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Van der Houwen L, Schreurs A, Dancet E, Apers S, Kuchenbecker W, Van de Ven P, Maas J, Lambalk C, Nelen W, Mijatovic V. P-334 Are measurements of patient-centeredness of endometriosis care and quality of life in women with endometriosis associated? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
To examine the hypothesis that experiences with patient-centred endometriosis care are associated with the endometriosis-specific quality of life dimensions ‘emotional wellbeing’ and ‘social support’.
Summary answer
Positive associations were found between experienced patient-centeredness of care and the quality of life domains ‘emotional well-being’ and ‘social support’.
What is known already
Women with endometriosis have lower quality of life. Furthermore, research showed that the patient-centeredness of endometriosis care could still be improved. The quality of the provided endometriosis care might impact women’s quality of life, as demonstrated in the field of fertility care. A previous explorative study identified associations between patient-centred endometriosis care and two in five dimensions of endometriosis-specific quality of life (i.e. ‘emotional well-being’ and ‘social support’) but concluded that a more focussed and adequately powered study was needed.
Study design, size, duration
A secondary regression analysis of two cross-sectional cohort studies was performed. Both studies investigated patient-centeredness of endometriosis care and endometriosis-specific quality of life using respectively the ENDOCARE questionnaire (ECQ) and the Endometriosis Health Profile 30 (EHP-30). In total the data from 300 women was eligible for analysis, exceeding the, according to our power calculation, required sample size of 200 women.
Participants/materials, setting, methods
The participating women all had surgically proven endometriosis and were recruited by one secondary and two tertiary endometriosis clinics in the Netherlands. The regression analysis focused on the previously found association between the ten dimensions of the ECQ and the EHP-30 domains ‘emotional well-being’ and ‘social support’ rather than all five EHP-30 domains. After the Bonferroni correction to limit type I errors, the adjusted p-value was 0.003 (0.05/20).
Main results and the role of chance
The participating women had a mean age of 35.7 years and had predominantly been diagnosed with moderate to severe (68.6%). Regarding the EHP-30 domain ‘emotional well-being’, an association was found with the following five patient-centeredness dimensions: ‘respect for patients’ values, preferences and expressed needs’ (p = 0.046, Beta=0.159), ‘coordination and integration of care’ (p = 0.013, Beta=0.193), ‘information, communication and integration of care’ (p = 0.010, Beta=0.258), ‘emotional support and alleviation of fear and anxiety’ (p = 0.010, Beta=0.178), and ‘continuity and transition’ (p = 0.015, Beta=0.179). None of the associations between the EHP-30 domain ‘emotional well-being’ and a dimension of patient-centred endometriosis care, were significant when compared to the Bonferroni corrected p-value (all p ≥ 0.010). The EHP-30 domain ‘social support’ proved to be significantly associated to the following three dimensions of patient-centered endometriosis care (in order of strength): ‘information, communication and integration of care’ (p < 0.001, Beta=0.436), ‘coordination and integration of care’ (p = 0.001, Beta=0.307), and ‘emotional support and alleviation of fear and anxiety’ (p = 0.002, Beta=0.259).
Limitations, reasons for caution
This cross-sectional studies identified associations rather than proving causality between experiencing less patient-centeredness of care and having lower quality of life. Nevertheless, it is very tangible that some causality exists, either directly or indirectly (e.g. through empowerment) and that by improving patient-centeredness, quality of life might be improved as well.
Wider implications of the findings
Improving the patient-centeredness of endometriosis care was already considered an important goal, but even more so given its association with women’s quality of life, which is increasingly considered the ultimate measure of health care quality.
