in gynaecology and six studies have prioritised unanswered research questions in obstetrics. The quantitative, qualitative, and consensus methods used to prioritise unanswered research questions varied considerably. Methodological quality varied considerably limitations including poor reporting of consensus science methods, prioritised unanswered research questions which could not be addressed within a research setting, and limited involvement of patients. Conclusions: Prioritising unanswered research questions should ensure future research has the necessary reach and relevance to inform future clinical practice and improve clinical outcomes. However, the impact of such initiatives can be muted if the consultation is inadequate, robust consensus science methods are not used, and the final research uncertainties are poorly constructed. We are drowning in research that is singularly lacking in impact. We need fewer but better studies
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