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  1. Article ; Online: The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies.

    Solangon, S A / Otify, M / Gaughran, J / Holland, T / Ross, J / Jurkovic, D

    Human reproduction open

    2022  Volume 2022, Issue 1, Page(s) hoab046

    Abstract: Study question: What is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy?: Summary answer: In women diagnosed with heterotopic pregnancies, minimally invasive ...

    Abstract Study question: What is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy?
    Summary answer: In women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy.
    What is known already: Previous studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that.
    Study design size duration: A retrospective observational case-control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London early pregnancy units (EPUs) covering a 20-year period between April 2000 and November 2019.
    Participants/materials setting methods: All women attended EPUs because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management.There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation.
    Main results and the role of chance: In the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2-30.3) miscarriages <12 weeks' gestation and 9/49 (18%, 95% CI 8.7-32) miscarriages in those treated surgically. In the control group, there were 28/156 (18%, 95% CI 12.2-24.8) miscarriages <12 weeks' gestation, which was not significantly different from heterotopic pregnancies who were treated surgically [odds ratio (OR) 1.03 95% CI 0.44-2.36]. There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9-90.2) and 38/48 (79%, 95% CI 65-89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4-87.2) live births in the control group (OR 0.87, 95% CI 0.39-1.94).
    Limitations reasons for caution: This study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis.
    Wider implications of the findings: This study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies.
    Study funding/competing interests: This work did not receive any funding. None of the authors has any conflict of interest to declare.
    Trial registration number: Research Registry: researchregistry6430.
    Language English
    Publishing date 2022-01-03
    Publishing country England
    Document type Journal Article
    ISSN 2399-3529
    ISSN (online) 2399-3529
    DOI 10.1093/hropen/hoab046
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  2. Article ; Online: Outcomes of ovarian transposition in cervical cancer; an updated meta-analysis.

    Laios, Alexandros / Otify, Mohamed / Papadopoulou, Argyro / Gallos, Ioannis D / Ind, Thomas

    BMC women's health

    2022  Volume 22, Issue 1, Page(s) 305

    Abstract: Background: Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early ...

    Abstract Background: Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early menopause. As women become more knowledgeable about their fertility options, it is still unclear who will benefit from the intervention. We updated our previous meta-analysis of ovarian function preservation, symptomatic ovarian cysts, and metastases to the transposed ovaries following ovarian transposition in cervical cancer patients to further guide current clinical practice.
    Methods: A systematic search of Medline, Embase, Web of Science, and The Cochrane Library databases, dating from January 1980 to July 2021, was conducted. We computed the summary proportions of women who had ovarian function preservation, non-ovarian cyst formation and metastases to the transposed ovaries following ovarian transposition by random-effects meta-analysis and we explored study heterogeneity by type of radiotherapy.
    Results: There were 29 publications reporting on 1160 women with cervical cancer who underwent ovarian transposition. In the group that underwent surgery alone, 91% of the women had preserved ovarian function (95% CI 83-100), 89% (95% CI 80-99) of women who did not develop ovarian cysts, and 99% (95% CI 1-5) of women who did not suffer metastases to the transposed ovaries. In the surgery ± brachytherapy (BR) group, the proportion of women with the preserved ovarian function was 93% (95% CI 76-113), 84% (95% CI 69-103) of women who did not develop ovarian cysts, and 99% (95% CI 82-120) of women who did not suffer metastases to the transposed ovaries. In the external beam pelvic radiotherapy (EBRT) ± BR ± surgery group, the proportion of women with the preserved ovarian function was 61% (95% CI 55-69), and 95% (95% CI 85-107) of women who developed ovarian cysts. There were no metastases to the transposed ovaries in that group.
    Conclusions: In women with cervical cancer, ovarian transposition offers a significant preservation of the ovarian function. Despite an expected incidence of ovarian cyst formation, it carries almost no risk for metastases to the transposed ovaries.
    MeSH term(s) Brachytherapy ; Female ; Humans ; Ovarian Cysts ; Pelvis ; Uterine Cervical Neoplasms/surgery
    Language English
    Publishing date 2022-07-22
    Publishing country England
    Document type Journal Article ; Meta-Analysis
    ZDB-ID 2050444-5
    ISSN 1472-6874 ; 1472-6874
    ISSN (online) 1472-6874
    ISSN 1472-6874
    DOI 10.1186/s12905-022-01887-8
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  3. Article ; Online: A systematic review and meta-analysis of the use of ultrasound to diagnose borderline ovarian tumours.

