Knowledge, skills and attitude of evidence-based medicine among obstetrics and gynaecology trainees: a questionnaire survey

Objectives: To determine current evidence-based medicine skills and practice among trainees. Design: Questionnaire study. Setting: Electronic survey was sent to all obstetrics and gynaecology trainees in East Midlands South Deanery, and responses collected were anonymous. Participants: All obstetrics and gynaecology trainees in East Midland South Deanery. Main outcome measures: Self-reported attitude, skills and knowledge in various components of evidence-based medicine. Results: 69 trainees were included in the study of which 35 responded. Among all respondents, almost 72% of trainees use non-evidence-based methods to find answers for their clinical questions, whereas only 18% use appropriate evidence-based medicine practice for such queries. Just 35% of trainees have minimum skills of literature searching. Most of the trainees struggle to understand various components of evidence-based medicine. Nearly 80% of trainees do not have formal education or training with regard to evidence-based medicine. Conclusions: This study highlights the inadequacy of evidence-based medicine skills among trainees and urges that evidence-based medicine be incorporated in formal training along with specialty study modules

Plasma MIC-1 and PAPP-A Levels Are Decreased among Women Presenting to an Early Pregnancy Assessment Unit, Have Fetal Viability Confirmed but Later Miscarry

Background: We have recently shown first trimester Macrophage inhibitory cytokine-1 (MIC-1) and Pregnancy Associated Plasma Protein-A (PAPP-A) serum concentrations are depressed among asymptomatic women destined to miscarry. Here we examined whether plasma levels of MIC-1 and PAPP-A are depressed among women presenting to an Early Pregnancy Assessment Unit (EPAU), noted to have a confirmed viable fetus, but subsequently miscarry. Methods: We performed a prospective cohort study, recruiting 462 women in the first trimester presenting to EPAU and had fetal viability confirmed by ultrasound. We obtained plasma samples on the same day and measured MIC-1, PAPP-A and human chorionic gonadotrophin (hCG), grouping the cohort according to whether they later miscarried or not. To correct for changes in analyte levels across gestation, we expressed the data as Multiples of the normal Median (MoMs). Results: We recruited 462 participants presenting to EPAU at 5-12 weeks gestation. Most (80%) presented with symptoms of threatened miscarriage (e.g. abdominal pain, vaginal bleeding). 34 (7.4%) subsequently miscarried. Median plasma MIC-1 levels among those who miscarried were 50% of those with ongoing pregnancies (Miscarriage cohort MoM 0.50 (25th-75th centiles: 0.29-1.33) vs ongoing pregnancies MoM 1.00 (0.65-1.38); p=0.0025). Median plasma PAPP-A MoMs among those who miscarried was 0.57 (0.00-1.12), significantly lower than those with ongoing pregnancies (MoMs 1.00 (0.59-1.59); p=0.036). Plasma hCG levels were also significantly depressed among those who miscarried compared to those with ongoing pregnancies. However, the performance of MIC-1 as a diagnostic marker to predict miscarriage in this cohort was modest, and not improved with the addition of hCG. Conclusion: MIC-1 and PAPP-A levels are significantly depressed in women presenting to EPAU with ultrasound evidence of fetal viability, but later miscarry. While they are unlikely to be useful as predictive biomarkers in this clinical setting, they probably play important roles in the maintenance of early pregnancy

Plasma MIC-1, PAPP-A and hCG concentrations.

<p>(A) Mean MIC-1 levels across gestation. (B) Box and Whisker plots of MoM MIC1 levels in the ongoing pregnancy (n=428) and miscarriage cohorts (n=34) (C) Mean PAPP-A levels across gestation (D) Box and Whisker plots MoM PAPP-A levels in the ongoing pregnancy (n=312) and miscarriage cohort (n=11) (E) Mean hCG levels across gestation (F) Box and Whisker plots of MoM hCG levels in the ongoing pregnancy (n=428) and miscarriage (n=34) cohorts. *P=0.036, **P=0.0025, *** P=0.0008. For <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0072437#pone-0072437-g001" target="_blank">Figure 1A,C,E</a>, the numbers for each gestation were: 5 weeks n=19; 6 weeks n=132; 7 weeks n=95; 8 weeks n=65; 9 weeks n=54; 10 weeks n=35; 11 weeks n=21; 12 weeks n=6. For <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0072437#pone-0072437-g001" target="_blank">Figure 1A,C,E</a> error bars are standard error of the mean.</p

