Khalid S Khan

Queen Mary, University of London, Londinium, England, United Kingdom

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Publications (392)1646 Total impact

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    BJOG An International Journal of Obstetrics & Gynaecology 07/2012; 119(8):903-5. DOI:10.1111/j.1471-0528.2011.03242.x · 3.86 Impact Factor
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    ABSTRACT: Around 50% of women of childbearing age are either overweight [body mass index (BMI) 25-29.9 kg/m(2)] or obese (BMI ≥ 30 kg/m(2)). The antenatal period provides an opportunity to manage weight in pregnancy. This has the potential to reduce maternal and fetal complications associated with excess weight gain and obesity. To evaluate the effectiveness of dietary and lifestyle interventions in reducing or preventing obesity in pregnancy and to assess the beneficial and adverse effects of the interventions on obstetric, fetal and neonatal outcomes. Major electronic databases including MEDLINE, EMBASE, BIOSIS and Science Citation Index were searched (1950 until March 2011) to identify relevant citations. Language restrictions were not applied. Systematic reviews of the effectiveness and harm of the interventions were carried out using a methodology in line with current recommendations. Studies that evaluated any dietary, physical activity or mixed approach intervention with the potential to influence weight change in pregnancy were included. The quality of the studies was assessed using accepted contemporary standards. Results were summarised as pooled relative risks (RRs) with 95% confidence intervals (CIs) for dichotomous data. Continuous data were summarised as mean difference (MD) with standard deviation. The quality of the overall evidence synthesised for each outcome was summarised using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology and reported graphically as a two-dimensional chart. A total of 88 studies (40 randomised and 48 non-randomised and observational studies, involving 182,139 women) evaluated the effect of weight management interventions in pregnancy on maternal and fetal outcomes. Twenty-six studies involving 468,858 women reported the adverse effect of the interventions. Meta-analysis of 30 RCTs (4503 women) showed a reduction in weight gain in the intervention group of 0.97 kg compared with the control group (95% CI -1.60 kg to -0.34 kg; p = 0.003). Weight management interventions overall in pregnancy resulted in a significant reduction in the incidence of pre-eclampsia (RR 0.74, 95% CI 0.59 to 0.92; p = 0.008) and shoulder dystocia (RR 0.39, 95% CI 0.22 to 0.70; p = 0.02). Dietary interventions in pregnancy resulted in a significant decrease in the risk of pre-eclampsia (RR 0.67, 95% CI 0.53 to 0.85; p = 0.0009), gestational hypertension (RR 0.30, 95% CI 0.10 to 0.88; p = 0.03) and preterm birth (RR 0.68, 95% CI 0.48 to 0.96; p = 0.03) and showed a trend in reducing the incidence of gestational diabetes (RR 0.52, 95% CI 0.27 to 1.03). There were no differences in the incidence of small-for-gestational-age infants between the groups (RR 0.99, 95% CI 0.76 to 1.29). There were no significant maternal or fetal adverse effects observed for the interventions in the included trials. The overall strength of evidence for weight gain in pregnancy and birthweight was moderate for all interventions considered together. There was high-quality evidence for small-for-gestational-age infants as an outcome. The quality of evidence for all interventions on pregnancy outcomes was very low to moderate. The quality of evidence for all adverse outcomes was very low. The included studies varied in the reporting of population, intensity, type and frequency of intervention and patient complience, limiting the interpretation of the findings. There was significant heterogeneity for the beneficial effect of diet on gestational weight gain. Interventions in pregnancy to manage weight result in a significant reduction in weight gain in pregnancy (evidence quality was moderate). Dietary interventions are the most effective type of intervention in pregnancy in reducing gestational weight gain and the risks of pre-eclampsia, gestational hypertension and shoulder dystocia. There is no evidence of harm as a result of the dietary and physical activity-based interventions in pregnancy. Individual patient data meta-analysis is needed to provide robust evidence on the differential effect of intervention in various groups based on BMI, age, parity, socioeconomic status and medical conditions in pregnancy.