    Otify, M / Laios, A / Elshamy, T / D'Angelo, A / Amso, N N

    European journal of obstetrics, gynecology, and reproductive biology

    2019  Volume 244, Page(s) 120–127

    Abstract: Borderline ovarian tumours (BOTs) are difficult to diagnose preoperatively. The ability to distinguish between BOTs and other ovarian cancer types prior to surgery could have a profound impact on patient childbearing counselling and surgical planning. ... ...

    Abstract Borderline ovarian tumours (BOTs) are difficult to diagnose preoperatively. The ability to distinguish between BOTs and other ovarian cancer types prior to surgery could have a profound impact on patient childbearing counselling and surgical planning. Ultrasound (US) pattern recognition by an expert examiner can be an excellent tool for the discrimination of benign and malignant ovarian masses. With respect to US features, most studies were based on well-known risk models. Nevertheless, very few studies have solely evaluated the utility of ultrasound in diagnosing BOTs. We aimed to evaluate the use of US in identifying BOTs solely from benign and malignant ovarian tumours in isolation from risk models. We performed a systematic literature review to identify publications that evaluated the use of US to differentiate between BOTs and malignant and/or benign ovarian tumours using Pubmed, Web of Science and the Cochrane Library. We performed a meta-analysis of the diagnostic sensitivity and specificity studies. We computed the summary estimates for sensitivity and specificity of US in diagnosing BOTs using the bivariate approach of Reitsma in the mada package in R. The initial search resulted in 24,737 publications. Hundred and seven publications were screened, and five studies contained diagnostic data. Different US criteria applied to identify BOTs. Four out of five studies including 244 women with BOTs and 965 women with benign or malignant tumours were suitable for the meta-analysis. Pooling of the results from four studies showed an overall sensitivity of 0.660 (95 % CI: 0.597 - 0.718) and specificity of 0.854 (95 % CI: 0.728 - 0.927). The overall US accuracy was uniform in sensitivity and variable in specificity. A low false positive rate, 0.146 (95 % CI: 0.073 - 0.272) was observed. US correctly identified BOTs in more than six out of 10 women for potential ovarian sparing surgery, whereas it correctly identified the absence of BOTs in more than eight out of 10 symptomatic women. More carefully designed studies are needed to evaluate the use of pre-operative US for the diagnosis of BOTs.
    MeSH term(s) Female ; Humans ; Ovarian Neoplasms/diagnostic imaging ; Ultrasonography
    Language English
    Publishing date 2019-11-23
    Publishing country Ireland
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 190605-7
    ISSN 1872-7654 ; 0301-2115 ; 0028-2243
    ISSN (online) 1872-7654
    ISSN 0301-2115 ; 0028-2243
    DOI 10.1016/j.ejogrb.2019.11.016
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  4. Article ; Online: Ovarian transposition and cervical cancer.

    Laios, Alexandros / Duarte Portela, Sara / Papadopoulou, Argyro / Gallos, Ioannis D / Otify, Mohamed / Ind, Thomas

    Best practice & research. Clinical obstetrics & gynaecology

    2021  Volume 75, Page(s) 37–53

    Abstract: Cervical cancer is the fourth most common female malignancy worldwide. As the focus of treatment is shifting towards balancing oncological outcomes with reproductive benefit, women are becoming increasingly aware of their fertility options. Cervical ... ...

