Publications
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Shah H, Al-Memar M, de Bakker B, et al., 2017, The first-trimester fetal central nervous system: a novel ultrasonographic perspective, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 217, Pages: 220-221, ISSN: 0002-9378
Wynants L, Timmerman D, Verbakel JY, et al., 2017, Clinical utility of risk models to refer patients with adnexal masses to specialized oncology care: multicenter external validation using decision curve analysis, Clinical Cancer Research, Vol: 23, Pages: 5082-5090, ISSN: 1557-3265
Purpose: To evaluate the utility of preoperative diagnostic models for ovarian cancer based on ultrasound and/or biomarkers for referring patients to specialized oncology care. The investigated models were RMI, ROMA, and 3 models from the International Ovarian Tumor Analysis (IOTA) group [LR2, ADNEX, and the Simple Rules risk score (SRRisk)].Experimental Design: A secondary analysis of prospectively collected data from 2 cross-sectional cohort studies was performed to externally validate diagnostic models. A total of 2,763 patients (2,403 in dataset 1 and 360 in dataset 2) from 18 centers (11 oncology centers and 7 nononcology hospitals) in 6 countries participated. Excised tissue was histologically classified as benign or malignant. The clinical utility of the preoperative diagnostic models was assessed with net benefit (NB) at a range of risk thresholds (5%-50% risk of malignancy) to refer patients to specialized oncology care. We visualized results with decision curves and generated bootstrap confidence intervals.Results: The prevalence of malignancy was 41% in dataset 1 and 40% in dataset 2. For thresholds up to 10% to 15%, RMI and ROMA had a lower NB than referring all patients. SRRisks and ADNEX demonstrated the highest NB. At a threshold of 20%, the NBs of ADNEX, SRrisks, and RMI were 0.348, 0.350, and 0.270, respectively. Results by menopausal status and type of center (oncology vs. nononcology) were similar.Conclusions: All tested IOTA methods, especially ADNEX and SRRisks, are clinically more useful than RMI and ROMA to select patients with adnexal masses for specialized oncology care. Clin Cancer Res; 1-9. ©2017 AACR.
Glanc P, Benacerraf B, Bourne T, et al., 2017, First International Consensus Report on Adnexal Masses: Management Recommendations, JOURNAL OF ULTRASOUND IN MEDICINE, Vol: 36, Pages: 849-863, ISSN: 0278-4297
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- Citations: 64
Mitchell-Jones N, Farren J, Tobias A, et al., 2017, Efficacy of outpatient management of severe nausea and vomiting (hyperemesis gravidarum): a randomised controlled trial and patient preference trial, Publisher: WILEY, Pages: 7-7, ISSN: 1470-0328
Bobdiwala S, De Cock B, Abdallah Y, et al., 2017, The potential use of urinary β-human chorionic gonadotrophin (β-hCG) for managing pregnancies of unknown location: Correlating urinary and serum β-hCG levels using two immunoassays, Publisher: WILEY, Pages: 8-8, ISSN: 1470-0328
Bobdiwala S, Al-Memar M, Lee Y, et al., 2017, Ectopic pregnancy is associated with increased vaginal bacterial diversity and reduced <i>Lactobacillus</i> species dominance, Publisher: WILEY, Pages: 63-64, ISSN: 1470-0328
Bobdiwala S, Farren J, Mitchell-Jones N, et al., 2017, Assessing the value of endometrial thickness in triaging women with a pregnancy of unknown location, Publisher: WILEY, Pages: 8-8, ISSN: 1470-0328
Al-Memar M, Bobdiwala S, Lee Y, et al., 2017, Association between vaginal microbiome dysbiosis and miscarriage, Publisher: WILEY, Pages: 65-65, ISSN: 1470-0328
Van Calster B, Van Hoorde K, Vergouwe Y, et al., 2017, Validation and updating of risk models based on multinomial logistic regression, Diagnostic and Prognostic Research, Vol: 1, ISSN: 2397-7523
Background: Risk models often perform poorly at external validation in terms of discrimination or calibration. Updating methods are needed to improve performance of multinomial logistic regression models for risk prediction. Methods: We consider simple and more refined updating approaches to extend previously proposed methods for dichotomous outcomes. These include model recalibration (adjustment of intercept and/or slope), revision (re-estimation of individual model coefficients), and extension (revision with additional markers). We suggest a closed testing procedure to assist in deciding on the updating complexity. These methods are demonstrated on a case study of women with pregnancies of unknown location (PUL). A previously developed risk model predicts the probability that