    07/2012; 16(31):iii-iv, 1-191. DOI:10.3310/hta16310
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    ABSTRACT: To evaluate the effects of dietary and lifestyle interventions in pregnancy on maternal and fetal weight and to quantify the effects of these interventions on obstetric outcomes. Systematic review and meta-analysis. Major databases from inception to January 2012 without language restrictions. Randomised controlled trials that evaluated any dietary or lifestyle interventions with potential to influence maternal weight during pregnancy and outcomes of pregnancy. Results summarised as relative risks for dichotomous data and mean differences for continuous data. We identified 44 relevant randomised controlled trials (7278 women) evaluating three categories of interventions: diet, physical activity, and a mixed approach. Overall, there was 1.42 kg reduction (95% confidence interval 0.95 to 1.89 kg) in gestational weight gain with any intervention compared with control. With all interventions combined, there were no significant differences in birth weight (mean difference -50 g, -100 to 0 g) and the incidence of large for gestational age (relative risk 0.85, 0.66 to 1.09) or small for gestational age (1.00, 0.78 to 1.28) babies between the groups, though by itself physical activity was associated with reduced birth weight (mean difference -60 g, -120 to -10 g). Interventions were associated with a reduced the risk of pre-eclampsia (0.74, 0.60 to 0.92) and shoulder dystocia (0.39, 0.22 to 0.70), with no significant effect on other critically important outcomes. Dietary intervention resulted in the largest reduction in maternal gestational weight gain (3.84 kg, 2.45 to 5.22 kg), with improved pregnancy outcomes compared with other interventions. The overall evidence rating was low to very low for important outcomes such as pre-eclampsia, gestational diabetes, gestational hypertension, and preterm delivery. Dietary and lifestyle interventions in pregnancy can reduce maternal gestational weight gain and improve outcomes for both mother and baby. Among the interventions, those based on diet are the most effective and are associated with reductions in maternal gestational weight gain and improved obstetric outcomes.
    BMJ (online) 05/2012; 344:e2088. DOI:10.1136/bmj.e2088 · 16.38 Impact Factor
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    ABSTRACT: Evidence profiled in the World Health Organization induction of labor guideline extended to 84 tables and 116 pages, which is hard to assimilate. Summarizing this evidence graphically can present information on key outcomes succinctly, illustrating where the gaps, strengths and weaknesses lie. For induction of labor, graphic representation clearly showed that evidence was lacking on maternal complications when comparing oxytocin with other agents, evidence was strong on birth within 24 h when comparing vaginal prostaglandins with placebo or no treatment, but again it was weak on uterine hyperstimulation when comparing oxytocin with vaginal prostaglandins. These graphs/plots allow readers to capture the essence of the information gathered at a glance. The use of graphical displays when interpreting and publishing data on several comparisons and outcomes is encouraged.
    Acta Obstetricia Et Gynecologica Scandinavica 05/2012; 91(8):885-92. DOI:10.1111/j.1600-0412.2012.01459.x · 1.99 Impact Factor
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    BMJ (online) 05/2012; 344:e3011. DOI:10.1136/bmj.e3011 · 16.38 Impact Factor
  • Pédagogie médicale 05/2012; 13(2):115-145. DOI:10.1051/pmed/2012013
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    ABSTRACT: Screening for critical congenital heart defects in newborn babies can aid in early recognition, with the prospect of improved outcome. We assessed the performance of pulse oximetry as a screening method for the detection of critical congenital heart defects in asymptomatic newborn babies. In this systematic review, we searched Medline (1951-2011), Embase (1974-2011), Cochrane Library (2011), and Scisearch (1974-2011) for relevant citations with no language restriction. We selected studies that assessed the accuracy of pulse oximetry for the detection of critical congenital heart defects in asymptomatic newborn babies. Two reviewers selected studies that met the predefined criteria for population, tests, and outcomes. We calculated sensitivity, specificity, and corresponding 95% CIs for individual studies. A hierarchical receiver operating characteristic curve was fitted to generate summary estimates of sensitivity and specificity with a random effects model. We screened 552 studies and identified 13 eligible studies with data for 229,421 newborn babies. The overall sensitivity of pulse oximetry for detection of critical congenital heart defects was 76·5% (95% CI 67·7-83·5). The specificity was 99·9% (99·7-99·9), with a false-positive rate of 0·14% (0·06-0·33). The false-positive rate for detection of critical congenital heart defects was particularly low when newborn pulse oximetry was done after 24 h from birth than when it was done before 24 h (0·05% [0·02-0·12] vs 0·50 [0·29-0·86]; p=0·0017). Pulse oximetry is highly specific for detection of critical congenital heart defects with moderate sensitivity, that meets criteria for universal screening. None.