    Abstract Cervical cancer is the fourth most common female malignancy worldwide. As the focus of treatment is shifting towards balancing oncological outcomes with reproductive benefit, women are becoming increasingly aware of their fertility options. Cervical cancer is one of the primary malignancies where transposition of the ovaries may be indicated. Ovarian transposition should be performed in pre-menopausal women, undergoing pelvic irradiation to preserve ovarian function and prevent early menopause. The review discusses the available literature and synthesises a concise summary for gynaecologic oncology surgeons to counsel affected women. The paradoxical controversy, leading to its under use is acknowledged, due to the scarcity of published data with regard to functional outcomes, and the lack of clinical trials. In cervical cancer, ovarian transposition remains a safe fertility preservation (FP) option, which is associated with high ovarian function preservation, an acceptable rate of ovarian cysts and a negligible risk for metastases in the transposed ovaries.
    MeSH term(s) Female ; Fertility ; Fertility Preservation ; Genital Neoplasms, Female ; Humans ; Ovary ; Uterine Cervical Neoplasms/surgery
    Language English
    Publishing date 2021-02-26
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2050090-7
    ISSN 1532-1932 ; 1521-6934
    ISSN (online) 1532-1932
    ISSN 1521-6934
    DOI 10.1016/j.bpobgyn.2021.01.013
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  5. Article ; Online: Survival and Chemosensitivity in Advanced High Grade Serous Epithelial Ovarian Cancer Patients with and without a BRCA Germline Mutation: More Evidence for Shifting the Paradigm towards Complete Surgical Cytoreduction.

    De Jong, Diederick / Otify, Mohamed / Chen, Inga / Jackson, David / Jayasinghe, Kelum / Nugent, David / Thangavelu, Amudha / Theophilou, Georgios / Laios, Alexandros

    Medicina (Kaunas, Lithuania)

    2022  Volume 58, Issue 11

    Abstract: Background and Objectives: Approximately 10−15% of high-grade serous ovarian cancer (HGSOC) cases are related to BRCA germline mutations. Better survival rates and increased chemosensitivity are reported in patients with a BRCA 1/2 germline mutation. ... ...

    Abstract Background and Objectives: Approximately 10−15% of high-grade serous ovarian cancer (HGSOC) cases are related to BRCA germline mutations. Better survival rates and increased chemosensitivity are reported in patients with a BRCA 1/2 germline mutation. However, the FIGO stage and histopathological entity may have been confounding factors. This study aimed to compare chemotherapy response and survival between patients with and without a BRCA 1/2 germline mutation in advanced HGSOC receiving neoadjuvant chemotherapy (NACT). Materials and Methods: A cohort of BRCA-tested advanced HGSOC patients undergoing cytoreductive surgery following NACT was analyzed for chemotherapy response and survival. Neoadjuvant chemotherapy served as a vehicle to assess chemotherapy response on biochemical (CA125), histopathological (CRS), biological (dissemination), and surgical (residual disease) levels. Univariate and multivariate analyses for chemotherapy response and survival were utilized. Results: Thirty-nine out of 168 patients had a BRCA ½ germline mutation. No differences in histopathological chemotherapy response between the patients with and without a BRCA ½ germline mutation were observed. Survival in the groups of patients was comparable Irrespective of the BRCA status, CRS 2 and 3 (HR 7.496, 95% CI 2.523−22.27, p < 0.001 & HR 4.069, 95% CI 1.388−11.93, p = 0.011), and complete surgical cytoreduction (p = 0.017) were independent parameters for a favored overall survival. Conclusions: HGSOC patients with or without BRCA ½ germline mutations, who had cytoreductive surgery, showed comparable chemotherapy responses and subsequent survival. Irrespective of BRCA status, advanced-stage HGSOC patients have a superior prognosis with complete surgical cytoreduction and good histopathological response to chemotherapy.
    MeSH term(s) Humans ; Female ; Cytoreduction Surgical Procedures ; Carcinoma, Ovarian Epithelial/drug therapy ; Carcinoma, Ovarian Epithelial/genetics ; Carcinoma, Ovarian Epithelial/surgery ; Germ-Line Mutation ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/genetics ; Ovarian Neoplasms/surgery ; Cystadenocarcinoma, Serous/drug therapy ; Cystadenocarcinoma, Serous/genetics ; Cystadenocarcinoma, Serous/surgery ; Neoadjuvant Therapy ; Retrospective Studies
    Language English
    Publishing date 2022-11-08
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2188113-3
    ISSN 1648-9144 ; 1010-660X
    ISSN (online) 1648-9144
    ISSN 1010-660X
    DOI 10.3390/medicina58111611
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  6. Article ; Online: Feature Selection is Critical for 2-Year Prognosis in Advanced Stage High Grade Serous Ovarian Cancer by Using Machine Learning.