a PUL is a failed, intra-uterine, or ectopic pregnancy. We validated and updated this model on more recent patients from the development setting (temporal updating; n = 1422) and on patients from a different hospital (geographical updating; n = 873). Internal validation of updated models was performed through bootstrap resampling. Results: Contrary to dichotomous models, we noted that recalibration can also affect discrimination for multinomial risk models. If the number of outcome categories is higher than the number of variables, logistic recalibration is obsolete because straightforward model refitting does not require the estimation of more parameters. Although recalibration strongly improved performance in the case study, the closed testing procedure selected model revision. Further, revision of functional form of continuous predictors had a positive effect on discrimination, whereas penalized estimation of changes in model coefficients was beneficial for calibration. Conclusions: Methods for updating of multinomial risk models are now available to improve predictions in new settings. A closed testing procedure is helpful to decide whether revision is preferre
Al-Karawi D, Sayasneh A, Al-Assam H, et al., 2017, An automated technique for potential differentiation of ovarian mature teratomas from other benign tumours using neural networks classification of 2D ultrasound static images: a pilot study, Conference on Mobile Multimedia/Image Processing, Security, and Applications, Publisher: SPIE-INT SOC OPTICAL ENGINEERING, ISSN: 0277-786X
Ayim F, Tapp S, Guha S, et al., 2016, Can risk factors, clinical history and symptoms be used to predict risk of ectopic pregnancy in women attending an early pregnancy assessment unit?, Ultrasound in Obstetrics & Gynecology, Vol: 48, Pages: 656-662, ISSN: 0960-7692
OBJECTIVE: To examine whether risk factors and symptoms may be used to predict the likelihood of ectopic pregnancy (EP) in women attending early pregnancy assessment units in the UK. METHODS: This was an observational cohort study of pregnant women under 12 weeks' gestation who were recruited from three London university hospitals between August 2012 and April 2013. One hospital continued recruitment between January and June 2015. A standardized information sheet incorporating patient demographics, medical history and symptoms was completed by patients and confirmed by examining clinicians. The outcome measure was final pregnancy location. RESULTS: There were 1320 eligible patients included in the analysis, with a total of 72 EPs (rate of 6%). Pelvic pain and diarrhea > three times in the previous 24 h were independent symptoms that increased the risk of EP, with relative risks of 2.4 (95% CI, 1.4-4.0; P = 0.002) and 2.2 (95% CI, 1.08-4.5; P = 0.03), respectively. The only other independent marker of risk of EP was duration of vaginal bleeding; the risk of EP increased by 20% (95% CI, 14%-27%) for every 1-day increment in duration (P < 0.001). A logistic regression model incorporating these factors demonstrated an area under the receiver-operating characteristics curve of 0.73 (95% CI, 0.67-0.79). The prevalence of EP was low when there was no pelvic pain, no diarrhea and the duration of bleeding was ≤ 3 days, with an EP rate of 2% (6/391). In the presence of a single risk factor, the EP rate increased to 5% (29/631) when only pelvic pain was present, 8% (1/12) when only diarrhea > three times in the previous 24 h was reported and 9% (9/103) when there was only vaginal bleeding with a duration > 3 days. Women with pelvic pain and vaginal bleeding of any severity for > 3 days had a high EP rate of 16% (23/146). In the nine women who also reported diarrhea > three times in the previous 24 h, two had EP. CONCLUSIONS: Only the presence of pelvic pai
Al-Memar M, Caccitore S, Bobdiwala S, et al., 2016, Urine metabolomic changes by gestational age in early pregnancy and differences in the metabolome in viable pregnancies that miscarry compared to those that remain viable, Publisher: WILEY-BLACKWELL, Pages: E1-E1, ISSN: 1470-0328
Van Calster B, Steyerberg EW, Bourne T, et al., 2016, Flawed external validation study of the ADNEX model to diagnose ovarian canceron behalf of TG6 of the STRATOS initiative, Gynecologic Oncology Reports, Vol: 18, Pages: 49-50, ISSN: 2352-5789
Farren JA, Jalmbrant M, Ameye L, et al., 2016, Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study, BMJ Open, Vol: 6, ISSN: 2044-6055