    The Lancet 05/2012; 379(9835):2459-64. DOI:10.1016/S0140-6736(12)60107-X · 45.22 Impact Factor
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    ABSTRACT: To determine the relative effectiveness of second generation ablation techniques in the treatment of heavy menstrual bleeding. Network meta-analysis on the primary outcome measures of amenorrhoea, heavy bleeding, and patients' dissatisfaction with treatment. Nineteen randomised controlled trials (involving 3287 women) were identified through electronic searches of the Cochrane Library, Medline, Embase and PsycINFO databases from inception to April 2011. The reference lists of known relevant articles were searched for further articles. Two reviewers independently selected articles without language restrictions. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials involving second generation endometrial destruction techniques for women with heavy menstrual bleeding unresponsive to medical treatment. Of the three most commonly used techniques, network meta-analysis showed that bipolar radiofrequency and microwave ablation resulted in higher rates of amenorrhoea than thermal balloon ablation at around 12 months (odds ratio 2.51, 95% confidence interval 1.53 to 4.12, P<0.001; and 1.66, 1.01 to 2.71, P=0.05, respectively), but there was no evidence of a convincing difference between the three techniques in the number of women dissatisfied with treatment or still experiencing heavy bleeding. Compared with bipolar radio frequency and microwave devices, an increased number of women still experienced heavy bleeding after free fluid ablation (2.19, 1.07 to 4.50, P=0.03; and 2.91, 1.23 to 6.88, P=0.02, respectively). Compared with radio frequency ablation, free fluid ablation was associated with reduced rates of amenorrhoea (0.36, 0.19 to 0.67, P=0.004) and increased rates of dissatisfaction (4.79, 1.07 to 21.5, P=0.04). Of the less commonly used devices, endometrial laser intrauterine thermotherapy was associated with increased rates of amenorrhoea compared with all the other devices, while cryoablation led to a reduced rate compared with bipolar radio frequency and microwave. Bipolar radio frequency and microwave ablative devices are more effective than thermal balloon and free fluid ablation in the treatment of heavy menstrual bleeding with second generation endometrial ablation devices.
    BMJ (online) 04/2012; 344(apr23 1):e2564. DOI:10.1136/bmj.e2564 · 16.38 Impact Factor
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    ABSTRACT: To evaluate the cost-effectiveness of diagnostic strategies incorporating the diagnostic value of patient characteristics for endometrial carcinoma using prediction models. A decision analytic model was created to compare four diagnostic strategies for women with postmenopausal bleeding: the main outcome measures were 5 year survival, costs, and cost-effectiveness of three model based strategies compared to the strategy reflecting current practice. A strategy selecting women for endometrial biopsy based on their history only, dominated all other strategies (more effective, less cost). In a clinical scenario where transvaginal sonography (TVS) was assumed to be an integral part of the consultation without additional costs, a strategy selecting high-risk women for TVS became the most cost-effective strategy. Strategies taking into account the individual probability based on a prognostic model are less costly than the currently applied strategy for a similar effectiveness. The most cost-effective strategy depends on the clinical setting: in areas where TVS is performed by the consulting gynecologist without extra costs, selective TVS based on history is the most cost-effective strategy. When TVS is not readily available and therefore incurs extra costs, a risk selection based on patient characteristics is most cost-effective.