Trial registration number
not applicable
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Affiliation(s)
- L Van der Houwen
- Amsterdam UMC- Vrije Universiteit Amsterdam, Endometriosis Center- department of Reproductive Medicine , Amsterdam, The Netherlands
| | - A Schreurs
- Amsterdam UMC- Vrije Universiteit Amsterdam, Endometriosis Center- department of Reproductive Medicine , Amsterdam, The Netherlands
| | - E Dancet
- KU Leuven- University of Leuven, Department of Development and Regeneration , Leuven, Belgium
| | - S Apers
- KU Leuven- University of Leuven, Department of Development and Regeneration , Leuven, Belgium
| | - W Kuchenbecker
- Isala clinics, Department of Obstetrics and Gynaecology , Zwolle, The Netherlands
| | - P Van de Ven
- Amsterdam UMC- Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics , Amsterdam, The Netherlands
| | - J Maas
- Maastricht UMC+ and Grow – School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology , Maastricht, The Netherlands
| | - C Lambalk
- Amsterdam UMC- Vrije Universiteit Amsterdam, Endometriosis Center- department of Reproductive Medicine , Amsterdam, The Netherlands
| | - W Nelen
- Radboud University medical center, Department of Obstetrics and Gynaecology , Nijmegen, The Netherlands
| | - V Mijatovic
- Amsterdam UMC- Vrije Universiteit Amsterdam, Endometriosis Center- department of Reproductive Medicine , Amsterdam, The Netherlands
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Rashedi AS, de Roo SF, Ataman LM, Edmonds ME, Silva AA, Scarella A, Horbaczewska A, Anazodo A, Arvas A, Ramalho de Carvalho B, Sartorio C, Beerendonk CCM, Diaz-Garcia C, Suh CS, Melo C, Yding Andersen C, Motta E, Greenblatt EM, Van Moer E, Zand E, Reis FM, Sánchez F, Terrado G, Rodrigues JK, de Meneses E Silva JM, Smitz J, Medrano J, Lee JR, Winkler-Crepaz K, Smith K, Ferreira Melo E Silva LH, Wildt L, Salama M, Del Mar Andrés M, Bourlon MT, Vega M, Chehin MB, De Vos M, Khrouf M, Suzuki N, Azmy O, Fontoura P, Campos-Junior PHA, Mallmann P, Azambuja R, Marinho RM, Anderson RA, Jach R, Antunes RDA, Mitchell R, Fathi R, Adiga SK, Takae S, Kim SH, Romero S, Chedid Grieco S, Shaulov T, Furui T, Almeida-Santos T, Nelen W, Jayasinghe Y, Sugishita Y, Woodruff TK. Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe. JCO Glob Oncol 2020; 6:008144. [PMID: 32259160 PMCID: PMC7853877 DOI: 10.1200/jgo.2016.008144] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Accepted: 05/09/2017] [Indexed: 11/20/2022] Open
Abstract
Oncofertility focuses on providing fertility and endocrine-sparing options to patients who undergo life-preserving but gonadotoxic cancer treatment. The resources needed to meet patient demand often are fragmented along disciplinary lines. We quantify assets and gaps in oncofertility care on a global scale.
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Affiliation(s)
| | - Saskia F de Roo
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | - Chang Suk Suh
- Seoul National University Hospital College of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Elnaz Zand
- Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | | | - Flor Sánchez
- Centro de Estudios e Investigaciones en Biología y Medicina Reproductiva, Lima, Peru
| | | | | | | | - Johan Smitz
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Medrano
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Jung Ryeol Lee
- Seoul National University Hospital College of Medicine, Seoul, South Korea
| | | | | | | | - Ludwig Wildt
- Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Maria T Bourlon
- Instituto Nacional de Ciencias Médicas y Nutricíon Salvador Zubirán, Mexico City, Mexico
| | - Mario Vega
- IVF Centro de Reproducción, Panama City, Panama
| | | | | | | | - Nao Suzuki
- St Marianna University School of Medicine, Kawasaki, Japan
| | | | - Paula Fontoura
- Banco de Sêmen do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Ricardo M Marinho
- Pró-Criar Medicina Reprodutiva, Minas Gerais, Belo Horizonte, Brazil
| | | | - Robert Jach
- Jagiellonian University Medical College, Kraków, Poland
| | | | - Rod Mitchell
- University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Seido Takae
- St Marianna University School of Medicine, Kawasaki, Japan
| | - Seok Hyun Kim
- Seoul National University Hospital College of Medicine, Seoul, South Korea
| | - Sergio Romero
- Centro de Estudios e Investigaciones en Biología y Medicina Reproductiva, Lima, Peru
| | | | - Talya Shaulov
- University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | | | | | - Willianne Nelen
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Yodo Sugishita