Objectives: This is a pilot study to investigate the type and severity of emotional distress in women after early pregnancy loss (EPL), compared to a control group with ongoing pregnancies. The secondary aim was to assess whether miscarriage or ectopic pregnancy impacted differently on the type and severity of psychological morbidity.Design: This was a prospective survey study. Consecutive women were recruited between January 2012 and July 2013. We emailed women a link to a survey one, three and nine months after a diagnosis of EPL, and one month after the diagnosis of a viable ongoing pregnancy. Setting: The Early Pregnancy Assessment Unit (EPAU) of a central-London teaching hospitalParticipants: We recruited 186 women. 128 had a diagnosis of EPL, and 58 of ongoing pregnancies. 11 withdrew consent, and 11 provided an illegible or invalid e-mail address. Main outcome measures: Post-traumatic stress disorder (PTSD) was measured using the Post-traumatic Diagnostic Scale (PDS), and Anxiety and Depression using the Hospital Anxiety and Depression Scale (HADS)Results: Response rates were 69/114 at 1 month and 44/68 at three months in the EPL group, and 20/50 in controls. Psychological morbidity was higher in the EPL group with 28% meeting criteria for probable PTSD, 32% for anxiety, and 16% for depression at one month and 38%, 20%, and 5% respectively at three months. In the control group, no women met criteria for PTSD and 10% met criteria for anxiety and depression. There was little difference in type or severity of distress following ectopic pregnancy or miscarriage. Conclusions: We have shown a large number of women having experienced a miscarriage or ectopic pregnancy fulfill the diagnostic criteria for probable PTSD. Many suffer from moderate to severe anxiety, and a lesser number depression. Psychological morbidity, and in particular PTSD symptoms, persists at least three months following pregnancy loss.
Van Calster B, Bobdiwala S, Guha S, et al., 2016, Managing pregnancy of unknown location based on initial serum progesterone and serial serum hCG levels: development and validation of a two-step triage protocol, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 48, Pages: 642-649, ISSN: 0960-7692
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- Citations: 31
Al-Memar M, Tapp S, Ayim F, et al., 2016, Abstracts of the 26th World Congress on Ultrasound in Obstetrics and Gynecology, Rome, Italy, 24-28 September 2016., Ultrasound Obstet Gynecol, Vol: 48 Suppl 1
Landolfo C, Froyman W, Bourne T, et al., 2016, Abstracts of the 26th World Congress on Ultrasound in Obstetrics and Gynecology, Rome, Italy, 24-28 September 2016., Ultrasound Obstet Gynecol, Vol: 48 Suppl 1
Al-Memar M, Bobdiwala S, Nikolic G, et al., 2016, EP25.02: Does pregnancy outcome in the first trimester correlate with the amount of vaginal bleeding and pain? A preliminary study., Ultrasound Obstet Gynecol, Vol: 48 Suppl 1, Pages: 371-372
Bobdiwala S, Farren J, Mitchell-Jones N, et al., 2016, Abstracts of the 26th World Congress on Ultrasound in Obstetrics and Gynecology, Rome, Italy, 24-28 September 2016., Ultrasound Obstet Gynecol, Vol: 48 Suppl 1
Sundar S, Rick C, Dowling F, et al., 2016, Refining Ovarian Cancer Test accuracy Scores (ROCkeTS): protocol for a prospective longitudinal test accuracy study to validate new risk scores in women with symptoms of suspected ovarian cancer., BMJ Open, Vol: 6, ISSN: 2044-6055
INTRODUCTION: Ovarian cancer (OC) is associated with non-specific symptoms such as bloating, making accurate diagnosis challenging: only 1 in 3 women with OC presents through primary care referral. National Institute for Health and Care Excellence guidelines recommends sequential testing with CA125 and routine ultrasound in primary care. However, these diagnostic tests have limited sensitivity or specificity. Improving accurate triage in women with vague symptoms is likely to improve mortality by streamlining referral and care pathways. The Refining Ovarian Cancer Test Accuracy Scores (ROCkeTS; HTA 13/13/01) project will derive and validate new tests/risk prediction models that estimate the probability of having OC in women with symptoms. This protocol refers to the prospective study only (phase III). METHODS AND ANALYSIS: ROCkeTS comprises four parallel phases. The full ROCkeTS protocol can be found at http://www.birmingham.ac.uk/ROCKETS. Phase III is a prospective test accuracy study. The study will recruit 2450 patients from 15 UK sites. Recruited patients complete symptom and anxiety questionnaires, donate a serum sample and undergo ultrasound scored as per International Ovarian Tumour Analysis (IOTA) criteria. Recruitment is at rapid access clinics, emergency departments and elective clinics. Models to be evaluated include those based on ultrasound derived by the IOTA group and novel models derived from analysis of existing data sets. Estimates of sensitivity, specificity, c-statistic (area under receiver operating curve), positive predictive value and negative predictive value of diagnostic tests are evaluated and a calibration plot for models will be presented. ROCkeTS has received ethical approval from the NHS West Midlands REC (14/WM/1241) and is registered on the controlled trials website (ISRCTN17160843) and the National Institute of Health Research Cancer and Reproductive Health portfolios.