    European journal of obstetrics, gynecology, and reproductive biology 04/2012; 163(1):91-6. DOI:10.1016/j.ejogrb.2012.03.025 · 1.63 Impact Factor
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    ABSTRACT: Currently systematic reviews focus on diagnosis or effectiveness of treatment. It is the understanding of disease aetiology that underpins medical education, practice and research. Whether an association meets causal criteria is usually assessed qualitatively. However, this can also be examined through evidence synthesis and systematic reviews to evaluate disease causation and mechanisms are much needed. It is important in such a review to specify the questions to be addressed regarding causal criteria such as strength, consistency, temporality, specificity, biological gradient, plausibility and experimental evidence. The next step is to conduct a thorough literature search to identify the relevant studies and to assess them for their quality, particularly in relation to the risk of bias, ascertainment of exposures and ascertainment of outcomes. Data synthesis can then examine if the observed associations in collated studies are consistent, strong and temporal using techniques such as meta-analysis, testing for heterogeneity and meta-regression. Biological plausibility and coherence with existing theories can also be examined systematically through an assessment of the basic scientific literature. Experimental evidence might also be collated and synthesised to determine if removal of a causal agent alters the outcome. Through these steps a systematic review can help to establish whether an association is causal or not.
    Evidence-based medicine 04/2012; 17(5):137-41. DOI:10.1136/ebmed-2011-100287
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    ABSTRACT: Introduction: Low birth weight is associated with developmental delays and special education needs at school age in both singletons and twins. However, there are suggestions that developmental delays in early childhood are due to antenatal head circumference. Little is known about the effect of antenatal head size and growth on developmental skills of infant twins. This study aimed to investigate this effect on developmental skills of twins up to 24 months. Methods: Forty-four healthy monochorionic and 73 dichorionic twins from The Birmingham Registry for Twin and Heritability Studies cohort in the United Kingdom were assessed with the Ages and Stages Questionnaires (ASQ-3) at 3, 6, 9, 12, 18 and 24 months. Antenatal head circumference at 20, 28, 33 and 36 weeks were obtained from ultrasound scans. Three antenatal age windows (20-27, 28-32, 33-36 weeks) were assigned to determine the effect of head growth (mm per window) on developmental skills. We performed multilevel regression analyses, with twins relatedness as a nested level with random intercept, to study the effect of antenatal head size at each gestation and rate of growth in each age window on developmental skills at each follow-up. Results: A 1mm increase in head size at 20 weeks decreased monochorionic fine motor and problem solving z-scores at 6 months by up to -0.09 (95% confidence interval -0.13—0.04). Head size from 28 weeks onwards was negatively associated with developmental skills in the first year with decreases up to -0.12 (-0.20—0.04), but increased z-scores up to 0.21 (0.08-0.32) in the second year. Effect sizes of 33 and 36-week head circumference were smaller than of 28 weeks. Monochorionic head growth in 20-27 weeks was associated with up to 0.24 (0.01-0.49) increases in z-scores from 9 months onwards, while growth in 28-32 weeks were associated with up to -0.07 (-0.13—0.01) decreases in the second year. No effect of growth in 33-36 weeks was found. Effects of dichorionic head size were only found on motor and personal-social skills, with motor scores decreasing up to -0.04 (-0.06—0.02) and personal-social scores increasing up to 0.03 (0.00-0.06) in relation to 36-week head size. Dichorionic head growth in 28-32 and 33-36 weeks was related to decreased social scores up to -0.09 (-0.17—0.01) in the first year and increased scores by 0.04 (0.01-0.07) in the second year. Growth in 33-36 weeks was associated with decreased motor z-scores of up to -0.04 (-0.08—0.01). No effects were found for head size at 28 weeks and growth in 20-27 weeks. Discussion: This pilot study confirms a relationship between absolute head size and rate of growth and early developmental skills. Furthermore, our results suggest the possibility of critical antenatal age windows and different optimal growth windows for monochorionic and dichorionic twins. The current findings should be replicated in other studies.
