Search

This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group. Rapid reviews (RRs) use modified systematic review methods to accelerate the review process while maintaining systematic, transparent and reproducible methods. This paper addresses considerations for rating the certainty of evidence (COE) in RRs. We recommend the full implementation of GRADE (Grading of Recommendations, Assessment, Development and Evaluation) for Cochrane RRs if time and resources allow.If time or other resources do not permit the full implementation of GRADE, the following recommendations can be considered: (1) limit rating COE to the main intervention and comparator and limit the number of outcomes to critical benefits and harms; (2) if a literature review or a Delphi approach to rate the importance of outcomes is not feasible, rely on informal judgements of knowledge users, topic experts or team members; (3) replace independent rating of the COE by two reviewers with single-reviewer rating and verification by a second reviewer and (4) if effect estimates of a well-conducted systematic review are incorporated into an RR, use existing COE grades from such a review. We advise against changing the definition of COE or the domains considered part of the GRADE approach for RRs.

This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group. Rapid reviews (RR) use modified systematic review methods to accelerate the review process while maintaining systematic, transparent and reproducible methods. In this paper, we address considerations for RR searches. We cover the main areas relevant to the search process: preparation and planning, information sources and search methods, search strategy development, quality assurance, reporting, and record management. Two options exist for abbreviating the search process: (1) reducing time spent on conducting searches and (2) reducing the size of the search result. Because screening search results is usually more resource-intensive than conducting the search, we suggest investing time upfront in planning and optimising the search to save time by reducing the literature screening workload. To achieve this goal, RR teams should work with an information specialist. They should select a small number of relevant information sources (eg, databases) and use search methods that are highly likely to identify relevant literature for their topic. Database search strategies should aim to optimise both precision and sensitivity, and quality assurance measures (peer review and validation of search strategies) should be applied to minimise errors.

This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group (RRMG). Rapid reviews (RRs) use modified systematic review (SR) methods to accelerate the review process while maintaining systematic, transparent and reproducible methods to ensure integrity. This paper addresses considerations around the acceleration of study selection, data extraction and risk of bias (RoB) assessment in RRs. If a RR is being undertaken, review teams should consider using one or more of the following methodological shortcuts: screen a proportion (eg, 20%) of records dually at the title/abstract level until sufficient reviewer agreement is achieved, then proceed with single-reviewer screening; use the same approach for full-text screening; conduct single-data extraction only on the most relevant data points and conduct single-RoB assessment on the most important outcomes, with a second person verifying the data extraction and RoB assessment for completeness and correctness. Where available, extract data and RoB assessments from an existing SR that meets the eligibility criteria.

Objective To determine whether the addition of placental growth factor (PlGF) measurement to current clinical assessment of women with suspected pre-eclampsia before 37 weeks' gestation would reduce maternal morbidity without increasing neonatal morbidity. Design Stepped wedge cluster randomised control trial from 29 June 2017 to 26 April 2019. Setting National multisite trial in seven maternity hospitals throughout the island of Ireland Participants Women with a singleton pregnancy between 20 +0 to 36 +6 weeks’ gestation, with signs or symptoms suggestive of evolving pre-eclampsia. Of the 5718 women screened, 2583 were eligible and 2313 elected to participate. Intervention Participants were assigned randomly to either usual care or to usual care plus the addition of point-of-care PlGF testing based on the randomisation status of their maternity hospital at the time point of enrolment. Main outcomes measures Co-primary outcomes of composite maternal morbidity and composite neonatal morbidity. Analysis was on an individual participant level using mixed-effects Poisson regression adjusted for time effects (with robust standard errors) by intention-to-treat. Results Of the 4000 anticipated recruitment target, 2313 eligible participants (57%) were enrolled, of whom 2219 (96%) were included in the primary analysis. Of these, 1202 (54%) participants were assigned to the usual care group, and 1017 (46%) were assigned the intervention of additional point-of-care PlGF testing. The results demonstrate that the integration of point-of-care PlGF testing resulted in no evidence of a difference in maternal morbidity—457/1202 (38%) of women in the control group versus 330/1017 (32%) of women in the intervention group (adjusted risk ratio (RR) 1.01 (95% CI 0.76 to 1.36), P=0.92)—or in neonatal morbidity—527/1202 (43%) of neonates in the control group versus 484/1017 (47%) in the intervention group (adjusted RR 1.03 (0.89 to 1.21), P=0.67). Conclusions This was a pragmatic evaluation of an interventional diagnostic test, conducted nationally across multiple sites. These results do not support the incorporation of PlGF testing into routine clinical investigations for women presenting with suspected preterm pre-eclampsia, but nor do they exclude its potential benefit. Trial registration ClinicalTrials.gov NCT02881073 .

IntroductionSelective reporting bias, inconsistency in the chosen outcomes between trials and irrelevance of the chosen outcomes for women, limit the efficiency and value of research for prevention and treatment of gestational diabetes mellitus (GDM). One way to address these challenges is to develop core outcome sets (COSs).Methods and analysisThe aim of this manuscript is to present a protocol for a study to develop COSs for GDM prevention and treatment. This is a three-phase project consisting of (1) a systematic review of the literature to create two lists of outcomes that have been reported in trials and systematic reviews of trials of interventions for the prevention and treatment of GDM, (2) a three-round, web-based e-Delphi survey with key stakeholders to prioritise these outcomes and (3) a consensus meeting to resolve any remaining disagreements and to agree on two COSs.Ethics and disseminationEthical approval to conduct this study was obtained from the ethics committee at Galway University Hospitals on 13 December 2018 (Reference: C.A.2078). We will disseminate our research findings through peer-reviewed, open access publications and present at international conferences to reach a wide range of knowledge users.