- St Marianna University School of Medicine, Kawasaki, Japan
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Rashedi AS, de Roo SF, Ataman LM, Edmonds ME, Silva AA, Scarella A, Horbaczewska A, Anazodo A, Arvas A, Ramalho de Carvalho B, Sartorio C, Beerendonk CCM, Diaz-Garcia C, Suh CS, Melo C, Andersen CY, Motta E, Greenblatt EM, Van Moer E, Zand E, Reis FM, Sánchez F, Terrado G, Rodrigues JK, Marcos de Meneses E Silva J, Smitz J, Medrano J, Lee JR, Winkler-Crepaz K, Smith K, Ferreira Melo E Silva LH, Wildt L, Salama M, Del Mar Andrés M, Bourlon MT, Vega M, Chehin MB, De Vos M, Khrouf M, Suzuki N, Azmy O, Fontoura P, Campos-Junior PHA, Mallmann P, Azambuja R, Marinho RM, Anderson RA, Jach R, Antunes RDA, Mitchell R, Fathi R, Adiga SK, Takae S, Kim SH, Romero S, Grieco SC, Shaulov T, Furui T, Almeida-Santos T, Nelen W, Jayasinghe Y, Sugishita Y, Woodruff TK. Survey of Third-Party Parenting Options Associated With Fertility Preservation Available to Patients With Cancer Around the Globe. JCO Glob Oncol 2020; 6:009944. [PMID: 32259159 PMCID: PMC7853875 DOI: 10.1200/jgo.2017.009944] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/20/2022] Open
Abstract
In the accompanying article, “Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe,” we showed that specific fertility preservation services may not be offered at various sites around the world because of cultural and legal barriers. We assessed global and regional experiences as well as the legal status of third-party reproduction and adoption to serve as a comprehensive international data set and resource for groups that wish to begin oncofertility interventions.
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Affiliation(s)
| | - Saskia F de Roo
- Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | - Chang Suk Suh
- Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Elnaz Zand
- Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | | | - Flor Sánchez
- Centro de Estudios e Investigaciones en Biología y Medicina Reproductiva, Lima, Peru
| | | | | | | | - Johan Smitz
- Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Jose Medrano
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Jung Ryeol Lee
- Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | - Ludwig Wildt
- Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Maria T Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mario Vega
- IVF Centro de Reproduccion, Panama City, Panama
| | | | | | | | - Nao Suzuki
- St Marianna University School of Medicine, Kawasaki, Japan
| | | | - Paula Fontoura
- Banco de Sêmen do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Robert Jach
- Jagiellonian University Medical College, Kraków, Poland
| | | | - Rod Mitchell
- University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Seido Takae
- St Marianna University School of Medicine, Kawasaki, Japan
| | - Seok Hyun Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Sergio Romero
- Centro de Estudios e Investigaciones en Biología y Medicina Reproductiva, Lima, Peru
| | | | - Talya Shaulov
- University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | | | | | - Willianne Nelen
- Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Yodo Sugishita
- St Marianna University School of Medicine, Kawasaki, Japan
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de Man AM, Rashedi A, Nelen W, Anazodo A, Rademaker A, de Roo S, Beerendonk C, Woodruff TK. Female fertility in the cancer setting: availability and quality of online health information. HUM FERTIL 2018; 23:170-178. [DOI: 10.1080/14647273.2018.1506891] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anne Marie de Man
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alexandra Rashedi
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Willianne Nelen
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Antoinette Anazodo
- School of Women and Children’s Health Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alfred Rademaker
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Saskia de Roo
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Catharina Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