    14th International Congress on Twin Studies and 2nd World Congress on Twin Pregnancy, Florence, Italy; 04/2012
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    ABSTRACT: Biomarkers have been proposed for identification of women at increased risk of developing pre-eclampsia. To investigate the capacity of circulating placental growth factor (PlGF), vascular endothelial growth factor (VEGF), soluble fms-like tyrosine kinase-1 (sFLT1) and soluble endoglin (sENG) to predict pre-eclampsia. Medline and Embase through October 2010 and reference lists of reviews, without constraints. We included original publications on testing of PlGF, VEGF, sFLT1 and sENG in serum or plasma of pregnant women at <30 weeks of gestation and before clinical onset of pre-eclampsia. Two reviewers independently identified eligible studies, extracted descriptive and test accuracy data and assessed methodological quality. Summary estimates of discriminatory performance were obtained. We included 34 studies. Concentrations of PlGF (27 studies) and VEGF (three studies) were lower in women who developed pre-eclampsia: standardised mean differences (SMD) -0.56 (95% CI -0.77 to -0.35) and -1.25 (95% CI -2.73 to 0.23). Concentrations of sFLT1 (19 studies) and sENG (ten studies) were higher: SMD 0.48 (95% CI 0.21-0.75) and SMD 0.54 (95% CI 0.24-0.84). The summary diagnostic odds ratios were: PlGF 9.0 (95% CI 5.6-14.5), sFLT1 6.6 (95% CI 3.1-13.7), sENG 4.2 (95% CI 2.4-7.2), which correspond to sensitivities of 32%, 26% and 18%, respectively, for a 5% false-positive rate. PlGF, sFLT1 and sENG showed modest but significantly different concentrations before 30 weeks of gestation in women who developed pre-eclampsia. Test accuracies of all four markers, however, are too poor for accurate prediction of pre-eclampsia in clinical practice.
    BJOG An International Journal of Obstetrics & Gynaecology 03/2012; 119(7):778-87. DOI:10.1111/j.1471-0528.2012.03311.x · 3.86 Impact Factor
  • American family physician 02/2012; 85(4):386-7. · 1.82 Impact Factor
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    ABSTRACT: The role of vitamin D in maintaining a healthy pregnancy has seen emerging interest among clinicians and researchers in recent years. The functions of this hormone are widespread and complex, and during pregnancy and breastfeeding it facilitates crucial transfer of calcium from mother to child for skeletal development. Aside from the role of vitamin D in bone development and health, a myriad of other physiological actions are now known, and it is hypothesized that maternal deficiency may increase susceptibility to adverse pregnancy events during pregnancy such as pre-eclampsia. The role of vitamin D in pregnancy and breastfeeding is summarized and applied to the knowledge from studies associating vitamin D deficiency with a range of adverse pregnancy outcomes, including pre-eclampsia and childhood asthma. Current clinical guidelines for vitamin D supplementation in pregnancy are discussed in the context of the available evidence. The need for robust randomized controlled trials to address areas of existing uncertainty is highlighted.
