Seema A. Tirlapur

Preferred and actual delivery mode after a cesarean in London, UK

To determine the delivery mode preferred by pregnant women with 1 previous cesarean delivery and to investigate the relationship between preferred and actual mode of delivery.

Quality of information on the internet related to bladder pain syndrome: a systematic review of the evidence

Introduction and hypothesisBladder pain syndrome (BPS) has an impact on quality of life and available treatments often only provide temporary symptomatic relief. The information provided by websites can be valuable for patient education and management. The hypothesis was to assess medical information available on the internet related to bladder pain syndrome in terms of accuracy, credibility, readability and quality.MethodsA search was performed in the meta-search engine Copernic Agent, using the search terms “bladder pain syndrome, interstitial cystitis, painful bladder syndrome and pelvic pain”, which simultaneously captured websites from a range of engines. Websites in the English language that were open-access were included. The four quality assessments used were: credibility using a ten-point scale, accuracy based on the American Urological Association guidelines, quality using the DISCERN questionnaire and readability using the Flesch Reading Ease Score. Inter-rater agreement was tested by intra-class coefficient (ICC).ResultsEighteen suitable websites were identified; 7 (39%) were specialist or specific to BPS. The combined mean scores for accuracy, quality, credibility and readability ranged from 83 to 144 for specialist websites and 76 to 137 for non-specialist ones, with a maximum possible score of 208. There was good inter-observer agreement for the assessments performed with an ICC ranging from 0.80 for DISCERN to 0.53 for readability. Specialist websites had higher quality scores (median difference 10, p = 0.07) and readability scores (median difference 5.4, p = 0.05) compared with non-specialist websites whereas credibility and accuracy scores were no different.ConclusionWe found four websites that fulfilled our criteria for good quality information.

Nerve stimulation for chronic pelvic pain and bladder pain syndrome: a systematic review

Chronic pelvic pain (CPP) and bladder pain syndrome (BPS) can have a negative impact on quality of life. Neuromodulation has been suggested as a possible treatment for refractory pain. To assess the effectiveness of tibial and sacral nerve stimulation in the treatment of BPS and CPP. We searched until July 2012: the Cochrane Library, EMBASE (1980–2012), Medline (1950–2012), Web of knowledge (1900–2012), LILACS (1982–2012) and SIGLE (1990–2012) with no language restrictions. We manually searched through bibliographies and conference proceedings of the International Continence Society. Randomized and prospective quasi‐randomized controlled studies vs. sham nerve stimulation treatment or usual care of patients with CPP and BPS who underwent sacral or tibial nerve stimulation were included. Any studies involving transcutaneous stimulation were excluded. The outcome was a cure or improvement in symptoms. Three studies with 169 patients treated with tibial nerve stimulation were included; two for CPP and one for BPS. There were improvements in pain, urinary and quality of life scores. There were no reported data for sacral nerve stimulation. There is scanty literature reporting variable success of posterior tibial nerve stimulation in improving pain, urinary symptoms and quality of life in CPP and BPS. In view of the dearth of quality literature, a large multi‐centered clinical trial investigating the effectiveness of electrical nerve stimulation to treat BPS and CPP along with the cost‐analysis of this treatment is recommended.

The management of secondary lower limb lymphoedema in cancer patients: A systematic review