Sayasneh A, Ferrara L, De Cock B, et al., 2016, Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study, British Journal of Cancer, Vol: 115, Pages: 542-548, ISSN: 1532-1827
BACKGROUND: The International Ovarian Tumour Analysis (IOTA) group have developed the ADNEX (The Assessment of Different NEoplasias in the adneXa) model to predict the risk that an ovarian mass is benign, borderline, stage I, stages II-IV or metastatic. We aimed to externally validate the ADNEX model in the hands of examiners with varied training and experience. METHODS: This was a multicentre cross-sectional cohort study for diagnostic accuracy. Patients were recruited from three cancer centres in Europe. Patients who underwent transvaginal ultrasonography and had a histological diagnosis of surgically removed tissue were included. The diagnostic performance of the ADNEX model with and without the use of CA125 as a predictor was calculated. RESULTS: Data from 610 women were analysed. The overall prevalence of malignancy was 30%. The area under the receiver operator curve (AUC) for the ADNEX diagnostic performance to differentiate between benign and malignant masses was 0.937 (95% CI: 0.915-0.954) when CA125 was included, and 0.925 (95% CI: 0.902-0.943) when CA125 was excluded. The calibration plots suggest good correspondence between the total predicted risk of malignancy and the observed proportion of malignancies. The model showed good discrimination between the different subtypes. CONCLUSIONS: The performance of the ADNEX model retains its performance on external validation in the hands of ultrasound examiners with varied training and experience.British Journal of Cancer advance online publication, 2 August 2016; doi:10.1038/bjc.2016.227 www.bjcancer.com.
Guerriero S, Van Calster B, Somigliana E, et al., 2016, Age-related differences in the sonographic characteristics of endometriomas, HUMAN REPRODUCTION, Vol: 31, Pages: 1723-1731, ISSN: 0268-1161
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Mitchell-Jones N, Gallos I, Farren J, et al., 2016, Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis, BJOG: An International Journal of Obstetrics and Gynaecology, Vol: 124, Pages: 20-30, ISSN: 1470-0328
BackgroundPsychological illness occurring in association with hyperemesis gravidarum (HG) has been widely reported.ObjectiveTo determine if there is a higher incidence of psychological morbidity in women with HG compared with women without significant nausea and vomiting in pregnancy.Search strategyPubMed, MEDLINE, Embase and PsychINFO were searched up to September 2015.Selection criteriaArticles referring to psychological morbidity in relation to HG. For meta-analysis case–control studies using numerical scales to compare psychological symptoms.Data collection and analysisArticles were independently assessed for inclusion by two reviewers and methodology was appraised using the Newcastle Ottawa Scale. Comparison was made using the standard mean difference (SMD) in symptom scale scores.Main resultsIn all, 59 articles were included in the systematic review, 12 of these were used in the meta-analysis. Meta-analysis of depression scale scores demonstrated a very large effect with statistically significantly higher depression scale scores in women with HG (SMD 1.22; 95% CI 0.80–1.64; P ≤ 0.01) compared with controls. Meta-analysis of anxiety scores demonstrated a large effect with statistically significantly higher anxiety disorder scale scores in women with HG (SMD 0.86; 95% CI 0.53–1.19; P ≤ 0.01). In both analyses significant heterogeneity was identified (depression and HG I2 = 94%, P ≤ 0.01; anxiety and HG I2 = 84%, P = 0.02).ConclusionsOur systematic review and meta-analysis have shown a significantly increased frequency of depression and anxiety in women with HG. The findings should prompt service development for women with HG that includes provision of psychological care and support.