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Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, Middeldorp S, Nelen W, Peramo B, Quenby S, Vermeulen N, Goddijn M. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open 2018; 2018:hoy004. [PMID: 31486805 PMCID: PMC6276652 DOI: 10.1093/hropen/hoy004] [Citation(s) in RCA: 395] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/05/2018] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION What is the recommended management of women with recurrent pregnancy loss (RPL) based on the best available evidence in the literature? SUMMARY ANSWER The guideline development group formulated 77 recommendations answering 18 key questions on investigations and treatments for RPL, and on how care should be organized. WHAT IS KNOWN ALREADY A previous guideline for the investigation and medical treatment of recurrent miscarriage was published in 2006 and is in need of an update. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 31 March 2017 and written in English were included. Cumulative live birth rate, live birth rate and pregnancy loss rate (or miscarriage rate) were considered the critical outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE The guideline provides 38 recommendations on risk factors, prevention and investigations in couples with RPL, and 39 recommendations on treatments. These include 60 evidence-based recommendations – of which 31 were formulated as strong recommendations and 29 as conditional – and 17 good practice points. The evidence supporting investigations and treatment of couples with RPL is limited and of moderate quality. Of the evidence-based recommendations, only 10 (16.3%) were supported by moderate quality evidence. The remaining recommendations were supported by low (35 recommendations: 57.4%), or very low quality evidence (16 recommendations: 26.2%). There were no recommendations based on high quality evidence. Owing to the lack of evidence-based investigations and treatments in RPL care, the guideline also clearly mentions investigations and treatments that should not be used for couples with RPL. LIMITATIONS, REASONS FOR CAUTION Several investigations and treatments are offered to couples with RPL, but most of them are not well studied. For most of these investigations and treatments, a recommendation against the intervention or treatment was formulated based on insufficient evidence. Future studies may require these recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in RPL, based on the best evidence available. In addition, a list of research recommendations is provided to stimulate further studies in RPL. One of the most important consequences of the limited evidence is the absence of evidence for a definition of RPL. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment. J.E. reports position funding from CARE Fertility. S.L. reports position funding from SpermComet Ltd. S.M. reports research grants, consulting and speaker’s fees from GSK, BMS/Pfizer, Sanquin, Aspen, Bayer and Daiichi Sankyo. S.Q. reports speaker’s fees from Ferring. The other authors report no conflicts of interest. ESHRE Pages are not externally peer reviewed. This article has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Ruth Bender Atik
- Miscarriage Association, 17 Wentworth Terrace, Wakefield WF1 3QW, UK
| | - Ole Bjarne Christiansen
- Aalborg University Hospital, Department of Obstetrics and Gynaecology Aalborg, Reberbansgade 15, Aalborg 9000, Denmark.,University Hospital Copenhagen, Rigshospitalet, Recurrent Pregnancy Loss Unit Kobenhavn, Fertility Clinic 4071Blegdamsvej 9, DK 2100 Kobenhavn, Denmark
| | - Janine Elson
- CARE Fertility Group, John Webster House, 6 Lawrence Drive, Nottingham NG8 6PZ, UK
| | - Astrid Marie Kolte
- University Hospital Copenhagen, Rigshospitalet, Recurrent Pregnancy Loss Unit Kobenhavn, Fertility Clinic 4071Blegdamsvej 9, DK 2100 Kobenhavn, Denmark
| | - Sheena Lewis
- School of Medicine, Obstetrics and Gynaecology, The Queens University of Belfast, Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland BT12 5GH, UK
| | - Saskia Middeldorp
- Academic Medical Center, Department of Vascular Medicine Amsterdam, Meilbergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Willianne Nelen
- Radboudumc, Department of Obstetrics and Gynaecology Nijmegen, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Braulio Peramo
- Al Ain Fertility Clinic, Al Ain, 29 Street, Al Jimi PO Box 13844, Al Ain 13844, United Arab Emirates
| | - Siobhan Quenby
- University of Warwick, Division of Reproductive Health Clinical Science Laboratories, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK
| | | | - Mariëtte Goddijn
- Academic Medical Center, Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam, Meilbergdreef 9, Amsterdam 1105 AZ, The Netherlands
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van den Bosch S, Koudstaal M, Versnel S, Maal T, Xi T, Nelen W, Bergé S, Faber M. Patients and professionals have different views on online patient information about cleft lip and palate (CL/P). Int J Oral Maxillofac Surg 2016; 45:692-9. [DOI: 10.1016/j.ijom.2015.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/09/2015] [Accepted: 11/25/2015] [Indexed: 11/17/2022]