    Acta Obstetricia Et Gynecologica Scandinavica 02/2012; 91(2):159-63. DOI:10.1111/j.1600-0412.2011.01305.x · 1.99 Impact Factor
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    ABSTRACT: To examine the effect of setting, intensity, and timing of peer support on breast feeding. Systematic review and metaregression analysis of randomised controlled trials. Cochrane Library, Medline, CINAHL, the National Research Register, and British Nursing Index were searched from inception or from 1980 to 2011. Review methods Study selection, data abstraction, and quality assessment were carried out independently and in duplicate. Risk ratios and 95% confidence intervals were calculated for individual studies and pooled. Effects were estimated for studies grouped according to setting (high income countries, low or middle income countries, and the United Kingdom), intensity (<5 and ≥5 planned contacts), and timing of peer support (postnatal period with or without antenatal care), and analysed using metaregression for any and exclusive breast feeding at last study follow-up. Peer support interventions had a significantly greater effect on any breast feeding in low or middle income countries (P<0.001), reducing the risk of not breast feeding at all by 30% (relative risk 0.70, 95% confidence interval 0.60 to 0.82) compared with a reduction of 7% (0.93, 0.87 to 1.00) in high income countries. Similarly, the risk of non-exclusive breast feeding decreased significantly more in low or middle income countries than in high income countries: 37% (0.63, 0.52 to 0.78) compared with 10% (0.90, 0.85 to 0.97); P=0.01. No significant effect on breast feeding was observed in UK based studies. Peer support had a greater effect on any breastfeeding rates when given at higher intensity (P=0.02) and only delivered in the postnatal period (P<0.001), although no differences were observed of its effect on exclusive breastfeeding rates by intensity or timing. Although peer support interventions increase breastfeeding continuation in low or middle income countries, especially exclusive breast feeding, this does not seem to apply in high income countries, particularly the United Kingdom, where breastfeeding support is part of routine postnatal healthcare. Peer support of low intensity does not seem to be effective. Policy relating to provision of peer support should be based on more specific evidence on setting and any new peer services in high income countries need to undergo concurrent evaluation.
    BMJ (online) 01/2012; 344:d8287. DOI:10.1136/bmj.d8287 · 16.38 Impact Factor
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    ABSTRACT: Chronic pelvic pain (CPP) is a common and costly health problem in gynecology. Operative pathological findings are often absent. In some women with CPP, pelvic venous congestion has been reported; however, this observation has also been made in asymptomatic women. Thus, it is not clear whether pelvic venous congestion causes CPP and, if it does, whether it is a direct or indirect cause. Venography and non-invasive imaging methods are used for the diagnosis, but scoring systems have not been validated. The current mainstay of treatment is venography-controlled embolization, which is less invasive than surgical interventions. However, the only evidence on effectiveness comes from uncontrolled case series. A systematic review of causation evidence is needed to prove whether pelvic venous congestion causes CPP and whether embolization treatment is effective. In addition, if causation is established, good-quality primary randomized controlled trials on embolization may be required.
    Acta Obstetricia Et Gynecologica Scandinavica 01/2012; 91(5):525-8. DOI:10.1111/j.1600-0412.2012.01368.x · 1.99 Impact Factor
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    ABSTRACT: Screening for congenital heart defects (CHDs) relies on antenatal ultrasound and postnatal clinical examination; however, life-threatening defects often go undetected. To determine the accuracy, acceptability and cost-effectiveness of pulse oximetry as a screening test for CHDs in newborn infants. A test accuracy study determined the accuracy of pulse oximetry. Acceptability of testing to parents was evaluated through a questionnaire, and to staff through focus groups. A decision-analytic model was constructed to assess cost-effectiveness. Six UK maternity units. These were 20,055 asymptomatic newborns at ≥ 35 weeks' gestation, their mothers and health-care staff. Pulse oximetry was performed prior to discharge from hospital and the results of this index test were compared with a composite reference standard (echocardiography, clinical follow-up and follow-up through interrogation of clinical databases). Detection of major CHDs - defined as