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Al Wattar BH, Rogozińska E, Vale C, Fisher D, Petersen I, Nicum S, Bannington D, Talaulikar V, Freemantle N. Effectiveness and safety of menopause treatments: pitfalls of available evidence and future research need. Climacteric 2024; 27:154-158. [PMID: 38275167 DOI: 10.1080/13697137.2023.2297880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
By 2050 more than 1.6 billion women worldwide will be of post-reproductive age, with >75% reporting severe menopausal symptoms. The last few years saw a gradual uplift in public awareness reaffirming the health needs of women with menopause. Still, effective translation of available evidence on menopause treatments is hindered by several methodological limitations and poor research conduct. We argue that a paradigm shift is required in menopause research to address the remaining knowledge gap and guide safe evidence-based care provision. A critical misconception across studies on menopause is the assumption that women represent a homogeneous group who respond similarly to a particular therapy irrespective of their exposure and individual risk factors. We highlight potential solutions to optimize the quality of future research in menopause including adopting robust trial methodology, standardize outcome reporting to capture quality-of-life measures, and improve lay patient and public involvement in future research.
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Affiliation(s)
- B H Al Wattar
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - E Rogozińska
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - C Vale
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - D Fisher
- MRC CTU, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - I Petersen
- Primary Care & Population Health, Institute of Epidemiology & Health, University College London Hospitals, London, UK
| | - S Nicum
- Research Department of Oncology, Cancer Institute, University College London Hospitals, London, UK
| | | | - V Talaulikar
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - N Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
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Vale C, Brihoum M, Chabaud S, Cook A, Fisher D, Forcat S, Fraser-Browne C, Herschtal A, Kneebone A, Nénan S, Parker C, Parmar M, Pearse M, Richaud P, Rogozińska E, Sargos P, Sydes M, Tierney J. Adjuvant or salvage radiotherapy for the treatment of localised prostate cancer? A prospectively planned aggregate data meta-analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rogozińska E, Eckert LO, Khan KS. Reducing research waste through the standardisation of outcomes and definitions. BJOG 2018; 126:308-309. [PMID: 29637678 DOI: 10.1111/1471-0528.15238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 01/26/2023]
Affiliation(s)
- E Rogozińska
- Women's Health Research Unit, Queen Marys University of London, London, UK.,Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
| | - L O Eckert
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - K S Khan
- Women's Health Research Unit, Queen Marys University of London, London, UK
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Rogozińska E, Kara-Newton L, Zamora JR, Khan KS. On-site test to detect syphilis in pregnancy: a systematic review of test accuracy studies. BJOG 2017; 124:734-741. [PMID: 28029229 DOI: 10.1111/1471-0528.14455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Syphilis in pregnancy can lead to fetal and neonatal death or congenital anomalies. Accurate on-site tests are an essential part of effective prevention of mother-to-child transmission of the disease. OBJECTIVE This systematic review assessed the accuracy of on-site tests to detect infection with Treponema pallidum in pregnant women. SEARCH STRATEGY Major databases were searched from inception to January 2016 using terms: 'pregnancy', 'antenatal', 'syphilis', 'Treponema pallidum' with their variations, and the search limit for the relevant study design. SELECTION CRITERIA We included studies that used dual reference standard (non-treponemal and treponemal tests) to detected syphilis in pregnancy. DATA COLLECTION AND ANALYSIS Extracted accuracy data were tabulated and pooled using hierarchical, bivariate random effects model. MAIN RESULTS Seven studies (combined sample 17 546) reporting the accuracy of four on-site tests met the eligibility criteria. On average, Determine™ and SD BioLine Syphilis 3.0 had the highest sensitivity of all the evaluated tests: 0.83 (95% CI 0.58, 0.98) and 0.86 (95% CI 0.82, 0.89), respectively, with a high specificity 0.96 (95% CI 0.89, 1.00) and 0.99 (95% CI 0.94, 1.00), respectively. The Qualitative Rapid Plasma Reagin card commonly used in clinical practice had a pooled sensitivity of 0.70 (95% CI 0.54, 0.88) and specificity of 0.97 (95% CI 0.96, 0.99). CONCLUSION Immunochromatographic tests such as Determine™ and SD BioLine Syphilis 3.0 seem to be acceptable options in antenatal testing for syphilis, especially in resource-limited settings. Future research should seek more evidence to strengthen this claim. TWEETABLE ABSTRACT On-site test to detect syphilis-options during antenatal care.
