Perinatal deaths and low birthweight in an urban health centre in the Gambia: A prospective cohort study.

Perinatal deaths (stillbirths after 28 weeks gestation and early neonatal deaths) are rarely reported separately but are the deaths most closely associated with complications during pregnancy, birth and the first days of life. We conducted a prospective cohort study to report perinatal deaths, late neonatal deaths and low birthweight babies as they occur. This cohort of birth outcomes from The Gambia was conducted between 2012 and 2016 and followed 1611 women attending a government-supported health center from the first antenatal visit to 28 days post-delivery. The outcome of the pregnancy was known for 1372 women (85.2%) and included 20 stillbirths and 12 early neonatal deaths. Of 1252 singleton babies with known birthweight 85 weighed less than 2500g (6.8%). Using multivariate analysis it was shown that women who attended the antenatal clinic four times or more were less likely to have a low birthweight baby than women who attended less than four times, OR 0.47 (95% CI:0.273-0.799). We conclude that frequent visits to the antenatal clinic are associated with better outcomes.

Reprint - Bipolar vs. monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction: A Cochrane review.

INTRODUCTION: There remains uncertainty regarding the differences in patient outcomes between monopolar transurethral resection of the prostate (MTURP) and bipolar TURP (BTURP) in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). METHODS: A systematic literature search was carried out up to March 19, 2019. Methods in the Cochrane Handbook were followed. Certainty of evidence (CoE) was assessed using the GRADE approach. RESULTS: A total of 59 randomized controlled trials (RCTs) with 8924 participants were included. BTURP probably results in little to no difference in International Prostate Symptom Score (IPSS) at 12 months (mean difference -0.24, 95% confidence internal [CI] -0.39--0.09; participants=2531; RCTs=16; moderate CoE) or health-related quality of life (HRQOL) at 12 months (mean difference -0.12, 95% CI -0.25-0.02; participants=2004, RCTs=11; moderate CoE), compared to MTURP. BTURP probably reduces TUR syndrome (relative risk [RR] 0.17, 95% CI 0.09-0.30; participants= 6,745, RCTs=44; moderate CoE) and blood transfusions (RR 0.42, 95% CI 0.30-0.59; participants=5727, RCTs=38; moderate CoE), compared to MTURP. BTURP may carry similar risk of urinary incontinence at 12 months (RR 0.20, 95% CI 0.01-4.06; participants=751; RCTs=4; low CoE), re-TURP (RR 1.02, 95% CI 0.44-2.40; participants=652, RCTs=6, I2=0%; low CoE) and erectile dysfunction (International Index of Erectile Function [IIEF-5]) at 12 months (mean difference 0.88, 95% CI -0.56-2.32; RCTs=3; moderate CoE), compared to MTURP. CONCLUSIONS: BTURP and MTURP probably improve urological symptoms to a similar degree. BTURP probably reduces TUR syndrome and blood transfusion slightly postoperatively. The moderate certainty of evidence available for primary outcomes suggests no need for further RCTs comparing BTURP and MTURP.

Determinants of compliance with the World Health Organisation recommendations for pregnant women in an urban health centre in The Gambia.

In 2001 the World Health Organization drew up recommendations for pregnant women in order to reduce maternal mortality: the first visit to the antenatal clinic to be in the first trimester, at least four visits in total and delivery with a trained birth attendant. This study reports the extent to which pregnant women attending a health centre in The Gambia complied with the recommendations. A cohort of 1611 consecutive pregnant women was recruited. Only 384 (23.9%) women first attended in the first trimester and 568 (41.6%) attended at least four times. Only 15.8% of the women complied with all recommendations. Following multivariate analysis the educational level of the partner was the sole factor associated with both recommendations regarding attendance. This level of compliance reflects widespread ignorance of the value of early antenatal care and frequent visits. Public health programmes require a basic level of education to be effective.

A core outcome set for localised prostate cancer effectiveness trials: protocol for a systematic review of the literature and stakeholder involvement through interviews and a Delphi survey.