Bourne T, Vanderhaegen J, Vranken R, et al., 2016, Doctors' experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data, BMJ Open, Vol: 6, ISSN: 2044-6055
OBJECTIVES: To examine doctors' experiences of complaints, including which aspects are most stressful. We also investigated how doctors felt complaints processes could be improved. DESIGN AND METHODS: A qualitative study based on a cross-sectional survey of members of the British Medical Association (BMA). We asked the following: (1) Try to summarise as best as you can your experience of the complaints process and how it made you feel. (2) What were the most stressful aspects of the complaint? (3) What would you improve in the complaints system? PARTICIPANTS: We sent the survey to 95 636 doctors, and received 10 930 (11.4%) responses. Of these, 6146 had a previous, recent or current complaint and 3417 (31.3%) of these respondents answered questions 1 and 2. We randomly selected 1000 answers for analysis, and included 100 using the saturation principle. Of this cohort, 93 responses for question 3 were available. MAIN RESULTS: Doctors frequently reported feeling powerless, emotionally distressed, and experiencing negative feelings towards both those managing complaints and the complainants themselves. Many felt unsupported, fearful of the consequences and that the complaint was unfair. The most stressful aspects were the prolonged duration and unpredictability of procedures, managerial incompetence, poor communication and perceiving that processes are biased in favour of complainants. Many reported practising defensively or considering changing career after a complaint, and few found any positive outcomes from complaints investigations. Physicians suggested procedures should be more transparent, competently managed, time limited, and that there should be an open dialogue with complainants and policies for dealing with vexatious complaints. Some felt more support for doctors was needed. CONCLUSIONS: Complaints seriously impact on doctors' psychological wellbeing, and are associated with defensive practise. This is not beneficial to patient care. To improve procedures
Guerriero S, Condous G, Van den Bosch T, et al., 2016, Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group., Ultrasound in Obstetrics & Gynecology, ISSN: 1469-0705
The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Al-Memar M, Cacciatore S, Bobdiwala S, et al., 2016, Urine metabolomic changes by gestational age in early pregnancy and differences in the metabolome in viable pregnancies that miscarry compared to those that remain viable, Publisher: Wiley, Pages: 76-76, ISSN: 1470-0328
Bobdiwala S, Farren J, Mitchell-Jones N, et al., 2016, A multi-centre study to predict ultimate viability in pregnancies of unknown location (PUL) - the role of progesterone, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 123, Pages: 240-240, ISSN: 1470-0328
Al-Memar M, Bobdiwala S, Madhra M, et al., 2016, The potential value of activin B and fibronectin as biomarkers to predict outcome in pregnancies of unknown location and first trimester viability, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 123, Pages: 241-241, ISSN: 1470-0328
Bobdiwala S, Farren J, Mitchell-Jones N, et al., 2016, Managing pregnancy of unknown location based on initial serum progesterone and serial serum hCG: A multi-centre trial on the performance and complications associated with using a two-step triage protocol, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 123, Pages: 76-77, ISSN: 1470-0328
Sundar S, Rick C, Dowling F, et al., 2016, Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) trial update, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 123, Pages: 102-102, ISSN: 1470-0328
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