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Provoost V, Tilleman K, D'Angelo A, De Sutter P, de Wert G, Nelen W, Pennings G, Shenfield F, Dondorp W. Beyond the dichotomy: a tool for distinguishing between experimental, innovative and established treatment. Hum Reprod 2014; 29:413-7. [PMID: 24430776 DOI: 10.1093/humrep/det463] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION The precise delineation of the research phase is a recurrent subject of debate: When is the evidence base firm enough to decide that a new technology or treatment no longer needs to be regarded as 'experimental'? SUMMARY ANSWER We propose a framework that distinguishes between three instead of two types of treatment and describes a continuum from experimental over innovative to established treatment, offering a tool meant to facilitate decision-making about the introduction of new technologies in the clinic. WHAT IS KNOWN ALREADY Traditionally, guidelines from medical societies on the notion of 'experimental treatment' depart from a dichotomy between experimental and established treatment. However, in the field of reproductive medicine, there are several problems with a dichotomous framework. First, it does not offer an adequate account of the reality in the clinic. Secondly, this view may bring about several negative effects for the patient, such as techniques being considered established too early, holding risks unknown to patients. A further drawback of the dichotomy is that if a technique is no longer considered experimental, centres offering the technique may no longer consider it useful gathering and critically examining (follow-up) data. STUDY DESIGN, SIZE, DURATION The framework and scoring tool were developed over several phases during which the authors operated as a consensus group of experts. PARTICIPANTS/MATERIALS, SETTING, METHODS The scoring tool reflects the continuous progression of a new procedure from experimental through innovative to established. For this evolution, four criteria were considered relevant. The first (efficacy) is a categorical criterion (pass/fail). The other three criteria (safety, procedural reliability and transparency and effectiveness) are ordinal in nature. Thresholds have been introduced for all four criteria to avoid that a technology scoring high on procedure and effectiveness but extremely low on safety could move to the next level because of a sufficiently high overall score. MAIN RESULTS AND THE ROLE OF CHANCE Only treatments that are rated above the thresholds for all four criteria could be considered at least innovative treatments. When they score 4 or higher on the last three criteria, they are considered established treatments. LIMITATIONS, REASONS FOR CAUTION Knowledge about the procedures or techniques under discussion is essential in order to use the tool. WIDER IMPLICATIONS OF THE FINDINGS The tool is designed to be used on a macro-level (e.g. by professional societies) although it could also be valuable in the local setting. Both the framework and the tool can bring more clarity on the notion of 'experimental treatment', especially with regard to how to decide when a specific technology or treatment falls in this category and when it can move into one of the other categories. STUDY FUNDING/COMPETING INTEREST(S) none. TRIAL REGISTRATION NUMBER none.
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Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29:400-12. [PMID: 24435778 DOI: 10.1093/humrep/det457] [Citation(s) in RCA: 1242] [Impact Index Per Article: 124.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION What is the optimal management of women with endometriosis based on the best available evidence in the literature? SUMMARY ANSWER Using the structured methodology of the Manual for ESHRE Guideline Development, 83 recommendations were formulated that answered the 22 key questions on optimal management of women with endometriosis. WHAT IS KNOWN ALREADY The European Society of Human Reproduction and Embryology (ESHRE) guideline for the diagnosis and treatment of endometriosis (2005) has been a reference point for best clinical care in endometriosis for years, but this guideline was in need of updating. STUDY DESIGN, SIZE, DURATION This guideline was produced by a group of experts in the field using the methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to January 2012 and consensus within the guideline group on all recommendations. To ensure input from women with