    Laios, Alexandros / Katsenou, Angeliki / Tan, Yong Sheng / Johnson, Racheal / Otify, Mohamed / Kaufmann, Angelika / Munot, Sarika / Thangavelu, Amudha / Hutson, Richard / Broadhead, Tim / Theophilou, Georgios / Nugent, David / De Jong, Diederick

    Cancer control : journal of the Moffitt Cancer Center

    2021  Volume 28, Page(s) 10732748211044678

    Abstract: Introduction: Accurate prediction of patient prognosis can be especially useful for the selection of best treatment protocols. Machine Learning can serve this purpose by making predictions based upon generalizable clinical patterns embedded within ... ...

    Abstract Introduction: Accurate prediction of patient prognosis can be especially useful for the selection of best treatment protocols. Machine Learning can serve this purpose by making predictions based upon generalizable clinical patterns embedded within learning datasets. We designed a study to support the feature selection for the 2-year prognostic period and compared the performance of several Machine Learning prediction algorithms for accurate 2-year prognosis estimation in advanced-stage high grade serous ovarian cancer (HGSOC) patients.
    Methods: The prognosis estimation was formulated as a binary classification problem. Dataset was split into training and test cohorts with repeated random sampling until there was no significant difference (p = 0.20) between the two cohorts. A ten-fold cross-validation was applied. Various state-of-the-art supervised classifiers were used. For feature selection, in addition to the exhaustive search for the best combination of features, we used the-chi square test of independence and the MRMR method.
    Results: Two hundred nine patients were identified. The model's mean prediction accuracy reached 73%. We demonstrated that Support-Vector-Machine and Ensemble Subspace Discriminant algorithms outperformed Logistic Regression in accuracy indices. The probability of achieving a cancer-free state was maximised with a combination of primary cytoreduction, good performance status and maximal surgical effort (AUC 0.63). Standard chemotherapy, performance status, tumour load and residual disease were consistently predictive of the mid-term overall survival (AUC 0.63-0.66). The model recall and precision were greater than 80%.
    Conclusion: Machine Learning appears to be promising for accurate prognosis estimation. Appropriate feature selection is required when building an HGSOC model for 2-year prognosis prediction. We provide evidence as to what combination of prognosticators leads to the largest impact on the HGSOC 2-year prognosis.
    MeSH term(s) Adult ; Age Factors ; Aged ; Aged, 80 and over ; Cystadenocarcinoma, Serous/mortality ; Cystadenocarcinoma, Serous/pathology ; Cystadenocarcinoma, Serous/therapy ; Female ; Humans ; Logistic Models ; Machine Learning ; Middle Aged ; Ovarian Neoplasms/mortality ; Ovarian Neoplasms/pathology ; Ovarian Neoplasms/therapy ; Patient Acuity ; Prognosis ; Prospective Studies ; Support Vector Machine
    Language English
    Publishing date 2021-11-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1328503-8
    ISSN 1526-2359 ; 1073-2748
    ISSN (online) 1526-2359
    ISSN 1073-2748
    DOI 10.1177/10732748211044678
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    Zs.A 4467: Show issues Location:
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  7. Article ; Online: Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled randomized trial.

