ABSTRACT
Randomised controlled trials are applied more readily to medical than surgical interventions. There are even more barriers to randomised trials of surgical interventions than to other randomised trials. These include reluctance among surgeons to undertake trials (owing to concern over expressing equipoise, surgical training and surgical learning curve issues, restrictions of funding and time for research, even financial conflict of interest), reluctance of patients to participate in surgical trials owing to fears over 'experimental surgery', failure of randomised trials to detect rare surgical complications and the almost universal failure of those conducting surgical trials to examine important long-term outcomes. Rapid advances in surgical fields mean that new surgical techniques are rapidly superseded and clinical questions surrounding new techniques may linger only until the next new technique becomes available. Nonetheless randomised controlled trials remain the cornerstone of evaluating the effectiveness of surgical interventions. Genuine progress has been made in this field. However, large multicentre collaborative randomised trials that have been prospectively defined in trial registries will be required in the future to answer the important clinical questions regarding gynaecological surgical interventions.
Subject(s)
Evidence-Based Medicine , Gynecologic Surgical Procedures/methods , Randomized Controlled Trials as Topic , Female , Gynecologic Surgical Procedures/trends , Humans , Multicenter Studies as Topic , Randomized Controlled Trials as Topic/trendsABSTRACT
As the Cochrane Collaboration is poised to begin publishing systematic reviews of diagnostic test accuracy studies in addition to its traditional systematic reviews of treatment effectiveness, we are likely to see a major expansion in the number of primary studies and systematic reviews of diagnostic test accuracy in the medical literature. Obstetricians and gynaecologists have played an important role in initiating this newer area of research. However, the methodology for such studies is challenging and the published literature is riddled with pitfalls. This editorial seeks to simplify the concepts involved in diagnostic test accuracy studies and systematic reviews, to reflect on the early development of this research in our specialty and to envision the future pathway for screening and diagnostic research.
Subject(s)
Diagnostic Techniques, Obstetrical and Gynecological/statistics & numerical data , Evidence-Based Medicine/statistics & numerical data , Review Literature as Topic , Evidence-Based Medicine/standards , Humans , Likelihood Functions , Meta-Analysis as Topic , Odds Ratio , Pilot Projects , Predictive Value of TestsABSTRACT
OBJECTIVE: To describe the demographics and clinical presentation of endosalpingiosis. To compare endosalpingiosis with endometriosis, particularly in regards to infertility and chronic pelvic pain. DESIGN: Retrospective analysis. SETTING: Hospital. PATIENT(S): We included women with a histologic diagnosis of endosalpingiosis, a second group with a histologic diagnosis of endometriosis, and a final group who had neither endosalpingiosis nor endometriosis, with histology reports after undergoing gynecologic surgery. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Infertility and chronic pelvic pain. RESULT(S): We found that 34.5% of endosalpingiosis cases had concurrent endometriosis; 40% of the endosalpingiosis group were postmenopausal. Endometriosis was significantly associated with infertility (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.4-8.5) and chronic pelvic pain (OR 3.0, 95% CI 1.7-5.5). In contrast, there was no significant link between endosalpingiosis and infertility (OR 1.6, 95% CI 0.7-3.7) nor chronic pelvic pain (OR 0.8, 95% CI 0.5-1.5). Gynecologic malignancy occurred significantly more in premenopausal women with endosalpingiosis than in those without (OR 10.3, 95% CI 3.6-29.8). CONCLUSION(S): Endosalpingiosis appears to affect postmenopausal women at a rate much higher than previously reported. Endosalpingiosis and endometriosis occur concurrently in 34% of endosalpingiosis cases; however, the two diseases have different clinical presentations. This demonstrates that endosalpingiosis is not a variant of endometriosis.
Subject(s)
Endometriosis/complications , Fallopian Tube Diseases/complications , Infertility, Female/complications , Adult , Aged , Chronic Pain/diagnosis , Chronic Pain/etiology , Endometriosis/diagnosis , Fallopian Tube Diseases/diagnosis , Female , Genital Neoplasms, Female/complications , Genital Neoplasms, Female/diagnosis , Humans , Infertility, Female/diagnosis , Middle Aged , Pelvic Pain/diagnosis , Pelvic Pain/etiology , Postmenopause , Retrospective StudiesABSTRACT
Current data supporting the effectiveness of metformin as a fertility treatment for women with polycystic ovary syndrome have been misinterpreted. Still unproven for women with polycystic ovary syndrome is, first, whether metformin adds to the standard first-line fertility management in all women, second, whether metformin is an effective fertility treatment for overweight women, and third, the relative fertility efficacy of metformin and clomiphene citrate as a first-line treatment in women with a lower body weight. The PCOSMIC (polycystic ovary syndrome: metformin for infertility with clomiphene) trial is an ongoing New Zealand multicentre double-blind placebo-controlled parallel randomised trial assessing these questions.