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Affiliation(s)
- E Rogozińska
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - L Kara-Newton
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - J R Zamora
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain
| | - K S Khan
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
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Meads C, Sutton AJ, Rosenthal AN, Małysiak S, Kowalska M, Zapalska A, Rogozińska E, Baldwin P, Ganesan R, Borowiack E, Barton P, Roberts T, Khan K, Sundar S. Sentinel lymph node biopsy in vulval cancer: systematic review and meta-analysis. Br J Cancer 2014; 110:2837-46. [PMID: 24867697 PMCID: PMC4056048 DOI: 10.1038/bjc.2014.205] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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: 05/23/2013] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the accuracy of sentinel lymph node (SLN) biopsy with technetium 99 (99mTc) and/or blue dye-enhanced lymphoscintigraphy in vulval cancer. METHODS Sensitive searches of databases were performed upto October 2013. Studies with at least 75% of women with FIGO stage IB or II vulval cancer evaluating SLN biopsy with 99mTc, blue dye or both with reference standard of inguinofemoral lymphadenectomy (IFL) or clinical follow-up were included. Meta-analyses were performed using Meta-Disc version 1.4. RESULTS Of the 2950 references, 29 studies (1779 women) were included; most of them evaluated 99mTc combined with blue dye. Of these, 24 studies reported results for SLN followed by IFL, and 5 reported clinical follow-up only for SLN negatives. Pooling of all studies was inappropriate because of heterogeneity. Mean SLN detection rates were 94.0% for 99mTc, 68.7% for blue dye and 97.7% for both. SLN biopsy had pooled sensitivity of 95% (95% CI 92-98%) with negative predictive value (NPV) of 97.9% in studies using 99mTc/blue dye, ultrastaging and immunohistochemistry with IFL as reference. Pooled sensitivity for SLN with clinical follow-up for SLN-negatives was 91% (85-95%) with NPV 95.6%. Patients undergoing SLN biopsy experienced less morbidity than those undergoing IFL. CONCLUSIONS Sentinel lymph node biopsy using 99mTC, blue dye and ultrastaging with immunohistochemistry is highly accurate when restricted to carefully selected patients, within a rigorous protocol, with close follow-up and where sufficient numbers for learning curve optimisation exist. Patients must make an informed choice between the slightly higher groin recurrence rates of SLN biopsy vs the greater morbidity of IFL.
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Affiliation(s)
- C Meads
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A J Sutton
- Unit of Health Economics, University of Birmingham, Birmingham, UK
| | | | | | | | | | - E Rogozińska
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - P Baldwin
- Addenbrooke's Hospital NHS Trust, Cambridge, UK
| | - R Ganesan
- Pan Birmingham Gynaecological Cancer Centre, City Hospital and School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | | | - P Barton
- Unit of Health Economics, University of Birmingham, Birmingham, UK
| | - T Roberts
- Unit of Health Economics, University of Birmingham, Birmingham, UK
| | - K Khan
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital and School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Ruifrok AE, van Poppel MNM, van Wely M, Rogozińska E, Khan KS, de Groot CJM, Thangaratinam S, Mol BW. Association between weight gain during pregnancy and pregnancy outcomes after dietary and lifestyle interventions: a meta-analysis. Am J Perinatol 2014; 31:353-64. [PMID: 23918523 DOI: 10.1055/s-0033-1352484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Lifestyle interventions in obese pregnant women reduce adverse maternal outcomes of pregnancy. However, the association between weight change due to interventions and the actual reduction in complications is unknown. The objective of this study was to determine the association between gestational weight gain (GWG) and the rate of pregnancy complications. STUDY DESIGN The authors included randomized controlled trials (RCTs) assessing the effect of lifestyle interventions during pregnancy on GWG and adverse maternal and fetal outcomes. For each outcome they assessed the association between GWG and the risk of adverse pregnancy outcomes. RESULTS They analyzed data of 23 RCTs (4,990 women). Increased GWG was associated with a nonsignificant increase in the incidence of preeclampsia (PE) (0.2% per gained kg, 95% confidence interval [CI] 0.5 to 0.9%, p > 0.05), gestational diabetes (GDM) (0.3% per gained kg, 95% CI -0.5 to 1.0%, p > 0.05), and induction of labor (IOL) (1.5% per gained kg, 95% CI -0.9 to 3.9%, p > 0.05). CONCLUSIONS Reduction in GWG due to lifestyle interventions in pregnancy had statistically nonsignificant effects on lowering the incidence of PE, GDM, and IOL. Possibly, the beneficial effect of lifestyle interventions on pregnancy outcomes is due to an effect independent of the reduction of GWG.