    Jurkovic, D / Memtsa, M / Sawyer, E / Donaldson, A N A / Jamil, A / Schramm, K / Sana, Y / Otify, M / Farahani, L / Nunes, N / Ambler, G / Ross, J A

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology

    2017  Volume 49, Issue 2, Page(s) 171–176

    Abstract: Objective: Methotrexate is used routinely worldwide for the medical treatment of clinically stable women with a tubal ectopic pregnancy. This is despite the lack of robust evidence to show its superior effectiveness over expectant management. The aim of ...

    Abstract Objective: Methotrexate is used routinely worldwide for the medical treatment of clinically stable women with a tubal ectopic pregnancy. This is despite the lack of robust evidence to show its superior effectiveness over expectant management. The aim of our multicenter randomized controlled trial was to compare success rates of methotrexate against placebo for the conservative treatment of tubal ectopic pregnancy.
    Methods: This study took place in two early-pregnancy units in the UK between August 2005 and June 2014. Inclusion criteria were clinically stable women with a conclusive ultrasound diagnosis of a tubal ectopic pregnancy, presenting with a low serum beta human chorionic gonadotropin (β-hCG) level of < 1500 IU/L. Women were assigned randomly to a single systemic injection of either 50 mg/m
    Results: We recruited a total of 80 women, 42 of whom were assigned to methotrexate and 38 to placebo. The arms of the study were matched in terms of age, ethnicity, obstetric history, pregnancy characteristics and serum levels of β-hCG and progesterone. The rates of success were similar for the two study arms: 83% with methotrexate and 76% with placebo. On univariate analysis, this difference was not statistically significant (χ
    Conclusions: The results of our study do not support the routine use of methotrexate for the treatment of clinically stable women diagnosed with tubal ectopic pregnancy presenting with low serum β-hCG (< 1500 IU/L). Further work is required to identify a subgroup of women with tubal ectopic pregnancy and β-hCG ≥ 1500 IU/L in whom methotrexate may offer a safe and cost-effective alternative to surgery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Comparación entre una sola dosis de metotrexate sistémico y la conducta expectante en el tratamiento de casos de embarazo ectópico tubárico: un ensayo aleatorio controlado con placebo RESUMEN OBJETIVO: El metotrexate se utiliza de modo rutinario en todo el mundo para el tratamiento de las mujeres clínicamente estables con un embarazo ectópico tubárico. Esto sucede a pesar de la falta de evidencia rigurosa que demuestre que su eficacia es superior a la conducta expectante. El objetivo de este ensayo controlado aleatorio multicéntrico fue comparar las tasas de éxito del metotrexate con las de un placebo para el tratamiento cauteloso del embarazo ectópico tubárico. MÉTODOS: Este estudio se llevó a cabo en dos clínicas de control de gestación temprana en el Reino Unido entre agosto de 2005 y junio de 2014. Los criterios de inclusión fueron mujeres clínicamente estables con un diagnóstico ecográfico concluyente de embarazo ectópico tubárico, las cuáles presentaban una concentración sérica baja de la β hormona coriónica gonadotrópica (β-hCG) inferior a 1500 UI/L. Las mujeres fueron asignadas aleatoriamente a una sola inyección sistémica de 50 mg/m2 de metotrexate o a placebo. El resultado primario fue un indicador binario del éxito del tratamiento conservador, definido como la resolución de los síntomas clínicos y la disminución en el suero de la β-hCG a <20 UI/L o una prueba de embarazo negativa en orina sin la necesidad de ninguna intervención médica adicional. Se hizo un análisis por intención de tratar.