Multi-Centre Observational Study of Transplacental Transmission of Influenza Antibodies following Vaccination with AS03_A-Adjuvanted H1N1 2009 Vaccine

<div><h3>Introduction</h3><p>Illness and death from influenza increase during pregnancy. In the United Kingdom pregnant women were targeted in a national programme for vaccination during the H1N1 2009–10 pandemic.</p> <h3>Methods</h3><p>In this study, pregnant women were recruited in labour from November 9, 2009 to March 10, 2010. Pandemic vaccination status was determined. Venous cord blood collected at delivery was evaluated for transplacental transfer of antibodies by measurement of haemagglutination inhibition and microneutralization titres.</p> <h3>Results</h3><p>Samples were collected from 77 vaccinated and 27 unvaccinated women. Seroprotection (HI titre ≥1∶40) was detected in 58 (75.3%, 95% CI 64.2–84.4) cord blood samples from vaccinated women and 5 (18.5%, 95% CI 6.3–38.1) from unvaccinated women (P<0.0001). There was evidence of transplacental seroprotection 8 days after maternal immunization (77.9%, 95 CI 66.2–87.1), maintained in most cases for at least 16 weeks.</p> <h3>Discussion</h3><p>Immunization of pregnant women with AS03_A-adjuvanted vaccine is followed by transplacental transfer of passive immunity at titres consistent with clinical protection in three-quarters of new-born infants. The findings support national and international pandemic H1N1 2009 recommendations for immunization during pregnancy.</p> </div

Multi-Centre Observational Study of Transplacental Transmission of Influenza Antibodies following Vaccination with AS03(A)-Adjuvanted H1N1 2009 Vaccine

Introduction: Illness and death from influenza increase during pregnancy. In the United Kingdom pregnant women were targeted in a national programme for vaccination during the H1N1 2009–10 pandemic. Methods: In this study, pregnant women were recruited in labour from November 9, 2009 to March 10, 2010. Pandemic vaccination status was determined. Venous cord blood collected at delivery was evaluated for transplacental transfer of antibodies by measurement of haemagglutination inhibition and microneutralization titres. Results: Samples were collected from 77 vaccinated and 27 unvaccinated women. Seroprotection (HI titre ≥1:40) was detected in 58 (75.3%, 95% CI 64.2–84.4) cord blood samples from vaccinated women and 5 (18.5%, 95% CI 6.3–38.1) from unvaccinated women (P<0.0001). There was evidence of transplacental seroprotection 8 days after maternal immunization (77.9%, 95 CI 66.2–87.1), maintained in most cases for at least 16 weeks. Discussion: Immunization of pregnant women with AS03A-adjuvanted vaccine is followed by transplacental transfer of passive immunity at titres consistent with clinical protection in three-quarters of new-born infants. The findings support national and international pandemic H1N1 2009 recommendations for immunization during pregnancy

Boxplot GMT haemagglutinination inhibition titre by interval from maternal vaccination to delivery.

<p>(Titres are expressed as reciprocal of the dilution and are given on a log₂ scale.).</p

Baseline characteristics of vaccinated and unvaccinated mothers [33].

<p>Data are means for: years/birth weight/gestational age (95% confidence interval) or number (%) for all other parameters.</p

Scatter-plots for cord blood haemagglutinination inhibition and microneutralization titres against interval between vaccination and delivery.

<p>(Titres are expressed as reciprocal of the dilution and are given on a log₂ scale.).</p

Reverse cumulative distribution curves of haemagglutinination inhibition and microneutralization antibody titres in cord blood serum samples.

<p>(Titres are expressed as reciprocal of the dilution and are given on a log₂ scale.) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0047448#pone.0047448-Puleston1" target="_blank">[33]</a>.</p