Surveys of clinician and patient attitudes to an add-on for in vitro fertilisation.

BACKGROUND: Add-ons at the time of in vitro fertilisation (IVF) have become commonplace, despite a general lack of evidence that they are effective and safe. The 'Colorado Protocol' is a commonly used add-on consisting of aspirin, steroid and an antibiotic. Before commencing planning for a clinical trial evaluating the Colorado Protocol, researchers and funders need evidence that the Colorado Protocol is being prescribed, and to be assured that sufficient numbers of participants can be recruited for a clinical trial. AIMS: To survey fertility clinicians and patients on attitudes toward use of add-ons during IVF, willingness of patients to be randomly assigned to an add-on trial treatment or placebo, and what would be the clinically meaningful outcomes, using the Colorado Protocol as a test case. MATERIALS AND METHODS: Two online surveys were conducted: clinicians from fertility clinics across the United Kingdom, Australia, and New Zealand; and patients from Auckland-based clinics and NZ patient support groups. RESULTS: Of 58 clinicians, 44 (75%) had recommended an add-on within the preceding year. Thirty-nine (67%) clinicians were aware of the Colorado Protocol, with 17 (29%) having recommended it within the preceding year. Of the 289 patients, 80% indicated willingness to take trial medications during IVF, and 68% were willing to be randomly assigned to the placebo arm of a trial. The median perceived minimum clinically important difference in live births in both samples was 5%. CONCLUSIONS: A future trial of this add-on in IVF would be supported by patients in the context of the New Zealand fertility healthcare system.

Obesity intervention evidence synthesis: Where are the gaps and which should we address first?

Health professionals and policymakers rely on evidence synthesized from high quality research studies. Yet, there remain unanswered questions about how to prevent and treat obesity. In this research project, international practice guidelines and Cochrane systematic reviews were examined in order to identify gaps in the synthesized obesity intervention evidence base. One hundred and forty-two partial or complete gaps were found. Systematic review questions to address these gaps were formulated and subjected to a prioritization consultation process with 36 international obesity expert stakeholders. Forty-three review questions were priority-assessed. The top 10 ranked review questions received support from at least 75.0% of stakeholders. The leading questions focused on preventive and community-based approaches, including those delivered through primary-care. Children within the context of their families were a highly-prioritized target group, as were persons with diabetes or disabilities. Experts also prioritized reviews to determine which elements of programs are the most effective, and by which mode they are best delivered. Experts recommended that negative, psycho-social, and longer-term outcomes be captured in reviews. We request reviewers and funders to strongly consider addressing the top 10 leading prioritized review questions presented here.