    Resultados: Se reclutó un total de 80 mujeres; a 42 de ellas se les asignó el metotrexate y a 38 el placebo. Los grupos del estudio se realizaron en función de la edad, el origen étnico, los antecedentes obstétricos, las características del embarazo y los niveles séricos de la β-hCG y la progesterona. Las tasas de éxito fueron similares para los dos grupos de estudio: 83% con metotrexate y 76% con placebo. En el análisis univariante, esta diferencia no fue estadísticamente significativa (χ2 (1 grado de libertad) = 0,53; P = 0,47). En la regresión logística multivariante, el nivel sérico de la β-hCG fue la única covariable que se encontró significativamente asociada con el resultado. Las probabilidades de fracaso aumentaron en un 0,15% por cada unidad de aumento de la β-hCG (cociente de probabilidad 1,0015 (IC 95%, 1,0002-1,003); P = 0,02). La tasa de éxito en las 14 mujeres con un nivel sérico de la β-hCG de 1000-1500 UI/L fue del 33% en las tratadas con conducta expectante frente al 62% en las que recibieron metotrexate. Esta diferencia no fue estadísticamente significativa, por lo que se necesitaría un tamaño de muestra mayor, lo suficiente como para poder detectar diferencias en el subgrupo de mujeres con una β-hCG más elevada. En las mujeres en las que el tratamiento conservador tuvo éxito, no hubo una diferencia significativa en la mediana de los tiempos de resolución de la ß-hCG entre los grupos del estudio (17,5 (amplitud intercuartílica (IQR), 14-28,0) días (n = 30) en el grupo de metotrexate frente a 14 (IQR, 7-29.5) días (n = 25) en el grupo de placebo; P = 0,73).
    Conclusiones: Los resultados de este estudio no apoyan el uso rutinario de metotrexate para el tratamiento de las mujeres clínicamente estables diagnosticadas con un embarazo ectópico tubárico que presenta un nivel sérico bajo la β-hCG (<1500 UI/L). Serán necesarios estudios adicionales para identificar un subgrupo de mujeres con embarazo ectópico tubárico y β-hCG ≥1500 UI/L para quienes el metotrexate puede ofrecer una alternativa segura y rentable en comparación con la cirugía. : : ,,。。 : 2005820146,2。,,β(beta human chorionic gonadotropin,β-hCG)<1500 IU/L。,(50 mg/m
    MeSH term(s) Adult ; Chorionic Gonadotropin, beta Subunit, Human/blood ; Female ; Humans ; Intention to Treat Analysis ; Logistic Models ; Methotrexate/administration & dosage ; Methotrexate/therapeutic use ; Pregnancy ; Pregnancy, Tubal/drug therapy ; Pregnancy, Tubal/metabolism ; Pregnancy, Tubal/surgery ; Treatment Outcome ; Young Adult
    Chemical Substances Chorionic Gonadotropin, beta Subunit, Human ; Methotrexate (YL5FZ2Y5U1)
    Language English
    Publishing date 2017-01-06
    Publishing country England
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
    ZDB-ID 1073183-0
    ISSN 1469-0705 ; 0960-7692
    ISSN (online) 1469-0705
    ISSN 0960-7692
    DOI 10.1002/uog.17329
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  8. Article: Machine Learning-Based Risk Prediction of Critical Care Unit Admission for Advanced Stage High Grade Serous Ovarian Cancer Patients Undergoing Cytoreductive Surgery: The Leeds-Natal Score.

