Khalid S Khan

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

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Publications (393)1649.17 Total impact

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    ABSTRACT: Background Scarcity of well-trained clinical tutors is a key constraint in integrating teaching of evidence-based medicine (EBM) into clinical activities.Objectives We developed a web-based educational course for clinical trainers to confidently teach EBM principles in everyday practice. Its e-learning modules defined the learning objectives and incorporated video clips of practical and effective EBM teaching methods for exploiting educational opportunities in six different clinical settings.Methods We evaluated the course with clinical tutors in different specialties across six European countries using a questionnaire to capture learning achievement against preset objectives.ResultsAmong 56 tutors, 47 participants (84%) improved their scores from baseline. The mean pre-course score was 69.2 (SD=10.4), which increased to 77.3 (SD=11.7) postcourse (p<0.0001). The effect size was moderate with a Cohen's d of 0.73.Conclusions An e-learning approach incorporating videos of applied EBM teaching and learning based on real clinical scenarios in the workplace can be useful in facilitating EBM teaching on foot. It can be integrated in the continuing professional development programmes for clinical trainers.
    Evidence-based medicine 08/2012; DOI:10.1136/eb-2012-100801
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    ABSTRACT: Point-of-care testing (POCT) is one of the fastest growing sectors of laboratory diagnostics. Most tests in routine use are haematology or biochemistry tests that are of low complexity. Microbiology POCT has been constrained by a lack of tests that are both accurate and of low complexity. We describe our experience of the practical issues around using more complex POCT for detection of Group B streptococci (GBS) in swabs from labouring women. We evaluated two tests for their feasibility in POCT: an optical immune assay (Biostar OIA Strep B, Inverness Medical, Princetown, NJ) and a PCR (IDI-Strep B, Cepheid, Sunnyvale, CA), which have been categorised as being of moderate and high complexity, respectively. A total of 12 unqualified midwifery assistants (MA) were trained to undertake testing on the delivery suite. A systematic approach to the introduction and management of POC testing was used. Modelling showed that the probability of test results being available within a clinically useful timescale was high. However, in the clinical setting, we found it impossible to maintain reliable availability of trained testers. Implementation of more complex POC testing is technically feasible, but it is expensive, and may be difficult to achieve in a busy delivery suite.
    Journal of Obstetrics and Gynaecology 07/2012; 32(5):458-60. DOI:10.3109/01443615.2012.673034 · 0.60 Impact Factor
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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: Research article A systematic review of tests for lymph node status in primary endometrial cancer
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    ABSTRACT: Research article Serum screening with Down&apos;s syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis
  • T Justin Clark, Khalid S Khan, Janesh K Gupta
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    ABSTRACT: Research article Effect of paper quality on the response rate to a postal survey: A randomised controlled trial. ISRCTN32032031
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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
  • The Lancet 02/2012; 379(9813):311. DOI:10.1016/S0140-6736(12)60138-X · 45.22 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

Publication Stats

11k Citations
1,649.17 Total Impact Points


  • 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
    • Università degli Studi di Sassari
      Sassari, Sardinia, Italy
  • 2013
    • Barts Health NHS Trust
      Londinium, England, United Kingdom
  • 2012–2013
    • University of Amsterdam
      • • Department of General Practice
      • • Department of Obstetrics and Gynaecology
      Amsterdam, North Holland, Netherlands
    • The Fetal Medicine Foundation
      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
  • 2008–2012
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Department of Obstetrics & Gynecology
      • • Academic Medical Center
      Amsterdam, North Holland, Netherlands
  • 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
  • 1996–2009
    • 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