causing death or requiring invasive intervention up to 12 months of age (subdivided into critical CHDs causing death or intervention before 28 days, and serious CHDs causing death or intervention between 1 and 12 months of age); acceptability of testing to parents and staff; and the cost-effectiveness in terms of cost per timely diagnosis. Fifty-three of the 20,055 babies screened had a major CHD (24 critical and 29 serious), a prevalence of 2.6 per 1000 live births. Pulse oximetry had a sensitivity of 75.0% [95% confidence interval (CI) 53.3% to 90.2%] for critical cases and 49.1% (95% CI 35.1% to 63.2%) for all major CHDs. When 23 cases were excluded, in which a CHD was already suspected following antenatal ultrasound, pulse oximetry had a sensitivity of 58.3% (95% CI 27.7% to 84.8%) for critical cases (12 babies) and 28.6% (95% CI 14.6% to 46.3%) for all major CHDs (35 babies). False-positive (FP) results occurred in 1 in 119 babies (0.84%) without major CHDs (specificity 99.2%, 95% CI 99.0% to 99.3%). However, of the 169 FPs, there were six cases of significant but not major CHDs and 40 cases of respiratory or infective illness requiring medical intervention. The prevalence of major CHDs in babies with normal pulse oximetry was 1.4 (95% CI 0.9 to 2.0) per 1000 live births, as 27 babies with major CHDs (6 critical and 21 serious) were missed. Parent and staff participants were predominantly satisfied with screening, perceiving it as an important test to detect ill babies. There was no evidence that mothers given FP results were more anxious after participating than those given true-negative results, although they were less satisfied with the test. White British/Irish mothers were more likely to participate in the study, and were less anxious and more satisfied than those of other ethnicities. The incremental cost-effectiveness ratio of pulse oximetry plus clinical examination compared with examination alone is approximately £24,900 per timely diagnosis in a population in which antenatal screening for CHDs already exists. Pulse oximetry is a simple, safe, feasible test that is acceptable to parents and staff and adds value to existing screening. It is likely to identify cases of critical CHDs that would otherwise go undetected. It is also likely to be cost-effective given current acceptable thresholds. The detection of other pathologies, such as significant CHDs and respiratory and infective illnesses, is an additional advantage. Other pulse oximetry techniques, such as perfusion index, may enhance detection of aortic obstructive lesions. The National Institute for Health Research Health Technology programme.
    01/2012; 16(2):v-xiii, 1-184. DOI:10.3310/hta16020
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    ABSTRACT: Key content• There is a need for an accessible guide for tutors and supervisors involved in training and assessment so that they can keep themselves updated with current educational initiatives.• E-learning courses on postgraduate educational supervision can be employed for continuing professional development.Learning objectives• To be introduced to the advantages and pitfalls of e-learning.• To be aware of the steps required to set up an e-learning programme.• To have a basic understanding of the content of a successful e-learning programme for training trainers.Ethical issues• All trainers need to find accessible and efficient ways of keeping updated with the skills they need to supervise, assess and appraise trainees.• Training support should be made readily available via e-material so that it is not dependent on timetables and venues.
    The Obstetrician & Gynaecologist 01/2012; 14(1). DOI:10.1111/j.1744-4667.2011.00087.x
  • The Lancet 01/2012; 379(9813):311. DOI:10.1016/S0140-6736(12)60138-X · 45.22 Impact Factor
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    ABSTRACT: Increased maternal weight or excessive weight gain in pregnancy is associated with adverse maternal and fetal outcomes. Existing reviews and guidelines making recommendations for interventions to manage weight gain in pregnancy are of limited value because of the small number of studies included. The best intervention that optimizes outcomes for the mother and baby has not been identified. Moreover, there is no consensus on what the desired outcomes are. This systematic review and meta-analysis assessed the effects of dietary and lifestyle interventions in pregnancy on maternal and fetal weight and ranked the importance of these interventions on obstetric outcomes. A search of major databases was conducted from inception of the study until January 2012 to identify relevant randomized controlled trials evaluating any dietary or lifestyle interventions that could influence maternal weight during pregnancy and