endometriosis, a patient representative was part of the guideline development group. In addition, patient and additional clinical input was collected during the scoping and review phase of the guideline. PARTICIPANTS/MATERIALS, SETTING, METHODS NA. MAIN RESULTS AND THE ROLE OF CHANCE The guideline provides 83 recommendations on diagnosis of endometriosis and on the treatment of endometriosis-associated pain and infertility, on the management of women in whom the disease is found incidentally (without pain or infertility), on prevention of recurrence of disease and/or painful symptoms, on treatment of menopausal symptoms in patients with a history of endometriosis and on the possible association of endometriosis and malignancy. LIMITATIONS, REASONS FOR CAUTION We identified several areas in care of women with endometriosis for which robust evidence is lacking. These areas were addressed by formulating good practice points (GPP), based on the expert opinion of the guideline group members. WIDER IMPLICATIONS OF THE FINDINGS Since 32 out of the 83 recommendations for the management of women with endometriosis could not be based on high level evidence and therefore were GPP, the guideline group formulated research recommendations to guide future research with the aim of increasing the body of evidence. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the implementation of the guideline. The guideline group members did not receive payment. All guideline group members disclosed any relevant conflicts of interest (see Conflicts of interest). TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- G A J Dunselman
- Department of Obstetrics & Gynaecology, Research Institute GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Kersten F, Nelen W, Goddijn M, Braat D, Mol B, Hermens R. P198 Adherence To Infertility Guidelines With Regard To Treatment Policy. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.202] [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: 11/03/2022]
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Dunselman G, Vermeulen N, Nelen W, Provoost V, Tilleman K, D'Angelo A, De Sutter P, De Wert G, Dondorp W, Nelen W, Pennings G, Shenfield F. Session 56: From experimental to established: ESHRE guidelines and position papers. Hum Reprod 2013. [DOI: 10.1093/humrep/det189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Saad H, Khalil E, Bora SA, Parikh J, Abdalla H, Thum MY, Bina V, Roopa P, Shyamala S, Anupama A, Tournaye H, Polyzos NP, Guzman L, Nelson SM, Lourenco B, Sousa AP, Almeida-Santos T, Ramalho-Santos J, Okhowat J, Wirleitner B, Neyer T, Bach M, Murtinger M, Zech NH, Polyzos NP, Nwoye M, Corona R, Blockeel C, Stoop D, Camus M, Tournaye H, Rajikin MH, Kamsani YS, Chatterjee A, Nor-Ashikin MNK, Nuraliza AS, Scaravelli G, D'Aloja P, Bolli S, De Luca R, Spoletini R, Fiaccavento S, Speziale L, Vigiliano V, Farquhar C, Brown J, Arroll N, Gupta D, Boothroyd C, Al Bassam M, Moir J, Johnson N, Pantasri T, Robker RL, Wu LL, Norman RJ, Buzaglo K, Velez M, Shaulov T, Sylvestre C, Kadoch IJ, Krog M, Prior M, Carlsen E, Loft A, Pinborg A, Andersen AN, Dolleman M, Verschuren WMM, Eijkemans MJC, Dolle MET, Jansen EHJM, Broekmans FJM, Van der Schouw YT, Fainaru O, Pencovich N, Hantisteanu S, Barzilay I, Ellenbogen A, Hallak M, Cavagna M, Baruffi RLR, Petersen CG, Mauri AL, Massaro FC, Ricci J, Nascimento AM, Vagnini LD, Pontes A, Oliveira JBA, Franco JG, Canas MCT, Vagnini LD, Nascimento AM, Petersen CG, Mauri AL, Massaro FC, Nicoletti A, Martins AMVC, Cavagna M, Oliveira JBA, Baruffi RLR, Franco JG, Lichtblau I, Olivennes F, Aubriot FA, Junca AM, Belloc S, Cohen-Bacrie M, Cohen-Bacrie P, de Mouzon J, Nandy T, Caragia A, Balestrini S, Zosmer A, Sabatini L, Al-Shawaf T, Seshadri S, Khalaf Y, Sunkara SK, Joy J, Lambe M, Lutton D, Nicopoullos J, Bora SA, Parikh J, Faris R, Abdalla H, Thum MY, Behre HM, Howles CM, Longobardi S, Chimote N, Mehta B, Nath N, Chimote NM, Mehta B, Nath N, Chimote N, Chimote NM, Mine K, Yoshida A, Yonezawa M, Ono S, Abe T, Ichikawa T, Tomiyama R, Nishi Y, Kuwabara Y, Akira S, Takeshita T, Shin H, Song HS, Lim HJ, Hauzman E, Kohls G, Barrio A, Martinez-Salazar J, Iglesias C, Velasco JAG, Tejada MI, Maortua H, Mendoza R, Prieto B, Martinez-Bouzas C, Diez-Zapirain M, Martinez-Zilloniz N, Matorras R, Amaro A, Bianco B, Christofolini J, Mafra FA, Barbosa CP, Christofolini DM, Pesce R, Gogorza S, Ochoa C, Gil S, Saavedra A, Ciarmatori S, Perman G, Pagliardini L, Papaleo E, Corti L, Vanni VS, Ottolina J, de Michele F, Marca AL, Vigano P, Candiani M, Li L, Yin Q, Huang L, Huang J, He Z, Yang D, Parikh J, Bora SA, Abdalla H, Thum MY, Tiplady S, Ledger W, Godbert S, Hart S, Johnson S, Wong AWY, Kong GWS, Haines CJ, Franik S, Nelen W, Kremer J, Farquhar C, Gillett WR, Lamont JM, Peek JC, Herbison GP, Sung NY, Hwang YI, Choi MH, Song IO, Kang IS, Koong MK, Lee JS, Yang KM, Celtemen MB, Telli P, Karakaya C, Bozkurt N, Gursoy RH, Younis JS, Ben-Ami M, Pundir J, Pundir V, Omanwa K, Khalaf Y, El-Toukhy T. Female (in)fertility. Hum Reprod 2013. [DOI: 10.1093/humrep/det213] [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: 11/14/2022] Open