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Affiliation(s)
- A E Ruifrok
- Department of Obstetrics and Gynaecology, The Academic Medical Centre, Amsterdam, The Netherlands
| | - M N M van Poppel
- Department of Public and Occupational Health and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - M van Wely
- Department of Obstetrics and Gynaecology, The Academic Medical Centre, Amsterdam, The Netherlands
| | - E Rogozińska
- Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - K S Khan
- Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - C J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - S Thangaratinam
- Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - B W Mol
- Department of Obstetrics and Gynaecology, The Academic Medical Centre, Amsterdam, The Netherlands
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Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Duda W, Borowiack E, Roseboom T, Tomlinson J, Walczak J, Kunz R, Mol BW, Coomarasamy A, Khan KS. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess 2012; 16:iii-iv, 1-191. [PMID: 22814301 DOI: 10.3310/hta16310] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Around 50% of women of childbearing age are either overweight [body mass index (BMI) 25-29.9 kg/m(2)] or obese (BMI ≥ 30 kg/m(2)). The antenatal period provides an opportunity to manage weight in pregnancy. This has the potential to reduce maternal and fetal complications associated with excess weight gain and obesity. OBJECTIVES To evaluate the effectiveness of dietary and lifestyle interventions in reducing or preventing obesity in pregnancy and to assess the beneficial and adverse effects of the interventions on obstetric, fetal and neonatal outcomes. DATA SOURCES Major electronic databases including MEDLINE, EMBASE, BIOSIS and Science Citation Index were searched (1950 until March 2011) to identify relevant citations. Language restrictions were not applied. REVIEW METHODS Systematic reviews of the effectiveness and harm of the interventions were carried out using a methodology in line with current recommendations. Studies that evaluated any dietary, physical activity or mixed approach intervention with the potential to influence weight change in pregnancy were included. The quality of the studies was assessed using accepted contemporary standards. Results were summarised as pooled relative risks (RRs) with 95% confidence intervals (CIs) for dichotomous data. Continuous data were summarised as mean difference (MD) with standard deviation. The quality of the overall evidence synthesised for each outcome was summarised using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology and reported graphically as a two-dimensional chart. RESULTS A total of 88 studies (40 randomised and 48 non-randomised and observational studies, involving 182,139 women) evaluated the effect of weight management interventions in pregnancy on maternal and fetal outcomes. Twenty-six studies involving 468,858 women reported the adverse effect of the interventions. Meta-analysis of 30 RCTs (4503 women) showed a reduction in weight gain in the intervention group of 0.97 kg compared with the control group (95% CI -1.60 kg to -0.34 kg; p = 0.003). Weight management interventions overall in pregnancy resulted in a significant reduction in the incidence of pre-eclampsia (RR 0.74, 95% CI 0.59 to 0.92; p = 0.008) and shoulder dystocia (RR 0.39, 95% CI 0.22 to 0.70; p = 0.02). Dietary interventions in pregnancy resulted in a significant decrease in the risk of pre-eclampsia (RR 0.67, 95% CI 0.53 to 0.85; p = 0.0009), gestational hypertension (RR 0.30, 95% CI 0.10 to 0.88; p = 0.03) and preterm birth (RR 0.68, 95% CI 0.48 to 0.96; p = 0.03) and showed a trend in reducing the incidence of gestational diabetes (RR 0.52, 95% CI 0.27 to 1.03). There were no differences in the incidence of small-for-gestational-age infants between the groups (RR 0.99, 95% CI 0.76 to 1.29). There were no significant maternal or fetal adverse effects observed for the interventions in the included trials. The overall strength of evidence for weight gain in pregnancy and birthweight was moderate for all interventions considered together. There was high-quality evidence for small-for-gestational-age infants as an outcome. The quality of evidence for all interventions on pregnancy outcomes was very low to moderate. The quality of evidence for all adverse outcomes was very low. LIMITATIONS The included studies varied in the reporting of population, intensity, type and frequency of intervention and patient complience, limiting the interpretation of the findings. There was significant heterogeneity for the beneficial effect of diet on gestational weight gain. CONCLUSIONS Interventions in pregnancy to manage weight result in a significant reduction in weight gain in pregnancy (evidence quality was moderate). Dietary interventions are the most effective type of intervention in pregnancy in reducing gestational weight gain and the risks of pre-eclampsia, gestational hypertension and shoulder dystocia. There is no evidence of harm as a result of the dietary and physical activity-based interventions in pregnancy. Individual patient data meta-analysis is needed to provide robust evidence on the differential effect of intervention in various groups based on BMI, age, parity, socioeconomic status and medical conditions in pregnancy.
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Affiliation(s)
- S Thangaratinam
- Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Korczowski R, Rogozińska E. [Acyclovir in the treatment of viral complications in patients with leukemia]. Pol Tyg Lek 1985; 40:171-3. [PMID: 3856833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Głowniak C, Bochenek W, Rogozińska E. [Fascioliasis as a new parasitological and medical problem in the light of laboratory studies]. Wiad Lek 1983; 36:725-32. [PMID: 6613122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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