affect maternal and fetal outcomes related to weight. A search was also conducted for pertinent unpublished studies. Relative risks (RRs) were calculated for dichotomous data, and mean differences for continuous data. A total of 44 relevant trials involving 7278 women were identified that evaluated the effects of 3 categories of interventions in pregnancy: diet, physical activity, and a mixed approach. Compared with controls, any intervention was associated with a reduced weight gain of 1.42 kg (95% confidence interval [CI], 0.95–1.89 kg; P < 0.001). For combined interventions, there were no significant differences in birth weight from controls (mean difference, −50 g; 95% CI, −100 to 0 g), or in the incidence of babies large for gestational age (RR, 0.85; 95% CI, 0.66–1.09) and small for gestational age (RR, 1.00; 95% CI, 0.78–1.28). However, physical activity by itself was associated with reduced birth weight (mean difference, −60 g; 95% CI, −120 to −10 g; P = 0.02). Interventions resulted in a significant reduction in the risk of preeclampsia (RR, 0.74; 95% CI, 0.60–0.92) and shoulder dystocia (RR,0.39; 95% CI, 0.22–0.70). There was no significant effect of interventions on other critically important outcomes. Compared with other interventions, the largest reduction in weight gain occurred with dietary intervention (mean difference, 3.84 kg; 95% CI, 2.45–5.22 kg; P < 0.001), with improved pregnancy outcomes. The evidence rating for important clinical outcomes such as preeclampsia, gestational diabetes, gestational hypertension, and preterm delivery was low to very low. These findings show that dietary and lifestyle interventions in pregnancy can reduce maternal gestational weight gain and are associated with improved outcomes for both mother and baby. Interventions based on diet are the most effective, with the greatest reduction in weight gain in pregnancy and with improved outcomes.
    Obstetrical and Gynecological Survey 01/2012; 67(10):603-604. DOI:10.1097/OGX.0b013e31826f78d9 · 2.36 Impact Factor

Publication Stats

10k Citations
1,646.00 Total Impact Points

Institutions

  • 2010–2015
    • Queen Mary, University of London
      • • Centre for Primary Care and Public Health
      • • Blizard Institute
      • • Institute of Health Sciences Education
      Londinium, England, United Kingdom
  • 2013
    • University of Amsterdam
      • Department of General Practice
      Amsterdam, North Holland, Netherlands
    • Barts Health NHS Trust
      Londinium, England, United Kingdom
  • 2011–2013
    • University of London
      Londinium, England, United Kingdom
  • 1998–2013
    • University of Birmingham
      • • School of Clinical and Experimental Medicine
      • • Department of Public Health, Epidemiology and Biostatistics
      • • Group of Reproduction, Genes and Development
      Birmingham, England, United Kingdom
  • 2012
    • The Fetal Medicine Foundation
      Londinium, England, United Kingdom
  • 2008–2012
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Department of Obstetrics & Gynecology
      • • Department of General Practice
      Amsterdam, North Holland, Netherlands
    • The University of Manchester
      Manchester, England, United Kingdom
  • 1998–2012
    • Birmingham Women's NHS Foundation Trust
      Birmingham, England, United Kingdom
  • 1999–2010
    • University Hospitals Birmingham NHS Foundation Trust
      Birmingham, England, United Kingdom
  • 2009
    • The Queen Elizabeth Hospital
      Tarndarnya, South Australia, Australia
    • Chelsea and Westminster Hospital NHS Foundation Trust
      Londinium, England, United Kingdom
  • 1997–2009
    • Ninewells Hospital
      Dundee, Scotland, United Kingdom
  • 2007
    • University of Auckland
      • Department of Obstetrics and Gynaecology
      Auckland, Auckland, New Zealand
  • 1998–2006
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2005
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2004–2005
    • Birmingham Community Healthcare NHS Trust
      Birmingham, England, United Kingdom
    • University of Leicester
      Leiscester, England, United Kingdom
  • 2001–2004
    • The University of York
      • Centre for Reviews and Dissemination
      York, England, United Kingdom
    • CUNY Graduate Center
      New York City, New York, United States
  • 2003
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2002
    • Maastricht University
      Maestricht, Limburg, Netherlands
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
  • 1993–1998
    • Aga Khan University Hospital, Karachi
      • Department of Obstetrics and Gynaecology
      Kurrachee, Sindh, Pakistan
  • 1995
    • Aga Khan University, Pakistan
      • Department of Obstetrics and Gynaecology, Pakistan
      Kurrachee, Sindh, Pakistan