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van den Boogaard NM, van den Boogaard E, Bokslag A, van Zwieten MCB, Hompes PGA, Bhattacharya S, Nelen W, van der Veen F, Mol BWJ. Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception. Hum Reprod 2011; 26:2122-8. [PMID: 21665873 DOI: 10.1093/humrep/der175] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND European guidelines on fertility care emphasize that subfertile couples should receive information about their chances of a natural conception and should not be exposed to unnecessary treatments and risks. Prognostic models can help to estimate their chances and select couples with a good prognosis for tailored expectant management (TEM). Nevertheless, TEM is not always practiced. The aim of this study was to identify any barriers or facilitators for TEM among professionals and subfertile couples. METHODS A qualitative study was performed with semi-structured in-depth interviews of 21 subfertile patients who were counselled for TEM and three focus-group interviews of 21 professionals in the field of reproductive medicine. Two theoretical models were used to guide the interviews and the analyses. The primary outcome was the set of identified barriers and facilitators which influence implementation of TEM. RESULTS Among the subfertile couples, main barriers were a lack of confidence in natural conception, a perception that expectant management is a waste of time, inappropriate expectations prior to the first consultation, misunderstanding the reason for expectant management and overestimation of the success rates of treatment. Both couples and professionals saw the lack of patient information materials as a barrier. Among professionals, limited knowledge about prognostic models leading to a decision in favour of treatment was recognized as a main barrier. A main facilitator mentioned by the professionals was better management of patients' expectations. CONCLUSIONS We identified several barriers and facilitators which can be addressed to improve the implementation of TEM. These should be taken into account when designing future implementation strategies.
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Affiliation(s)
- N M van den Boogaard
- Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
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Daly I, Lampic C, Skoog Svanberg A, Sydsjo G, Fryk N, Shyshak O, Donarelli Z, Lo Coco G, Gullo S, Marino A, Volpes A, Allegra A, Hinton L, Kurinczuk JJ, Ziebland S, Frederiksen Y, Zachariae R, Schmidt L, Ingerslev HJ, Vercammen L, Stoop D, De Vos M, Polyzos NP, Nekkebroeck J, Devroey P, Graham S, Jadva V, Morrissette M, Golombok S, Hamilton J, Behan H, Venables R, Maher B, Moorhead C, Hughes C, Mocanu E, Smeenk JMJ, Verhaak CM, Valladolid N, Guijarro JA, Brod M, Simone Crespi MPH, Hein Fennema P, Jadva V, Blake L, Readings J, Casey P, Golombok S, Jordan C, Broderick P, Winter C, Belva F, Nekkebroeck J, Bondulle M, Van den Broeck U, Vandermeeren M, Vanderschueren D, Enzlin P, Demyttenaere K, D'Hooghe TM, Harrison C, Bunting L, Tsibulsky I, Boivin J, Overbeek A, van den Berg MH, Louwe L, Hilders C, Veening MA, Lambalk CB, Stiggelbout AM, van Dulmen-den Broeder E, Ter Kuile MM, Indekeu A, D'Hooghe T, De Sutter P, Demyttenaere K, Vanderschueren D, Vanderschot B, Welkenhuysen M, Rober P, Colpin H, Riedel P, Baeckert-Sifedine IT, Iversen C. V, Ludwig O, Ludwig S, Kentenich H, Skoog Svanberg A, Lampic C, Brandstrom S, Geijervall AL, Gudmundsson J, Karlstrom PO, Solensten NG, Sydsjo G, Van Dongen AJCM, Kremer JAM, Van Sluisveld PHJ, Verhaak CM, Nelen WLDM, Galhardo A, Cunha M, Pinto-Gouveia J, Huppelschoten DA, Aarts JWM, van Empel IWH, Nelen WL, Kremer JAM, Ockhuysen H, Boivin J, Hoogen A, Macklon NS, Aarts A, van den Haak P, Nelen W, Tuil W, Faber M, Kremer J, Bak CW, Seok HH, Song SH, Yoo SW, Lee WS, Yoon TK. POSTER VIEWING SESSION - PSYCHOLOGY AND COUNSELLING. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.87] [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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van Peperstraten A, Nelen W, Grol R, Zielhuis G, Adang E, Stalmeier P, Hermens R, Kremer J. The effect of a multifaceted empowerment strategy on decision making about the number of embryos transferred in in vitro fertilisation: randomised controlled trial. BMJ 2010; 341:c2501. [PMID: 20884700 PMCID: PMC2948112 DOI: 10.1136/bmj.c2501] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the effects of a multifaceted empowerment strategy on the actual use of single embryo transfer after in vitro fertilisation. DESIGN Randomised controlled trial. SETTING Five in vitro fertilisation clinics in the Netherlands. PARTICIPANTS 308 couples (women aged <40) on the waiting list for a first in vitro fertilisation cycle. INTERVENTIONS The multifaceted strategy aimed to empower couples in deciding how many embryos should be transferred. The strategy consisted of a decision aid, support of a nurse specialising in in vitro fertilisation, and the offer of reimbursement by way of an extra treatment cycle. The control group received standard care for in vitro fertilisation. MAIN OUTCOME MEASURES Use of single embryo transfer in the first and second treatment cycles as well as decision making variables and costs of the empowerment strategy. RESULTS After the first treatment cycle, single embryo transfer was used by 43% (65/152) of couples in the intervention group and 32% (50/156) in the control group (difference 11%, 95% confidence interval 0% to 22%; P=0.05). After the second treatment cycle, single embryo transfer was used by 26% (14/154) of couples in the intervention group compared with 16% (8/51) in the control group (difference 10%, -6% to 26%; P=0.20). Compared with couples receiving standard care, those receiving the empowerment strategy had significantly higher empowerment and knowledge levels but no differences in anxiety levels. Mean total savings per couple in the intervention group were calculated to be €169.75 (£146.77; $219.12). CONCLUSIONS A multifaceted empowerment strategy encouraged use of single embryo transfer, increased patients' knowledge, reduced costs, and had no effect on levels of anxiety or depression. This strategy could therefore be an important tool to reduce the twin pregnancy rate after in vitro fertilisation. This trial did not, however, demonstrate the anticipated 25% difference in use of single embryo transfer of the power calculation. TRIAL REGISTRATION ClinicalTrials.gov NCT00315029.
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Affiliation(s)
- Arno van Peperstraten
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands.
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Tas BA, Nijhuis JG, Nelen W, Willems E. The intercostal-to-phrenic-inhibitory reflex (IPIR) in normal and intra-uterine growth-retarded (IUGR) human fetuses from 26 to 40 weeks of gestation. Early Hum Dev 1993; 32:177-82. [PMID: 8486119 DOI: 10.1016/0378-3782(93)90010-r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The existence of an IPIR in the healthy fetus between 37 and 40 weeks of gestation has already been demonstrated: compression of the fetal thoracic wall during an epoch of fetal breathing movements (FBM) consistently caused a fetal apnea (> or = 4 s). The apnea durations were similar in fetal behavioural states 1F and 2F, with a wide inter- and intrafetal variability. We therefore hypothesized that the duration of the IPIR-apnea would increase during gestation and would be increased in IUGR-fetuses as compared to healthy fetuses of the same age. Twenty-six healthy fetuses between 28 and 40 weeks (mean 34.3 weeks) and 14 IUGR-fetuses between 26 and 38 weeks (mean 33.5 weeks) were studied. If FBM were present, the caudolateral part of the fetal thoracic wall was shortly compressed manually and the duration of the resulting apnea was measured. In a random order a sham-compression was also carried out on the fetal head. In normal fetuses 21/28 real compressions were followed by an apnea in 1F, while this was only the case in 3/21 sham-compressions (P < 10(-4)). For 2F these results were 47/57 and 7/51, respectively (P < 10(-4)). In IUGR-fetuses 43/51 real compressions (1F and 2F together) and 7/46 sham-procedures provoked an apnea (P < 10(-4)). These results prove the existence of the IPIR in normal and IUGR-fetuses. The mean (+/- S.D.) duration of apnea in the IUGR-fetuses was 15.8 s (+/- 4.0) (range 4-80 s) and 15.2 s (+/- 4.3) (range 4-106 s) in the normal group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B A Tas
- Department of Obstetrics and Gynecology, University Hospital St-Radboud Nijmegen, Netherlands
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