    Laios, Alexandros / De Oliveira Silva, Raissa Vanessa / Dantas De Freitas, Daniel Lucas / Tan, Yong Sheng / Saalmink, Gwendolyn / Zubayraeva, Albina / Johnson, Racheal / Kaufmann, Angelika / Otify, Mohammed / Hutson, Richard / Thangavelu, Amudha / Broadhead, Tim / Nugent, David / Theophilou, Georgios / Gomes de Lima, Kassio Michell / De Jong, Diederick

    Journal of clinical medicine

    2021  Volume 11, Issue 1

    Abstract: Achieving complete surgical cytoreduction in advanced stage high grade serous ovarian cancer (HGSOC) patients warrants an availability of Critical Care Unit (CCU) beds. Machine Learning (ML) could be helpful in monitoring CCU admissions to improve ... ...

    Abstract Achieving complete surgical cytoreduction in advanced stage high grade serous ovarian cancer (HGSOC) patients warrants an availability of Critical Care Unit (CCU) beds. Machine Learning (ML) could be helpful in monitoring CCU admissions to improve standards of care. We aimed to improve the accuracy of predicting CCU admission in HGSOC patients by ML algorithms and developed an ML-based predictive score. A cohort of 291 advanced stage HGSOC patients with fully curated data was selected. Several linear and non-linear distances, and quadratic discriminant ML methods, were employed to derive prediction information for CCU admission. When all the variables were included in the model, the prediction accuracies were higher for linear discriminant (0.90) and quadratic discriminant (0.93) methods compared with conventional logistic regression (0.84). Feature selection identified pre-treatment albumin, surgical complexity score, estimated blood loss, operative time, and bowel resection with stoma as the most significant prediction features. The real-time prediction accuracy of the Graphical User Interface CCU calculator reached 95%. Limited, potentially modifiable, mostly intra-operative factors contributing to CCU admission were identified and suggest areas for targeted interventions. The accurate quantification of CCU admission patterns is critical information when counseling patients about peri-operative risks related to their cytoreductive surgery.
    Language English
    Publishing date 2021-12-24
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11010087
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Survival of women with early-stage cervical cancer in the UK treated with minimal access and open surgery.

    Martin-Hirsch, P / Wood, N / Whitham, N L / Macdonald, R / Kirwan, J / Anagnostopoulos, A / Hutson, R / Theophilou, G / Otify, M / Smith, M / Myriokefalitaki, E / Quinland, W / Mahon-Daly, F / Clayton, R D / Nagar, H / Harley, I / Dobbs, S / Ratnavelu, N / Kucukmetin, A /
    Fisher, A D / Tailor, A / Butler-Manuel, S / Madhuri, K / Edmondson, R J

    BJOG : an international journal of obstetrics and gynaecology

    2019  Volume 126, Issue 8, Page(s) 956–959

    MeSH term(s) Abdomen ; Chemotherapy, Adjuvant ; Female ; Humans ; Hysterectomy ; United Kingdom ; Uterine Cervical Neoplasms
    Language English
    Publishing date 2019-03-01
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 2000931-8
    ISSN 1471-0528 ; 0306-5456 ; 1470-0328
    ISSN (online) 1471-0528
    ISSN 0306-5456 ; 1470-0328
    DOI 10.1111/1471-0528.15617
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Are trainees working in obstetrics and gynecology confident and competent in the care of frail gynecological oncology patients?

    Owens, Gemma Louise / Sivalingam, Vanitha / Abdelrahman, Mohamed / Beirne, James P / Blake, Dominic / Collins, Anna / Davies, Rhianna / Dilley, James / Farquharson, Malcolm / Frimpong, Diana / Gomes, Nana / Hawco, Sarah / Ilenkovan, Narthana / Jones, Eleanor / Jones, Sadie Esme Fleur / Khan, Tabassum / Leung, Elaine / Otify, Mohamed / Parnell, Laura /
    Rimmer, Michael P / Ryan, Neil / Sanderson, Peter / Stocker, Linden / Wilkinson, Michael / Wong, Siewchee / Bharathan, Rasiah / Wan, Yee-Loi Louise

    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

    2020  Volume 30, Issue 12, Page(s) 1959–1965

    Abstract: Introduction: Older patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and ... ...

    Abstract Introduction: Older patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.
    Methods: A web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1-7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.
    Results: Of the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.
    Conclusions: Obstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.
    MeSH term(s) Aged ; Aged, 80 and over ; Clinical Competence ; Education, Medical, Graduate ; Female ; Frail Elderly ; Genital Neoplasms, Female/therapy ; Geriatrics/education ; Gynecology/education ; Gynecology/standards ; Humans ; Internet ; Ireland ; Medical Oncology/education ; Obstetrics/education ; Obstetrics/standards ; Self Concept ; Students, Medical/psychology ; Surveys and Questionnaires ; United Kingdom
    Language English
    Publishing date 2020-10-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 1070385-8
    ISSN 1525-1438 ; 1048-891X
    ISSN (online) 1525-1438
    ISSN 1048-891X
    DOI 10.1136/ijgc-2020-001834
    Database MEDical Literature Analysis and Retrieval System OnLINE

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