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BACKGROUND: Risk factors for maternal infection are clearly recognised, including caesarean section and operative vaginal birth. Antibiotic prophylaxis at caesarean section is widely recommended because there is clear systematic review evidence that it reduces incidence of maternal infection. Current WHO guidelines do not recommend routine antibiotic prophylaxis for women undergoing operative vaginal birth because of insufficient evidence of effectiveness. We aimed to investigate whether antibiotic prophylaxis prevented maternal infection after operative vaginal birth. METHODS: In a blinded, randomised controlled trial done at 27 UK obstetric units, women (aged ≥16 years) were allocated to receive a single dose of intravenous amoxicillin and clavulanic acid or placebo (saline) following operative vaginal birth at 36 weeks gestation or later. The primary outcome was confirmed or suspected maternal infection within 6 weeks of delivery defined by a new prescription of antibiotics for specific indications, confirmed systemic infection on culture, or endometritis. We did an intention-to-treat analysis. This trial is registered with ISRCTN, number 11166984, and is closed to accrual. FINDINGS: Between March 13, 2016, and June 13, 2018, 3427 women were randomly assigned to treatment: 1719 to amoxicillin and clavulanic acid, and 1708 to placebo. Seven women withdrew, leaving 1715 in the amoxicillin and clavulanic acid group and 1705 in the placebo groups. Primary outcome data were missing for 195 (6%) women. Significantly fewer women allocated to amoxicillin and clavulanic acid had a confirmed or suspected infection (180 [11%] of 1619) than women allocated to placebo (306 [19%] of 1606; risk ratio 0·58, 95% CI 0·49-0·69; p

Objectives To determine whether replacement of protocol‐driven repeat prostate biopsy (PB) with multiparametric magnetic resonance imaging (mpMRI) +/‐ targeted repeat prostate biopsy (TB) in evaluating men on active surveillance (AS) for low‐volume low‐ to intermediate‐risk prostate cancer (PCa) altered the likelihood or time to treatment, or reduced the number of repeat biopsies required to trigger treatment. Patients and methods 445 patients underwent AS from 2010‐2016 at our institution with median follow‐up of 2.4 (interquartile range IQR 1.2‐3.7) years. Patients followed a “pre‐2014″ AS protocol up to 2014, which incorporated PB, and following the 2014 NICE guidelines patients followed a “2014‐present” AS protocol including mpMRI. We identified four groups of patients within the cohort (“no mpMRI and no PB”, “PB alone”, “mpMRI +/‐ TB” and “PB and mpMRI +/‐ TB”). Kaplan‐Meier plots and log‐rank tests were used to compare groups. Results 132 of 445 (30%) patients came off AS and underwent treatment intervention, with a median (IQR) time to treatment of 1.55 (IQR 0.71‐2.4) years. The commonest trigger for treatment was PCa upgrading following mpMRI and TB (43 of 132 patients, 29%). No significant difference was observed in the time at which men receiving a PB alone or receiving mpMRI +/‐ TB came off AS to undergo treatment (median 1.9 versus 1.33 years, p=0.7471). Considering only men undergoing repeat biopsy, a greater proportion of individuals receiving post‐mpMRI TB came off AS compared with PB alone (29/66, 44% versus 32/87, 37%, p=0.0033). A single set of repeat biopsies was on average needed to trigger treatment regardless of whether this was a PB or TB. Conclusions Replacing a systematic PB with an mpMRI+/‐TB as part of an AS protocol increased the likelihood of re‐classifying patients on AS and identifying men with clinically significant disease requiring treatment. mpMRI+/‐TB as part of AS thereby represents a significant advance in the oncological safety of the AS protocol.

The COPE (Consortium for Organ Preservation in Europe) include three clinical trials to improve preservation and reconditioning strategies for kidneys and livers procured for transplantation aiming to increase the number and quality of grafts used.

Tests for paired data have been used extensively for assessing the treatment effect in studies involving paired organ systems (e.g. kidneys, eyes). However, there is considerable uncertainty when it comes to choose an appropriate multivariate regression model that would take into account the "within subject" clustering nature of these data. Robust sandwich estimate of the covariance matrix[1], generalized linear model[2] and use of mixed models and random effects[3] are some of the methods that have been proposed and used to deal with the correlation/clustering of these data. Still, a number of studies involving paired organ systems data either do not report or do not use methods to account for this effect. This review will identify and examine the different analysis approaches that have been previously used in studies involving paired organ systems and will discuss the potential benefits and limitations of the most common approaches. Relevant analysis techniques will be identified by searching the MEDLINE and EMBASE databases to find published papers in the English language which report the statistical methods used to analyse paired organ systems data in a multivariate framework. A search will also be undertaken on the Transplant Library Database. The findings from this review will help other researchers to select the most appropriate model when analysing paired organ systems data. 1. Khalil, A.K., et al., Retransplants compared to Primary Kidney Transplants Recipients: A Mate Kidney Paired analysis of the OPTN/UNOS database. Clin Transplant, 2016. 2. Robert, R., et al., A pair analysis of the delayed graft function in kidney recipient: the critical role of the donor. J Crit Care, 2010. 25(4): p. 58290. 3. Cook, R.J., et al., A conditional Markov model for clustered progressive multistate processes under incomplete observation. Biometrics, 2004. 60(2): p. 43643.

[This corrects the article DOI: 10.1186/s41512-016-0001-y.].