Objective To evaluate the effectiveness of a structured education pulmonary rehabilitation programme on the health status of people with chronic obstructive pulmonary disease (COPD). Design Two-arm, cluster randomised controlled trial. Setting 32 general practices in the Republic of Ireland. Participants 350 participants with a diagnosis of moderate or severe COPD. Intervention Experimental group received a structured education pulmonary rehabilitation programme, delivered by the practice nurse and physiotherapist. Control group received usual care. Main outcome measure Health status as measured by the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12–14 weeks postcompletion of the programme. Results Participants allocated to the intervention group had statistically significant higher mean change total CRQ scores (adjusted mean difference (MD) 1.11, 95% CI 0.35 to 1.87). However, the CI does not exclude a smaller difference than the one that was prespecified as clinically important. Participants allocated to the intervention group also had statistically significant higher mean CRQ Dyspnoea scores after intervention (adjusted MD 0.49, 95% CI 0.20 to 0.78) and CRQ Physical scores (adjusted MD 0.37, 95% CI 0.14 to 0.60). However, CIs for both the CRQ Dyspnoea and CRQ Physical subscales do not exclude smaller differences as prespecified as clinically important. No other statistically significant differences between groups were seen. Conclusions A primary care based structured education pulmonary rehabilitation programme is feasible and may increase local accessibility to people with moderate and severe COPD. Trial registration ISRCTN52403063.

Background The increase in Caesarean delivery rates over the past decades has resulted in it becoming one of the most commonly performed in-hospital surgical procedures. While many Caesarean deliveries are clinically indicated, other factors, such as medico-legal fears and maternal and health professional preferences, contribute to the decision-making process. To explore non-clinical factors, we investigated differences in Caesarean delivery rates and temporal trends by private and public patient status while giving consideration to patient case-mix. Methods A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010 in the Republic of Ireland. Procedural ICD–10-AM codes from hospital discharge records were used to identify emergency and elective Caesarean deliveries. Temporal trends in Caesarean delivery were determined using a Cochrane-Armitage test for trend. Multivariate multinomial regression analysis was used to determine the odds of Caesarean delivery (emergency or elective versus vaginal delivery) by mother’s public or private status while adjusting for age, multiple gestation, previous Caesarean delivery, induction of labour, maternal morbidity and other obstetric complications. Results 403,642 childbirth hospitalisations reviewed; approximately one-third of women (30.2%) were booked privately. Women booked privately were more likely to be at least 30 years of age or older, married and have had a previous Caesarean delivery. Over the study period, the overall Caesarean rate increased from 22.2% to 23.8% among women booked publicly versus 30.2% to 34.7% among women booked privately (test for trend p-value Conclusion Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have a Caesarean delivery than women booked publicly. Moreover, while increasing trends in Caesarean delivery were observed among all women, the increase was disproportionately higher among women booked privately. These findings suggest that significant differences in Caesarean rates are unlikely to be explained by differences in clinical risk factors. Mixed-method research is clearly warranted to explore disparities in Caesarean delivery rates. Such research should focus on clinical decision making and the role of personal preferences of women and maternity care professionals in decisions regarding mode of birth.

Objective To derive population-based incidence rates of postpartum haemorrhage (PPH) and to investigate trends associated with method of delivery and blood transfusion. Specific focus was given to PPH due to atonic uterus, the commonest type of PPH. Consideration was also given to morbidly adherent placenta, a rare but severe obstetric complication involving abnormally deep placental adherence to the uterine wall. Design Retrospective cohort study Setting Ireland Population All childbirth hospitalisations, 1999 through 2009 Methods Diagnostic codes from hospital discharge records were used to identify cases of PPH due to third stage haemorrhage, uterine atony, postpartum coagulation defects, or delayed and secondary PPH. Receipt of a blood transfusion was used as a proxy to indicate the severity of haemorrhage. Significant temporal trends in PPH incidence were determined using a Cochrane-Armitage test for trend. Multivariate logistic regression was conducted to measure the odds of PPH diagnosis by year of delivery while adjusting for potentially confounding covariates. Main outcome measures PPH due to uterine atony; blood transfusion; morbidly adherent placenta. Results Over the study period, there were 649 019 childbirth hospitalisations, of which 2.6% (n=16 909) included a diagnosis of PPH. The overall PPH rate among hospital-based deliveries increased from 1.5% in 1999 to 4.1% in 2009. The increase in the overall PPH rate was driven by a parallel increase in atonic PPH, which rose from 1.0% in 1999 to 3.4% in 2009. Irrespective of induction status, significant increasing trends in atonic PPH rates were observed across vaginal, instrumental and caesarean deliveries (p Conclusions Analysis of hospital discharge data indicate changing trends in the incidence and severity of PPH due to uterine atony and morbidly adherent placenta. There is a pressing need for case-control studies and detailed clinical audit to identify clinical and patient-related factors associated with these conditions.