BACKGROUND: Prostate cancer is a growing health problem worldwide. The management of localised prostate cancer is controversial. It is unclear which of several surgical, radiotherapeutic, ablative, and surveillance treatments is the most effective. All have cost, process and recovery, and morbidity implications which add to treatment decision-making complexity for patients and healthcare professionals. Evidence from randomised controlled trials (RCTs) is not optimal because of uncertainty as to what constitutes important outcomes. Another issue hampering evidence synthesis is heterogeneity of outcome definition, measurement, and reporting. This project aims to determine which outcomes are the most important to patients and healthcare professionals, and use these findings to recommend a standardised core outcome set for comparative effectiveness trials of treatments for localised prostate cancer, to optimise decision-making. METHODS/DESIGN: The range of potentially important outcomes and measures will be identified through systematic reviews of the literature and semi-structured interviews with patients. A consultation exercise involving representatives from two key stakeholder groups (patients and healthcare professionals) will ratify the list of outcomes to be entered into a three round Delphi study. The Delphi process will refine and prioritise the list of identified outcomes. A methodological substudy (nested RCT design) will also be undertaken. Participants will be randomised after round one of the Delphi study to one of three feedback groups, based on different feedback strategies, in order to explore the potential impact of feedback strategies on participant responses. This may assist the design of a future core outcome set and Delphi studies. Following the Delphi study, a final consensus meeting attended by representatives from both stakeholder groups will determine the final recommended core outcome set. DISCUSSION: This study will inform clinical practice and future trials of interventions of localised prostate cancer by standardising a core outcome set which should be considered in comparative effectiveness studies for localised prostate cancer.

Provision of cancer information as a "support for navigating the knowledge landscape": findings from a critical interpretive literature synthesis.

PURPOSE OF THE RESEARCH: Information is often seen as a crucial tool for the support of cancer patients, facilitating their involvement in care management and in decision-making. The importance of theory in guiding provision of cancer information has been widely accepted, but there is a growing need for critical reflection on the concepts underlying approaches to information provision. This paper presents findings from a critical review of literature related to information in cancer care. METHODS: Critical interpretive synthesis (CIS) was employed to review and synthesise published literature. 57 publications were selected in a multi-step systematic process. Their content was analysed and synthesised using established methodology consistent with primary qualitative research. KEY RESULTS: The synthesis identified and characterised a concept of cancer information provision as a "support for navigating the knowledge landscape". This concept recognises the diverse, changing and relational nature of patients' values, needs and preferences. It promotes a view of information provision as an ongoing and flexible process of navigating different resources, which in turn support the navigation of patients' broader experiences of their health and care. This process recognises various levels of patient involvement with healthcare services, and ensures timely provision of selected and personally relevant information. CONCLUSION: The concept of "support for navigating the knowledge landscape" offers a useful way of envisaging information services for people with cancer (and possibly also with other chronic illnesses), which would be responsive to patients' needs and preferences.

Defining a patient-reported outcome measure for urethral stricture surgery.

BACKGROUND: A systematic literature review did not identify a formally validated patient-reported outcome measure (PROM) for urethral stricture surgery. OBJECTIVE: Devise a PROM for urethral stricture surgery and evaluate its psychometric properties in a pilot study to determine suitability for wider implementation. DESIGN, SETTING, AND PARTICIPANTS: Constructs were identified from existing condition-specific and health-related quality of life (HRQoL) instruments. Men scheduled for urethroplasty were prospectively enrolled at five centres. INTERVENTION: Participants self-completed the draft PROM before and 6 mo after surgery. MEASUREMENTS: Question sets underwent psychometric assessment targeting criterion and content validity, test-retest reliability, internal consistency, acceptability, and responsiveness. RESULTS AND LIMITATIONS: A total of 85 men completed the preoperative PROM, with 49 also completing the postoperative PROM at a median of 146 d; and 31 the preoperative PROM twice at a median interval of 22 d for test-retest analysis. Expert opinion and patient feedback supported content validity. Excellent correlation between voiding symptom scores and maximum flow rate (r = -0.75), supported by parallel improvements in EQ-5D visual analogue and time trade-off scores, established criterion validity. Test-retest intraclass correlation coefficients ranged from 0.83 to 0.91 for the total voiding score and 0.93 for the construct overall; Cronbach's α was 0.80, ranging from 0.76 to 0.80 with any one item deleted. Item-total correlations ranged from 0.44 to 0.63. These values surpassed our predefined thresholds for item inclusion. Significant improvements in condition-specific and HRQoL components following urethroplasty demonstrated responsiveness to change (p < 0.0001). Wider implementation and review of the PROM will be required to establish generalisability across different disease states and for more complex interventions. CONCLUSIONS: This pilot study has defined a succinct, practical, and psychometrically robust PROM designed specifically to quantify changes in voiding symptoms and HRQoL following urethral stricture surgery.