Background: Lower limb lymphoedema is a recognised complication of cancer commonly encountered in palliative care, associated with reduced mobility and poor quality of life. Aim: To evaluate the available evidence for the treatment of secondary lower limb lymphoedema in patients with malignancies. Design: A systematic review of the literature. Data sources: The MEDLINE, Embase, LILACS, Science Citation Index, Cochrane Databases and conference proceedings for published data from date of inception to July 2014 were searched. Relevant unpublished studies via relevant databases, Internet searches and hand-searches of the bibliographies of relevant papers were performed. Results: From 1617 citations, 32 papers were selected for full-text assessment. Two randomised trials and five observational studies were identified. The two randomised controlled trials evaluated graded compression stockings and Coumarin capsules, respectively. The five observational studies evaluated lymphovenous microsurgical shunts, pneumatic compression devices, compression bandages alone, manual lymphatic drainage with compression and a herbal remedy combining Coumarin, Ginkgo and Melitoto (with or without manual lymphatic drainage), respectively. The extracted studies showed substantial heterogeneity. Hence, a meta-analysis was inappropriate and not performed. Conclusion: Few studies have evaluated the clinical effectiveness and potential side effects of treatments for lower limb lymphoedema. Moreover, symptoms and quality-of-life assessments were inconsistently reported. All included studies report lower limb volume reduction after treatment, which includes complex decongestion therapy, graded compression stockings and lymphovenous microsurgical shunts. Adequately powered randomised controlled trials of these interventions are recommended. Effort should be made to establish standardised outcomes, to minimise bias and to improve reporting quality in future trials of treatment for lower limb lymphoedema.

Variations in the reporting of outcomes used in systematic reviews of treatment effectiveness research in bladder pain syndrome

This paper investigates the quality of outcomes reported in systematic reviews and randomised controlled trials (RCTs) of bladder pain syndrome and its relationship with study quality and journal impact factor. We searched until August 2013 the Cochrane Library, EMBASE, Medline, CINAHL, LILACS and SIGLE, without language restrictions. Quality of outcome reporting in systematic reviews and constituent RCTs was assessed using a 6-point scale. Overall study quality was assessed using the AMSTAR and Jadad scoring systems, and impact factor in the year of publication was noted. Spearmans rank correlation was calculated. There were 8 systematic reviews, with a total of 28 RCTs (1732 patients), reporting 5 outcomes using 19 different measurement scales. The outcomes reported in individual RCTs were urinary symptoms (100%), pain (64%), quality of life (39%), general wellbeing (36%) and bladder capacity (36%). The mean quality of outcomes reported was 1.63 (95% CI 0.29-2.96) for systematic reviews and 3.25 (95% CI 2.80-3.70) for RCTs. The quality of outcomes reported showed correlation with overall study quality (0.90, 95% CI 0.79-0.95, p<0.0001) but not with journal impact factor (0.07, 95% CI -0.31-0.43, p=0.35). Multivariable linear regression showed a relationship between quality of outcome reporting and study quality (β=0.05, p<0.0001), adjusting for effects of study type, impact factor and journal type. There is a need to generate consensus over a set of core outcomes in bladder pain syndrome using standardised reporting tools and to disseminate these through good publication practice.

Planned caesarean section or trial of vaginal delivery? A meta-analysis.

Purpose of review This systematic review with meta-analysis aims to determine whether maternal outcomes are better with antenatal choice to give birth by caesarean section compared to vaginal birth, in singleton pregnancies in low-risk women without a subsequent pregnancy. The main outcome measures used were as follows: postpartum haemorrhage, postnatal depression, urinary incontinence and maternal mortality. Recent findings There were seven relevant studies (2 730 410 women) that were of high quality, identified for the purpose of this review. Randomized and observational evidence was synthesized, showing no real difference in maternal morbidity risk: maternal mortality (relative risk 0.19, 95% confidence interval 0.0013–27.27, P = 0.51); postpartum haemorrhage (relative risk 1.15, 95% confidence interval 0.40–3.31, P = 0.79) and blood transfusion (relative risk 0.91, 95% confidence interval 0.39–2.13, P = 0.84). Summary On the basis of the current research and the findings of this review, planned caesarean section is associated with a lower risk of developing urinary incontinence symptoms postpartum or having a blood transfusion yet conversely results showed an increased risk of postpartum haemorrhage. The synthesized data are not applicable to clinical practice; however, they prompt much further investigation into planned delivery and its associated morbidity risk.

Assimilating evidence quality at a glance using graphic display: research synthesis on labor induction

Evidence profiled in the World Health Organization induction of labor guideline extended to 84 tables and 116 pages, which is hard to assimilate. Summarizing this evidence graphically can present information on key outcomes succinctly, illustrating where the gaps, strengths and weaknesses lie. For induction of labor, graphic representation clearly showed that evidence was lacking on maternal complications when comparing oxytocin with other agents, evidence was strong on birth within 24 h when comparing vaginal prostaglandins with placebo or no treatment, but again it was weak on uterine hyperstimulation when comparing oxytocin with vaginal prostaglandins. These graphs/plots allow readers to capture the essence of the information gathered at a glance. The use of graphical displays when interpreting and publishing data on several comparisons and outcomes is encouraged.

Chronic pelvic pain: how does noninvasive imaging compare with diagnostic laparoscopy?

Purpose of review Chronic pelvic pain (CPP) has an annual prevalence of 38/1000 in the UK, with coexisting pathologies often present. Diagnostic laparoscopy has long been the gold standard diagnostic test, but with up to 40% showing no abnormality, we explore the value of noninvasive imaging, such as pelvic ultrasound and MRI. Recent findings A literature review from inception until January 2015 of the following databases: PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, and System for Information on Grey Literature in Europe were performed to identify published studies assessing the usefulness of ultrasound, MRI, and laparoscopy in the diagnosis of CPP. Three studies (194 women) addressed their comparative performance in patients with endometriosis, showing the sensitivity of ultrasound ranged between 58 and 88.5%; MRI was 56–91.5% and in the one study using histology as its reference standard, the sensitivity of laparoscopy was 85.7%. Noninvasive imaging has the additional benefit of being well tolerated, safer, and cheaper than surgery. Summary CPP, by nature of its multifactorial causation, can be difficult to manage and often requires a multidisciplinary team. Ultrasound and MRI may provide information about the presence or lack of abnormality, which would allow general practitioners or office gynaecologists to initiate treatment and think about surgery as a second-line investigative tool.

Bladder pain syndrome: validation of simple tests for diagnosis in women with chronic pelvic pain: BRaVADO study protocol

BackgroundBladder pain syndrome (BPS), a condition with no gold standard diagnosis, comprises of a cluster of signs and symptoms. Bladder filling pain and bladder wall tenderness are two basic clinical features, present in a high number of sufferers. This study will validate the performance of these simple tests for BPS in women with chronic pelvic pain (CPP).Methods/designWe will conduct a prospective test validation study amongst women with unexplained CPP presenting to gynaecology outpatient clinics. Two index tests will be performed: patient reported bladder filling pain and bladder wall tenderness on internal pelvic bimanual examination. A final diagnosis of BPS will be made by expert consensus panel. We will assess the rates of index tests in women with CPP; evaluate the correlation between index tests and Pelvic Pain Urgency/ Frequency (PUF) questionnaire results; and determine index test sensitivity and specificity using a range of analytical methods. Assuming a 50% prevalence of BPS and an 80% power approximately 152 subjects will be required exclude sensitivity of < 55% at 70% sensitivity.DiscussionThe results of this test validation study will be used to identify whether a certain combination of signs and symptoms can accurately diagnose BPS.Trial registrationISRCTN13028601

How do we define the term idiopathic

Purpose of review The term idiopathic is often used to describe a disease with no identifiable cause. It may be a diagnosis of exclusion; however, what specific minimum investigations need to be performed to define idiopathic is not always clear. This commentary describes the problems inherent in reaching a definition for the term idiopathic. Recent findings There is limited literature describing methodology to define a condition with no clear diagnostic criteria. This article offers chronic pelvic pain (CPP) syndrome as an example, in which structured qualitative interviews, literature searches and group consensus discussions were undertaken to produce a working definition for idiopathic CPP. Summary It is important to correctly develop these standardized definitions for use as outcome measures in research and as clinical indicators in healthcare.